The enhancement of an early childhood parenting programme in Colombia

Abstract

Background
Children under five years of age suffering poverty and stunting are at risk of not achieving their developmental potential. This situation affects near to 43% of children in low and middle-income countries and has short and long-term negative impacts for their physical and mental health, their economic earnings, and their educational achievements. Parenting programmes for early child development that promote stimulation, nutrition and health have shown long-term positive
effects on children’s development. The quality of the implementation may affect the effectiveness of these programmes. The challenge is to maintain quality when integrating interventions into existing services.

Methods
The current work focuses on the enhancement of a parenting programme integrated into a public service in Colombia to improve children’s development and nutritional status. The enhancement used curricula for home visits and group sessions adapted from the Reach Up and Learn programme. The effectiveness of the programme was evaluated through a randomised controlled trial (RCT) that showed positive impacts on children’s development (Effect size=0.16; 95% CI:
0.04-0.29). This thesis includes three articles with qualitative and quantitative data collected from the participants of this intervention. The first article presents the analysis of in-depth interviews of a subsample of participants of the intervention. Here we evaluated the acceptability, feasibility, and perceived effectiveness of the programme. The second article is divided in three phases. Phase 1 focuses on the facilitators’ training and supervision, from data collected through in-depth interviews, field notes and supervision forms. Phase 2 is a review of the training and supervision characteristics commonly used in other early child development interventions. Phase 3 is the first step in the development of a guideline to plan and report training and supervision. The third article presents the design of an instrument to measure the quality of group parenting sessions. We used the instrument to compare the quality of the group sessions between a subsample of treatment and control groups. We also evaluated the association between the quality of the group sessions and the attendance of the mothers in the treated group.

Results
The enhanced programme was well accepted by beneficiaries, facilitators, and supervisors. The
structured curriculum, and the play materials were valued. The participatory nature of the activities made the sessions enjoyable, and participants established supportive relationships among them. Mothers found feasible to do the activities at home, and facilitators found the curricula easy to use and helpful. All participants perceived that intervention brought benefits to them. Phase 1 of the second article showed that facilitators needed time to fully acquire the skills and feel comfortable with the new methodology after the training. The supportive relationship between supervisors and facilitators helped the learning process of the new methodology. Phase 2 showed that features of training and supervision were underreported in ECD parenting interventions in low- and middle-income countries. In Phase 3, we designed a checklist to guide implementers to plan and provide detailed reports of training and supervision. The third article showed that the facilitators from the enhanced group delivered higher-quality sessions (Effect size = 1.25, 95% CI: 0.89 – 1.61). Also, an increment of one standard deviation in quality predicted an increase in group sessions attendance of 4.39.

Conclusion
Two contributions of this thesis to the field of ECD parenting programmes are the guidelines to plan and report training and supervision, and the instrument to measure group sessions in low and middle-income countries. In addition, results from this thesis show that the intervention is a promising strategy to improve children’s development in Colombia.

Date of Award	21 Mar 2023
Original language	English
Awarding Institution	Bangor University
Supervisor	Helen Henningham (Supervisor) & Raquel Bernal (Supervisor)