{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T20:02:53Z","timestamp":1776628973035,"version":"3.51.2"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,18]],"date-time":"2021-07-18T00:00:00Z","timestamp":1626566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1174166"],"award-info":[{"award-number":["OPP1174166"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Double fortified salt (DFS) has proven efficacy in addressing iron deficiency and anaemia, thus improving maternal and child nutrition outcomes. However, DFS delivery in large\u2010scale settings is less understood, with limited documentation of its fidelity of implementation (FOI). We assessed the FOI of the DFS intervention in Uttar Pradesh, India, to improve the design and implementation of such programmes that aim to reduce the anaemia burden, especially in women of reproductive age (WRA). We conducted in\u2010depth interviews with DFS programme staff (<jats:italic>n<\/jats:italic>\u2009=\u200925) and end\u2010user WRAs (23), guided by a programme impact pathway. We transcribed and thematically analysed the interviews and used an adapted analytic framework to document FOI across four domains\u2014objects of intervention, implementation staff, implementation context and target of implementation. DFS utilisation remained low due to a combination of factors including poor product quality, distribution challenges, ineffective promotion and low awareness amongst end\u2010user WRAs. Motivation levels were higher amongst district\u2010level staff compared to frontline staff, who lacked supervisory support and effective incentives to promote DFS. Three typologies of DFS users emerged\u2014\u2018believers\u2019, \u2018thrifters\u2019 and \u2018naysayers\u2019\u2014who indicated differing reasons for DFS purchase and its use or nonuse. The implementation of the DFS programme varied significantly from its theorised programme impact pathway. The adapted analytic framework helped document FOI and assess the programme's readiness for impact assessments and subsequent scale\u2010up. The programme needs product quality improvements, incentivised distribution and stronger promotion to effectively deliver and improve the realisation of its potential as an anaemia prevention strategy.<\/jats:p>","DOI":"10.1111\/mcn.13243","type":"journal-article","created":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T05:46:19Z","timestamp":1626673579000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Making programmes worth their salt: Assessing the context, fidelity and outcomes of implementation of the double fortified salt programme in Uttar Pradesh, India"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4010-3827","authenticated-orcid":false,"given":"Shruthi","family":"Cyriac","sequence":"first","affiliation":[{"name":"Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta Georgia USA"},{"name":"Global Alliance for Improved Nutrition  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4414-720X","authenticated-orcid":false,"given":"Amy","family":"Webb Girard","sequence":"additional","affiliation":[{"name":"Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta Georgia USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usha","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta Georgia USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. G. Venkatesh","family":"Mannar","sequence":"additional","affiliation":[{"name":"The India Nutrition Initiative  New Delhi India"},{"name":"Department of Chemical Engineering and Applied Chemistry University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kriti","family":"Khurana","sequence":"additional","affiliation":[{"name":"Global Alliance for Improved Nutrition  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Rawat","sequence":"additional","affiliation":[{"name":"Bill and Melinda Gates Foundation  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2652-9108","authenticated-orcid":false,"given":"Lynnette M.","family":"Neufeld","sequence":"additional","affiliation":[{"name":"Global Alliance for Improved Nutrition  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reynaldo","family":"Martorell","sequence":"additional","affiliation":[{"name":"Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University  Atlanta Georgia USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1230-2367","authenticated-orcid":false,"given":"Mduduzi N. N.","family":"Mbuya","sequence":"additional","affiliation":[{"name":"Global Alliance for Improved Nutrition  Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,7,18]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/71.5.1280s"},{"key":"e_1_2_12_3_1","unstructured":"Anemia Mukt Bharat. (n.d.). Retrieved fromhttps:\/\/anemiamuktbharat.info\/home\/6x6x6-strategy\/"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.113.179085"},{"key":"e_1_2_12_5_1","first-page":"285","volume-title":"Insights in the Economics of Aging","author":"Banerjee A.","year":"2017"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdeveco.2017.12.004"},{"key":"e_1_2_12_7_1","unstructured":"Baxter J. &Zlotkin S.(2015).Compendium of evidence on double fortified salt: Technical report In.Ottawa (CA)."},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744987107081254"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-2-40"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzaa133"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12773"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0149-7189(80)90042-7"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10464-008-9165-0"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/28.1.10"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732316665344"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/nxaa175"},{"key":"e_1_2_12_18_1","unstructured":"International Institute of Population Sciences. 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