Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context
Summary: Background: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and fac...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | The Lancet Regional Health. Americas |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X23002399 |
| _version_ | 1827391155292078080 |
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| author | Gabriela Buccini Muriel Bauermann Gubert Poliana de Araújo Palmeira Lídia Godoi Laura Dal’Ava dos Santos Georgiana Esteves Sonia Isoyama Venancio Rafael Pérez-Escamilla |
| author_facet | Gabriela Buccini Muriel Bauermann Gubert Poliana de Araújo Palmeira Lídia Godoi Laura Dal’Ava dos Santos Georgiana Esteves Sonia Isoyama Venancio Rafael Pérez-Escamilla |
| author_sort | Gabriela Buccini |
| collection | DOAJ |
| description | Summary: Background: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods: This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings: Families’ limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding: NIH/NICHD. |
| first_indexed | 2024-03-08T17:05:40Z |
| format | Article |
| id | doaj.art-27b944c7011b4aea828cf8c172107e5a |
| institution | Directory Open Access Journal |
| issn | 2667-193X |
| language | English |
| last_indexed | 2024-03-08T17:05:40Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj.art-27b944c7011b4aea828cf8c172107e5a2024-01-04T04:40:03ZengElsevierThe Lancet Regional Health. Americas2667-193X2024-01-0129100665Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in contextGabriela Buccini0Muriel Bauermann Gubert1Poliana de Araújo Palmeira2Lídia Godoi3Laura Dal’Ava dos Santos4Georgiana Esteves5Sonia Isoyama Venancio6Rafael Pérez-Escamilla7Department of Social and Behavioral Health, University of Nevada Las Vegas, School of Public Health, Las Vegas, NV, United States; Corresponding author. Department of Social and Behavioral Health, University of Nevada, Las Vegas, School of Public Health, 4700 S Maryland Pkwy, 89119, Las Vegas, NV, United States.Department of Social and Behavioral Health, University of Nevada Las Vegas, School of Public Health, Las Vegas, NV, United States; Department of Nutrition, University of Brasilia, Brasilia, DF, BrazilFederal University of Campina Grande, Department of Health, Cuité, Paraíba, BrazilUniversity of São Paulo, Graduate Program in Public Health, São Paulo, BrazilDepartment of Nutrition, University of Brasilia, Brasilia, DF, BrazilDepartment of Social and Behavioral Health, University of Nevada Las Vegas, School of Public Health, Las Vegas, NV, United StatesMinistry of Health, Brasilia, DF, BrazilDepartment of Social and Behavioral Sciences, Yale University, School of Public Health, New Haven, CT, United StatesSummary: Background: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods: This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings: Families’ limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding: NIH/NICHD.http://www.sciencedirect.com/science/article/pii/S2667193X23002399Early child developmentHome-visiting programsNurturing careBrazilImplementation scienceScale-up |
| spellingShingle | Gabriela Buccini Muriel Bauermann Gubert Poliana de Araújo Palmeira Lídia Godoi Laura Dal’Ava dos Santos Georgiana Esteves Sonia Isoyama Venancio Rafael Pérez-Escamilla Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context The Lancet Regional Health. Americas Early child development Home-visiting programs Nurturing care Brazil Implementation science Scale-up |
| title | Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context |
| title_full | Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context |
| title_fullStr | Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context |
| title_full_unstemmed | Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context |
| title_short | Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysisResearch in context |
| title_sort | scaling up a home visiting program for child development in brazil a comparative case studies analysisresearch in context |
| topic | Early child development Home-visiting programs Nurturing care Brazil Implementation science Scale-up |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X23002399 |
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