Effectiveness of a Father-Inclusive Parenting Intervention on a Child’s Diet, Early Stimulation, and Father Involvement in Childcare in Rural Malawi: A Study Protocol for a Four-Arm, Cluster-Randomized Controlled Trial

Abstract

BACKGROUND. Increasing the engagement of fathers or couples in childcare may generate additional benefits on early child outcomes. However, parenting intervention that includes fathers and couples is limited in low-resource settings. Thus, this study designed a parenting intervention on child nutrition and responsive care that is inclusive of fathers and couples, using behavior change communication. First, we aimed to evaluate the effectiveness of the parenting intervention on a child’s diet, early stimulation, and father involvement in childcare among parents of a child aged 6-23 months in rural Malawi. Then, we assessed the added benefit of including fathers and couples in the intervention to improve the outcomes. METHODS. In this four-arm, cluster-randomized controlled trial, we assessed the effectiveness of a parenting intervention in rural Malawi. We randomly selected and allocated 40 communities to the intervention or control arms in a 3-to-1 ratio. Four arms included a mothers-only treatment arm, a fathers-only treatment arm, a couples treatment arm, and a control arm. Eligible households were a two-parent household having a child aged 6-23 months, a child having a mother as a primary caregiver living with a male partner, and a parent aged 18 or above. Intervention arms participated in two peer group sessions and two home visits focusing on child nutrition and responsive care. Behavior change communication was used to deliver key behavioral messages. Primary outcomes were child dietary diversity score, early stimulation, and father involvement in childcare. The analysis was done using difference-in-differences estimation. DISCUSSION. The study will provide evidence of the effectiveness of the parenting program that can be replicated and scaled-across in other low-resource settings like rural Malawi.