Implementation Evaluation of the Mother‐Child Education Program Among Refugee and Other Vulnerable Communities in Lebanon

Abstract

Despite the knowledge that quality early childhood development programs, including those that target parental knowledge and behaviors, are essential for ameliorating the negative effects of early-life adversity, robust analyses of their implementation and impact in highly vulnerable settings are scarce. To address this knowledge gap, we conducted a pilot wait-list randomized controlled trial (RCT) to assess the impact and the process of implementing and evaluating the Mother-Child Education Program (MOCEP) among refugee families and one low-income community in Beirut, Lebanon. This paper focuses on the analysis of MOCEP' s implementation (i.e., key enablers of and barriers to the application and evaluation of the program). Our analysis suggests that, despite multiple challenges, implementation and robust evaluations of early childhood parenting programs in fragile contexts are feasible and urgently needed. This study illustrates how implementation evaluations are a key component of RCTs and crucial

Effects of the Mother-Child Education Program on Parenting Stress and Disciplinary Practices Among Refugee and Other Marginalized Communities in Lebanon: A Pilot Randomized Controlled Trial

“…We have recently published a comprehensive process evaluation, focused on identification of barriers to and enablers of program implementation at each study site. 44 Despite the challenges encountered, the demonstrated effects of this program in critical domains of maternal stress and parental practices support the importance and utility of pursuing parenting programs in insecure and fragile contexts.…”

Introduction to the Special Issue. Randomized Controlled Trials (RCTs) in Clinical and Community Settings: Challenges, Alternatives, and Supplementary Designs

“…Also, an RCT may be premature to assess the impact of newly developed programs given the many challenges of implementing a protocolled program (i.e., with standardized program components) in dynamic real‐world settings. The assessment of new prevention and intervention programs could, thus, for example, be done in a step‐wise procedure by starting with a process evaluation (see Ponguta et al., 2019, this issue), then building toward quasi‐experimental and, finally, an RCT design. This step‐wise approach provides the opportunity to evaluate the implementation procedure and program integrity, and to adjust and sharpen the implementation process if necessary.…”

“…Two complementary designs are being discussed in this issue. First, Ponguta and colleagues (2019, this issue) describe methods to explore the context in which an RCT will be done and to map possible enablers and barriers of program implementation and impact evaluation. Using this knowledge, they conducted a randomized control trial with a wait‐list control group to assess a parenting intervention with refugee and marginalized communities in Beirut, Lebanon.…”

“…Whereas RCTs focus on the outcomes of an intervention, process evaluations explore how and in which settings the intervention is implemented and received, which may help us with the interpretation of findings on program outcomes. The study by Ponguta and colleagues (2019, this issue) suggests that despite multiple challenges, implementation of intervention programs and evaluation of these programs using randomized trials in fragile contexts is feasible.…”

“…In some populations, the RCT design might be difficult, untenable, or sometimes even inappropriate (Miller & Brody, ). Particularly in cases of hard‐to‐reach and vulnerable populations, such as refugee and marginalized communities (see Ponguta et al., 2019, this issue) or children and adolescents in residential care institutions (see Tavecchio et al., 2019, this issue), researchers are confronted with many practical, methodological, political, legal, and/or ethical challenges. The goal of this issue is to catalog such challenges of conducting an RCT and explore alternatives and supplementary study designs that address these challenges.…”