Improving Maternal and Infant Nutrition: A Framework for Action
Improving Maternal and Infant Nutrition: A Framework for Action
Improving Maternal and Infant Nutrition: A Framework for Action
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Government <strong>and</strong> WHO publications. It should be noted that NICE have <strong>for</strong>malised,robust <strong>and</strong> centrally quality-assured processes <strong>for</strong> the conduct of systematic reviews<strong>and</strong> generation of evidence-in<strong>for</strong>med recommendations; however, as NICE guidancehas no <strong>for</strong>mal status in Scotl<strong>and</strong> Scottish Perspectives are produced as appropriate.Plausible Theory5.12 Evidence of effectiveness underpins the maternal <strong>and</strong> infant nutrition logicmodel where it is available but it is not a limiting factor. However, the lack ofevidence of effectiveness does not necessarily mean ineffectiveness, it may “be dueto inadequate or inappropriate evaluation, failure of implementation, or simply lack ofevaluation.” 77 Despite the lack of evidence in some areas, a pragmatic approachusing practitioner opinion <strong>and</strong> experience was adopted, there<strong>for</strong>e, some activities areevidence-in<strong>for</strong>med rather than evidence-based <strong>and</strong> took account of the ten ethicalprinciples <strong>for</strong> health promotion, public health <strong>and</strong> health improvement proposed byTannahill (2008) 77 : do good, do not harm, equity, respect, empowerment,sustainability, social responsibility, participation, openness <strong>and</strong> accountability.Where gaps in the evidence were identified these were included in therecommendations <strong>for</strong> future research.Scope <strong>and</strong> Limitations of the Logic Model5.13 The purpose of the logic model is to identify key outcomes <strong>for</strong> improvingmaternal <strong>and</strong> infant nutrition <strong>and</strong> outline which activities should be carried out toachieve them based on evidence or plausible theory. The logic model is not acausal pathway <strong>for</strong> improving maternal <strong>and</strong> infant nutrition <strong>and</strong> does not try toexplain all of the interactions between activities <strong>and</strong> outcomes. The logic modeldoes not depict the true complexity of improving maternal <strong>and</strong> infant nutrition; it onlyattempts to clarify some of the key paths to achieving the outcomes.5.14 The logic model presents a snapshot of what is currently known <strong>and</strong>represents our best collective underst<strong>and</strong>ing of how to improve maternal <strong>and</strong> infantnutrition at this point in time. It will need to be regularly reviewed <strong>and</strong> refined toreflect changes in underst<strong>and</strong>ing of maternal <strong>and</strong> infant nutrition over time.Generation of Short, Medium <strong>and</strong> Long Term Outcomes5.15 Over the course of two facilitated meetings, the group reached consensus onthe short, medium <strong>and</strong> long term outcomes <strong>for</strong> improving maternal <strong>and</strong> infantnutrition. All of these contribute to the achievement of two national outcomes:• Our children have the best start in life <strong>and</strong> are ready to succeed ;• We live longer, healthier lives.5.16 Following these consensus meetings, the sub-groups worked independentlyto further develop <strong>and</strong> refine the outcomes. Any suggested amendments to thewording of the outcomes proposed by a sub-group were agreed by the other subgroups<strong>and</strong> approved by the Strategy group. This continuous refinement processtook place over a period of 12-18 months. During this process various drafts of theoutcomes framework were shared <strong>and</strong> discussed widely with key stakeholder
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