Observing home‐visiting quality at scale with the home visit rating scales and a supervisor checklist in Peru

Abstract

As home‐visiting programs expand, there is a need to develop cost‐effective tools to monitor their quality at scale. We compare the Home Visit Rating Scales (HOVRS), an instrument to measure home‐visit process quality widely used in the United States, to a checklist designed for the Peruvian national home‐visiting program, Cuna Mas. Both instruments were administered to a sample of 554 home visits and an equal number of mother–child dyads by their 176 home visitors. While the HOVRS was scored on video recordings of the visits by trained coders, the checklist was scored live by Cuna Mas supervisors. We assessed the validity of both measures in their first application in rural Peru, compared their performance, and selected a subset of items in the checklist to propose a simplified, shorter, and more cost‐efficient instrument. To this end, we reorganized checklist items into constructs that best mapped those covered by the HOVRS and selected the highest performing according to predefined criteria. We found that both the HOVRS and the checklist had high reliability and acceptable levels of validity. We argue that the simplified checklist could prove useful for quality monitoring of service delivery of at‐scale home‐visiting programs and as a tool to support in‐service training.

Scaling‐up an early childhood parenting intervention by integrating into government health care services in rural Bangladesh: A cluster‐randomised controlled trial

“…Some aspects of intervention delivery were weak, including praising the caregiver, conducting the language activities, conducting feedback from the previous 2 weeks activities and reviewing activities to be done at home in the following 2 weeks. These relative strengths and weaknesses of the HWs in delivering the sessions were similar to those reported from home‐visiting early childhood parenting programmes (Leer & Lopez‐Boo, 2019; Rubio‐Codina et al, 2019). With ongoing training and supervision, implementation quality of parenting programmes increases over time (Luoto et al, 2021; Yousafzai et al, 2018).…”

“…These relative strengths and weaknesses of the HWs in delivering the sessions were similar to those reported from home-visiting early childhood parenting programmes (Leer & Lopez-Boo, 2019;Rubio-Codina et al, 2019). With ongoing training and supervision, implementation quality of parenting programmes increases over time (Luoto et al, 2021;Yousafzai et al, 2018).…”

A Tale of Two Programs for Parents of Young Children: Independently-Conducted Case Studies of Workforce Contributions to Scale in Bhutan and Rwanda

“…The Bhutanese program has now put one in place using a local organization. Many parenting programs use such a system, including the Cuna Mas program in Peru [ 29 ]. Others have used videos of the home visit that are rated later for quality.…”

“…Regardless, feedback with some form of mentoring is essential. Few measures of quality exist outside of high-income countries, but those that do include many of the qualities we used here [ 29 ]. Although some adaptation needs to be considered, especially if the curriculum is not as structured as the ones observed here, many of these qualities are central, and have been validated against changes in parental practices [ 20 ].…”

Observing home‐visit quality with the home visit rating scales: Introduction to the special section

“…Home‐visiting programs are being implemented around the world in an effort to optimize child development, especially among families facing risks. Rubio‐Cordina, Dormal, and Araujo (this issue) were tasked with finding a practical way of facilitating high‐quality home‐visiting services across a large rural and isolated area of Peru. Home visitors, recruited from local villages and provided with minimal training, were intermittently visited by supervisors due to travel‐related challenges.…”