Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation

Kohli-Lynch, Maya; Hardy, Victoria Ponce; Salazar, Raquel; Bhopal, Sunil; Brentani, Alexandra; Cavallera, Vanessa; Goh, Esther C. L.; Hamadani, Jena Derakhshani; Hughes, Robert C; Manji, Karim; Milner, Kate; Radner, James; Sharma, Sonia; Silver, Karlee; Lawn, Joy E; Tann, Cally J

doi:10.1136/bmjopen-2019-032134

Cited by 20 publications

(34 citation statements)

References 37 publications

(29 reference statements)

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“…We encourage future studies in this area to pay close attention to this tradeoff that is so important for understanding program impact and sustainability. Consistent with previous studies, we identified major challenges with proper program implementation as a result of high personnel turnover, low salary, and short‐term workforce contracts 36 . Hence, provision of incentives based on performance are potential alternatives to improve both staff retention and motivation during scaling up of PCF 11,36 .…”

Section: Discussionsupporting

confidence: 80%

Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis

Buccini

Venâncio

Pérez‐Escamilla

2021

Annals of the New York Academy of Sciences

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To address inequities that prevent socioeconomically vulnerable young children from reaching their full developmental potential, Brazil implemented Programa Criança Feliz (PCF) (“Happy Child” early childhood development program) in 2934 of its 5570 municipalities. A qualitative case study was carried out on the basis of in‐depth interviews with 22 key informants, employing purposive sampling, from past or current national and state coordination teams. Thematic analysis followed the RE‐AIM framework, and complex adaptive system constructs mapped how barriers and enablers influenced scale‐up. One overarching theme related to PCF emergence, and 18 subthemes were identified within the RE‐AIM. An enabling national political environment favored PCF emergence through a top‐down approach that led to governance challenges. Changes in the enrollment criteria for families facilitated reach, and evidence‐based methodology favored the designing of the home visits. However, operationalizing the intersectoral actions remains a barrier for effectiveness, while intrasectoral resistance across levels delayed adoption. WhatsApp facilitated networking, capacity building, and adoption. Rushed scale‐up generated barriers for quality delivery and led to different implementation pathways across municipalities. Legal institutionalization is critical to assure permanent funding and maintenance. PCF has enhanced early childhood services in Brazil, but strong negative feedback loops need to be addressed for effective sustainability.

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Section: Discussionsupporting

confidence: 80%

Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis

Buccini

Venâncio

Pérez‐Escamilla

2021

Annals of the New York Academy of Sciences

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“…Interviews with parents, CHVs and supervisors recognized the improvement in quality that developed over time. Other implementers have similarly highlighted the importance of provider competence and the need for more training and supervision than initially expected (11,19,(34)(35)(36).…”

Section: Interviewee Quotesmentioning

confidence: 99%

An Implementation Evaluation of A Group-Based Parenting Intervention to Promote Early Childhood Development in Rural Kenya

Luoto

García

Aboud

et al. 2021

Front. Public Health

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Early childhood development (ECD) parenting interventions can improve child developmental outcomes in low-resource settings, but information about their implementation lags far behind evidence of their effectiveness, hindering their generalizability. This study presents results from an implementation evaluation of Msingi Bora (“Good Foundation” in Swahili), a group-based responsive stimulation and nutrition education intervention recently tested in a cluster randomized controlled trial across 60 villages in rural western Kenya. Msingi Bora successfully improved child cognitive, receptive language, and socioemotional outcomes, as well as parenting practices. We conducted a mixed methods implementation evaluation of the Msingi Bora trial between April 2018 and November 2019 following the Consolidated Advice for Reporting ECD implementation research (CARE) guidelines. We collected qualitative and quantitative data on program inputs, outputs, and outcomes, with a view to examining how aspects of the program's implementation, such as program acceptance and delivery fidelity, related to observed program impacts on parents and children. We found that study areas had initially very low levels of familiarity or knowledge of ECD among parents, community delivery agents, and even supervisory staff from our partner non-governmental organization (NGO). We increased training and supervision in response, and provided a structured manual to enable local delivery agents to successfully lead the sessions. There was a high level of parental compliance, with median attendance of 13 out of 16 fortnightly sessions over 8 months. For delivery agents, all measures of delivery performance and fidelity increased with program experience. Older, more knowledable delivery agents were associated with larger impacts on parental stimulation and child outcomes, and delivery agents with higher fidelity scores were also related to improved parenting practices. We conclude that a group-based parenting intervention delivered by local delivery agents can improve multiple child and parent outcomes. An upfront investment in training local trainers and delivery agents, and regular supervision of delivery of a manualized program, appear key to our documented success. Our results represent a promising avenue for scaling similar interventions in low-resource rural settings to serve families in need of ECD programming. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. https://clinicaltrials.gov/ct2/show/NCT03548558.

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“…However, only two-thirds of HCWs were able to return for the refresher training six months later. Di culties in delivering ongoing training and supervision to HCWs is a common issue in ECD programming, with high staff turnover and poor retention cited as a challenge [24]. Commitment by district health services to reduce staff rotation may improve retention and facilitate retention of knowledge and skills.…”

Section: Discussionmentioning

confidence: 99%

“…Creating a sustainable delivery platform with more geographically diverse facilitators, would increase access and attendance to the programme and facilitate a local network of peer support for families. However capacity for ongoing mentoring by trained therapists is an important consideration in scale-up to ensure maintenance of high delity programme delivery, as highlighted in previous literature [24].…”

Section: Discussionmentioning

confidence: 99%

Early Detection and Intervention for Young Children With Early Developmental Disabilities in Western Uganda: a Mixed-methods Evaluation

Sadoo

Nalugya

Lassman³

et al. 2021

Preprint

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Background: Early support for children with developmental disabilities is crucial but frequently unavailable in low-resource settings. We conducted a mixed-methods evaluation to assess the feasibility, acceptability, and impact of a programme of early detection and intervention for young children with developmental disabilities in Western Uganda. Methods: Early child development training for healthcare workers (HCWs) was implemented in three rural districts, and attendance was tracked. HCW knowledge and confidence were assessed pre-/post-training, and referral numbers tracked to evaluate impact. Facilitators were trained and mentored to deliver a participatory, group, early intervention programme (EIP) for young children with developmental disabilities and their families. Facilitators were tracked as they were identified, trained, and delivered the intervention, and attendance of families was tracked. Pre-/post-intervention assessments evaluated changes in family quality of life (PedsQL 2.0, Family Impact Module), and child nutritional outcomes. Focus group discussions with stakeholders also assessed feasibility, acceptability and impact.Results: Overall, 93 HCWs from 45 healthcare facilities received training. In the pre-/post-evaluation, median knowledge and confidence scores increased significantly (from 4.0 to 7.0 and from 2.7 to 4.7, respectively (p<0.001)). HCWs reported feeling empowered to refer and offer care for families with a young child with disability. Referral rates increased from 148 to 251 per annum (70%). Eleven EIP facilitators were trained, and all delivered the intervention; 84 families were enrolled, of which 78% attended at least 6 out of 10 modules. Amongst those with paired pre-/post-intervention data (n=48), total family quality of life scores increased significantly (21%, p<0.001). Improvements were seen across all domains of quality of life, with the largest impacts on emotional functioning and social functioning (p<0.001). The programme was acceptable to caregivers and facilitators. Caregivers reported improved knowledge, family relationships, hope, emotional wellbeing, and reduced self-stigma. Conclusions: A programme of early detection and intervention for children with early developmental disabilities and their families was feasible and acceptable in a rural community-based Ugandan setting. HCW training positively impacted knowledge, confidence, attitudes, and referral rates. Families enrolled to the EIP reported significant improvements in quality of life. Important programmatic barriers identified included geographical spread, poverty, gender inequality, and stigma.

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Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation

Cited by 20 publications

References 37 publications

Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis

Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis

An Implementation Evaluation of A Group-Based Parenting Intervention to Promote Early Childhood Development in Rural Kenya

Early Detection and Intervention for Young Children With Early Developmental Disabilities in Western Uganda: a Mixed-methods Evaluation

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