Page 49 - Demo

Integrating a parenting intervention with routine primary health care: A cluster randomised trial
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health services and serving predominantly lower and lower- middle income groups. Routine services are delivered by nurses assisted by community health workers (CHWs). Participants were enrolled from August 2011 to March 2012.
The intervention was conducted in the health centre waiting areas while the mothers waited with their infants to see the clinic nurse. The intervention had three (3) components:
1) DVDs – these were short films developed to cover topics taken from the researchers’ previous home interventions, selecting parental behaviours considered central to promoting child development. The topics covered were love, responding and comforting, talking to children, praise, using bath time to play and learn, looking at books, simple toys to make, drawing and games, and puzzles. All films showed Jamaican mothers doing the behaviours we wished to encourage.
2) Discussion – the CHWs discussed and demonstrated the activities shown on the DVD with the mothers.
3) Practice – the CHWs encouraged the mothers to practice the activities with their children at the centre and to continue the activities at home.
All CHWs were trained in the intervention over a three-day workshop, and given manuals that provided the steps and content for each session. The clinic nurses were trained in separate one-day workshop, and also encouraged the behaviours, gave out cue cards with the messages and a few play materials.
Of the 501 mother-child pairs enrolled, 426 were assessed at the end of the trial. The children’s mean age on assessment was 19.7 months. Loss did not differ by group (16% of children in the control and 14 % in the intervention). Results showed the intervention had a significant benefit to children’s cognitive development. However, there were no benefits to the language or fine motor development. Mothers in the intervention group also improved significantly more in their parenting scores than the control group, indicating that mothers remembered the messages that were shown and discussed.
The research results show that it is feasible to integrate a parenting intervention in child health clinics, without the need for additional staff or asking mothers to spend extra time at the clinic. Despite low intensity and challenging clinic conditions, the intervention benefitted child cognitive development and parent knowledge. This innovative approach is suitable for implementation in primary care centres in the Caribbean. Continued monitoring and evaluation would increase understanding of the benefits and challenges when implemented more widely.
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