title: Integrating a Parenting Intervention With Routine Primary Health Care: A Cluster Randomized Trial.
abstract: OBJECTIVE
  More than 200 million children globally do not attain their developmental potential. We hypothesized that a parent training program could be integrated into primary health center visits and benefit child development.
  
  
  METHODS
  We conducted a cluster randomized trial in the Caribbean (Jamaica, Antigua, and St Lucia). Fifteen centers were randomly assigned to the control (n = 250 mother-child pairs) and 14 to the intervention (n = 251 mother-child pairs) groups. Participants were recruited at the 6- to 8-week child health visit. The intervention used group delivery at 5 routine visits from age 3 to 18 months and comprised short films of child development messages, which were shown in the waiting area; discussion and demonstration led by community health workers; and mothers' practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child cognition, language, and hand-eye coordination and secondary outcomes were caregiver knowledge, practices, maternal depression, and child growth, measured after the 18-month visit.
  
  
  RESULTS
  Eight-five percent of enrolled children were tested (control = 210, intervention = 216). Loss did not differ by group. Multilevel analyses showed significant benefits for cognitive development (3.09 points; 95% confidence interval: 1.31 to 4.87 points; effect size: 0.3 SDs). There were no other child benefits. There was a significant benefit to parenting knowledge (treatment effect: 1.59; 95% confidence interval: 1.01 to 2.17; effect size: 0.4).
  
  
  CONCLUSIONS
  An innovative parenting intervention, requiring no additional clinic staff or mothers' time, was integrated into health services, with benefits to child cognitive development and parent knowledge. This is a promising strategy that merits further evaluation at scale.
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica;
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Institute of Child Health, and.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Grantham-McGregor
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica;
authors.forename: Christine A
authors.initials: CA
authors.lastname: Powell
authors.affiliation: Department of Economics, University College London, London, United Kingdom;
authors.forename: Marcos
authors.initials: M
authors.lastname: Vera-Hernández
authors.affiliation: Social Protection and Health Division, Inter-American Development Bank, Washington, District of Columbia; and.
authors.forename: Florencia
authors.initials: F
authors.lastname: Lopez-Boo
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica; School of Psychology, Bangor University, Bangor, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Baker-Henningham
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica; susan.walker@uwimona.edu.jm.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Walker
mesh_terms: D002657:Child Development; D018479:Early Intervention, Educational; D005260:Female; D006801:Humans; D007223:Infant; D007563:Jamaica; D008297:Male; D009035:Mothers; D016487:Parenting; D011320:Primary Health Care