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      A qualitative analysis of the nurturing care environment of families participating in Brazil’s Criança Feliz early childhood program

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          Abstract

          Investing in early childhood programs such as Brazil’s Criança Feliz Program (PCF) to support low-income families in providing a nurturing care environment is critical to ensure that children reach their full developmental potential. We aimed to analyze the influence of the PCF on the nurturing care environment provided by families enrolled in the program in the Federal District, Brazil. A qualitative case study was conducted based on in-depth interviews with a purposive sampling of 22 caregivers enrolled in the PCF for at least six months. Eighteen subthemes emerged from the thematic analysis following the five components of the Nurturing Care Framework (i.e., good health, adequate nutrition, responsive care, early learning, and security and safety). Caregivers recognized the benefits of the PCF on children’s mental health ( good health) and reported challenges in providing adequate nutrition due to food insecurity ( adequate nutrition). A bond between the home visitor and families was identified as critical to promote responsive parenting practices ( responsive care). Caregivers appreciated the early stimulation activities provided during PCF home visits ( opportunities for early learning). Access to social welfare programs, such as conditional cash transfer and food assistance, were facilitated through PCF multisectoral actions ( safety and security). On the other hand, families reported not receiving support from PCF for issues such as breastfeeding, maternal mental health, and disciplinary practices. In summary, PCF enhanced the components of the nurturing care environment provided by families. However, their vulnerabilities and contextual implementation barriers may prevent families from fully benefiting from PCF activities.

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          Most cited references33

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          Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

          Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
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            Qualitative data analysis for health services research: developing taxonomy, themes, and theory.

            To provide practical strategies for conducting and evaluating analyses of qualitative data applicable for health services researchers. DATA SOURCES AND DESIGN: We draw on extant qualitative methodological literature to describe practical approaches to qualitative data analysis. Approaches to data analysis vary by discipline and analytic tradition; however, we focus on qualitative data analysis that has as a goal the generation of taxonomy, themes, and theory germane to health services research. We describe an approach to qualitative data analysis that applies the principles of inductive reasoning while also employing predetermined code types to guide data analysis and interpretation. These code types (conceptual, relationship, perspective, participant characteristics, and setting codes) define a structure that is appropriate for generation of taxonomy, themes, and theory. Conceptual codes and subcodes facilitate the development of taxonomies. Relationship and perspective codes facilitate the development of themes and theory. Intersectional analyses with data coded for participant characteristics and setting codes can facilitate comparative analyses. Qualitative inquiry can improve the description and explanation of complex, real-world phenomena pertinent to health services research. Greater understanding of the processes of qualitative data analysis can be helpful for health services researchers as they use these methods themselves or collaborate with qualitative researchers from a wide range of disciplines.
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              Nurturing care: promoting early childhood development.

              The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Writing – original draft
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 July 2023
                2023
                : 18
                : 7
                : e0288940
                Affiliations
                [1 ] Postgraduate Program in Human Nutrition, University of Brasilia, Brasília, Federal District, Brazil
                [2 ] Postgraduate Program in Public Health, University of São Paulo, São Paulo, Brazil
                [3 ] Graduate in Nutrition, University of Brasilia, Brasilia, Federal District, Brazil
                [4 ] Department of Human Nutrition, University of Brasilia, Brasilia, Federal District, Brazil
                [5 ] Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
                [6 ] Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, United States of America
                Universidade Federal do Espirito Santo, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-6008-0987
                Article
                PONE-D-23-10075
                10.1371/journal.pone.0288940
                10355381
                88caef85-d2bd-4020-a495-746c7389213a
                © 2023 dos Santos et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 April 2023
                : 6 July 2023
                Page count
                Figures: 2, Tables: 0, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100009633, Eunice Kennedy Shriver National Institute of Child Health and Human Development;
                Award ID: R00HD097301
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100005668, Fundação de Apoio à Pesquisa do Distrito Federal;
                Award ID: 498/2021
                Award Recipient :
                Funded by: National Council for Scientific and Technological Development (CNPQ)
                Award Recipient :
                L. M. T. D. Santos received scholarship from the National Council for Scientific and Technological Development (CNPQ). VSSG received support for the data analysis of the interviews carried out in the Federal District from the Federal District Research Support Foundation (FAPDF) under number 498/2021 - FAPDF/SUCTI/COOTEC. GB received support for designing and conducting this study from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R00HD097301. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is the sole responsibility of the authors and does not necessarily represent the official opinion of the funders.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Caregivers
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Medicine and Health Sciences
                Mental Health and Psychiatry
                People and places
                Geographical locations
                South America
                Brazil
                Social Sciences
                Sociology
                Social Welfare
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Biology and Life Sciences
                Nutrition
                Diet
                Food
                Medicine and Health Sciences
                Nutrition
                Diet
                Food
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Custom metadata
                A de-identified data set is not possible to provide due to ethical and legal considerations. These sharing restrictions are imposed by the University of Nevada, Las Vegas Institutional Board Review (IRB). The authors declare that a de-identified data set from this study are available upon request directly to UNLV IRB ( irb@ 123456unlv.edu ).

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