A mixed-methods process evaluation of the Familia Bora parenting program for couples with young children in Mwanza, Tanzania

• In Event: Gender-Transformative Parenting and Community Workforce

Proposal

Background: Parenting interventions have been widely implemented in low- and middle-income countries to improve early childhood development (ECD) outcomes. However, these parenting programs have traditionally been designed for and delivered primarily to mothers, with limited direct engagement of fathers throughout the duration of the program. We co-developed an multi-component, father inclusive parenting program for couples with young children in Mwanza, Tanzania and conducted a small-scale pilot that established its feasibility. Building upon the pilot, we are now implementing the program through community health workers (CHWs). This study reports on a process evaluation to assess the feasibility, acceptability, and appropriateness of our updated program model in this delivery context.

Methods: From 2022-2024, we co-designed Familia Bora with fathers, mothers, and local stakeholders. From July to November 2024, we piloted this intervention in 6 communities in Mwanza, and the lessons learned informed revisions to the intervention. In June 2025, we launched a cluster-randomized controlled trial to evaluate our updated program model. We enrolled 396 couples with children under the age of two years across 33 villages in Sengerema and Misungwi districts of Mwanza (204 in intervention and 192 in control). Familia Bora involves 17 weekly community- and couples-based group sessions facilitated by trained CHWs residing in the intervention villages. Familia Bora covered a range of topics including responsive caregiving, early learning, nutrition, caregiver mental health, discipline, early childhood care and education (ECCE), couples’ relationships, and addressing gender roles and norms with the ultimate goal of improving ECD. This process evaluation, guided by the RE-AIM framework, explores the implementation experiences from mothers, fathers, CHWs, group leaders, and the implementing partner (Tanzania Home Economics Organization, TAHEA). Throughout the study, we consistently collected process data from multiple sources after each session, including exit interviews with participants, CHW-completed feedback forms, session attendance records, and structured session observations by the M&E officers. We also conducted in-depth qualitative interviews at both midline and endline. We triangulated data from the four quantitative-data sources to comprehensively capture the implementation experiences, and to assess the intervention’s reach, acceptability, feasibility (i.e. fidelity), and appropriateness. Additionally, qualitative data from the midline and endline were used in an explanatory manner to further enrich and contextualize the quantitative findings.

Results: Caregivers rated the sessions highly, with about 97% of caregivers who completed the exit interviews rating the session as “good” or “very good”. This was supported by observation data, which rated participant engagement as “good” or “excellent” in about 87% of sessions. Additionally, the M&E officers observed that in approximately 70% and 68% of sessions fathers and mothers, respectively, appeared to be actively engaged. Additionally, the program content was also perceived as highly acceptable, with 94% of caregivers “agreeing” or “strongly agreeing” that the information delivered was useful to their lives. Caregivers appreciated the mixed-gender format. They noted that the content was relevant to both fathers and mothers, and it provided them an opportunity to learn together, receive the same information, better understand each other’s challenges and support each other. While most topics resonated equally with both mothers and fathers, a few participants perceived certain topics as more relevant to mothers. Observation data underscored high quality of session delivery by CHWs, with M&E officers rating high fidelity and acceptable facilitation, with an average score of 7 out of 10. The CHWs were also observed to clearly explain the session content in about 82% of the sessions and appeared confident and well-prepared in about 90% and 86% of the sessions, respectively. These findings were corroborated by caregivers, with 98% of those who completed the exit interviews “agreeing” or “strongly agreeing” that the CHW clearly explained the content. A majority of CHWs (92%) also reported that the sessions were “mostly easy” or “very easy” to deliver. This was attributed to both their own preparation, trainings, and the supportive supervision received by TAHEA staff. In addition to the CHWs’ facilitation, the images and materials were highly appreciated by the caregivers, with 96% of caregivers “agreeing” or “strongly agreeing” that the images and materials used in the session were interesting. Overall, fathers, mothers and CHWs found the “Familia Bora” program to be highly acceptable, feasible and appropriate within their setting and for their roles as caregivers. Caregivers appreciated the lessons learned and gender-inclusive model which actively engaged both caregivers by leveraging the group-nominated female and male group leader, who played a key role in encouraging attendance among their peers.

Conclusions: Findings from this process evaluation indicate that the Familia Bora program was delivered by CHWs with high fidelity across the intervention villages and was perceived as highly acceptable by male and female participants and CHWs. These results highlight how previously piloting the program helped shape a culturally relevant, gender-responsive program model, and how many of the success factors identified during the pilot evaluation, such as cultural relevance, participatory approaches during group sessions, and consideration of both mothers’ and fathers’ preferences, remained central to successful implementation. More broadly, this study provides an example for how the RE-AIM framework can be used to systematically assess implementation quality and program experiences and in turn provide critical insights to inform program adaptation, improvement, and scale-up of parenting interventions in low-resource settings.

Authors

• Valencia Lambert, Emory University

• Carina Wolfram Mayombo, Tanzania Home Economics Organization (TAHEA MWANZA)

• Gabriel Sangarara

• Julieth Joseph Bhoke, Tanzania Home Economics Organization (TAHEA MWANZA)

• Damas Joachim, Tanzania Home Economics Organization (TAHEA MWANZA)

• Joshua Jeong, Emory University