What implementation evidence matters: scaling‐up nurturing interventions that promote early childhood development

Abstract

Research in early childhood development (ECD) has established the need for scaling-up multisectoral interventions for nurturing care to promote ECD, for improved socioeconomic outcomes for sustainable societies. However, key elements and processes for implementation and scale-up of such interventions are not well understood. This special series on implementation research and practice for ECD brings together evidence to inform effectiveness, quality, and scale in nurturing care programs; identifies knowledge gaps; and proposes further directions for research and practice. This paper frames the dimensions and components fundamental to the understanding of implementation processes for nurturing care interventions, factors for improving implementation of interventions, and strategies to scale by embedding interventions in delivery systems. We discuss emerging issues in implementation research for ECD, including (1) the role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) the importance of feasibility studies to inform scale-up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems. Effective implementation of nurturing care interventions is at the heart of achieving positive developmental outcomes for young children. It is pivotal to adapt and implement these interventions based on evidence for high impact, especially in low-resource settings.

Feasibility and acceptability of a home‐based intervention to promote nurturing interactions and healthy behaviours in early childhood: The Amagugu Asakhula pilot study

“…Furthermore, the findings of this pilot study indicate that Amagugu Asakhula was able to address many of the key components of nurturing care: responsive caregiving behaviours, attitudes and knowledge; nutrition; stimulation; and early learning (Britto et al, , ). In addition, the caregivers who participated in this pilot study appeared to engage in nurturing interactions that provided their child with learning opportunities that were age appropriate, safe, and enjoyable for those involved (Daelmans et al, ).…”

“…Information addressing the themes of feasibility, acceptability, and factors affecting these was extracted. These data, as well as data from the feedback forms, were then collated according to the following themes relating to implementation (Britto et al, 2018):…”

“…Information addressing the themes of feasibility, acceptability, and factors affecting these was extracted. These data, as well as data from the feedback forms, were then collated according to the following themes relating to implementation (Britto et al, ): Preparation for implementation; Intervention dose; Intervention delivery; Perceived benefits of the intervention; and Recommendations for future implementation. …”

“…It was a support from each other to another one … and 2 Application of an intervention science framework for early childhood nurturing interventions (Britto et al, 2018) Implementation science concept Description of concept Amagugu Asakhula feasibility and acceptability…”

“…These interventions should promote nurturing interactions, which are crucial for the mitigation of risks for poor development in early childhood (Britto et al, ; Daelmans et al, ). Nurturing care includes safety and security; responsive caregiving behaviours, attitudes, and knowledge (including health related); nutrition; stimulation (including play); and early learning (Britto et al, ; Britto, Singh, Dua, Kaur, & Yousafzai, ). Nurturing interactions occur when caregivers respond attentively to their young child's attempts to discover and relate to the world around them.…”