Leveraging Lean Research Principles to Engage Caregivers to Improve Child Undernutrition: a Case Example in Kolkata, India.

Abstract Background: For social purpose organizations (SPOs), decisions on which programs to scale are driven by information that often falls short of the gold-standard randomized control trial (RCT). This article offers a case study of how lean research, lean experimentation and lean impact principles can be leveraged by SPOs to inform strategic decision-making.Methods: Through two Phases of iterative experimentation, Children International assessed the feasibility and effectiveness of at-home anthropometric evaluation [mid-upper arm circumference Z-score (MUACz) tape] and nutritional support [supplementary foods (SupF)] to influence caregiver engagement and improve children’s nutritional status compared to centralized interventions. Body Mass Index Z-scores (BMIz) at baseline and completion of each Phase were collected along with semi-structured survey and focus group discussion data. Results: Phase I enrolled 37 caregiver/child dyads (17 MUACz, 20 control). The group receiving MUACz tapes reported ease of use for the intervention and a trend towards improved nutrition outcomes. The findings informed the design of Phase II, which enrolled 88 caregiver/child dyads across four groups (20 control, 21 MUACz, 27 SupF, 20 MUACz + SupF). Phase II uncovered low satisfaction with supplementary food and modest overall impact of the interventions despite favorable perceptions of changes in children’s overall health and higher levels of caregiver engagement addressing child nutritional needs. Conclusions: Lean approaches allow SPOs to innovate within the constraints of their organizations, and provide practical platforms to co-create and test evidence-based solutions with the populations they serve. Lean process and a lean mindset allowed the team to rapidly respond with at-home nutrition implementation strategies when faced with the emerging COVID-19 pandemic. Lean approaches can provide a framework to guide teams towards new solutions even during the most unpredictable and unprecedented times.