Early parenting interventions have shown to be effective for changing parenting behaviours to provide stimulation at home. However, evidence about the effect on decision to timely enrol the child in preschool and the related pathways is scarce. A follow-up study of a rural cohort exposed to early parenting interventions in the first 2 years of life in Pakistan though indicated benefits for children’s cognitive skills and learning environment at home but did not improve preschool enrolment rates. The aim of this study was to explore stakeholder knowledge, attitudes and perceptions about preschool education that may influence parent’s decision of enrolment. A qualitative study using a phenomenological approach was conducted. Data collection methods included focus group discussion and in-depth interviews with the parents and the teachers and observations of selected preschools. An emergent thematic analysis was followed. Findings showed that community attitudes related to their role in children’s preschool education (e.g. lack of parental involvement), and their perceptions of stakeholders’ responsibilities and accountability (child being responsible for own motivation and interest to learn) were barriers to preschool enrolment. Facilitators included quality of preschools and older siblings enrolled in the school. Early parenting interventions may be insufficient to change community perceptions of preschool education in disadvantaged contexts with dysfunctional education systems. Targeted strategies addressing socio-cultural barriers for early learning are needed.

Background Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships and energize the workplace environments but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited owing to human and financial constraints. Objective The current study describes the development of a feasible an on-job nursing mentorship program using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience from a tertiary care hospital in Pakistan. Methods The intervention package was built by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps that were based on the principles of implementation science, a) identification of a framework, b) creating a working group and c) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme. Results The intermediate outcome was to have nurses demonstrate skills of compassion with the eventual outcome of improving the patient's experience of compassion. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, precision of compassionate experience definition, creation of a compassionate culture and development of competent head nurses as supervisor. In order to ensure the pre-conditions, various interventions were planned and some were implemented through the course of designing. These involved, creation of space to talk about compassionate skills with staff, provide trainings and on-job coaching, revising career ladder of supervisors, inclusion of pediatric compassion specific nursing education service orientation program, recognition of efforts and promotion of compassionate values in numerous communication platforms, arrangement of training workshops, creation of checklists and development of dashboards. Conclusion The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme through strengthening routine supervision leading to improved patient experience of care in the pediatric service.