Blueprint for Enhancing Implementation Quality of Criança Feliz Program in Brazil: A Combined Program Impact Pathways-ERIC Approach.

Abstract

Brazil's Criança Feliz Program is one of the largest early childhood development home-visiting programs globally. After seven years of scaling up, implementation barriers across diverse municipality settings prevented the program from achieving the intended impact on parenting skills and child development. We conducted a program impact pathway analysis to generate a blueprint to enhance implementation quality by (1) identifying the critical quality control points that need to be monitored throughout the scaling up and (2) specifying implementation strategies for enhancing implementation quality. The program impact pathway analysis consisted of inductive and deductive coding of pre-existing retrospective (e.g. reports, and codebooks from in-depth interviews) and workshop with national team to identify the critical quality control points and corresponding implementation barriers and facilitators. The Expert Recommendations for Implementation Change taxonomy was used to specify implementation strategies facilitating the scaling up or opportunities to address barriers across critical quality control points. We identified seven critical quality control points: hiring municipal workforce; staff training; home visits; complementary multisectoral actions; municipal supervision; technical assistance and monitoring; and funding. Implementation strategies facilitating the scale-up were "providing assistance" and "supporting teams;" opportunities for enhancing implementation quality were "financial strategies" and "evaluative and iterative strategies." Our analysis identified seven critical quality control points necessary to achieve the intended implementation and program outcomes. The combined use of the program impact pathway and the Expert Recommendations for Implementation Change taxonomy generated a meaningful blueprint of implementation strategies to enhance implementation quality, which may support the sustainability of a large-scale program.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-024-00141-7.