Translating the strategy of integrating comprehensive nutrition assessment, counselling, and support into action using a grounded theory approach in Tororo district, Uganda

Background Integrating comprehensive nutrition assessment, counselling, and support into the health system is crucial for providing preventive, holistic care and managing chronic conditions. While Uganda adopted this strategy over the past decade, tailored to clients’ needs, evidence of health workers' understanding of the integration concept remains limited. The study explored how health workers interpret the integration of nutrition assessment, counselling and support in health service delivery and how these interpretations translate into their day-to-day practices. Methods The study utilised grounded theory to interrogate the integration of comprehensive nutrition assessment, counselling and support in health service delivery. Using purposive and theoretical sampling, data were gathered through three health facility levels, four focus group discussions, 24 key informant interviews, 22 in-depth interviews and 17 observations. Results The findings confirm that health and nutrition education sessions, nutrition assessment and categorisation, and active follow-up are essential components of daily routines in 17 health facilities. However, food demonstrations, growth monitoring, community linkages, and nutrition-focused quality improvement activities require strengthening. A model for integrating nutrition assessment, counselling, and support was developed based on health workers’ interpretations and experiences. This model demonstrates the multidimensional nature of integration, involving health worker-client factors, nutrition assessment, counselling, and support characteristics, as well as external environmental factors that interact to facilitate effective nutrition service delivery. Conclusions The study shows that although some aspects of nutrition are included in routine service delivery, the level of this integration varies across health facilities. The multidimensional model highlights the importance of health workers' cognitive attributes, client factors, interpersonal dynamics, service features, and external environmental influences in improving health service delivery. The study identifies key areas for enhancing daily nutrition services that could guide interventions to improve the overall effectiveness of nutrition service provision.