Elizabeth Pulsipher, Savannah Henshaw and Dr. Scott Sanders, Sociology

Introduction

Last summer, we conducted quantitative and qualitative research for an in-depth analysis of the attrition occurring in the Liahona Children’s Foundation’s program—a program attempting to alleviate child malnutrition in sixteen countries. Our findings draw upon five sources: 1) individual interviews we conducted with a randomized sample of Liahona Children’s Foundation program participants, 2) focus groups we led with all program coordinators in the Philippines, 3) our individual interviews with all program coordinators in the Urdaneta region, 4) a survey of program participants at the screenings, and 5) observations from program screenings and distributions. Upon returning home and receiving the ORCA grant, we worked with Dr. Scott Sanders to analyze the data we collected and identify the main reasons for attrition in micronutrient programs. He trained us in both quantitative and qualitative research methods. After an extensive analysis of our data, we found that our results were not conclusive and did not warrant publishing. However, they were extremely useful to Liahona Children’s Foundation and provide a foundation for further research.

Methodology

With the guidance of Dr. Scott Sanders, we analyzed the data we collected in the Philippines in the summer of 2017. We collected the data from a randomized control trial conducted in the Pangasinan region of the Philippines in 2016. The RCT was an integral part of the research that we conducted. It provided a baseline data set that allowed us to test our hypotheses and potentially publish statistically significant results. We used a mixed-methods approach to analyze attrition and barriers prohibiting children from returning to continue supplement use. Dr. Sanders trained us on qualitative data analysis and we used the COREQ guidelines and conducted an extensive analysis on the data we received from surveys, focus groups, and interviews. In doing so, we attempted to identify several main barriers and causes of attrition in programs that administer micronutrient supplements. We also used quantitative analyses, including running regressions in Stata, to help us identify key demographics that were at risk for attrition. First we had to code, enter, and clean the data from the paper surveys we administered in the Philippines. Dr. Sanders helped us with the regression analysis and data visualization. Through this mixedmethods approach we attempted to find the main causes of attrition.

Results

Following this extensive mixed-methods analysis, our findings were inconclusive. The qualitative analysis led us to many valid barriers to attendance and reasons for attrition. However, it provided so many answers that it was difficult to be conclusive and identify results that we could publish. The quantitative findings were also inconclusive and did not provide any statistically significant results. We continued to analyze the data to find statistically significant demographic barriers and again did not find conclusive results that we could generalize to all micronutrient supplement programs.

However, our findings were extremely valuable to the non-profit that we analyzed. We compiled an extensive report outlining our methods, analysis, and further recommendations. We gave a written report to the leaders of the foundation and then gave an oral presentation to members of the board of the non-profit. We provided them with suggestions to lower attrition, and barriers to attendance, and thus increase the quality of help they provide to the malnourished children in their programs throughout the world.

Discussion

While our results were inconclusive, we found significant barriers to attrition in micronutrient programs that we believe with more research and a larger data size could be statistically significant and publishable. One of the most prevalent barriers we identified is a lack of communication. Coordinators are diligent in reaching out to the participants they can, but when large numbers of participants enter the program who are from distant locations, it is incredibly difficult for coordinators to contact them. This is especially applicable to the Philippines and other developing countries because of the lack of regular cell-phone usage among very poor populations. Another leading barrier for continued participation is the lack of understanding of malnutrition among participants. Evidence of this misunderstanding is seen from our interviews from parents. For instance, among the 25 parents we interviewed, opinions on how long their children need to take supplements ranged from one month to 78 months, and all the interviewed parents with severely malnourished or acutely malnourished children believe that their children are healthy or slightly unhealthy. This has caused many parents to not return to the screenings. Lack of incentives to attend screenings and distributions is another main barrier we identified. Parents often spend more money on fare to the screenings than the cost of the actual supplements they are receiving. As mentioned previously, our findings were extremely specific to the program we evaluated, and while valuable to them, they were not publishable. We recommend doing a future analysis comprising many similar programs and a larger sample size to further narrow down the main reasons for attrition.

Conclusion

While our findings were inconclusive and unable to be published, we acknowledge their usefulness to the program we evaluated. We learned a great deal about program evaluation, impact evaluation, quantitative data analysis, and qualitative data analysis. Dr. Sanders was incredibly helpful in teaching us these methods and mentoring us in our endeavor to publish. This research helped us prepare for graduate school and our future academic and career aspirations. We learned that collecting data and doing both quantitative and qualitative analysis are essential to a program or company’s development. We hope that this research provides a platform, both for us and for others, to continue working on improving micronutrient programs, and to better help malnourished children throughout the world.