Enhancing the Health Extension Workers Capacity for Promotion of Maternal and Child Nutrition in Northwest Ethiopia: Applying the Pender's Health Promotion Model

Background: Maternal and child nutrition is a lingering public health concern, affecting the lives of the most vulnerable individuals, in particular mothers and children. To counteract the burden, the Ethiopian government has applied various strategies, including incorporating the promotion of nutrition as one package of primary health care provided by the health extension workers (HEWs). However, the provider's knowledge, promotion skill, and competency for promoting maternal and child nutrition have not been examined. Moreover, health extension workers have been promoting using the traditional model of education and indicating the need for continuous professional development to strengthen the workforce. Thus, the study is aimed to assess and enhance the health extension worker's capacity in promoting maternal and child nutrition through comprehensive and evidence-based capacity-building training.

Methods: A quasi-experimental study will be employed among 92 health extension workers. A baseline study, involving both qualitative and quantitative studies will be conducted to identify the gaps in maternal and child nutrition promotion. The knowledge, promotion as well as counseling skills of the HEWs will be assessed using a self-administered questionnaire and observational checklist, respectively. The intervention will involve training, supportive supervision, and coaching in a real environment. A four-day training will be given, which will be followed by supportive supervision of expert supervisors. Further, the greet, ask, listen, identify, discuss, recommend, and agree counseling model with Pender's health promotion model will be applied to enhance HEWs promotion skill. A post-test aimed at assessing the knowledge and counseling competency will be conducted and the pretest and posttest results will be compared using a t-test. Factors affecting both knowledge and counseling capacity will be assessed using binary logistic and linear regression, respectively. Similarly, a qualitative study will be used to explore promotion skills.

Discussion: Given there are problems associated with the knowledge and counseling skills of HEWs in Ethiopia, nutrition education using a well-designed and comprehensive strategy would bring a positive impact on professionals' promotion capacity thereby improving mothers/caregivers' behavior regarding child and maternal nutrition. The evidence will also enforce nutrition programmers and the Amhara regional health bureau to end maternal and child undernutrition.