A community-based parenting programme in Uganda engaging both mothers and fathers and their children under 3 years has found that the most popular message in the programme was “love and respect”.

The overall programme focused on other messages also, about diet, hygiene and stimulation of the child. It was  found to have significant effects on preventing maternal depressive symptoms, improving child cognitive and receptive language and parenting practices at home.

The “love and respect” component targeted key risk factors known to be related to maternal depressive symptoms, including enhancing communication and problem-solving skills, active ways of coping, and emotional regulation. Mothers reported immediate and positive changes at home, for example, more perceived support from spouses.

While the programme was being designed, local stakeholders recommended more sessions on the “love and respect” theme than in the earlier drafts, and this was subsequently endorsed by mothers as the most popular of all key messages . (Fathers who participated were not asked by the researchers.)

The parenting programme was designed and delivered with a great deal of thought and preparation in the Lira district of Uganda. Implementation includes some of the best evaluated approaches to parent support from around the world.

The programme consisted of 12 bi-weekly sessions delivered to groups of parents aged 25 to 35 with children aged 6 to 36 months. In addition, all participating families receive one or two home visits in the latter part of the programme where implementation of the messages in the group sessions can be discussed in more detail and privately. This was reported as making the parents feel special.

The sessions cover five messages and adopt active and interactive learning approaches as opposed to a didactic approach:

• diversify the child’s diet with animal-source foods and provide three to four meals
• handwash with soap, and use latrines
• engage in two-way talk with the child using pictures
• provide home-available play materials
• love and respect yourself, your child and your spouse

The sessions were delivered by trained and supervised members of the community, an equal number of men and women, using a detailed manual with plans for each session, accompanied by a variety of material – posters, cards and take-home activity toolkits.

In order to overcome the barriers to fathers entering into a stereotypical female domain, the programme was clearly presented as something for both parents and their children, with specific recruitment measures for fathers, including involving community leaders to encourage fathers to attend sessions. Specifically, community leaders explained to fathers the objectives and benefits of the programme and how this could help them care better for their family. (Though not reported, one assumes there were also parallel discussions with mothers about the benefits of engaging fathers.) Despite this recruitment, some fathers were hesitant about attending sessions that involved children, attending more regularly father-only and father-mother-only sessions.

This programme is a strong example of family-inclusive practice, with tangible and effective elements that have been well-evaluated across the world in developed and developing countries alike.

1. The programme implements specific measures to recruit fathers in the context of a culture where roles are highly defined and childrearing is considered to be a female domain. The service does not blame fathers for not attending but takes upon itself the responsibility to make the change, and achieves this without much difficulty.
2. In engaging with fathers, the programme appeals to their motivation to support their wife, baby and family. This is a “strengths based” approach and contrasts with approaches that focus on changing fathers by pointing out how they have to change.
3. The programme focuses on joint sessions with both parents – these evaluate better than father-only approaches.
4. The sessions engage with fathers on practical childcare activities so that they both implement them themselves and support the mother doing so at home.
5. The programme focuses on how parents engage with each other – in other words, building the capacity of the “community of care”. Parenting programmes for couples that include relationship work evaluate better than those that only focus on parenting skills.
6. The programme is based on group work, which triggers peer support and community expectation of fathers as well as mothers.
7. The programme includes home visits that engage with both parents, not just one.

The researchers admit that a weakness of the research was the exclusion of fathers from the questioning. This prevented a vital user insight into the programme and may have communicated at community level that what fathers think about the programme does not matter, thereby reinforcing some of the barriers that the programme itself is so specifically tackling.

The reticence of fathers to attend sessions involving the children indicates perhaps a need to include more focus on developing the father-baby relationship, which is the thing that triggers immediate hormonal and permanent neurospsychological changes in men (as in women) to bring out their instincts to nurture and care and results in their investing more in their children (and grandchildren) long-term.

The research was carried out by Drs Daisy Singla and Frances Aboud at McGill University in Canada and Elias Kumbakumba at the Mbarara University of Science and Technology.

Singla DR, Kumbakumba E & Aboud FE (2015), Effects of a parenting intervention to address both maternal psychological wellbeing and child development and growth in rural Uganda: a community-based, cluster-randomised trial, Lancet Global Health 3

Singla DF, Kumbakumba E (2015), The development and implementation of a theory-informed, integrated mother-child intervention in rural Uganda, Social Science & Medicine