Effects of an early childhood father engagement program in Rohingya camps and host community in Cox's Bazar, Bangladesh: a cluster randomized controlled trial.

Abstract

Background: This study evaluates a 6-month early childhood father engagement intervention delivered in-person to fathers in the Rohingya camps and surrounding host communities in Cox's Bazar, Bangladesh. The intervention is an added component to an existing intervention that works with mothers of 0-3-year-old children to improve positive outcomes of child development and targets fathers with children below 3 years, with objectives to promote fathers' wellbeing by improving their emotional literacy, encouraging fathers to strengthen relationships with their spouses and children, and encouraging responsive and stimulating caregiving practices among fathers.

Methods: We used a cluster-randomized controlled trial design (total N = 2002 fathers, 786 in the Rohingya camps and 1216 in the host communities) to assess the impact of the program on fathers' parenting and engagement with family (reported by both fathers and mothers), fathers' mental health, and child development.

Results: We find that the program has a positive impact on the fathers' parenting (father reported) and engagement with family (father and mother reported), as well as on father-reported child social-emotional development, compared to the mother-only program. While the program did not have a main effect on directly assessed child development outcomes, we do find that baseline mother-reported stimulation with child and mother health moderate the impact on father-reported child social-emotional development in the camp community (larger positive impacts for fathers from households with lower baseline mother-reported stimulating behaviors and health). We also find that child gender and mother-reported stimulating behaviors moderate impacts on multiple mother-reported child developmental outcomes in both host and camp communities (treatment effects on these outcomes were negative for boys and positive but weak for girls, and larger positive impacts on mother-reported motor development were found among mothers from households who reported lower stimulation at baseline). Additionally, child age moderates the impact on fathers' collaboration with the mother (reported by the mother), such that the treatment effect is larger for mothers of older children.

Conclusions: Our findings demonstrate the potential of father-focused programs as powerful caregiver interventions.

Trial registration: Pre-registered with REES (13880.1v2); retrospectively registered at ISRCTN (ISRCTN13510859).