Effectiveness of a large-scale home visiting programme (PIM) on early child development in Brazil: quasi-experimental study nested in a birth cohort

Abstract

BackgroundA large-scale parenting programme with weekly home visits (Primeira Infância Melhor (PIM)) has been implemented in the south of Brazil for nearly two decades, but lacks evaluation of its effects on early childhood development (ECD). This quasi-experimental study aimed to assess the effects of PIM in real-life settings within a population-based birth cohort study.MethodsData from the 2015 Pelotas Birth Cohort Study and the state programme information system were linked to identify study children who received PIM. Propensity score matching was used to create a comparable control group (using one-to-one matching) to estimate the effect of PIM on ECD measured at age 4 years. First, the impact of any enrolment in PIM was evaluated; then the intervention group was stratified according to whether enrolment occurred during pregnancy or after birth. Double adjustment was applied in linear regression to analyse child development scores, and Poisson regression for delayed development (below the 10th percentile of whole cohort). Effect modification due to family income was explored.ResultsThere was no evidence that any enrolment in PIM (601 pairs) by age 4 years was associated with child development. However, PIM starting during pregnancy (estimated for 121 pairs) predicted higher development scores (0.27 SD; 95% CI 0.02 to 0.52), and 71% lower prevalence of delayed development (prevalence ratio=0.29; 95% CI 0.13 to 0.69), compared with the control group. There was strong statistical evidence (p=0.003, test of interaction) that the effect of PIM starting in pregnancy was larger than when starting after birth (480 pairs). The effect of PIM starting during pregnancy was found to be restricted to poorer families.ConclusionsIn a real-life setting, PIM was effective only when starting during pregnancy and only for poorer families. A higher-quality programme might be more effective with a broader population.

Towards a better understanding of real-world home-visiting programs: a large-scale effectiveness study of parenting mechanisms in Brazil

“…Primary data from the 2015 Pelotas birth cohort were linked with PIM state database based on the child’s name, mother’s name and child’s DOB in order to evaluate the effects of PIM on participants in the cohort. PIM funding is contingent on the number of children registered per city, so it is unlikely families received the programme without being registered 24…”

“…PIM became a public policy by law in 2006 and served as a model for Brazil’s federal parenting programme, Crianca Feliz (CF), which is the largest home-visiting programme in the world 27. Previous studies have found that children who received PIM demonstrated small reductions in infant mortality28 and school-reported behaviour problems29 and improvements in cognitive development 24. This is the first peer-reviewed evaluation of its kind to assess PIM’s effect on parent behavioural mechanisms.…”

“…The current study contributes to this literature by evaluating whether Primeira Infância Melhor (PIM), a state-wide, pragmatic home-visiting programme in Southern Brazil (1) improved five caregiving practices at 4 year follow-up and (2) whether effects were moderated by child age, duration of participation or family income. PIM was previously found to benefit child development at age 4 years, when implemented from gestation onwards 24…”

A meta‐analytic review of the implementation characteristics in parenting interventions to promote early child development

“…13 Quantitatively, individual studies have focused on program characteristics such as delivery modality and age of infant at enrollment, with little evidence that these implementation features are associated with program effectiveness in improving parent or child outcomes. 2,14,15 Indeed, quantitative analysis of program characteristics associated with the engagement of families and child and parent outcomes has often been restricted due to limited numbers of studies reporting implementation characteristics. 16 The few meta-analyses examining implementation characteristics have focused on intended dosage (i.e., duration 2 and intensity 4 ).…”

“…In addition to contextual features, common programmatic features found in effective parenting interventions (e.g., supportive supervision) have been qualitatively identified 13 . Quantitatively, individual studies have focused on program characteristics such as delivery modality and age of infant at enrollment, with little evidence that these implementation features are associated with program effectiveness in improving parent or child outcomes 2,14,15 . Indeed, quantitative analysis of program characteristics associated with the engagement of families and child and parent outcomes has often been restricted due to limited numbers of studies reporting implementation characteristics 16 .…”