An Analysis of Behaviour Change Techniques used in the Care for Child Development Parenting Program

Care for Child Development (CCD) is one of several parenting programs implemented in low- and middle-income countries to improve child cognitive development outcomes by increasing responsive stimulation practices in caregivers of young children. Broadly, these programs have been demonstrated to be effective. However, there is markedly little high-quality evidence for the effectiveness of CCD. Despite this, CCD is promoted by UNICEF and the World Health Organisation as an evidence-based program and is implemented in many countries. We conducted a scoping review, including grey literature and a systematic search of published literature, to obtain an overview of the available evidence. We also performed an analysis of two quantitative outcomes, child cognitive development and caregiver behaviour, to investigate their correlation with behaviour change techniques used in CCD program implementation. We found no significant correlation between any behaviour change techniques and child cognitive development outcomes. There was a significant correlation between the techniques of performance and social support, as well as the total number of techniques used, and caregiver behaviour outcomes. This analysis was limited by the quality of reported data available about the program; of 27 total identified papers, only 14 reported quantitative data regarding either child cognitive development or caregiver behaviour change. Inconsistent reporting of this data required us to use a rating system to perform our analysis; we consequently lost specificity. Even those papers that did report quantitative data were subject to methodological flaws; the measures and study designs used did not always inspire confidence in their results. We concluded that CCD is not one single, well-defined program, and that there is an important distinction to be made between CCD-based and CCD-informed programs. The generic Care for Child Development Package (2012) is a framework that contains too many gaps to be easily adaptable. Not enough high-quality studies of this program are available to draw concrete conclusions concerning its effectiveness, in whole or in part.