Fidelity Assessment Checklist Development for Community Nursing Research in Early Childhood

Abstract

Nurses play an important role in promoting positive childhood development via early interventions intended to support parenting. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has largely been ignored. Fidelity refers to the degree to which healthcare programs follow a well-defined set of criteria specifically designed for a particular program model. With increasing demands for early intervention programs to be delivered by non-specialists, rigorous yet pragmatic strategies for maintaining fidelity are needed. This paper describes the step-by-step development and evaluation of a program fidelity measure, using the Attachment and Child Health (ATTACH™) parenting program as an exemplar. The overall quality index for program delivery varied between “very good” to “excellent,” with a mean of 4.3/5. Development of checklists like the ATTACH™ fidelity assessment checklist enables the systematic evaluation of program delivery and identification of therapeutic components that enable targeted efforts at improvement. In future, research should examine links between program fidelity and targeted outcomes to ascertain if increased fidelity scores yield more favorable effects of parenting programs.

Effect of Attachment and Child Health (ATTACHTM) Parenting Program on Parent-Infant Attachment, Parental Reflective Function, and Parental Depression

“…As a quantifiable human psychological ability that is crucial for mutual interactions and functioning [ 84 ], RF’s relevance to attachment research, intervention and prevention will likely continue to grow [ 83 ]. Our findings along with the others’ [ 41 , 42 , 43 , 44 , 45 , 48 , 53 , 55 , 77 , 83 , 84 ] indicate that parental RF plays a central role in early years, as parents’ representations of their children can influence several domains of child development [ 15 , 56 ]. Nonetheless, the results from the study need to be verified with a larger sample size for the depression outcomes.…”

“…ATTACH TM is a 10–12-week, manualized psychoeducational program with dyadic (caregiver, usually mother and child) and triadic (caregiver, usually mother, child, and co-parent) components, designed to promote RF in vulnerable families experiencing toxic stress [ 15 , 52 , 56 , 57 ]. The format consists of eight to ten face-to-face, one-on-one ATTACH™ program sessions with the parent and a RF facilitator and two to three face-to-face ATTACH™ program sessions with the parent, co-parent, and RF facilitator.…”

“…Stressful parenting moments, specifically those where the parent’s ability to reflect is compromised, are discussed in detail. By doing so, ATTACH TM promotes the involvement of parents in a RF process by looking at different ways to perceive any stressful moment, rather than fixating on one particular way to view the content or situation [ 52 , 56 , 58 ]. These strategies also more likely help promote secure attachment [ 15 ].…”

“…These strategies also more likely help promote secure attachment [ 15 ]. The facilitator’s curious, inquisitive, non-judgmental behavior is considered crucial to the facilitator-client relationship, which in turn encourages the caregiver to remain actively engaged in a RF process [ 56 ].…”

Association between maternal reflective function and preschool children’s cognitive abilities

“…It is a modifiable trait (Byrne et al, 2020;Letourneau et al, 2020;Slade et al, 2020) that is theorized to improve children's developmental attainment, including cognitive abilities (Steele et al, 1996;Fonagy and Target, 1997;Fonagy et al, 2002;Allen et al, 2008;Sharp and Fonagy, 2008). Interventions designed to improve parental RF have demonstrated improvements in infants' speech development (Bain, 2014), reductions in school-aged children's externalizing (e.g., aggressiveness) behaviors (Londono Tobon et al, 2020), and improvements in preschool-aged children's developmental outcomes (Anis et al, 2020a). Given the importance of children's cognitive abilities and modifiability of parental RF, further research is needed to examine whether parental RF is associated with preschool children's cognitive abilities.…”