Measuring the Quality of Father Home-Visiting in Conflict-Affected Areas

• In Event: Education Conflict, Protest and Development

Proposal

Since the beginning of the Rohingya influx, more than 500,000 Rohingya children have fled their country with their families into Cox’s Bazar, Bangladesh, which now hosts the world’s largest refugee camp (UNHCR, 2019). The negative impacts of war and displacement not only have lifelong developmental impacts for children (lone & Mann, 2016; Kadir et al., 2019; Masten & Narayan, 2012; Shonkoff et al., 2012) but also take a toll on caregivers, hindering their psychosocial well-being and their ability to interact responsively and positively with their children (Eltanamly et al., 2019; Murphy et al., 2017). To date, Early Childhood Development (ECD) interventions in conflict-affected areas remain scarce (Murphy et al., 2018; RTI, 2020). While most of the existing parenting interventions for young children have primarily focused on supporting mothers as the primary caregivers, there has been little attention given to strengthening male caregivers’ (i.e., fathers) well-being and their role in providing nurturing care (Affleck et al., 2018; Jeong et al., 2023a). A recent systematic review on the implementation characteristics of father-inclusive interventions in low- and middle-income countries (LMICs) documents wide variability in the manner in which interventions are being delivered, commonly relying in the same program structure used with female caregivers without appropriate adaptations (Jeong, 2023b).
In response to this need, BRAC-IED and Sesame Workshop, under the Play to Learn initiative, designed the Fathers’ Engagement Model to enhance fathers’ emotional literacy, their knowledge about early childhood child development, and to encourage positive parenting for the healthy development of Rohingya children aged 0-2 years. The father engagement intervention is been implemented in 2022-2023 in the Rohingya host community and refugee camps in Cox’s Bazar, Bangladesh. Father volunteers from the community were selected and trained in child development, protection, and psychosocial support to facilitate weekly home-visiting sessions with Rohingya male caregivers.
Home visiting programs that target fathers of young children are an innovative way of providing psychosocial support while also promoting playful and caring interactions with their children. However, there is a dearth of evidence about the effectiveness of this intervention model in low and middle-income countries to promote positive outcomes for caregivers and young children (Jeong et al., 2023a; Jeong et al., 2023b). One important aspect that influences the successful implementation of home-visiting programs is the quality of the home visitor's relationship with the caregiver (Saïas et al., 2016; Schodt et al., 2015). To our knowledge, no instruments are available to robustly assess home-visiting quality in crisis settings, specifically focusing on the relationship established between male volunteers and fathers. Our study explores the quality of implementation of the above father engagement program by developing and validating an observation tool to measure the quality of interactions between facilitators and fathers during the home visiting sessions. The validation study aims to answer the following questions:
- What are the psychometric properties of an instrument measuring the quality of father home-visits in Rohingya and host community facilitator-father dyads in Cox’s Bazar, Bangladesh?
- What are the meaningful factors of home-visit quality in a sample of home-visits made to Rohingya and host community fathers in Cox’s Bazaar, Bangladesh?
- Do scales represented in the resulting factor structure show evidence of concurrent validity?
Methods
The initial version of the instrument was developed based on the Home Visit Rating Scale (HOVRS-3) scale (Roggman et al., 2019), an extensive examination of the literature on father engagement interventions, specifically those in LMIC or emergency contexts, consultation with experts on father and masculinity related interventions, and observations of six home-visiting sessions implemented in the Rohingya camp context and in the host community context in Cox’s Bazar, Bangladesh. This first version of the instrument was then tested on four video recordings of the intervention that were used to create gold codes for enumerator training. The instrument includes 24 items divided into four subscales: (1) relationship between father volunteer and caregiver/father (e.g., “Facilitator engages in positive interactions”, “Shows respect and acceptance of the family”); (2) responsiveness to family strengths, culture, needs, and circumstances (e.g., “Adapts content to family’s interest and needs”, “Gives feedback on family strengths”); (3) active listening (e.g., “Facilitator provides sufficient time for caregiver to think and speak”, “Facilitator reflects the father’s words”), and (4) parent engagement (e.g., “Caregiver asks questions or presents problems”, “Caregiver shares information in a forthcoming fashion”).
As part of the father engagement intervention’s midline evaluation, data on home-visiting quality has been collected from 300 facilitator-father dyads in Rohingya refugee (n = 300) and host community (n = 300) populations of Cox’s Bazar, Bangladesh. The psychometric analysis to answer the first research question entail conducting exploratory and confirmatory factor analyses to investigate the instrument’s empirical structure, as well as item response theory analyses to ensure that the items cover a range of abilities and have good discriminating power. Additionally, to answer the second research, we will examine concurrent validity by testing associations between the instrument and facilitator’s well-being (as measured through self-reports of anxiety and depressive symptoms, and work-based social support).
As home-visiting programs expand into refugee response contexts and adapt to include male caregivers, there is a pressing need for valid and reliable measures that can provide evidence of the implementation quality of these models. Findings from the development and validation of the father home-visit quality instrument will provide insights on how to effectively measure quality and fidelity in home-visiting programs that engage male caregivers, particularly in emergency and LMIC contexts. Validly measuring the quality of facilitator-father interactions and assessing how these are related to caregiver well-being and child development outcomes will allow us to understand what the key “active ingredients” are that can enhance the quality of implementation of father engagement programs.

Authors

• Silvana Freire, New York University

• Anaga Ramachandran, New York University

• Sneha Bolisetty, NYU Global TIES for Children

• Shikhty Sunny, New York University

• Yeshim Iqbal