Table 6.
Examples of some challenges and solutions during adaptation and implementation.
| Sub-theme | Examples of comments | |
|---|---|---|
| Challenges encountered | Solutions implemented | |
| Stakeholder engagement |
Getting access to the local health department was difficult. (R2) Challenges are balancing with other content needs and bureaucracy. (R5) The challenge was that [XX] was implementing many programs at the same time for the same families without coordination. (R4) Authorities did not want the program because it was not bringing materials/infrastructure. (R9) During that time in [XX] the ministries, the directors of the ministries were changing a lot, there was not much stability. (R13) |
Having a local person to support adaptation and liaise with the government to manage voices was helpful. (R6) Held workshop with government technical staff to present the curriculum. (R5) Community fairs helped them to see the importance of play in children’s growth and development. (R9) We used a community mobilization strategy with the Ministry, community leadership for continuous engagement. We saw that the supervisors had too much to do in coaching the home visitors, so we hired supervisors just to engage with government and community stakeholders and to keep them abreast of the project activities. (R9) |
| Material Procurement |
Sometimes difficult to find empty water bottles. (R12) Getting cardboard given the ban on plastics has made it difficult. (R14) Parents thought toys were outdated. (R10) |
Have recycling containers to collect empty water bottles and provide these for the volunteers to start work with. (R12) We have had to use lamination and foam boards. (R14) Some toys were replaced with store-bought toys. (R10) |
| Supervision | At the beginning, they had challenges in applying the methodology. (R10) | This was resolved through weekly meetings with supervisors, which focused on discussing challenges and building strategies to resolve those challenges. (R10) |
| Working relationship | One major success was the relationship between supervisors and home visitors. (R4) | The focus on modelling, reflection, and problem solving helped them to feel supported. They texted their supervisors regularly to problem solve and the supervisors did the same with the coordinator. (R4) |
| Cultural norms | Because of culture they are uncomfortable for anyone to allow male visitors to conduct activities. Most said we need females. (R12) | If we have males we prefer to have a female accompany him. (R12) |
| Relationship with families |
Even the availability of the mothers, the timing when the mothers were available. (R15) A main challenge was getting the mothers to participate because of existing cultural norms-husbands/fathers did not want home visitors to enter the home or the mothers to travel to attend group sessions. (R3) |
Sometimes the community nutrition worker had to work either in the evenings or very early mornings. (R15) Fathers also became very active in toymaking. (R3) |
| Workload | Supervisors complained of heavy workloads since they had to observe every home visitor at least once in a month. (R10) | To reduce workload, the program developed an app for their monitoring tools. This helped a lot. (R10) |
| Turnover |
High staff turnover because home visitors are volunteers and do not have any benefits. (R12) There was some attrition of home visitors which was a significant challenge. (R13) |
Pay transportation and meals during work. (R12) Train more staff than is needed in case you need replacement staff. (R13) |