• The Early Nutrition Access Program (ENAP) is fundamentally rooted in the Social Ecological Model (SEM), recognizing that child nutrition outcomes are influenced by multiple levels of interaction from individual to policy levels (El Zaatari & Maalouf, 2022). The program addresses nutritional challenges among internally displaced children through a multi-level intervention approach that considers both individual behaviors and environmental contexts (Gooding et al., 2024).

    The program's theoretical framework combines SEM with Social Cognitive Theory (Bandura, 2019), emphasizing the importance of knowledge transfer, behavioral modeling, and self-efficacy development among caregivers. This integrated theoretical approach recognizes that sustainable nutrition improvements require both individual behavior change and supportive environmental conditions (Berkemeyer & Wehrmann, 2022).

    ENAP's theory of change posits that combining direct nutrition support with caregiver education and local food system strengthening will create sustainable improvements in child health outcomes (WHO, 2023). This comprehensive approach acknowledges that effective nutrition interventions must address both immediate needs and underlying systemic factors (UNICEF, 2023).

Nutrition Education

  • The weekly workshops influence both the caregiver's individual knowledge and their direct interactions with their children around food and nutrition

    • Primary: Interpersonal level (targeting parent-child relationships)

    • Secondary: Individual level (increasing parent/caregiver knowledge and skills)

Fresh Produce Access/Distribution

  • The distribution system creates organizational infrastructure while connecting with community food systems

    • Primary: Organizational level (creating systems for food distribution)

    • Secondary: Community level (engaging local markets and vendors)

Health Monitoring

  • Health monitoring focuses on individual child outcomes while building organizational capacity for health-tracking

    • Primary: Individual level (tracking individual child growth)

    • Secondary: Organizational level (establishing healthcare monitoring systems)

Community Engagement

  • The farmers' markets strengthen community bonds

    • Primary: Community level (building broader community connections)

REFERENCES


Bamberger, M., Tarsilla, M., & Hesse-Biber, S. (2020). Why so many "rigorous" evaluations fail to identify
unintended consequences of development programs: How mixed methods can contribute. Evaluation and Program
Planning, 79, 101761. https://doi.org/10.1016/j.evalprogplan.2019.101761


Bandura, A. (2019). Applying theory for human betterment. Perspectives on Psychological Science, 14(1), 12-15.
Berkemeyer, S., & Wehrmann, J. (2022). Sustainable nutritional behavior change (SNBC) model: How personal
nutritional decisions bring about sustainable change in nutritional behavior. Obesity pillars, 4, 100042.
https://doi.org/10.1016/j.obpill.2022.100042


El Zaatari, W., & Maalouf, I. (2022). How the bronfenbrenner bio-ecological system theory explains the
development of students’ sense of belonging to school? Sage Open, 12(4).
https://doi.org/10.1177/21582440221134089


Gooding, C., Musa, S., Lavin, T., Sibeko, L., Ndikom, C. M., Iwuagwu, S., Ani-Amponsah, M., Maduforo, A. N., &
Salami, B. (2024). Nutritional Challenges among African Refugee and Internally Displaced Children: A
Comprehensive Scoping Review. Children (Basel, Switzerland), 11(3), 318.
https://doi.org/10.3390/children11030318Patton, M. Q. (2021). Evaluation science. American Journal of Evaluation,
42(1), 11-26. https://doi.org/10.1177/1098214020905897


Saunders, R.P., Evans, M. H., & Joshi, P. (2005). Developing a Process-Evaluation Plan for Assessing Health
Promotion Program Implementation: A How-To Guide. Health Promotion Practice, 6(2), 134-147


Sphere Association. (2023). The Sphere handbook: Humanitarian charter and minimum standards in humanitarian
response (4th ed.). Sphere Association.


UNICEF. (2023). Ethical research involving children: Guidelines and tools. UNICEF Office of Research.


UNICEF. (2023). Global nutrition monitoring framework: Operational guidance for tracking progress in meeting
targets for 2025. UNICEF Publication.


UNICEF. (2023). Theory of change in nutrition programming. UNICEF Publication.


World Health Organization. (2023). Framework for nutrition intervention in humanitarian settings. WHO Press.


World Health Organization. (2022). Guidelines on early childhood nutrition education programs. WHO Press.

  • Nutrition education consists of weekly 1-hour workshops for parents over eight weeks, delivered by nutrition educators with an expected 80% attendance rate, tracked through logs and knowledge assessments, aligned with WHO guidelines for early childhood nutrition interventions (World Health Organization [WHO], 2022).

    The nutrition education workshops focus on teaching parents and caregivers of displaced children about age-appropriate nutrition, with particular attention to common nutritional challenges in displacement settings. These weekly sessions cover topics like creating balanced meals with available resources, identifying affordable nutrient-rich foods common in Lebanon, addressing picky eating behaviors typical of preschoolers, and maintaining proper nutrition despite limited facilities. Special emphasis is placed on helping families maintain cultural food practices while adapting to their current circumstances.

    The program's volunteer educator training initiative is expected to create a significant educational impact across the 10 shelters, reaching approximately 1,500 individuals through structured weekly nutrition lessons. Over the 8-week period, trained volunteers will deliver targeted 30-minute sessions to both parents (500 total) and children (1,000 total), integrating nutrition concepts through engaging activities. This dual-approach strategy, focusing on both parent and child education, is designed to create a supportive learning environment that promotes increased fruit and vegetable consumption. The expected outcomes include enhanced educator self-efficacy in nutrition education, successful implementation of at least two nutrition-focused activities weekly, and ultimately, increased fruit and vegetable consumption among displaced children. The program's structured approach, combining regular educational sessions with practical activities, creates a comprehensive learning environment that supports sustainable dietary behavior change.

  • Fresh produce distribution occurs weekly from the partnered local markets and vendors following strict quality control protocols, aiming for 100% distribution to enrolled families and monitoring through a digital system and consumption diaries.

    The fresh produce access and distribution system is tailored to reach families in temporary housing or displacement centers. The system includes mobile distribution points that can access various areas, with produce selections focusing on child-friendly items that require minimal preparation given limited cooking facilities. Distribution schedules are coordinated with other humanitarian aid deliveries to ensure convenient access for families.

    The ADRA-funded program aims to significantly impact the nutritional status of internally displaced children ages 3-5 through a systematic approach to increasing fruit and vegetable consumption. During the 8-week implementation period, the program expects to establish a sustainable produce distribution network through partnerships with 75% of local farmers, serving 10 shelters housing displaced families. The direct impact chain begins with reliable weekly deliveries of fresh, seasonal produce to shelters, making fruits and vegetables consistently accessible to children. This increased accessibility, combined with children's improved awareness of produce availability, is expected to result in measurable behavioral changes - specifically, an increase to at least one serving each of fruits and vegetables per child daily. The cumulative effect of these interventions is anticipated to enhance the overall nutritional status of the target population, creating a foundation for improved health outcomes among internally displaced children ages 3-5.

  • Health monitoring includes weekly growth measurements and quarterly health checks targeting 90% completion, documented through comprehensive health records, following UNICEF's child growth monitoring standards (United Nations Children's Fund [UNICEF], 2023).

    Health monitoring is designed to maintain consistent growth tracking despite the challenges of displacement. ENAP establishes regular monitoring stations at key locations where displaced families are located, with portable equipment for reaching less accessible areas. The monitoring system includes specific markers for common nutritional challenges among displaced preschoolers, with clear pathways to local healthcare providers who can address more serious health concerns.

    The Lebanese Red Cross (LRC) and local health departments' comprehensive health assessment program is expected to establish crucial baseline data and ongoing monitoring of children's nutritional status through multiple interventions. The program aims to achieve 90% coverage of health screenings within 48 hours of shelter admission for children ages 3-5, conducting anthropometric measurements and blood tests to evaluate nutritional status. Children identified as at-risk for malnutrition will receive intensified weekly monitoring, including detailed dietary intake data collection with parental input. The program's impact will be measured through comprehensive blood tests at weeks 8 and 12, tracking specific nutritional indicators. Success metrics include maintaining height-for-age and weight-for-age measurements within the 25th-75th percentile on WHO growth charts for 85% of participants through a three-month post-program period, demonstrating sustained improvement in nutritional status.

  • Community engagement features monthly meetings and quarterly farmers' markets, aiming for 70% stakeholder participation measured through attendance records and feedback surveys.

    Community engagement activities are structured to build connections among displaced families and with the host community. Monthly meetings provide opportunities for families to share experiences and coping strategies around feeding young children in displacement settings, while quarterly farmers' markets are organized near temporary housing areas. These events incorporate traditional Lebanese food practices while helping families adapt to their new circumstances. Special attention is given to creating child-friendly spaces during community events, ensuring that the 3-5 year old children can be safely engaged while their caregivers participate in program activities.

    The social media and digital communication strategy aims to extend ENAP's impact through accessible, technology-driven nutrition education. The program expects to reach 50% of internally displaced parents through targeted content distribution via social media platforms, e-card handouts, and messaging, featuring infographics and educational materials accessible through QR codes. This digital engagement is anticipated to enhance parents' nutritional knowledge specifically regarding fruit and vegetable consumption for children ages 3-5, leading to increased confidence and motivation. A key expected outcome is the organic development of a community-based WhatsApp group that facilitates health-related activities and events, including local fun runs, gardening classes, and cooking demonstrations, creating a sustainable digital support network for continued health promotion within the displaced community.

COMPLETE & ACCEPTABLE DELIVERY OF ENAP FOCUSES ON 4 KEY STRATEGIES