Briefing Report: Strategies to enhance effective approaches of nutrition-related research projects and nutritional programs conducted in Cambodia

This briefing report aims to inform stakeholders and policymakers working, or planning to work, in Cambodia of approaches that could enhance implementation of nutrition programs and research projects. The report synthesises findings from systematic reviews of nutrition research and implementation projects conducted in Cambodia(1, 2), original research(3, 4) and contributions from an engagement process with key stakeholders, including eminent national and international researchers and coordinators of nutrition projects and programs conducted in Cambodia.

This briefing report identified both effective and ineffective characteristics of nutrition programs and research conducted with the Cambodian population. Stakeholders highlighted many characteristics that are relevant to other populations and cultures, while some were unique to the Cambodian context only. The identified characteristics were initially mapped to the existing Society for Implementation Science in Nutrition (SISN)(5, 6) framework, which identified over 150 strategies across 34 constructs within five domains from the Cambodia-specific data (Table 1; Appendix A). These five domains covered the spectrum of implementation of projects or programs:

1) Nutrition research projects/programs implementation characteristics

2) Local implementing organisation and staff

3) Enabling environment and stakeholder dynamics

4) Cambodian participants, households and communities

5) Implementation processes

Following the initial mapping to the existing SISN framework, an adaptation was applied to incorporate three additional constructs identified in the Cambodian data relating to staff training and support, international stakeholders and local community. This resulted in a framework fit for purpose for nutrition implementing research specifically in Cambodia that can be applied across part or whole research projects and programs. This framework has been named the ‘Nutrition Implementation Framework for Cambodia” (NIFC) and can be used as a ‘handbook’ to guide planning of nutrition projects and programs for researchers with limited exposure in the Cambodian context, or a reference checklist for more experienced researchers and stakeholders. While focused on the Cambodian context, this adapted framework has relevance for other low-middle-income country (LMIC) contexts also.

Strategic recommendations and nutrition program design considerations are suggested in Section 4 of this briefing report based on experiences described during stakeholder and community engagements.

Key recommendations for increasing effectiveness of nutrition research projects and programs are:

· Use the framework as a handbook or checklist when designing and implementing projects/programs

· Build trusting relationships with reputable national and international partners

· Consult with community to ensure cultural relevance, adapting to their needs

· Co-design and collaborate broadly; build capacity with locals

· Conduct comprehensive practical training of field staff

· Link nutrition-specific strategies with nutrition-sensitive ones