Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis.

Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis.

Publication date: Jan 01, 2024

In 2016, Brazil scaled up the CriancE7a 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. 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. 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. 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. NIH/NICHD.

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Concepts Keywords
Brazil Brazil
Covid Case study
Managers Early child development
Pandemic Home-visiting programs
Implementation science
Nurturing care
Qualitative methods


Type Source Name
disease VO effectiveness
disease MESH COVID-19 pandemic
disease VO population
disease IDO country
disease VO time
disease VO LACK
disease VO effective
drug DRUGBANK Trestolone
drug DRUGBANK Coenzyme M
disease VO organization
disease MESH emergency
disease IDO quality
disease VO pregnant women
disease IDO process
drug DRUGBANK Tretamine
disease IDO intervention
disease IDO replication
drug DRUGBANK Mitomycin
disease VO monthly
disease VO biweekly
disease VO frequency
drug DRUGBANK Hexocyclium
drug DRUGBANK Etoperidone
disease MESH social vulnerability
disease VO dose
disease VO mouth
disease VO Thing
drug DRUGBANK Methionine
drug DRUGBANK Huperzine B
disease VO document
disease MESH uncertainty
drug DRUGBANK Spinosad
disease MESH violence
disease MESH domestic violence
disease VO ineffective
disease VO Equity
disease IDO history
pathway REACTOME Translation
drug DRUGBANK Sodium hydroxide
drug DRUGBANK Alpha-1-proteinase inhibitor
disease MESH childhood obesity
disease VO efficient
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH Mody
drug DRUGBANK Sulfasalazine
drug DRUGBANK Ribostamycin

Original Article

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