Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, BT52 1SA, UK.
BMC Public Health. 2019 Jul 18;19(1):961. doi: 10.1186/s12889-019-7204-4.
Understanding stakeholders' perceptions is crucial to the development and implementation of any intervention. However, a structured approach to eliciting stakeholder insights into complex, multisector issues of food security, household environment and health is lacking in many low and middle-income countries. This qualitative, workshop-based participatory study explores stakeholders' experiences of developing and implementing multisector interventions to provide transdisciplinary lessons for future developments in low and middle-income countries.
Participants were purposely selected based on their involvement in, or exposure to, the multisector intervention. Participants with interests in agriculture, nutrition, household air-quality, drinking water-quality and health from academic institutes, government and developmental organisations were brought together at a one-day workshop to participate in a series of discussions on issues relating to food security, nutrition, household environment and health in Nepal. All group discussions were audio-recorded and transcribed, and a thematic qualitative analysis performed to identify relevant themes.
The government's ongoing Multisector Nutrition Plan, stakeholders' willingness to work together, availability of local infrastructure for cross-institutional inputs and increasing global movement towards transdisciplinary approaches were identified by the 33 workshop participants, representing 23 organisations as key factors determining success of transdisciplinary work. Fragmentation, lack of research-based and practice-based evidence, limited transdisciplinary knowledge amongst sectoral stakeholders, short-term funding and lack of knowledge-sharing mechanisms were identified as barriers, often creating systematic problems for successful implementation. Stakeholders suggested methods to bring about success included: improved knowledge, both amongst policy-makers and implementers, of food security and its linkage with nutrition, household environments, health and hygiene; investment in collaborative practice-based research and evidence-based practice; and strengthened transdisciplinary collaboration between multi-stakeholders, such as researchers, implementers and beneficiaries, throughout the intervention development and implementation process.
This study suggests that multisector approach needs to adapt to take into account the experiences and views of the stakeholders concerned. The paper offers recommendations for successful development and implementation of future multisector interventions in Nepal that can be extrapolated to other low and middle-income countries, and lays foundations for future transdisciplinary working to support realisation of the recommendations.
了解利益相关者的看法对于任何干预措施的制定和实施都至关重要。然而，在许多低收入和中等收入国家，缺乏一种系统的方法来引出利益相关者对粮食安全、家庭环境和健康等复杂多部门问题的看法。本研究采用基于研讨会的定性方法，探讨了利益相关者在制定和实施多部门干预措施方面的经验，为低收入和中等收入国家的未来发展提供了跨学科的经验教训。
根据其参与或接触多部门干预措施的情况，有目的地选择参与者。从学术机构、政府和发展组织中挑选对农业、营养、家庭空气质量、饮用水质量和健康感兴趣的参与者，在为期一天的研讨会上聚集一堂，参与一系列关于尼泊尔粮食安全、营养、家庭环境和健康问题的讨论。所有小组讨论都进行了录音和转录，并进行了主题定性分析，以确定相关主题。
33 名研讨会参与者（代表 23 个组织）确定了政府正在进行的多部门营养计划、利益相关者合作的意愿、跨机构投入的当地基础设施的可用性以及全球朝着跨学科方法发展的趋势是决定跨学科工作成功的关键因素。参与者还确定了碎片化、缺乏基于研究和实践的证据、部门利益相关者之间有限的跨学科知识、短期资金和缺乏知识共享机制等障碍，这些障碍经常给成功实施带来系统性问题。利益相关者提出了实现成功的方法，包括：提高决策者和执行者对粮食安全及其与营养、家庭环境、健康和卫生的联系的认识；投资于合作的基于实践的研究和基于证据的实践；以及在干预措施的制定和实施过程中，加强多利益攸关方之间的跨学科合作，如研究人员、执行者和受益者。
本研究表明，多部门方法需要适应，以考虑到有关利益相关者的经验和观点。本文提出了在尼泊尔成功制定和实施未来多部门干预措施的建议，这些建议可以推广到其他低收入和中等收入国家，并为未来支持实现这些建议的跨学科工作奠定基础。
