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Aboud F, Choden K, Tusiimi M, Gomez RC, Hatch R, Dang S, Betancourt T, Dyenka K, Umulisa G, Omoeva C. A Tale of Two Programs for Parents of Young Children: Independently-Conducted Case Studies of Workforce Contributions to Scale in Bhutan and Rwanda. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1413. [PMID: 37628412 PMCID: PMC10453503 DOI: 10.3390/children10081413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Two case studies of parenting programs, aiming to improve parenting practices and child development outcomes, and implemented by Save the Children/Ministry of Health/Khesar Gyalpo University in Bhutan and Boston College/University of Rwanda/FXB in Rwanda, respectively called Prescription to Play and Sugira Muryango, were conducted by an independent research and learning group. Implementation research focused on the workforce, a crucial but little-studied element determining the success of programs going to scale. Mixed methods were used to examine their training, workload, challenges, and quality of delivery. Health assistants in Bhutan and volunteers in Rwanda were trained for 10-11 days using demonstrations, role plays, and manuals outlining activities to deliver to groups of parents (Bhutan) or during home visits (Rwanda). Workers' own assessments of their delivery quality, their confidence, and their motivations revealed that duty, confidence, and community respect were strong motivators. According to independent observations, the quality of their delivery was generally good, with an overall mean rating on 10 items of 2.36 (Bhutan) and 2.44 (Rwanda) out of 3. The facilitators of scaling for Bhutan included institutionalizing training and a knowledgeable workforce; the barrier was an overworked workforce. The facilitators of scaling for Rwanda included strong follow-up supervision; the barriers included high attrition among a volunteer workforce.
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Affiliation(s)
- Frances Aboud
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
| | | | - Michael Tusiimi
- College of Education, University of Rwanda, Rwaamagana P.O. Box 55, Rwanda;
| | | | - Rachel Hatch
- FHI360, 2101 L Street NW, Washington, DC 20037, USA; (R.C.G.); (R.H.); (C.O.)
| | - Sara Dang
- Save the Children, 899 North Capitol Street NE, Suite 900, Washington, DC 20002, USA; (S.D.); (K.D.)
| | - Theresa Betancourt
- School of Social Work, Boston College, 140 Commonwealth Ave, Newton, MA 02467, USA;
| | - Karma Dyenka
- Save the Children, 899 North Capitol Street NE, Suite 900, Washington, DC 20002, USA; (S.D.); (K.D.)
| | - Grace Umulisa
- FXB Rwanda, Ruyenzi, Kamonyi District, Kigali P.O. Box 188, Rwanda;
| | - Carina Omoeva
- FHI360, 2101 L Street NW, Washington, DC 20037, USA; (R.C.G.); (R.H.); (C.O.)
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Bernal R, Gómez ML, Pérez-Cardona S, Baker-Henningham H. Implementation Quality of an Early Childhood Parenting Program in Colombia and Child Development. Pediatrics 2023; 151:191216. [PMID: 37125883 DOI: 10.1542/peds.2023-060221j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES We conducted a cluster-randomized trial of an enhancement to an existing parenting program in rural Colombia (called the Family, Women, and Infancy Program [FAMI]), and found benefits to parenting practices and child development. In this study, we examine the effects of the enhancement on the quality of intervention implementation and examine associations between quality and child and maternal outcomes. METHODS In Colombia, 340 FAMI mothers in 87 towns were randomly assigned to quality enhancement through the provision of structured curricula, play materials, and training and supervision from professional tutors, or to control (no enhancement). Children aged <12 months were enrolled (N = 1460). A subsample of 150 FAMI mothers (83 intervention, 67 control) in 29 towns (17 intervention, 12 control) participated in the assessment of the quality of group parenting sessions through independent observation. Child development and parenting practices were measured at endline (10.5 months after baseline). RESULTS In intention-to-treat analyses, we found significant benefits of intervention for the observed quality of group sessions (1.67 SD [95% confidence interval, 1.23-2.11]). An SD increase in session quality predicted an increase in treatment mothers' attendance of 4.68 sessions (95% confidence interval, 1.37-7.98). Session quality partially mediated the effect of the intervention on parental practices and child development. CONCLUSIONS Enhancing an existing parenting program led to large benefits to the observed quality of intervention implementation. Quality was associated with increased maternal engagement, parenting practices, and child development. The observational measure of quality has potential to promote and maintain quality at scale.
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Affiliation(s)
| | - María Lucía Gómez
- School of Human and Behavioral Sciences, Bangor University, Bangor, Wales, United Kingdom
| | | | - Helen Baker-Henningham
- School of Human and Behavioral Sciences, Bangor University, Bangor, Wales, United Kingdom
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Mehrin SF, Salveen NE, Kawsir M, Grantham-McGregor S, Hamadani JD, Baker-Henningham H. Scaling-up an early childhood parenting intervention by integrating into government health care services in rural Bangladesh: A cluster-randomised controlled trial. Child Care Health Dev 2022. [PMID: 36513387 DOI: 10.1111/cch.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
AIMS We evaluated the feasibility and effectiveness of utilising government health supervisors to train and supervise primary health care workers (HWs) in community clinics to deliver parenting sessions as part of their usual duties. METHODS We randomly allocated 16 unions in the Mymensing district of Bangladesh 1:1 to an intervention or control group. HWs in clinics in the eight intervention unions (n = 59 health workers, n = 24 clinics) were trained to deliver a group-based parenting intervention, with training and supervision provided by government supervisors. In each of the 24 intervention clinics, we recruited 24 mothers of children aged 6-24 months to participate in the parenting sessions (n = 576 mother/child dyads). Mother/child dyads attended fortnightly parenting sessions at the clinic in groups of four to five participants for 6 months (13 sessions). We collected data on supervisor and HW compliance in implementing the intervention, mothers' attendance and the observed quality of parenting sessions in all intervention clinics and HW burnout at endline in all clinics. We randomly selected 32 clinics (16 intervention, 16 control) and 384 mothers (192 intervention, 192 control) to participate in the evaluation on mother-reported home stimulation, measured at baseline and endline. RESULTS Supervisors and HWs attended all training, 46/59 health workers (78%) conducted the majority of parenting sessions, (only two HWs [3.4%] refused) and mothers' attendance rate was 86%. However, supervision levels were low: only 32/57 (56.1%) of HWs received at least one supervisory visit. Intervention HWs delivered the parenting sessions with acceptable levels of quality on most items. The intervention significantly benefitted home stimulation (effect size = 0.53SD, 95% confidence interval: 0.50, 0.56, p < 0.001). HW burnout was low in both groups. CONCLUSION Integration into the primary health care service is a promising approach for scaling early childhood development programmes in Bangladesh, although further research is required to identify feasible methods for facilitator supervision.
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Affiliation(s)
- Syeda Fardina Mehrin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nur-E Salveen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Masuma Kawsir
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Chen J, Zheng B, Yin L, Zhou Q, Liu W, Li P, Zhao X, Chen X, Li Y, Ding H, Li G. Exploring agreement and feasibility between virtual home visits and in-person home visits for peritoneal dialysis patients-a paired study. Ren Fail 2022; 44:490-502. [PMID: 35285398 PMCID: PMC8928823 DOI: 10.1080/0886022x.2022.2049305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Virtual home visits may improve chronic disease management. However, whether they are suitable for peritoneal dialysis (PD) patients has not yet been fully investigated. This study aimed to compare the agreement and acceptance of virtual home visits and in-person home visits in PD patients. METHODS This was a paired, single center, noninferiority trial. Participants received a virtual home visit and an in-person home visit simultaneously. A home visit checklist was built for standardization visits. The content was divided into three parts: domestic habits (57 items), bag exchange procedures (56 items), and exit site care (53 items). Satisfaction questionnaires for both patients and nurses were designed to assess attitudes toward home visits and socioeconomic effects. RESULTS A total of 30 PD patients were enrolled in a single center. The information collected from virtual home visits and in-person home visits was found to be highly consistent. The perfect agreement was found in 52/57, 49/56, and 44/53 items (Cohen's kappa 0.81-1.00), substantial agreement in 4/57, 7/56, and 8/53 items (Cohen's kappa 0.61-0.80). Patients reported almost identical satisfaction for virtual home visits and in-person home visits (Z = 0.39, p = 0.70). PD nurses reported similar feasibility and patient cooperation for the two visit types (Z = 0.99, p = 0.33; Z = 1.65, p = 0.10, respectively). In addition, virtual home visits were found to be more cost-effective than in-person home visits. CONCLUSIONS Virtual home visits information collection was similar to in-person home visits in PD. There were no differences in participant satisfaction and feasibility between the two visit types.
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Affiliation(s)
- Jin Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Zheng
- Department of Sanitary Technology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lijuan Yin
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Zhou
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenshu Liu
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Pengli Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuxiu Zhao
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuling Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hanlu Ding
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guisen Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Peterson CA, Zhang D, Flittner A, Shelley MC, Doudna K, Cohen RC, Aaron L, Fan L. Estimating Home Visit Activities: How Much Observation is Enough? CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Harden BJ. A step forward to quality: The home visit rating scales and the measurement of process quality in home-visiting programs. Infant Ment Health J 2019; 40:401-404. [PMID: 30969441 DOI: 10.1002/imhj.21782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Brenda Jones Harden
- Department of Human Devleopment, University of Maryland, College Park, Maryland
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Roggman LA, Cook GA, Innocenti MS, Jump Norman VK, Boyce LK, Olson TL, Christiansen K, Peterson CA. The Home Visit Rating Scales: Revised, restructured, and revalidated. Infant Ment Health J 2019; 40:315-330. [PMID: 30934132 DOI: 10.1002/imhj.21781] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Home Visit Rating Scales (HOVRS) were initially developed from field-based descriptions of successful home visits and are supported by home-visiting research in multiple disciplines. Four home-visiting practices scales include indicators of relationship building with families, responsiveness to family strengths, facilitation of parent-child interaction, and collaboration with parents. Three family engagement scales include indicators of parent-child interaction, parent engagement, and child engagement in the visit. The original version, the HOVRS-1, was validated using video and data from two Early Head Start home-visiting programs. Conceptual and structural changes for the HOVRS-3 were designed to improve readability, usability, and clarity. Newly trained observers used the HOVRS-3 to observe archived videos from the original measurement sample. The HOVRS-3 showed good interrater reliability, scale internal consistency, convergent validity, predictive validity, practical significance, and version stability. When the HOVRS-3 home-visit quality scores were higher, it was twice as likely for parenting scores to be average or better and for child language to be at age level or better at age 3 years, over and above parenting and child language at age 1 year. The HOVRS can guide observations of home-visit quality in infant-toddler and early childhood programs to improve home-visiting practices and family engagement.
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Affiliation(s)
- Lori A Roggman
- Human Development and Family Studies Department, Utah State University, Logan, Utah
| | - Gina A Cook
- Department of Psychology and Child Development, California State University Stanislaus, Turlock, California
| | - Mark S Innocenti
- Center for Persons with Disabilities, Utah State University, Logan, Utah
| | - Vonda K Jump Norman
- Department of Sociology, Social Work, and Anthropology, Utah State University, Logan, Utah
| | - Lisa K Boyce
- Human Development and Family Studies Department, Utah State University, Logan, Utah
| | - Tasha L Olson
- Human Development and Family Studies Department, Utah State University, Logan, Utah
| | - Katie Christiansen
- Human Development and Family Studies Department, Utah State University, Logan, Utah
| | - Carla A Peterson
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa
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Green BL. Understanding quality in home visiting-How Far Have We Come and Where Do We Need to Go? Infant Ment Health J 2019; 40:395-400. [PMID: 30921493 DOI: 10.1002/imhj.21778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Beth L Green
- Center for Improvement of Child and Family Services, Portland State University, Portland, Oregon
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Peterson CA, Roggman LA. Observing home-visit quality with the home visit rating scales: Introduction to the special section. Infant Ment Health J 2019; 40:309-314. [PMID: 30893486 DOI: 10.1002/imhj.21777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Evidence-based home-visiting programs aim to address one of the most important challenges facing our species-setting the next generation on a healthy path of development that prepares them for a future that is simultaneously uncertain and promising. Diverse research literatures have pointed to practices to effectively meet this challenge and better achieve the unfulfilled promise of home visiting by more effectively engaging parents in supporting their children's early development and well-being. Measures of home-visit quality practices drawn from social work, pediatric nursing, early childhood, and early intervention research literatures have identified building relationships with families and focusing on their strengths as effective, practices that are particularly important for vulnerable families. The articles in this special section used the Home Visit Rating Scales to examine stability in home-visit quality over time, study specific home-visiting processes linked with quality, validate a supervisor checklist of home-visiting implementation, and consider the home visit in relation to an array of indicators reflecting overall home-visiting program strength and stability. These articles exemplify progress in home-visiting research over recent decades, including advances in direct observational methods and measurement as well as examinations of home visiting as an observable process across various home-visiting program models and populations.
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Affiliation(s)
- Carla A Peterson
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa
| | - Lori A Roggman
- Department of Family, Consumer and Human Development, Family Life 129, Utah State University, Logan, Utah
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