Abstract
BackgroundNurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability.MethodsA qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework.ResultsThe delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work.ConclusionsBased on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.
Highlights
Nurturing care interventions have the potential to promote health and development in early childhood
(2021) 7:60 (Continued from previous page). Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector Community health worker (CHW) in South Africa
Integrating nurturing care into existing systems has been recommended in low- and middle-income countries with scarce resources for scaling up interventions, but there were uncertainties regarding the feasibility of public sector community health workers delivering such interventions in South Africa
Summary
Nurturing care interventions have the potential to promote health and development in early childhood. The importance of promoting early childhood development is well established and widely recognised, but the implementation and scale-up of interventions that can achieve such outcomes in LMIC settings need to be enhanced [4, 5]. It is important to understand dimensions such as delivery, feasibility, context, and integration of interventions into existing systems [4, 6]. These dimensions can be examined through process evaluations and formative research, which are recommended components of intervention development and testing [7, 8]. The embedment of process evaluations and formative research, in implementation research in LMIC settings, has been called for in order to maximise learning about interventions and avoid wasting scarce resources [5, 13, 14]
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