Evaluating Implementation Fidelity of “Mother Supportive Group” Intervention to Improve Childhood Nutrition in Monaragala District of Sri Lanka

A higher level of implementation fidelity of nutrition interventions is required to make a significant impact on nutrition promotion especially among children of age under five years. Mother Supportive Group is a community empowerment programme of the Ministry of Health, which has been operating in Sri Lanka since 2012 for promotion of nutrition among under five years in the community. The objective of this study was to assess the implementation fidelity of Mother Supportive Group intervention in a selected community. A series of key informant interviews were conducted with nine middle-level healthcare managers and six focus group discussions were conducted with programme supervisors and members of the Mother Supportive Groups. Implementation fidelity of this intervention was assessed giving emphasis to adherence, dose & exposure, quality of delivery, participants’ responsiveness and programme environment. According to the results, adherence to key components of the implementation fidelity of this intervention in Monaragala district was unsatisfactory. Activities within Mother Supportive Groups have been delivered to a lesser extent than expected and the quality of delivered components was also found to be poor. Acceptance of Mother Supportive Group intervention by its primary target population was also unsatisfactory because of various programme issues and unconducive environment existed in the community for its implementation. As reported in number of other studies, relationship between implementation fidelity and outcome of the intervention has a positive correlation. In this study it was clear that, the implementation fidelity of Mother Supportive Group intervention was low and it has led to less effective coverage of primary target population, giving rise to no tangible impact on the nutrition of children in the study group. Therefore, measures need to be taken to increase the implementation fidelity of Mother Supportive Group intervention to achieve the expected level of nutrition and growth promotion.