Abstract
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 this interpretation translates into their day-to-day practices. METHODS: The study utilised grounded theory to interrogate health workers' interpretation of the integration of comprehensive nutrition assessment, counselling and support into health service delivery. Observations were conducted to examine whether their interpretation is reflected in daily practices. The study was conducted in Tororo district, Eastern Uganda, among district-level policymakers, implementing partners, and health workers. The study participants were aged between 22 and 60 years, with work experience ranging from 5months to 35 years. Using purposive and theoretical sampling, data were gathered across 17 health facilities through 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.