Population Council, New Delhi, India.
Project Concern International, New Delhi, India.
Glob Health Sci Pract. 2022 Apr 29;10(2). doi: 10.9745/GHSP-D-21-00383. Print 2022 Apr 28.
In India, a large network of self-help groups (SHGs) implements interventions to improve women's and children's health and nutrition. There is growing evidence on the effectiveness of women's group interventions to improve health but limited information on implementation intensity, including how often groups meet, for how long, and with whom, despite this often being cited as a key factor for success. We aimed to assess the implementation intensity of large SHG-based health and nutrition interventions with rural, low-income women, to inform program design, delivery, and measurement.
We synthesized process data from surveys, meeting observations, and process evaluations across 8 maternal and child health and nutrition interventions in India. We examined the implementation intensity of 3 common intervention delivery channels: group meetings, home visits, and community-level activities.
SHG members spent approximately 30 minutes in monthly meetings discussing health or nutrition. SHG dissolution or limited participation in meetings was a common challenge. Beyond group meetings, home visits reached approximately 1 in 3 households with an SHG member. Pregnant and breastfeeding women's participation in community events varied across interventions.
Interventions that aim to capitalize on existing networks of financial women's groups not specifically formed for health and nutrition objectives, such as SHGs, will need to have an implementation intensity that matches the ambition of their health objectives: substantial changes in behavioral or mortality outcomes are unlikely to be achieved with relatively light intensity. Interventions that require sustained interactions with members to achieve health outcomes need to ensure adequate community and individual outreach to supplement group meetings, as well as improved participation through more intensive community mobilization approaches. Evaluations of group-based interventions should report on implementation intensity to support the interpretation of evaluation evidence and to inform further scale-up.
在印度，一个庞大的自助小组（SHG）网络实施干预措施，以改善妇女和儿童的健康和营养状况。越来越多的证据表明，妇女团体干预措施在改善健康方面是有效的，但关于实施强度的信息有限，包括小组会议的频率、时长以及与谁会面，尽管这通常被认为是成功的关键因素。我们旨在评估以农村低收入妇女为对象的大型基于 SHG 的健康和营养干预措施的实施强度，以为项目设计、交付和衡量提供信息。
我们综合了来自印度 8 项母婴健康和营养干预措施的调查、会议观察和过程评估的过程数据。我们考察了 3 种常见的干预措施交付渠道的实施强度：小组会议、家访和社区活动。
SHG 成员每月在讨论健康或营养问题的会议上花费大约 30 分钟。SHG 解散或成员有限地参与会议是一个常见的挑战。除了小组会议之外，家访覆盖了大约 1/3 有 SHG 成员的家庭。处于孕期和哺乳期的妇女参加社区活动的情况因干预措施而异。
旨在利用并非专门针对健康和营养目标而成立的金融妇女团体（如 SHG）现有网络的干预措施，将需要具有与健康目标的雄心相匹配的实施强度：仅通过相对较轻的强度不太可能实现行为或死亡率的重大变化。需要与成员持续互动才能实现健康结果的干预措施需要确保充分的社区和个人外联，以补充小组会议，并通过更密集的社区动员方法提高参与度。基于小组的干预措施的评估应报告实施强度，以支持对评估证据的解释，并为进一步扩大规模提供信息。
