Abstract
BackgroundHome-visiting programs are a common and effective public health approach to promoting parent and child well-being, including in low- and middle-income countries. The World Health Organization and UNICEF have identified responsive caregiving as one key component of the nurturing care children need to survive and thrive. Nonetheless, the importance of responsive caregiving and how to coach it is often overlooked in trainings for staff in home-visiting programs.MethodsTo determine whether it is possible to enhance home-visitors’ understanding of responsive caregiving and how to coach it, we conducted a cluster randomized controlled trial with 181 staff working in Brazil’s national home-visiting program. We used a computerized random number generator to randomly assign half of participants to take an online professional development course about responsive caregiving immediately and the other half to a waitlist. Individuals assessing outcome data were blind to group assignment.ResultsCompared to those in the control group (N = 90, both randomized and analyzed), participants assigned to take the course (N = 91, both randomized and analyzed) were more knowledgeable about responsivity (Cohen’s d = 0.64, 95% Confidence Interval (CI) = 0.34, 0.94) and its importance for children’s socioemotional (odds ratio (OR) = 1.88, 95% CI = 1.00, 3.50) and cognitive (OR = 2.57, 95% CI = 1.15, 5.71) development, better able to identify responsive parental behaviors in videotaped interactions (d = 1.86, 95% CI = 1.51, 2.21), and suggested more effective strategies for coaching parents on responsivity (d = 0.51, 95% CI = 0.21, 0.80) and tracking goal implementation (OR = 3.20, 95% CI = 1.28, 7.99). There were no significant changes in participants’ tendency to encourage goal setting and reflection, or their perspective-taking skills. Participants were very satisfied with the course content and mode of delivery and there was no drop-out from the program.ConclusionsA short, online professional development program created moderate to large improvements in home-visitors’ knowledge and intended coaching practices. This suggests that such programs are feasible, even in low-income and rural areas, and provide a low-cost, scalable option for possibly maximizing the impact of home-visiting programs – particularly with regard to parental responsivity, and in turn, child outcomes.
Highlights
Home-visiting programs are a common and effective public health approach to promoting parent and child well-being, including in low- and middle-income countries
A popular approach to promoting healthy child development is through the use of home-visiting programs in which nurses or community health workers visit expecting and new mothers in their homes to provide knowledge and support as they transition to parenthood
The findings from this study have inspired similar programs to emerge across many low- and middle-income countries (LMICs), some of which have replicated impressive results for children’s cognitive, language, and motor development [6], while others have fallen short [7]
Summary
We aimed to recruit at least 50 municipalities based on reasonable power calculations for cluster randomized trials using an alpha of 0.05, beta of 0.2, and assuming an average of three participants per municipality, an intraclass correlation of 0.2, and an estimated effect size of 0.6 based on findings from other PD programs [33]
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