Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.
State Department of Social Assistance, Labour, and Human Rights, Piauí, Brazil.
J Glob Health. 2022 Feb 5;12:04007. doi: 10.7189/jogh.12.04007. eCollection 2022.
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. 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.
To 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.
Compared 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 = 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 ( = 1.86, 95% CI = 1.51, 2.21), and suggested more effective strategies for coaching parents on responsivity ( = 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.
A 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.
家访项目是促进父母和子女健康的一种常见且有效的公共卫生方法，包括在低收入和中等收入国家。世界卫生组织和儿基会已将响应式照护确定为儿童生存和茁壮成长所需的培育护理的一个关键组成部分。尽管如此，响应式照护的重要性以及如何进行指导，在家访项目工作人员的培训中往往被忽视。
为了确定是否可以增强家访人员对响应式照护的理解并学习如何进行指导，我们对巴西国家家访项目中的 181 名工作人员进行了一项基于群组的随机对照试验。我们使用计算机随机数发生器随机分配一半参与者立即参加关于响应式照护的在线专业发展课程，另一半参与者则进入候补名单。评估结果数据的人员对分组分配不知情。
与对照组（N=90，均为随机分配和分析）相比，参加课程的参与者（N=91，均为随机分配和分析）对响应性的了解更丰富（Cohen's d=0.64，95%置信区间（CI）=0.34，0.94）及其对儿童社会情感（比值比（OR）=1.88，95%CI=1.00，3.50）和认知（OR=2.57，95%CI=1.15，5.71）发展的重要性，能够更好地识别录像互动中父母的响应性行为（d=1.86，95%CI=1.51，2.21），并为指导父母响应性（d=0.51，95%CI=0.21，0.80）和跟踪目标实施（OR=3.20，95%CI=1.28，7.99）提供了更有效的策略。参与者鼓励设定目标和反思的倾向或换位思考技能没有显著变化。参与者对课程内容和交付方式非常满意，并且没有退出该项目。
简短的在线专业发展课程可使家访人员的知识和预期的指导实践得到适度到较大的改善。这表明，即使在低收入和农村地区，此类方案也是可行的，并且为可能最大限度地提高家访项目的影响力提供了一种低成本、可扩展的选择 - 特别是在父母响应性方面，进而影响儿童的结果。
