Optimal Design for a Psychosocial Intervention on Severely Acute Malnourished Children in Humanitarian Settings: Results of an Expert Survey

Background Common psychosocial interventions focus on feeding, stimulation, emotional responsiveness and childcare and parenting. Inclusion of such a component in the outpatient management of severe acute malnutrition (SAM) children is recommended. However, evidence remains scarce on both the optimal modalities and the potential impact of psychosocial interventions integrated into SAM treatment protocols. This survey aimed to gather expert opinions on the optimal design of a combined psychosocial and nutrition intervention feasible in humanitarian settings. Methods From March to May 2018, an online survey was emailed to international experts in nutrition and mental health and psychosocial support, mainly from academia and international non-governmental organisations (INGOs). It included multiple choices questions on the key components of an optimal combined intervention. Results Of the 76 experts targeted, 20 responded. 11 (55%) belonged to INGOs, 2 (10%) to academia, and 4 (20%) to international organizations and donors. For most respondents, a combined intervention should be provided in weekly 45-minute counselling sessions, provided individually (rather than in a group) and at home (rather than at a health center). No consensus emerged regarding the ideal overall duration of the intervention. Experts thought that 35% of staff training should be in “Active listening for psychosocial support”, and 30% in “Early child development”, 25% in “Maternal depression” and 9% in “Anthropometric measurements”. Respondents estimated a mean expected recovery rate of 74% (n = 17), corresponding to an expected 14 percentage-point increase compared with the 60% reference recovery rate. Qualitative results highlighted the importance of tailoring the intervention to the individual, the population and the settings; as well as considering feasibility and scalability at the design stage. Conclusion Among the proposed modalities, the most frequently selected options were weekly 45-minute psychosocial sessions, individual rather than group delivery, and delivery at home rather than at a health centre. Respondents also emphasized that duration and delivery modalities should be adapted to context. Further research should refine these components through formative work or a consensus-building process before assessing feasibility, effectiveness and cost-effectiveness in humanitarian SAM programmes.