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Disseminating and Implementing ParentCorps to Low-Resource Schools in Nepal and Uganda: Strategies and Impacts

Thu, March 21, 4:00 to 5:30pm, Hilton Baltimore, Floor: Level 2, Key 9

Integrative Statement

Many children in LMICs grow up in environments characterized by extreme poverty and violence, and many are victims of abuse and neglect (WHO, 2005, 2011). Toxic stressors and a range of social determinants combine to yield high levels of child social emotional problems and poor development (UNICEF, 2008; WHO, 2004). Despite the success of numerous interventions for promoting socioemotional development in young children, most evidence-based interventions (EBIs) are not available in LMICs. This study apply a cost-effective population-level strategy to address existing early childhood developmental service gaps by adapting and implementing ParentCorps, a school-based early childhood development (ECD) promotion EBI, to schools in Uganda and Nepal. This study describes localized implementation adaptation methodology and processes, and evaluates the impact of EBI in Ugandan and Nepali schools.

The design of the study is based on the Framework of Translational and Implementation in Health Service Research (Spoth et al., 2013), which includes 4 stages: 1) understanding the fit of EBIs in LMICs; 2) carrying out program adaptation, 3) conducting implementation study to evaluate implementation quality and EBI effectiveness, and 4) studying strategies for EBI sustainability (see Figure 1). This study examine implementation-effectiveness findings from 40 schools (10/30 from Uganda/Nepal), 301 teachers (99/202 from Uganda/Nepal), and 700 students/families (154/550 from Uganda/Nepal.

To understand the fit of the EBIs in LMIC contexts (Stage 1), a cross-sectional study design was applied, and qualitative and quantitative data were gathered. To study impacts of program implementation (Stages 2 & 3 study), a cluster randomized controlled trial in Uganda and a pre-post evaluation study in Nepal were carried out. The Stage 1 study supported the fit and feasibility of transporting ParentCorps to LMICs. Specifically, ParentCorps targets knowledge and skills that are relevant to Ugandan and Nepali teachers and families; the ParentCorps model that relies on school staff for implementation is pertinent and appealing to teachers in LMICs; and the EBI is in line with governments’ ECD and mental health policies. The Stages 2 & 3 study also supported the fidelity and effectiveness of ParentCorps. We found that ParentCorps with a well structural implementation manual and policy-academic-community partnership implementation model can be easily adapted and implemented with high fidelity in low-resource developing countries. In addition, teacher and child outcome evaluation found expected program impacts. For example, there was significant impact on teachers’ EBP knowledge (d=1.03-1.36), and on their use of EBP strategies and observed classroom practices (e.g., decreased use of harsh discipline and negative classroom climate; improved teacher-student relationships and positive classroom climate) (d=.55- 1.74). There was also significant impact on child social emotional competence and behaviors (d=.30-1.03).

This study documents the utility of applying implementation frameworks to guide translational research and to increase the utilization of EBIs in diverse populations and communities. Findings also suggest the transportability of EBIs from developed countries to developing countries to promote child development. The implementation of EBI in LMICs contributes to solutions for accomplishing the United Nations’ Sustainable Development Goals (SDGs 3, 4, 5, 11) in LMICs (United Nations, 2015).

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