ASSESSMENT OF BARRIERS TO IMPLEMENTATION OF THE HOME VISITATION PROGRAM IN BRAZIL AND A FEASIBILITY TRIAL TO TEST AN IMPROVED IMPLEMENTATION STRATEGY BUNDLE

While the use of home visitors to conduct community-based education has been shown to be effective at improving child development outcomes, outcomes vary greatly. Many countries have implemented home visitation programs with limited results due to implementation barriers. The home visitation program in Brazil (PCF) is the largest home visitation program to support child development in the world. Although PCF has contributed to positive changes in early childhood development, the results have varied greatly by region and fall short of what is expected. Despite the immense size and importance of PCF, and the difficulties it is facing, few studies have analyzed the barriers to the program and no previous study has tested new implementation strategies to address barriers. The current study aims to apply the monitoring, evaluation, research, learning, and adaptation (MERLA) cycle to the PCF program to improve its implementation. The MERLA cycle links monitoring and evaluation exercises with learning and adapting to address barriers that are identified. The current study consists of two aims that are part of the MERLA cycle to improve the implementation of PCF: 1) assessment of barriers to implementation of PCF and 2) an implementation feasibility trial to test an improved implementation strategy bundle. The results of the study will provide several benefits, both locally to the PCF program and globally. The findings will be used to inform the design of an RCT to test improvements to the program more broadly. Additionally, the findings will inform the implementation process of other home visitation programs globally that apply a similar home visitation methodology.