Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh

Abstract

Supporting caregivers’ mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar–April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children <24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of “unhealthy thoughts” in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting.

Adapting an Evidence-Based, Early Childhood Parenting Programme for Integration into Government Primary Health Care Services in Rural Bangladesh

“…The lack of an incentive and family members discouraging attendance were the most frequent barriers to mothers' engagement. These barriers have also been reported in a recent study in Bangladesh ( 20 ). We tried two specific engagement strategies, giving cooking oil as an incentive for attendance and community motivational meetings to engage all family members.…”

“…Both strategies were effective although giving oil proved difficult due to logistical problems. The importance of community sensitization to increase participant engagement in parenting programmes has been reported in other studies ( 19 , 20 ).…”

“…Also, when many activities were introduced during the session, mothers were unable to recall the content. A simple, streamlined intervention with user-friendly manuals is recommended to maintain the interest and engagement of participants and to maximize the likelihood that the intervention will be delivered with fidelity ( 20 ). Reducing the complexity of the intervention to make it easier to deliver is also likely to lead to higher motivation among the health staff ( 25 ).…”

A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh

“…Each of the individual intervention components was developed and refined by adapting existing curricula based on field testing and feedback from community members and CHWs. 18 Group sessions took 45-60 min and home visits took 20-25 min. Those in the group arm received 18 group sessions delivered every 2 weeks in a location close to their homestead with 3-6 pregnant women and caregiver-child dyads.…”

Exploration of Attendance, Active Participation, and Behavior Change in a Group-Based Responsive Stimulation, Maternal and Child Health, and Nutrition Intervention

“…Group sessions may be more engaging for the participants. 25 There are several intervention models incorporating group sessions. These sessions require a larger time commitment by participants than individual sessions conducted in the home, but may result in improved outcomes.…”