Process evaluation of a national, community-based, food supplementary programme for improving the nutritional status of children in Iran.

Objective: To evaluate the process of implementation of a national nutritional programme for improving the nutritional status of children in Iran.
Design: A cross-sectional process evaluation was carried out using field observations, document reviews, semi-structured interviews and focus group discussions.
Setting: Data were collected across urban and rural areas of Qazvin and Semnan provinces of Iran, March-September 2014.
Subjects: Mothers (n 362) of children under programme coverage were chosen for the survey. Senior nutrition officers, the head of Hygiene, Remedy and Insurance Affairs at Imam Khomeini Relief Foundation and community health workers were selected purposively for interviews. Mothers with at least one child under 6 years of age covered by the programme were selected to participate in focus group discussions.
Results: Five steps of programme implementation were identified: supplementary food basket content, food basket distribution methods, selection of eligible children, distributed food consumption, and child growth monitoring and nutrition training sessions for mothers. The distributed food baskets did not have enough milk/dairy products, vegetables and fruits. Nearly 50 % of children consumed 75-100 % of the distributed milk and cake/biscuit, while staple foods were shared with other family members. When electronic cards were offered instead of food baskets, attendance for child growth monitoring and the food items participants chose with the cards tended to differ from what was originally designed.
Conclusions: Focusing on food items that are mostly being used for child feeding (e.g. eggs or milk in food baskets) may be beneficial to assure the target child is receiving the distributed foods.