Effectiveness of a training programme on frontline workers' skills and competencies in promoting safe and stable nurturing relationships: A quasi-experimental study from rural central India.

Background and objectives Adverse childhood experiences are known to impact lifelong health, while safe, stable, and nurturing relationships act as protective factors. Frontline workers (FLW) in India, are well-positioned to support at-risk families but often lack structured training on these topics. This study assessed the effectiveness of a training programme in improving FLWs' knowledge and self-perceived competencies regarding these topics, and its impact on nurturing relationships among high-risk families. Methods A quasi-experimental single-group pre-post study was conducted in Central India. Thirty FLWs were enrolled, of whom 25 completed training and follow up assessments. The intervention comprised a co-developed, participatory training module covering adverse childhood experiences, safe, stable, and nurturing relationships, community engagement, and referral pathways. FLWs' knowledge and self-perceived competencies were assessed at baseline, 1 month, and 6 months using a 23-item validated tool. High-risk families identified by trained FLWs, were assessed for safe, stable, and nurturing relationships outcomes at baseline and 6 months using a 14-item scale. In-depth interviews explored implementation experiences. Results FLWs' mean scores improved from 0.47 (SD=0.17) at baseline to 0.82 (SD=0.06) at 1 month and 0.80 (SD=0.05) at 6 months (P<0.001). No significant change was observed in safe, stable and nurturing relationships outcomes (7.53 to 7.54; P=0.15). Interviews highlighted improved awareness but cited barriers like workload, inadequate follow up, and supervision. Interpretation and conclusions Training enhanced FLWs' competencies, but this did not translate into family-level outcomes.