Acceptability and feasibility of a group-based intervention to improve outcomes for children at risk for developmental delays in Kenya: A piloted randomized trial
Restricted accessResearch articleFirst published online December, 2025
Acceptability and feasibility of a group-based intervention to improve outcomes for children at risk for developmental delays in Kenya: A piloted randomized trial
The Care for Child Development (CCD) program may improve child development outcomes in resource-limited settings, but has not yet been adapted to group-based settings to facilitate sustainable dissemination. In this study, we determined the acceptability and feasibility of a group-based CCD program, with evaluation of program outcomes for child development, home environment, and symptoms of maternal depression as secondary outcomes. We evaluated this adapted program using a 2 × 2 crossover-designed pilot study administered over 10 bi-weekly sessions. Acceptability and feasibility were assessed through focus group discussions using qualitative methods. Child development, home observations, and symptoms of maternal depression were evaluated at baseline, 6 months, and 12 months and assessed quantitatively. Twenty-six mother-child dyads participated. Overall, they perceived CCD as acceptable and feasible, and especially beneficial within its group-based format. Although there were no measured improvements in child development, improvements in stimulating home environments (mean difference 2.5, 95% C.I. [0.37, 4.72]) were found. Further scale-up of this intervention is needed to determine effectiveness.
AhunMNAboudFWamboldtC, et al. (2023) Implementation of UNICEF and WHO's care for child development package: lessons from a global review and key informant interviews. Frontiers in Public Health11: 1140843.
2.
BayleyN (2006) Bayley Scales of Infant and Toddler Development. San Antonio, TX: Pearson.
3.
BrowneRH (1995) On the use of a pilot sample for sample size determination. Statistics in Medicine14: 1933–1940.
4.
BunningKGonaJKNewtonCR, et al. (2017) The perception of disability by community groups: stories of local understanding, beliefs and challenges in a rural part of Kenya. PLoS One12: e0182214.
5.
ChenCHTsengYFChouFH, et al. (2000) Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan. Journal of Psychosomatic Research49: 395–399.
6.
Christoffersen-DebARuhlLElung’AtJ, et al. (2015) Chamas for Change: an integrated community-based strategy of peer support in pregnancy and infancy in Kenya. Lancet Global Health3: S22.
7.
DambiJMJelsmaJMlamboT (2015) Caring for a child with Cerebral Palsy: the experience of Zimbabwean mothers. Afr J Disabil4: 168.
8.
DEDOOSE. (2020). Dedoose Version 8.3.35, Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Method Research Data. Los Angeles, CA: SocioCultural Research Consultants, LLC. Available:https//www.dedoose.com.
9.
DennisCL (2003) The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry48: 115–124.
10.
EastLJacksonDO'BrienL (2006) Father absence and adolescent development: a review of the literature. Journal of Child Health Care10: 283–295.
11.
GonaJKMung'Ala-OderaVNewtonCR, et al. (2011) Caring for children with disabilities in Kilifi, Kenya: what is the carer’s experience?Child: Care, Health and Development37: 175–183.
12.
GoodmanSHBroganDLynchME, et al. (1993) Social and emotional competence in children of depressed mothers. Child Development64: 516–531.
13.
GoodmanSHRouseMHConnellAM, et al. (2011) Maternal depression and child psychopathology: a meta-analytic review. Clinical Child and Family Psychology Review14: 1–27.
14.
GovenderDNaidooSTaylorM (2020) “I have to provide for another life emotionally, physically and financially”: understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa. BMC Pregnancy and Childbirth20: 620.
15.
Grantham-McgregorSCheungYBCuetoS, et al. (2007) Developmental potential in the first 5 years for children in developing countries. Lancet369: 60–70.
16.
GreenSE (2003) “What do you mean ‘what's wrong with her?'”: stigma and the lives of families of children with disabilities. Social Science & Medicine57: 1361–1374.
17.
GuralnickMJ (1998) Effectiveness of early intervention for vulnerable children: a developmental perspective. American Journal on Mental Retardation102: 319–345.
18.
JeongJMccoyDCYousafzaiAK, et al. (2016) Paternal stimulation and early child development in low- and middle-income countries. Pediatrics138.
19.
JohnsonRFO'ReillyMVostanisP (2006) Caring for children with learning disabilities who present problem behaviours: a maternal perspective. Journal of Child Health Care10: 188–198.
20.
KaminskiJWValleLAFileneJH, et al. (2008) A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology36: 567–589.
21.
LuotoJELopez GarciaIAboudFE, et al. (2021) Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial. Lancet Global Health9(3): 309–319.
22.
MaldonadoLYSongokJJSnelgroveJW, et al. (2020) Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya. BMC Pregnancy and Childbirth20: 288.
23.
MashalaPERBassonWNelK (2012) Qualitative exploration of the experiences and challenges of adolescents during pregnancy. Journal of Psychology in Africa27(2): 49–55.
24.
MchenryMSMcateerCIOyunguE, et al. (2018) Neurodevelopment in young children born to HIV-infected mothers: a meta-analysis. Pediatrics141.
25.
MchenryMSOyunguEYangZ, et al. (2021) Neurodevelopmental outcomes of young children born to HIV-infected mothers: a pilot study. Front Pediatr9: 697091.
26.
MkabileSSwartzL (2020) ‘I waited for it until forever’: community barriers to accessing intellectual disability services for children and their families in cape town, South Africa. International Journal of Environmental Research and Public Health17: 8504.
27.
National Council On DisabilityChapter 13: supporting parents with disabilities and their families in the community. Available at:https://www.ncd.gov/publications/2012/Sep272012/Ch13 (Accessed 31 December 2020).
28.
National Research Council Institute Of Medicine (2009) Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: The National Academies Press.
29.
NayarUSStanglALDE ZalduondoB, et al. (2014) Reducing stigma and discrimination to improve child health and survival in low- and middle-income countries: promising approaches and implications for future research. Journal of Health Communication19(Suppl 1): 142–163.
30.
OdongoG (2018) Barriers to parent/family participation in the education of a child with disabilities in Kenya. International Journal of Special Education33.
31.
PelchatDLefebvreHPerreaultM (2003) Differences and similarities between mothers’ and fathers’ experiences of parenting a child with a disability. Journal of Child Health Care7: 231–247.
32.
RabieSSkeenSTomlinsonM (2020) Fatherhood and early childhood development: perspectives from sub-saharan Africa. In: FitzgeraldHEVon KlitzingKCabreraNJ, et al. (eds) Handbook of Fathers and Child Development: Prenatal to Preschool. Cham: Springer International Publishing.
RobertsonEGKeladaLIlinR, et al. (2024) Psychological wellbeing among parents of a child living with a serious chronic illness: a cross-sectional survey study. Journal of Child Health Care0(0): 13674935241238485.
35.
ScherzerALChhaganMKauchaliS, et al. (2012) Global perspective on early diagnosis and intervention for children with developmental delays and disabilities. Developmental Medicine and Child Neurology54: 1079–1084.
36.
ShearerJPapanikolaouNMeiser-StedmanR, et al. (2018) Cost-effectiveness of cognitive therapy as an early intervention for post-traumatic stress disorder in children and adolescents: a trial based evaluation and model. Journal of Child Psychology and Psychiatry59: 773–780.
37.
SimJLewisM (2012) The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. Journal of Clinical Epidemiology65: 301–308.
38.
SinglaDRKumbakumbaEAboudFE (2015) Effects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: a community-based, cluster-randomised trial. Lancet Global Health3: e458–e469.
39.
SundalH (2023) Home-like care: collaboration between parents and nurses in everyday situations when children are hospitalized. Journal of Child Health Care0(0): 13674935221149778.
WalkerSPWachsTDGardnerJM, et al. (2007) Child development: risk factors for adverse outcomes in developing countries. Lancet369: 145–157.
42.
WalkerSPWachsTDGrantham-McgregorS, et al. (2011) Inequality in early childhood: risk and protective factors for early child development. Lancet378: 1325–1338.
43.
WillisEGodboldR (2023) Children's complex health: maternal experiences of care and decision making. Journal of Child Health Care: 13674935231158456.
44.
WoolhouseHGartlandDMensahF, et al. (2015) Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG: An International Journal of Obstetrics and Gynaecology122: 312–321.
45.
YeungWJLinverMRBrooks-GunnJ (2002) How money matters for young children’s development: parental investment and family processes. Child Development73: 1861–1879.
46.
YousafzaiAKObradovićJRasheedMA, et al. (2016) Effects of responsive stimulation and nutrition interventions on children's development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. Lancet Global Health4: 548–588.
47.
YousafzaiAKRasheedMASiyalS (2018) Integration of parenting and nutrition interventions in a community health program in Pakistan: an implementation evaluation. Annals of the New York Academy of Sciences1419: 160–178.
48.
ZuurmondMNyanteGBaltussenM, et al. (2019) A support programme for caregivers of children with disabilities in Ghana: understanding the impact on the wellbeing of caregivers. Child: Care, Health and Development45: 45–53.
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