Top 10 research lessons learned from a digital childrearing program in low- and middle-income countries: a multi-case study (Preprint)

Abstract

BACKGROUND Extensive literature highlights the effectiveness of parenting programs for early childhood and parental outcomes globally. Increasing evidence shows that digital parenting programs are equally effective as those delivered in-person, and that digital delivery is acceptable to parents. Parenting programs, however, cannot be ‘one-size-fits-all’ but rather need to be developed, adapted, and refined to account for the context, culture, attitudes, behaviours, and expectations of the intended target audience. OBJECTIVE This study aimed to identify the key research lessons learned from Minderoo Foundation’s Thrive by Five International Program, a large-scale digital and non-digital childrearing program. The Medical Research Council’s (MRC) Framework for Developing and Evaluating Complex Interventions emphasises ‘core elements’ that underpin all aspects of the research and development (R&D) process. The MRC Framework guided the approach to synthesising the data from this three-year (2021-2024) Program. The objectives were to: 1) identify critical learnings about the Program; 2) explore how these learnings related to R&D processes and outcomes; and, 3) examine how these may have varied based on sociocultural context. METHODS A multi-case study design was used to build a deep understanding of the Program, including how it varied across, and was influenced by, diverse sociocultural and contextual factors across 10 low- and middle-income countries. The data included field notes and transcriptions from semi-structured and conversational interviews, and group-based workshops. Data analysis occurred over three phases. First, for each case, qualitative data was analysed using established thematic techniques, with all primary findings being summarised into outcome reports. Next, an overarching report was produced for each case to integrate the learnings across all research activities to inform the transfer of learnings to the Program. Finally, a secondary analysis was conducted relating to program theory, stakeholder engagement, and the refinement of the Program as they related to, interacted with, and were influenced by context. RESULTS The analysis resulted in five themes: 1) The role and value of partnerships; 2) Building collaborative practice with partners; 3) Honing a target audience; 4) Navigating the digital landscape; and, 5) Managing linguistic diversity and translation. Learnings regarding context and cultural diversity were integrated throughout the results. CONCLUSIONS Digital health interventions must be appropriate for and accessible to the target audience, aligned with ICT infrastructure and policies, and fill a need in the digital health marketplace. When this is not feasible, a multi-channel approach to dissemination using digital and non-digital strategies is necessary. While likely to increase project complexity, cross-sectorial partnerships, including with government bodies, are likely to broaden Program reach. To facilitate digital health projects, it is critical that sufficient time be allocated to build meaningful collaborative partnerships centred on respect, cultural understanding, and open communication and grounded by a shared vision.