Blended Delivery of a Primary Care Parenting Program for Child Development: A Randomized Clinical Trial.

Importance: There is substantial evidence that programs that build parents' abilities to support early learning benefit children's development. Evidence is needed on how to integrate and scale these programs within government services. Objective: To determine whether a parenting program implemented by government primary health care services and combining in-person and remote delivery benefits children's development and parenting attitudes and behaviors. Design, Setting, and Participants: In this single-blind randomized clinical trial, enrollment began in July 2022 in primary health care centers in Jamaica. The intervention was phased in from September 2022 to August 2023 and lasted 8 months. Data collection ended in April 2024. Families with children aged 3 to 28 months from communities served by the centers were identified by health staff. Following eligibility checks and informed consent, families were randomly assigned to intervention or waiting list control. Intervention: The intervention aimed to strengthen parents' skills in helping their child learn through play and responsive interactions. Community health workers used a curriculum with age-appropriate play and language activities and made fortnightly contacts with families, alternating between home visits and telephone calls. Main Outcomes and Measures: Child development was measured with the Griffiths Mental Development Scales and parenting behaviors (involvement, responsivity, acceptance, and learning materials) with the Home Observation for Measurement of the Environment (HOME). Effect size (ES) was calculated by dividing the regression coefficient by the pooled-sample SD. Results: A total of 627 children were enrolled (311 intervention and 316 control; 322 [51.4%] male). At follow-up, 491 children (78.3%) were assessed, 237 (76.2%) of those in the intervention group and 254 (80.4%) in the control group. Children's mean (SD) age at follow-up was 27.0 (5.8) months in the control and 27.0 (6.1) months in the intervention group. A total of 393 mothers (62.7%) had completed secondary school. There were no significant differences in follow-up rate or characteristics between groups. Intention-to-treat multivariate regression analyses with inverse probability weights showed benefits for children's overall developmental quotient (ES, 0.17 SD; 95% CI, 0.01-0.33 SD), fine motor ability score (ES, 0.19 SD; 95% CI, 0.03-0.36 SD), and parent behaviors (HOME score ES, 0.25 SD; 95% CI, 0.08-0.41 SD). Conclusions and Relevance: In this randomized clinical trial of a parenting program delivered through primary health care, the intervention benefited child development and parenting. Findings suggest combining in-person and remote methods may be a useful strategy for scaling. Trial Registration: ISRCTN Registry Identifier: ISRCTN11059214.