Implementation evaluation of a nurturing care intervention in a humanitarian setting in Rwanda

Abstract

Abstract Background: In a humanitarian context in Rwanda, a nurturing care parenting program was delivered in high and low doses, revealing similar changes in care practices compared to the control group but no significant improvements in early childhood development outcomes. This study examines program implementation to understand delivery processes. Methods: We employed Proctor’s implementation outcomes, including measures of acceptability, fidelity, and quality of dose delivered. A customized questionnaire was administered post-intervention by trained research assistants, and qualitative interviews were conducted to explore the experiences of families, the delivery team, and community stakeholders. Additionally, program monitoring and documentation, such as monthly reports, were included in the analysis. Qualitative analysis followed a deductive approach. Findings: Implementation data from caregiver surveys indicated that the majority of families received 50% of the intended dosage for group sessions in both the high and low dose arms. Program records showed that over 90% of eligible caregivers attended the sessions, with families expressing a preference for the shared space and activities during the first half of the group sessions. However, in terms of home visits, more than half of the families had never received one. Qualittaive data revealed acceptability of the intervention and professional development opportunities through mentorshp as key to engagement of the delivery staff. Conclusion: Continuous monitoring and adaptation of delivery strategies are essential for improving early childhood development outcomes in humanitarian settings like Rwanda.