Blended parenting program improves early child development

A parenting program utilizing both in-person and remote delivery may benefit child development and parenting, according to a recent study published in JAMA Network Open.¹

The World Health Organization has highlighted responsive caregiving and opportunities to learn as vital aspects of care, with data indicating benefits toward parental behaviors and child development by building parent skills.² Additionally, implementing early childhood development (ECD) programs alongside other services may be suitable for scaling.¹

“Combining remote and in-person delivery could facilitate scaling,” wrote investigators.

Program assessment

The study was conducted to evaluate the benefits of implementing the Reach Up program, a program designed for increasing the capacity to implement ECD parenting programs in low- and middle-income countries. This program includes curricula, training materials, and manuals.

In 6 parishes, remote delivery was implemented in September 2020 and assessed between July and October 2021. Families with a child aged 3 to 18 years that were beneficiaries of the Jamaica conditional cash transfer program were included in the analysis. Those with a maternal age under 18 years, no consistent caregiver at home, or a child attending daycare were excluded.

Eight families were enrolled per community health worker, 4 of which were randomly assigned to the intervention group and 4 to the control group. Children in the intervention group received an intervention curriculum with age-appropriate activities.

Activities and parental data

Activities were recommended to intervention recipients based on the child’s ability, with fortnightly contacts completed through home visits or telephone calls conducted alternately. An interviewer-administered questionnaire was used to obtain baseline data about mother’s age, education level, and employment status.

Paternal data was also collected through the questionnaire, included the father’s age and whether he resided in the home. Finally, home environment variables were obtained, such as crowding, type of toilet, water supply, and household possessions.

A maternal report was used to assess maternal attitude about child development and parents’ roles, while depressive symptoms were measured using the 10-item Center for Epidemiological Studies–Depression scale. Investigators repeated measurements of parenting attitudes, parent practices, and maternal depressive symptoms at endline. The Griffiths Mental Development Scales were used to evaluate child development.

Patient characteristics and developmental outcomes

There were 627 children enrolled at baseline, 311 of whom were randomized to the intervention group and 316 to the control group. Of these groups, 76.2% and 80.4%, respectively, were assessed at end line. Secondary school completion was reported by 62.7% of mothers, and the mean child age was 27 months in both groups.

Of the final sample, 48.3% were female patients and 51.7% male patients. Characteristics and rates of loss to follow up did not significantly differ between groups, but the intervention group presented with significantly greater fine motor and Home Observation for Measurement of the Environment (HOME) scores vs the control group.

The developmental quotient (DQ) effect size (ES) was increased by 0.17 in the intervention group, while the fine motor subscale scale ES was increased by 0.19 in these patients and the HOME score ES by 0.25. Language and cognition subscales, alongside parenting attitudes, did not significantly differ between groups.

Implications

These results indicated benefits to children’s DQ and fine motor ability, alongside the quality of their home environment, from a mixed delivery program by a government primary health care system. Investigators concluded remote and in-person visits could be combined to expand ECD programs.

“This reinforces the value of sustained partnerships between researchers and policymakers for scaling ECD programs,” wrote investigators.

References

1. Chang SM, Smith JA, Wright AS, et al. Blended delivery of a primary care parenting program for child development: a randomized clinical trial. JAMA Netw Open. 2026;9(2):e2556024. doi:10.1001/jamanetworkopen.2025.56024
2. World Health Organization, United Nations Children’s Fund, World Bank Group.Nurturing Care for Early Childhood Development: A framework for helping children survive and thrive to transform health and human potential. World Health Organization. 2018. Accessed February 05, 2026. https://www.who.int/publications/i/item/9789241514064