Edited by: Jane Fisher, Monash University, Australia
Reviewed by: Stacie Craft DeFreitas, University of Houston–Downtown, United States; Joshua Jeong, Harvard University, United States
This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health
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This paper describes the development of the Irie Homes Toolbox, a violence prevention program targeting parents of children aged two to six years. The intervention was designed to complement an existing, teacher-training, violence prevention program, the Irie Classroom Toolbox, thus promoting an integrated approach across home and school settings. The Irie Homes Toolbox was developed through a four-stage process by integrating data from theory, formative research, and practice to ensure the intervention is acceptable, feasible, relevant, and effective in the context. The perspectives of Jamaican preschool teachers and parents of preschool children, who are the end users, were integrated into the design of the intervention throughout the development process. Stage one involved integrating theory and formative research to inform the initial intervention design. Stages two and three involved iterative cycles of design, implementation and evaluation of the intervention content, process of delivery, structure and materials. Stage four involved a further cycle of learning through a process evaluation conducted as part of a cluster-randomized controlled trial. Data from each of these four stages was used to inform the design and ongoing revisions of the toolbox with the aim of developing a low-cost, scalable and sustainable intervention for the Jamaican context. The resulting program is theory-informed and uses empirically derived content and behavior change principles operationalized for the context in which it will be delivered. The Irie Homes Toolbox is suitable for integration into the existing preschool provision in Jamaica, thus utilizing an existing service and existing staff and increasing the likelihood for wide-scale dissemination.
Globally, violence against children exists in almost all countries with the violence often being committed by caregivers (
Parenting interventions are a key strategy used to prevent violence against children (
Jamaican parents regularly use verbal aggression and physical punishment to discipline their children (
Integrating such programs into existing services would promote parent participation and program sustainability. The most common services accessed by parents of young children are the health and education sector. For example, a parenting program for parents of two to six year old children, implemented in child health clinics in Iran decreased dysfunctional parenting practices and child physical and emotional abuse (
Jamaican preschools cater to children aged three to six years and over 98% of young Jamaican children attend preschool. Training Jamaican preschool teachers in appropriate discipline techniques has shown benefits to teachers' child behavior management practices (
Developing a complementary parent-training program to be implemented in preschools is a logical next step and has the potential for near universal coverage. Integrating the Irie Homes Toolbox into the services offered to parents through community preschools maximizes on this training of preschool teachers as (1) teachers trained in the Irie Classroom Toolbox can deliver the intervention with the parents, and (2) it promotes an integrated approach across home and school settings. In addition, integrating training in violence prevention into early childhood educational services will promote a high quality caregiving environment for young children that is safe, secure, and nurturing, in addition to providing cognitive stimulation. Provision of integrated violence prevention and early childhood development interventions thus promote child development across multiple domains, address multiple risk factors, and help children develop to their full potential (
This paper describes the development of the Irie Homes Toolbox, a violence prevention parenting program for parents of children aged two to six years. The main aims of the Irie Homes Toolbox are: (1) to prevent violence against children by parents/caregivers of young children, (2) to promote positive parenting practices including positive discipline, and (3) to prevent the early development of antisocial behavior in young children. The Irie Homes Toolbox was developed as a complementary program to the Irie Classroom Toolbox to promote an integrated approach to child behavior management across home and school settings. It was developed to be integrated into the existing preschool network and to be suitable for implementation by preschool teachers. Preschool teachers have regular contact with parents and are ideally placed to engage parents in a parent-training program being conducted at school. “Irie” is a Jamaican word that describes feeling at peace and in harmony with oneself and with others.
The Irie Homes Toolbox was developed over fifteen months using the framework of the UK Medical Research Council Guidance on Developing and Evaluating Complex Interventions (
Stages in the development of the Irie Homes Toolbox.
In stage one, conducted in December 2017 and January 2018, we integrated evidence from theory, empirical research studies and the perspectives of Jamaican parents. The first step involved identifying the core components of evidence-based parenting programs related to both the content and methods of implementation (
The common core components of evidence-based parenting interventions and the components of the Irie Classroom Toolbox relevant to parents are shown in
Core content and behavior change techniques used in parenting interventions to prevent and/or treat child disruptive behavior and child maltreatment and in the Irie Classroom Toolbox.
Knowledge of child development Parent-child relationship building Child-led play Praise Rewards Promoting children's social skills Giving commands Setting rules Ignoring negative behavior Timeout Consequences Anger management Emotional communication (understanding, identifying and labeling emotions) Parent-self management Consistent responding |
Praise Rewards Choices Responsibilities Coaching/narrating Interactive reading Clear Instructions Teaching required skills Emotion regulation Anger management Redirect Withdraw attention Consequences Discipline hierarchy |
Psychoeducation Role-plays, practice and rehearsal Demonstration and modeling Positive and supportive feedback Problem solving Practicing with own child Assigning homework Providing materials Reviewing goals and progress |
Modeling Demonstrations Role-plays, practice and rehearsal Positive and supportive feedback Goal setting Collaborative problem-solving Classroom assignments Providing resources Group/peer support |
How parents' interview responses were used in the development of the intervention.
Common misbehaviours and reasons for slapping child | • Practice activities were designed to demonstrate and practice how to teach desired skills to children (e.g., how to pack up toys, how to put toothpaste on a toothbrush, how to put dirty clothes in the wash basket). |
Instructions given to child repeatedly | • The phrases reported by parents were used to design role-plays to help parents to give clear instructions. The role plays involved the facilitator using common ineffective instructions (e.g., “Behave yourself,” “settle down,” “relax yourself,” “stop doing that”) and the parents would problem-solve how to change the ineffective to an effective instruction. |
Typical games/toys children play with | • The parental responses informed the play materials that would be used in the program. These included coloring, blocks, cars, animals, kitchen set, and picture books. |
Words used to praise and to reprimand child | • These words were used in the dialogue for role-plays. This ensures the content was relatable to parents. |
Household routines, common activities and common issues | • Visual aids were developed to depict everyday routines of children and parents (e.g., eating breakfast, bathing, brushing teeth, getting dressed) and common household chores (e.g., washing clothes, making dumplings, sweeping). These visual aids were used to encourage parents to think about (1) what they can say to their child, (2) what they can praise their child for, (3) what skills they can teach their child, (4) how they can involve their child, and (5) how they can promote choice and independence. |
Theory of change.
The aim of stage two was to undertake preliminary piloting of the intervention content and methods of implementation to produce a first draft of the intervention. The activities for stage two were conducted in February and March 2018. We continued to work within the same four community preschools that participated in stage one and convenience samples of five to twelve parents were invited to participate in sessions. The majority of participants were mothers although four fathers and one grandfather were included in the sample. Sessions were conducted at the beginning of the school day. Each individual session was piloted twice with different groups of parents, with ongoing revisions based on lessons learnt during each session. During these sessions one member of the team delivered the content while another team member made notes on: (1) parents' engagement, level of understanding, ability to use the strategies, and what content resonated within the group, (2) ideas for materials and visual aids that would help to promote parents' understanding and engagement, (3) session logistics including session structure, duration and optimal group size. Throughout the process of piloting the sessions, we used the following guidelines to inform our decision making and note taking:
Be reflective: constantly think of ways to improve the acceptability, feasibility, relevance, and effectiveness of the program.
Evaluate whether parents understand and are able to use the concepts introduced and plan how their knowledge and skills can be improved.
If something does not work, or does not work well, problem solve in real-time. Try a different approach and document what happens.
Pay close attention to the group vibe; if it's flat then something is wrong. Identify ways to maximize participation, fun, and interest.
Pay attention to individuals in the group, ensure all are participating.
Make note of scenarios that resonate with the group.
Note parents' strengths and needs throughout the session.
Note examples that parents give and use their comments and ideas to revise the content and delivery of the program.
After each session, the notes were discussed among the research team and decisions made to increase the acceptability, feasibility, relevance, and effectiveness of the intervention. These decisions were incorporated into the relevant session prior to piloting the session with a different group of parents.
Decisions made to improve the acceptability, feasibility, and relevance of the intervention.
Fun and engaging | • Session structure incorporates variety to maintain interest. |
Acknowledges parents' strengths | • Parents share positive strategies they are using and are praised for using them. |
Parents see benefits to themselves and their child | • Brainstorms and discussions are done to point out benefits of the strategies. |
Logistics of session: timing and duration | • The sessions are conducted at a convenient time: either in the mornings when parents drop off their child or in the afternoon after school, depending on the availability of parents in the group. Sessions are conducted while the child is at school so they don't need to arrange for child care. |
Minimum equipment required to conduct intervention | • All visual aids were designed to be hand-held and we choose not to use a flip-charts and a flip chart stand to display materials or to scribe parents' responses. |
Parents are able to use strategies in their daily lives | • Content presented easily fits into parents' daily routines with their children. |
Individualizing the content | • Parents are encouraged to share any difficulties faced with their use of the strategies at home and to engage in group problem-solving. |
Scenarios/examples resonate with parents | • Incorporate content that resonated with parents the most. |
Include content related to homework | • As the parenting intervention is designed to be integrated into the services provided by preschools, we included a session on how parents can support their child's homework. This included content on homework routines, explaining the task, scaffolding their child, and providing positive and corrective feedback. |
Decisions made to improve the effectiveness of the intervention.
Logistic of session: group size | • The group size is small (6 participants) so that each participant gets an opportunity to practice skills with individual support. |
Parent understanding of skills and using the strategies | • Facilitators model the use of the strategies throughout the sessions. |
Parents are motivated to use the strategies | • Parents are given positive feedback when they use the strategies in the group and when they share how they used the strategies at home. |
Parents use strategies at home | • Home assignments are given that encourage parents to use the strategies at home. |
Parents can generalize to a variety of situations | • Parents set individual goals of how they will use the strategies across different context and situations. This encourages parents to consider how the strategies can be integrated into their daily lives and increases the chances of them using it. |
Collaborative, supportive/non-critical | • Parents are encouraged to openly share their struggles with parenting and to engage in group problem-solving. |
Session structure | • In addition to discussions, demonstrations, practice, and rehearsal with the parents, we decided to include the opportunity for parents to also practice the child-led play activities with their child as an integral part of each session. During this practice activity, parents receive support, and feedback from the facilitators. |
A core component of the intervention is to encourage parents to engage in daily child-led play or Irie Time. To ensure parents had the resources available to do this, we decided to include a toy or book in the materials given to parents after each session. We choose toys that facilitated free-play such as blocks, cars, animals and a pretend play set, rather than structured toys such as puzzles, and matching games. We also included three wordless picture books. Two of these books were adapted from the Reach Up and Learn parenting intervention, additional details, and extra pictures were added to make them more suitable for the older child age range targeted in this intervention (
By the end of stage two, we had developed an initial draft of the content and process of delivery of the intervention and designed the intervention materials (for example, picture cards, charts, take-home cards for parents, homework assignment record forms for parents, picture books) to be tested in stage three.
The first draft of the Irie Homes Toolbox produced through stage two activities consisted of eight 90-min sessions. The full program was then piloted in five new community preschools from April-June 2018. The ultimate goal is for the Irie Homes Toolbox to be delivered by preschool teachers who have been trained in the Irie Classroom Toolbox, hence it was important to include the perspectives of preschool teachers in the development of this parenting intervention. We invited preschools whose teachers had participated in the Irie Classroom Toolbox training to assist us (
Refinements made to the content, delivery, materials, and structure of the intervention in stage three.
Additional content: included content that would explicitly benefit parents | • Self-praise: each week parents share one thing they are proud of as a parent. This was necessary as we recognized that the parents found it difficult to identify and verbalize their positive parenting skills. |
Content misunderstood/hard to grasp: refinement included: changing the delivery format or including an additional mode of delivery to better elucidate the concept. | • Include additional demonstrations by the facilitator prior to having the parents role-play a skill when necessary. This ensured the parents had a better understanding of how to use the strategy prior to participating in the activity. |
Session structure: include a structured feedback section in each session where parents share how they completed the home assignment. | • More structure was given to the feedback part of the session to encourage parents to do the home assignments. Each parent shared how they used the strategies at home, using the weekly record sheet as a guide. This demonstrates the importance of completing the assignment and shows that it is expected that program participants engage with the material at home. |
Additional materials: irie parent oath, irie tower | • At the end of the final session of the program parents sign an oath that they will continue to be an Irie Parent and use the strategies learnt. The oath is designed to help parents self-identify as an Irie Parent. |
Building in redundancy | • We revised the parent training scripts to ensure that the key concepts are reinforced as often as possible in every session. |
Additional training guidelines for the co-facilitator | • To promote the engagement of the co-facilitator in the parent sessions, we designed a structured, scripted role in the session for the co-facilitator which was made explicit in the script. This role included participating in role plays and demonstrations, prompting, and coaching parents as they practiced the activities, promoting parent engagement, and assisting parents as they practiced with their child. |
Acceptability, feasibility, relevance and effectiveness of a behavior change intervention.
The most effective recruitment strategies involved working through the teachers and/or school principal rather than the research team recruiting parents directly. Three of the parents recruited directly by the research team decided they no longer wanted to participate before the program commenced and four parents attended only the first session. These parents were replaced by parents recruited through their child's teacher and/or the school principal. The average attendance of the participating parents was 81% (range 50–100%). We also found that the collaborating teachers would rarely attend the entire session and would leave the sessions frequently to attend to other duties. To promote teacher engagement, we therefore included a structured and scripted co-facilitator role for the teacher in the revised intervention as shown in
The intervention was tested in a cluster-randomized trial in eighteen community preschools that had not participated in stages one to three. The parenting sessions were implemented during the period September 2018 to April 2019. Preschools were selected to participate in the trial based on the following criteria: (1) had participated in the Irie Classroom Toolbox training and had two or more Irie trained teachers still working at the school, (2) were interested in participating in the program, (3) had parents who consistently dropped children and/or picked up children from school rather than a driver, (4) had no other structured parenting program currently operating, and (5) the principal and all teachers in the school consented to participate in the study. Nine preschools were randomized to participate in the parenting intervention and an ongoing process evaluation was conducted. Parents were recruited at the school by the research team with the help of the teachers and principal. A minimum of six parents were recruited from each school in the Autumn term and an additional six recruited in the Spring term resulting in a minimum total of 12 parents per school. The inclusion criteria for parents were: (1) interested in participating in the program, (2) able to stay back for 90 min either in the morning after dropping off their child or in the afternoon when they came for pick-up one day a week, and (3) parent gave consent for him/herself and his/her child to participate in the study. The quantitative results from the trial will be reported separately. In this paper we are focusing on the process of developing the intervention. One hundred and fifteen parent-child dyads participated in the intervention. The children were aged two to six years old with a mean age of four years; 52.2 % of the sample were boys. Caregivers had mean age of 31 years, 104 (90.4%) were mothers, two (1.7%) were fathers, and nine (7.8%) were other relatives. Less than half the parents completed high school (46%) and 43% were in paid employment. The ultimate aim is for the preschool teachers to implement the intervention. However, in this small-scale efficacy trial we wanted to assess the effectiveness of the program when delivered consistently and with high fidelity; when the intervention is delivered by teachers the quality of implementation may be more variable. Hence, a member of the research team delivered the intervention. Each school principal allocated one preschool teacher to assist the research team by co-facilitating the parenting session. This ensured that we were able to continue integrating the perspectives of the preschool teachers, into the program design. Parenting sessions were held on the school compound (in the school yard or any available room), once a week for eight weeks and lasted 90 min.
The ongoing process evaluation included a quantitative and qualitative component. The quantitative component included recording parent and teacher attendance. For the qualitative component, after each session the facilitators (including the preschool teacher) discussed the session together and then the main facilitator completed a record form that documented enablers and barriers related to: (1) the content of the session (for example, what resonated with parents and what was more difficult), (2) the process of delivery (for example, techniques parents enjoyed the most and least), (3) the context in which the session was delivered (for example, logistics and environment), (4) the involvement of the children, (5) teachers' co-facilitation of the sessions, and (6) facilitators' skills in delivering the session. Notes were also made on individual parents' engagement, understanding, strengths, and needs. Facilitators noted their perceptions of which strategies were most acceptable, feasible, relevant, and effective and suggested solutions to any problems encountered in implementing the intervention. The information from the facilitator record forms was used to further refine the Irie Homes Toolbox.
In addition to the ongoing process evaluation, in-depth, individual, semi-structured interviews were conducted with a subsample of participating parents (
Parental attendance averaged 71.5% in round one (Autumn term) and 67.1% in round two (Spring term). 61.8% parents attended six or more sessions with 28.7% all eight sessions. We documented the reasons for parent non-attendance and 79% of the absences were rated as legitimate. Legitimate absences were absences that were deemed unavoidable such as: clinic/doctor visit, called in to work unexpectedly, child being sick, unchangeable appointments, and meeting at older children's school. Teachers co-facilitated a mean of 7.1 (SD 0.9) sessions in round one (the Autumn term) and 3.4 (SD 2.8) sessions in round two (the Spring term). In the Spring term, teachers had many competing activities and responsibilities and attendance was more challenging. In addition, teachers were confident that the facilitator would continue to conduct the sessions if they were absent and this also led to reduced attendance, especially in the face of competing activities.
Facilitators made notes of multiple instances that supported the fact that the intervention developed was acceptable, feasible, relevant, and effective to the participants. In terms of acceptability it was noted that parents would consistently laugh and have fun with the games, role-plays, and visual aids presented. Parents were eager and willing to participate in the different activities during the sessions and they would incorporate their own personality and flair to the activities further confirming their acceptability. The feasibility of the strategies was shown through the parents' reports on how they used the strategies at home in different situations. The relevance of the intervention was illustrated through the discussions in which parents shared instances of issues they were experiencing with their child and would provide examples of how the strategies helped them at home. Throughout the sessions, facilitators documented evidence of effectiveness including parents being able to use strategies with little to no prompting and becoming more confident and skilled in using the strategies as the weeks progressed.
Parents' perceptions of the benefits of the Irie Homes Toolbox.
Parent is better able to regulate emotions | • “It help me because I can look at myself and say alright I am going to try to control my anger, I'm going to try to control my temper, I am going to try and control my emotions.” |
Parent bonds more with child | • “It make me spend more time with them and help me to identify when something is wrong with them and it also helps to meet their needs more.” |
Parent uses less violence against children | • “I stop beating I just start putting him in the corner. I just used to lick (hit) him for.every little thing and I just stop do that and put him in the corner …so I realize that beatings don't have anything to do with it cause you beat them and them still not going to hear.” |
Increased confidence and pride in parenting skills | • “It help me as a mommy, it make me feel proud of myself as a mother.” |
Increased autonomy and responsibility | • “Yeah because all shoes them now, she put them under the dresser plus her dirty clothes, she put it in the basket without me have to tell her.” |
Increased participation in chores | • “She sweep out the room, she will spread up the bed. Sweep off the veranda, just to get praise.” |
Increased level of compliance by child | • “If you tell her to sit down she listen, it change her a whole heap because first time me talk to her she doesn't listen.” |
Decrease in occurrence of tantrums and/or disruptive behaviors | • “…he is more calmer, he know how to share like it helps, even with the blocks. Instead of jumping up and down and doing things that is not right to get your attention.” |
Program promotes positive behavior and emotions | • “He would do more good things to get your attention, so he wants to be good cause he wants your attention so you get less trouble and more good.” |
Teachers' perceptions of the benefits of the Irie Homes Toolbox.
Parents show better emotional self-regulation | • “I realize that … they were better able to manage their emotions so they were calmer and I saw it in how they dealt with the children.” |
Parents praise their child more | • “Praising the child more, they actually praise the child a lot more now. |
Increased parental interest in school activities | • “You are now seeing the parents having more interest in how their children learn and the things that they do.” |
Stronger parent/child relationship | • “Parents are spending more time with the child…interacting and getting to know their child, and know what their child is about.” |
Parents use less violence against children | • “Instead of shouting at the child, screaming at the child, barking at the child and the licking, once they started learning how to manage the behavior, that gradually went.” |
Children have fewer behavior difficulties | • “He [child] has changed because him nuh fling down himself anymore … Him nuh throw down and carry on, no tantrum nuh throw, nuh nothing.” |
Children show increased confidence | • “It has built their confidence because like before some of them would've been a little bit more on the reserve side now they're interacting more, they're talking out more” |
Children show increased autonomy and responsibility | • “Yeah they are excited, always wanting to do something all when nothing is on the floor they are sweeping. Yeah, they just want to be helpful.” |
Teachers have increased emotional self-regulation | • “So it actually show me. how to manage my emotions, do not lose temper, being in control, it actually help me to do that.” |
Teacher uses less violence against children at home and at school | • “So interacting with this program it has now rounded me a little bit more on how to effectively parent without administering slaps.” |
Teacher increased use of other strategies from the Toolbox at home and at school | • “It help me with the praising, the modeling, knowing each child in the classroom, so praising and awarding them like that is one of the biggest things for my class, and withdrawing attention.” |
Stronger parent-teacher relationships | • “We work together and anything they can come to me and they can talk with me, they can send messages, they write notes. We have a communication.” |
Teacher shows more empathy toward parents | • “So things that I took for granted that they knew, they really didn't know. It was like an eye opener and it taught me how to be a little more patient and tolerant with them.” |
Areas of the intervention requiring revision as extracted from the process evaluation tool and changes made in stage four.
A core component of the program is the use of modeling (that is being a role model for your child). The strategy modeling was not explicitly introduced, it was discussed and explained when it came up organically during a session. | • Incorporate content in the intervention so that it is explicitly addressed. |
Parents sometimes missed a session and the sessions are cumulative. Therefore, a strategy to ensure parents can catch up is required. | • During the feedback portion of the sessions, prompt parents to demonstrate how they used the strategies at home, instead of simply discussing it. This ensures that parents who have missed a session see a demonstration of the skills. |
Games were used to introduce some skills and parents sometimes had difficulty generalizing the skills used in a game to an activity with their child. | • After playing the game, conduct a brainstorm of different things parents can say and do with their child during the activity. |
For some of the practice activities, parents needed additional scaffolding before being asked to practice the activity themselves. | • Develop different delivery methods to make the skills clearer. For example, incorporate additional demonstrations, provide clear and simple guidelines of the steps demonstrated, use a visual aid showing the strategy in use, and/or brainstorm with parents what they can say or do prior to asking them to practice the activity. |
There were times when parents were less engaged with the material in the sessions. | • Make adaptations to maximize parent participation by revising the delivery mode for the content to make it more fun, engaging, and interactive. |
Labeling children's emotions was a relatively new concept for parents and they often reported that they did not use this strategy at home. | • Develop additional practice activities in labeling emotions and include additional emphasis on the rationale for labeling children's emotions so that parents view this as important. |
Although the simple and clear guidelines outlining the steps in using a strategy were generally helpful, some parents stuck to the guidelines too rigidly and missed opportunities to expand their interaction with child. | • Facilitators need to make it clear that the guidelines can be used like a recipe. The steps provide the overall structure and parents can add additional steps to it according to their child's interests, needs, and responses. |
In the session that included problem-solving activities around managing child misbehavior, parents often chose the same three strategies (clear instruction, chillax, and consequences), rather than using the full range of skills introduced in the program. | • Develop a wider variety of child misbehavior scenarios to ensure there is a good match for each strategy introduced through the program. |
Parents sometimes found it difficult to see things from their child's point of view. | • Provide additional opportunities for parents to play the role of the “child” especially in situations in which they were less empathic. |
The intervention developed through the four stages of this study is a violence prevention program for parents of children aged two to six years called the Irie Homes Toolbox. The main goals of the program are to prevent and/or reduce parents' use of violence against children, increase positive parent-child interaction, and prevent and/or reduce child externalizing behavior problems. The Irie Homes Toolbox is a group-based parenting program consisting of eight sessions, each lasting 90 min, delivered once a week for eight weeks. Each of these eight sessions follows a set structure that includes (1) a game or song, (2) feedback from the previous week including a discussion of the home assignment, (3) introduction of a new topic consisting of discussions, role plays, demonstrations, rehearsal, and practice, (4) introduction of a child-led play or picture book reading activity with demonstration, rehearsal, and practice, (5) practicing the child-led play or book activity with their child with supportive feedback, and (6) review, goal setting, and allocating homework assignment. The toolbox consists of content divided into five modules (1) promoting positive behavior, (2) preventing misbehavior, (3) understanding emotions, (4) managing misbehavior, and (5) supporting homework (
Session content of the Irie Homes Toolbox.
1 | Praise | Paying attention to your child's positive behavior. |
Coloring |
2 | Praise throughout the day | Giving your child positive attention during daily activities by describing what your child is doing and responding to your child. |
Blocks |
3 | Clear instructions | How to give your child clear instructions. |
Picture book (My School Day) |
4 | Why children misbehave and teaching household rules | Understanding the reasons for child misbehavior. |
Blocks and animal |
5 | Emotions | Understanding how your own emotions affect the way you respond to your child's behavior. |
Picture book (My Emotions) |
6 | Managing misbehavior 1 | Redirecting your child's attention and behavior. |
Blocks, animals, and a vehicle |
7 | Managing misbehavior 2 | How to use Chillax (timeout for misbehavior). |
Pretend play (kitchen set) |
8 | Helping with homework | Establishing a homework routine. |
Picture book (My Day with Mommy) |
The Irie Tower: pictorial representation of the strategies introduced in the Irie Homes Toolbox. The base of the tower (green blocks) are strategies to promote positive behavior and to build a positive parent-child relationship. The yellow blocks are strategies to prevent child misbehavior. The orange and red blocks are strategies to manage child misbehavior. Parents are encouraged to use the strategies in the two bottom rows liberally and the strategies in the top rows more sparingly.
Examples of resources used in the Irie Homes Toolbox.
The Irie parent oath.
The development of the Irie Homes Toolbox was guided by theory, evidence, and practice. Through a series of four stages, the intervention content, materials, structure, and process of delivery was tested through an iterative and cyclical process of design, implementation and evaluation with the aim of producing a parenting intervention that was acceptable, feasible, relevant, and effective in the context. The resulting intervention: (1) is theory-informed and incorporates evidence-based content and evidence-based behavior change principles, (2) was developed with participation of Jamaican parents and teachers who are the end users, and (3) was designed to be low-cost and integrated into the existing preschool network thus promoting wider dissemination and sustainability. Evidence from stage four showed that parent attendance and retention in the intervention was good indicating that the intervention was acceptable to parents. Parents and teachers reported benefits to parenting and child behaviors that were targeted through the intervention. Specifically, this included: (1) parents using less violence against children and spending more time building a positive relationship with their child, and (2) children displaying more positive behaviors and fewer behavior difficulties at home and at school. These perceived benefits indicate that parents understood and were willing and able to use the strategies taught through the program, providing evidence for feasibility, relevance, and the perceived effectiveness of the intervention. Parents reported greater confidence in their parenting skills which is likely due to the positive, supportive, and non-critical nature of the program in combination with the changes that they perceived in their own and their children's behavior. The advantages of integrating the intervention into the preschool network were evident as teachers reported benefits to their relationship with the parents and to parents' interest and engagement in school activities. There was also evidence that teachers' involvement in delivering the Irie Homes Toolbox reinforced and enhanced their previous training in the Irie Classroom Toolbox as they reported increased use of appropriate child behavior management strategies in the classroom, in addition to with their own child(ren). The fact that teachers reported benefits to their own personal and professional life is promising as interventions are most likely to be sustained when there are clear benefits to the persons delivering an intervention, in addition to the intended beneficiaries (
There are three broad categories in the literature for the development of behavior change interventions that involve: (1) transporting an existing evidence-based program for use in a new cultural and/or economic context [for example, (
The Irie Homes Toolbox incorporates the use of evidence-based behavior principles with a particular emphasis on behavior change principles that have been shown to be most valued by Jamaican preschool teachers in a complementary teacher-traning program. These behavior change principles include rehearsal and practice, positive feedback, group support, provision of materials, and ensuring sessions are fun and interactive (
The development and/or adaptation of interventions for use in LMICs often entail formative research (
Following this development process, we now have an intervention that can be tested in a larger scale effectiveness trial. In the next phase of implementation, the program will be implemented by preschool teachers and supervised by government supervisors from the Early Childhood Commission. There will be a continued need for ongoing learning cycles to identify the strengths and needs of preschool teachers and government supervisors to implement the program and to identify the optimal levels of training and support to ensure the intervention maintains its effectiveness at scale. From a public health stand point, scaling up effective programs is critical to achieving population-level benefits in terms of reduced violence against children and reduced child externalizing behavior problems (
The methods used in the development of the Irie Homes Toolbox are relevant for use in developing or adapting other educational and public health programs. We recommend an approach that integrates formative research, theory, empirically derived content and behavior change principles, with extensive piloting in the context. Throughout this process, ongoing attention should be given to ensuring the content, process of delivery, and materials used in the intervention meet the four key principles of acceptability, feasibility, relevance, and effectiveness.
The datasets generated for this article are not readily available because the data is mostly formative data and is not suitable for sharing as it is difficult to anonymise. Requests about datasets should be directed to
The studies involving human participants were reviewed and approved by University of the West Indies, Ethics Committee and School of Psychology, Bangor University Ethics Committee. Written informed consent to participate in the study was provided by participating parents and teachers.
HB-H and TF contributed to the conceptualization of the study, funding acquisition, project administration, investigation, data curation, data analysis, writing the original draft, and reviewing and editing the manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We thank the principals, teachers, parents, and children who participated in this study.