Mobile Health (mHealth) Tools to Improve Delivery Quality of a Family Home Visiting Intervention
Condition: Parent-Child Relations; Behavioral Intervention; Exposure to Violent Event; Child Development; Mental Health; Implementation Science; mHealth; Community Health Workers
Study type: Interventional

Summary: 
      This study will pilot a family-focused, behavioral health intervention while also developing
      and piloting mHealth tools to support Community Health Workers (CHWs) in Sierra Leone. This
      dual focus will help build capacity both for delivery of evidence-based mental health
      services to reduce family violence and harsh parenting practices, and for effective use of
      mHealth strategies to improve healthcare delivery quality. This study will leverage
      Government of Sierra Leone investments in community health initiatives as a strategy to
      address critical healthcare workforce limitations that plague delivery of evidence-based
      interventions to vulnerable families in post-conflict Sierra Leone. Study aims are to:

      Aim 1. Employ a five-phase user-centered design approach to develop and test mHealth tools to
      improve training, supervision, and fidelity monitoring of Community Health Workers. Study
      investigators hypothesize that mHealth tools will be feasible, acceptable, and user-friendly.

      Aim 2. Conduct a Randomized Controlled Pilot Study to assess feasibility, acceptability,
      costs and preliminary effects of the mHealth-supported delivery of FSI-ECD on parent mental
      health, emotion regulation, and familial violence in high risk families with children aged
      6-36 months (n=40) in comparison to control families (n=40) who receive standard care.
      Parental mental health, emotion regulation, household violence, and parenting practices will
      be assessed at baseline, post-intervention and 6-month follow-up. Study investigators
      hypothesize that (a) the effects of the FSI-ECD will be comparable to results observed with
      vulnerable families in Rwanda; (b) digital tools will be feasible and acceptable to CHWs and
      supervisors.

      Aim 3. Leverage well-established relationships and government partners to strengthen capacity
      for mHealth research and quality healthcare delivery in Sierra Leone. Partners include the
      University of Makeni, the Directorate of Science, Technology and Innovation, and the Ministry
      of Health and Sanitation.
    


Intervention name(s): Family Strengthening Intervention for Early Childhood Development; Community Health Worker Routine
Intervention type(s): Behavioral; Other
Intervention description(s): The Family Strengthening Intervention for Early Childhood Development (FSI-ECD) is an evidence-based home-visiting behavioral intervention for vulnerable families with children aged 6-36 months. The FSI-ECD targets improving parental emotion regulation and parent-child interactions to improve parental mental health and child development outcomes and reduce family violence. FSI-ECD compromises five core components delivered in 12 modules delivered in weekly sessions via active coaching by community health workers. Core components include coaching on: a) nutrition, health and hygiene; b) early stimulation and playful parenting; c) building resilience and coping skills; d) building problem-solving skills; and d) building emotion regulation and conflict resolution skills.; Standard CHW care involves three home visiting sessions delivered to families following childbirth with weekly supervision via phone or face-to-face. Topics of home visiting sessions include: skilled post-natal care for mothers, early initiation of breastfeeding and exclusive breastfeeding practices, adequate nutrition, immunization services and timely use of these services, hand washing and hygiene practices (including waste disposal and food hygiene), building the capacity of family members to appropriately take care of newborns and children under age 5, and building the capacity of family members to recognize and act on postnatal danger signs for newborns, mothers, and children under 5. CHWs also conduct screenings for acute malnutrition and growth monitoring to identify early referrals, and they can provide family planning methods, deworming tablets and other vitamins for acute malnutrition, dehydration, and anti-malaria treatment. Each home-visiting session lasts about 60 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research