Improving maternal and infant nutrition: a framework for action

Chapter 6: Research, Monitoring and Evaluation

6.1 The Framework endorses the research recommendations of NICE Public Health Guidance 11 which relates to pregnant women, those who are planning to become pregnant, mothers and other carers of children aged up to five years, and is particularly aimed at those on a low income or from a disadvantaged group. The NICE research recommendations can be found in Appendix 5.

6.2 In addition to the NICE recommendations, there are a number of areas of particular relevance to Scotland.

Research Commissioners and funders should fund research that seeks to identify:

• The attitudes, values and beliefs of women in Scotland to maternal and infant nutrition, before, during and after pregnancy in order to identify the drivers of change and barriers to change.

Practice evaluation should be carried out to identify the most effective ways to:

• Reduce social inequalities in the initiation and duration of breastfeeding, and exclusive breastfeeding;
• Improve infant feeding practices including timely and healthy complementary feeding;
• Improve maternal diet, particularly to increase fruit and vegetable and oily fish consumption, and reduce the risk of obesity;
• Increase uptake of vitamin D supplementation during pregnancy, while breastfeeding and in infants and young children;
• Increase uptake of folic acid supplementation prior to pregnancy and for the first 12 weeks of pregnancy.

Research commissioners, funders of large scale surveys, managers of large scale surveys and managers of routinely collected data should:

• Continue to use and improve routinely collected data ( ISD Scotland data) and regular surveys carried out in Scotland e.g. Scottish Health Survey, Infant Feeding Survey, Growing up in Scotland study, to monitor progress of the Framework.

6.3 Particular attention should be paid to ensuring that the most relevant and helpful data is provided for monitoring purposes:

• Identify and address gaps where no data is available;
• Improve questions and questionnaires as appropriate;
• Make full use of existing surveys e.g. by boosting UK surveys (e.g. National Diet and Nutrition Survey and the new UK Diet and Nutrition Survey of Infant and Young Children) and carrying out secondary analysis (including data linking) of existing surveys to fill gaps in the evidence;
• Introduce new routinely collected data, new survey questions or new surveys where a need has been identified.

6.4 Particular gaps have been identified for Scotland relating to data on dietary intake during pregnancy and post pregnancy; maternal vitamin D, folate and iron status; maternal and infant obesity and weight gain, and infant nutrition during and post weaning.

Implementation

6.5 A national Implementation Group will be established to drive and co-ordinate implementation of the Framework and action plan. This Group will comprise of representatives from the lead organisations identified in the action plan and other key stakeholders as appropriate.

6.6 Strategic and operational leadership and organisational ownership are critical to the success of implementation of this Framework therefore each NHS Board and partner organisation should identify an Executive Director and appropriate senior member of staff who will have lead responsibility for implementation and development of a local delivery and results plan.

Results Chain

6.7 The action plan has identified several key areas of activity across a range of interventions, policy and practice areas. These activities seek to move from the current situation, as set out in chapter 4, to the outcomes the Framework aims to achieve to improve maternal and infant nutrition. High level milestones and timescales have been identified to enable monitoring of progress on implementation of the activities and, for many of these, there will be a need for the activity to continue beyond the timescale identified.

6.8 The Framework recognises each activity requires a number of key partners to take responsibility for contributing to these activities and not one agency is able to deliver these activities on their own. To enable partners to understand their progress towards achieving change, it is suggested each partner develops a results plan which sets out how their organisation intends to respond to the activities identified in the action plan. Specifically:

• What activities they will undertake;
• Who they expect to engage with when undertaking these activities and what response is expected;
• What changes they expect to see as a result of these activities.

Indicators

6.9 To enable us to recognise progress towards the changes we are expecting to see, potential indicators for each outcome have been identified and are presented in Appendix 6. Many of the indicators proposed are proxy indicators; they will not measure an outcome precisely. Furthermore, many of the indicators will need to be developed over time and therefore will need to be refined as work progresses. The indicators have been drawn from a wide range of national and local data sources including existing data available for example from research, large scale surveys and practice evaluation identified above, project reports, performance reports, annual reviews, inspections and audits.

6.10 For several indicators a data source could not be identified, therefore, further discussion will be undertaken to prioritise the areas where data sources are needed, and to determine the resources required to develop a suitable data source.

6.11 Indicators are currently being developed for a number of other policy areas that will impact on maternal and infant nutrition outcomes; for example the 'Early Years Framework', the 'Refreshed Maternity Services Framework' and 'Preventing Overweight and Obesity in Scotland'. It is important to minimise the number of indicators, therefore, where relevant, the same indicators will be used across as many policy areas as possible.

Monitoring and Evaluation

6.12 Key partners, as identified in the Action Plan, will need to develop monitoring and evaluation frameworks to underpin their results plans. These frameworks link actions to the indicators and evidence which will help partners to check the progress of their efforts and the extent to which these efforts are achieving the results they have identified.

6.13 The frameworks will help partners to understand whether they are heading in the right direction towards achieving the changes they wish to see and/or whether they need to adjust or redirect their efforts. The frameworks will also help partners to describe their contribution to the overall actions of the Framework.

6.14 We recognise that it will take time for partners to think through what their results plans will look like and develop their monitoring and evaluation frameworks, especially as there are gaps in the evidence and/or information available to enable partners to have full picture of their progress and impacts. However, by taking this approach we anticipate partners will be able to articulate their contribution to the overall aims of the Framework. In addition, the Implementation Group will develop a national monitoring and evaluation structure, which will complement local evaluation frameworks.