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Sierra Leone has set ambitious 2030 Sustainable Development Goal (SDG) targets for child development, supported by the 2021 National Policy on Integrated Early Childhood Development. This policy mandates multisectoral support for early learning, health, nutrition, and responsive caregiving. However, Sierra Leone lags behind sub-Saharan African peers in child survival and protection due to the legacy of civil war, the Ebola and COVID-19 pandemics, and climate-related emergencies. Scalable solutions are urgently needed to promote nurturing care and prevent violence. The Family Strengthening Intervention for Early Childhood Development and Violence Prevention (FSI-ECD+VP) is a 12-session home-visiting program proven to improve child outcomes in conflict-affected settings. This paper documents the systematic process of adapting and testing this intervention in Sierra Leone.
Methods:
To guide the adaptation process, we leveraged the Assessment, Decisions, Administration, Production, Topical experts, Integration, Training staff and Testing (ADAPT-ITT) framework (Wingood & DiClemente, 2008). Following the ADAPT-ITT framework served to center the unique context of Sierra Leone during the adaptation process and deepen local engagement and commitment. This adaptation pilot was evaluated through a mixed-methods open trial. Forty households with children aged 0-36 months participated in a pre-post quantitative assessment. The quantitative tools examined changes in parenting practices, child stimulation, health behaviors, caregiver mental health, and intimate partner violence. To complement the quantitative assessment of the pilot adaptation, qualitative data were collected through semi-structured interviews with six caregivers and six interventionists. These interviews were designed to explore participants’ experiences with the FSI-ECD+VP modules.
Results:
High program adherence was observed, with 38 families completing all 12 sessions. Qualitative findings indicated high satisfaction, with participants highlighting benefits in the areas of family unity, hygiene, and caregiver-child interactions (e.g., play). Quantitative results showed positive trends in early learning and responsive caregiving behaviors and dietary diversity for children, as well as decreases in physical victimization by intimate partners at post-test.
Conclusions and Implications:
The ADAPT-ITT process provided a useful framework for culturally adapting the FSI-ECD+VP program for the context of Sierra Leone. The multistep, consultative progress supported the study team in developing a culturally relevant curriculum that aligned with the priorities of the MBSSE and contained relevant content for families with young children. In addition, the findings from this pilot study provide encouraging evidence that the culturally adapted FSI-ECD+VP intervention can be feasibly delivered by preschool teachers to improve caregiving behaviors in Sierra Leone.