DEVELOPMENT OF A SUPPORT PROGRAMME FOR FACILITATING THE INTEGRATION OF NUTRITION AND FOOD SECURITY

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CHAPTER 2 LITERATURE REVIEW

INTRODUCTION

In the previous chapter, detailed information has been presented regarding the overall orientation of the study including but not limited to the background, statement of the research problem, research objectives, research questions, theoretical framework and research methods. This chapter focuses on the literature review.
A literature review is a process where researchers locate books and journal articles on a topic, choose the literature to include in their review, and then summarise and critically evaluate the included literature (Clark & Creswell 2015:15). Grove, Gray and Burns (2015:163) described that literature reviews of published research reports provide the background for the problem studied. Such reviews include describing the current knowledge of a practice problem, identifying the gaps in this knowledge base, and explaining how the study being reported contributed to building knowledge in this area. Literature review conveys a researcher with what is and is not known about the research topic. It provides a sound base upon which new research can be founded (Paul 2012:1). In the current chapter, relevant studies that were conducted on factors of malnutrition and food insecurity, the result of nutrition and food security on treatment outcome and quality of life of PLWHA is broadly explored. The chapter provides the literature review process, thematic areas that emerged from of reviewed literature, theoretical framework used and the role of nutrition and food security on treatment outcome and quality of life, and also explored the determinants of malnutrition and food insecurity among PLWHA.

THE LITERATURE REVIEW PROCESS

The literature review process includes preparing evidence in a systematic approach (Aveyard 2014:74). For this study, the literature review was systematically carried out in reviewing existing evidence focused on factors related to malnutrition and food insecurity, and the outcome of nutrition and food security on treatment and quality of life peoples living with HIV. The scope of the review is limited to English language publications, those studies published between the year 2011 and 2018, and literature which discuss nutrition and food security among PLWHA. Global, regional and country perspective data sources relevant to the topic of the study were systematically explored and reviewed from published articles in journals or periodicals, internet publications, monographs, conference papers, theses and dissertations, clinical journals, textbooks, and other books. National and international strategic reports, policy documents, websites and reports developed by government agencies and professional organizations were also included. The researcher reviewed websites and articles published on PLOS ONE, Cochrane systematic review database, PubMed, EBSCOhost, CINAHIL, BioMed Central Health Services Research, Google Scholar, SAGE and Elsevier/Embase. Guideline and periodicals published by UNAIDS, World Food Programme, WHO and FMOH of Ethiopia were also reviewed. Examples of terms used for literature search were: nutrition and HIV, food security and HIV, nutrition and food security and HIV, malnutrition and AIDS, food insecurity and HIV/AIDS, malnutrition and food insecurity and HIV/AIDS, malnutrition and ART outcome, impacts of malnutrition and food insecurity on quality of life among peoples living with HIV, food insecurity among peoples living with HIV, food insecurity and treatment outcome, and policies and programmes for HIV epidemic response.

 THEMATIC DEVELOPMENT PROCESS

Polit and Beck (2012:97) recommend thinking of doing a literature review as similar to doing a qualitative study that is continuing the search strategies until redundant information and important themes were generated. Qualitative data analysis techniques are suitable for analysing literature as every selected literature whether regardless of the approach/methodology used contains several sources of qualitative data (for example, literature review of source article, conceptual or theoretical framework, author’s interpretations, author’s conclusion), thereby justifying within-case qualitative analyses (Onwuegbuzie, Leech & Collins 2012:3). With this in mind, the researcher used the framework method of data analysis technique to analyse and interpret the literature. The framework analysis method sits within a broad family of analysis methods often termed thematic analysis or qualitative content analysis (Gale, Heath, Cameron, Rashid & Redwood 2013:2). According to Gale et al (2013:2), this approach is not aligned with a particular epistemological viewpoint or theoretical approach. Therefore it can be adapted for use in inductive or deductive analysis or a combination of the two (using pre-existing theoretical constructs deductively, then revising the theory with inductive aspects; or using an inductive approach to identify themes in the data, before returning to the literature and using theories deductively to help further explain certain themes).
In this study, the framework method of the data analysis (Gale et al 2013: 4-5) is used deductively using pre-existing theoretical constructs of nutritional, mental health and behavioral conceptual framework to map the connections of literature between the conceptual framework and generate typologies and interrogating prior concepts within the framework. As such, relationships identified, themes in the data or literature were arranged, written, and re-written across the conceptual framework. Nevertheless, the framework method of the analysis has seven steps, the last three: applying the analytical framework, charting data into the framework matrix and interpreting the data were utilised because the conceptual framework of this study was pre-specified. The process followed was as follows:
• Emerging transcripts from the literature review were categorised, coded and indexed in line to the nutritional, mental health and behavioural pathways conceptual framework through reading and re-reading of the literature.
• The reviewed data were charted into the nutritional, mental health and behavioural framework matrix. Transcripts of the review were captured in the framework to generate a data matrix from the reviewed literature and summarised into pre-identified nutritional, mental health and behavioural category from each transcript.
• Characteristics of and differences between ideas in literature, typologies with prior nutritional, mental and behavioural conceptual frameworks were mapped to generate connections across themes and to explore a relationship. Based on coded extracts and the data set in the review, thematic analysis was generated and refined into the broad theme for discussion.

EMERGED THEMES

The following are the final themes that emerged from the appraisal of reviewed literature:
• The nutrition and food security context,
• Nutrition, food security and HIV,
• Determinants of malnutrition among people living with HIV,
• Determinants of food insecurity among people living with HIV,
• Nutritional, mental health, and behavioural pathways conceptual framework,
• Nutrition and food security, and HIV: nutritional, mental health, and behavioural pathways conceptual framework analysis on treatment outcome and quality of life nexus, and
• Nutrition and food security: policy support for integration into HIV and AIDS response programming.

 The nutrition and food security context

Nutrition and food security is a multi-dimensional concept which includes dimensions such as the availability of food, physical and economic access to food, as well as adequate use and utilisation of available food by individuals, throughout the year (Trentmann, Latzke, Jülich & Oppeln 2015:5). Trentmann et al (2015:14) further explained the term ‘food security’ as the supply and access of food at national, community and household level, while ‘nutrition security’ refers to the consumption and proper utilisation of food in the body. Secure access to an appropriate and nutritious diet can only lead to good nutrition if coupled with sufficient care and good health.
Scarcity and lack of sustainability in nutrition and food security continue to be fundamental human welfare challenges in developing and developed countries. The rate and magnitude of malnutrition in the world are rising (FAO, IFAD, UNICEF, WFP & WHO 2018:2). The absolute number of malnourished people has increased to nearly 821 million in 2017, from around 804 million in 2016 (see figure 2.1). According to the FAO et al (2018:2) report, the situation is worsening in South America and most regions of Africa. However, Africa remains the continent with the highest prevalence of malnutrition, affecting almost 21 percent of the population (more than 256 million people). The situation is also deteriorating in South America, where the prevalence of malnutrition has increased from 4.7 percent in 2014 to a projected five percent in 2017.

CHAPTER 1  INTRODUCTION AND ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND TO THE RESEARCH PROBLEM
1.3 STATEMENT OF THE RESEARCH PROBLEM
1.4 AIM OF THE STUDY
1.5 DEFINITIONS OF KEY CONCEPTS
1.6 THEORETICAL FOUNDATIONS OF THE STUDY
1.7 RESEARCH METHODOLOGY
1.8 SCIENTIFIC RIGOR
1.9 ETHICAL CONSIDERATIONS
1.10 STRUCTURE OF THE THESIS
1.11 CONCLUSION
CHAPTER 2  LITERATURE REVIEW
2.1. INTRODUCTION
2.2 THE LITERATURE REVIEW PROCESS
2.3 THEMATIC DEVELOPMENT PROCESS
2.4 EMERGED THEMES
2.5 GAPS IN LITERATURE
CHAPTER 3  RESEARCH DESIGN AND METHODOLOGY
3.1 INTRODUCTION
3.2 RESEARCH APPROACH
3.3 RESEARCH DESIGN
3.4 RESEARCH METHOD
3.5 CONCLUSION
CHAPTER 4  FINDINGS, PRESENTATION AND ANALYSIS
4.1 INTRODUCTION
4.2 SECTION 1: QUANTITATIVE RESULT
4.3 SECTION 2: QUALITATIVE RESULTS
4.4 CONCLUSION
CHAPTER 5  DISCUSSION AND INTERPRETATION OF THE RESEARCH FINDINGS
5.1 INTRODUCTION
5.2 RESEARCH APPROACH, DESIGN AND METHO
5.3 OVERVIEW OF THE RESEARCH FINDINGS AND DISCUSSION
5.4 CONCLUSION
CHAPTER 6   DEVELOPMENT OF A SUPPORT PROGRAMME FOR FACILITATING THE INTEGRATION OF NUTRITION AND FOOD SECURITY WITH HIV PREVENTION, TREATMENT AND CARE
6.1 INTRODUCTION
6.2 TRIANGULATED FINDINGS
6.3 PEOPLE-CENTRED AND INTEGRATED HEALTH SERVICES CONCEPTUAL FRAMEWORK
6.4 SUPPORT PROGRAMME FOR FACILITATING THE INTEGRATION OF NUTRITION AND FOOD SECURITY WITH HIV PREVENTION, TREATMENT AND CARE
CHAPTER 7  CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS
7.1 INTRODUCTION
7.2 SYNOPSIS OF THE RESEARCH DESIGN AND METHODOLOGY
7. 3 SUMMARY OF THE RESEARCH FINDING
7.4 CONCLUSIONS OF THE STUDY
7.5 RECOMMENDATIONS
7.6 RECOMMENDATION FOR RESEARCH
7.7 CONTRIBUTION OF THE STUDY
7.8 LIMITATION OF THE STUDY
7.9 CONCLUDING REMARKS
LIST OF REFERENCES .
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