The COVID-19 pandemic led to the suspension of parenting programs through home visits and group meetings in many low- and middle-income countries. The detrimental impact from the lack of these services for children’s development and parents’ well-being was highlighted early in the pandemic and several innovations were developed to find ways to continue reaching families in countries across Latin America and the Caribbean. These included suggesting activities and toys directly to parents for them to use with their children and contacting parents through audio calls and text and video messages.
Lessons from these hybrid delivery methods were a focus of the Inter-American Development Bank’s (IDB) Regional Policy Dialogue, which brought together more than 80 regional leaders at the end of 2021. In this third blog post of the series highlighting the Dialogue, we will focus on hybrid models through the Jamaica example.
The Jamaica Hybrid Model
Right before the pandemic, the Ministry of Health and Wellness had begun the nation-wide implementation of the Reach Up parenting intervention in Jamaica, with home visits delivered by community health aides (CHAs) working in government health centers. Unfortunately, like most activities around the world, home visits were suspended in March 2020.
To restart the intervention, we first created an easy-to-read illustrated manual containing activities from the Reach Up curriculum. We targeted parents and included activities that they could do with their child using materials found in the home, as well as guidance on how to make simple toys and tips for parental well-being. With the support of the IDB, the manual and a few play materials were provided to parents who had participated in the home visits. To support families in the use of the ‘parent package,’ home visits were replaced with twice monthly phone calls from the CHAs, and 1-2 weekly text messages as behavioral nudges.
After 6-9 months of implementation, interviews were conducted with a subsample of parents, CHAs, and the nurses who supervised the program to obtain their views on the feasibility and acceptability of the new remote delivery methods. Initial findings show the acceptability of providing a simple manual to parents. Parents found it easy to use and reported doing activities and toys with their child as described.
Well, the book is a very good book…it tells you what to do so you can help your child and motivate him more.”
Health staff saw providing play materials as important and encouraging for the parents, who also appreciate them.
Both CHAs and nurses felt the shift to phone calls was a good one and allowed the program and the contact with the families to continue. They liked the flexibility of when to make the calls, which allowed them to accommodate to parents’ busy schedules. Parents felt supported and enjoyed the calls, although not all accepted or had time for them, which CHAs found frustrating. There were also logistical problems, mainly related to poor phone service or lack of access to a phone by the parent.
CHAs and nurses found the text messages useful reminders for the parents. Parents also saw them as good reminders and some indicated that they looked forward to them. Another aspect highlighted by parents was the fact that the messages were always different, not repeated, and based on the age of the child. As with the phone calls, there were sometimes technical difficulties. There was also some concern with the timing of messages in relation to the activities the CHAs were introducing in the calls.
Although remote delivery of the intervention was well accepted by most CHAs, many expressed a preference for home visits and spoke about wanting to be able to see what the mother and child were doing. Some CHAs felt they could not always trust what the parent said on the call.
The play activity with the phone is difficult. So, I would ask her, I would ask the mother, you know, if I actually seen it face to face, I could relate to it some more”
During the interviews, nurses mentioned that home visits were more effective and motivating for the CHAs. Some went further and suggested a blended approach.
…if it would be blended would be great than just straight home visits or straight phone calls.”
The findings show that this approach to remote delivery is acceptable to parents and staff and is feasible despite challenges. The health staff themselves pointed to the need for face-to-face interaction with parents and children, and a blended approach has the potential to facilitate scaling of this and other parenting programs.
Have you been involved in a parenting program using remote delivery in your country? In the comments section below, please share the methods you used and how they were accepted.