Implementation of parenting interventions through health services in Jamaica

Integration of parenting programmes that promote early child development with health services has been recommended as one strategy to reduce the large numbers of children not achieving their potential in low and middle income countries. There is limited information on implementation to guide integration for delivery at scale. We conducted a cluster randomized trial of 1) a home visit and 2) a health centre based intervention, in primary health services in Kingston, Jamaica, delivered separately or combined. The two approaches to delivery had similar effects on child cognition (home visit 0.34SD; health centre 0.38). In this report, we describe the inputs required such as intervention content, staff training and supervision and resources. Intervention delivery was assessed through contacts achieved and quality documented. Views of health staff (n=29) and mothers (n=25) were obtained through qualitative interviews and analyzed using thematic content analysis. The interventions provided modeling of behaviours and activities, and interactive practice but varied in how this was conducted. Supervision was provided by the research team. Community health workers (CHWs) conducted 75% of planned home visits and 83% of mothers attended all 5 health centre sessions. CHWs were able to implement the interventions with adequate to good quality. Mothers and health staff perceived benefits for mothers’ parenting practices and child development. Health staff also felt they personally benefited. Mothers who received both interventions preferred the home visit intervention and thought their child benefitted more. The main implementation challenges perceived by CHWs were engaging parents who were less interested, and conducting the intervention in addition to their existing workload. Staff workload was the main challenge reported by nurses. Sustainable implementation at scale would require investment in additional staff, particularly for programme management and supervision.