Table 3.

Supervisors', health staff and mothers' perceptions in stage two.

Mothers' perceptions and understanding of the parenting sessions
Interviews with mothers attending pair sessions		Interviews with mothers attending group sessions
Mothers opinions on the session	n = 23 n (%)	Mothers understanding of the sessions	n = 19 n (%)
Mother believes programme is important for her child's development	19 (82%)	Book activity reported by mother was appropriate to the child's age	10 (53%)
Mother reports other family members believe the programme is important	15 (65%)	Toy 1 activity reported by mother was appropriate to the child's age	12 (63%)
Likes the toys	10 (43%)	Toy 2 activity reported by mother was appropriate to the child's age	15 (79%)
Mothers' reasons for missing sessions	n = 18 n (%)	Language activity reported by mother was correct for the child's age	12 (63%)
No incentive given	13 (72%)	Mother recalled the developmental message	12 (63%)
Family members discouraged attendance	7 (39%)	Mother followed the nutritional advice	15 (79%)
Sessions are not important for the development of their child	6 (33%)	Mother practiced the activity at home Every day 3–4 times a week 1–2 times a week	8 (42%) 10 (53%) 1 (5%)
Toys were not attractive and interesting	6 (33%)
Live far from clinic	5 (28%)
Involvement with earning sources	4 (22%)
Perceptions of health staff on the enablers and barriers to successful implementation of the parenting sessions
Enablers - CC staff believed that the activities introduced through the curriculum are suitable for young children and will help children's development. - Most CC staff enjoyed conducting the sessions and believed that conducting the parenting sessions was an appropriate part of their role.
Barriers - Mothers expect to be provided with food supplements or medicine when they attend clinic. - Family members were not motivated well during the recruitment process and hence they were not always supportive of the mother attending the sessions. - Some mothers do not like the home-made toys and they find them unattractive. - Delivering so many toy activities is difficult. It is hard to keep the interest of the mothers and children and to organize the materials. - The curriculum manual was difficult to use during the session: it was too large and difficult to navigate between the sections. - It was difficult to conduct so many sessions and continue to meet the demands of their regular workload. - It was difficult to handle children of different age groups, especially in the group curriculum.
Observations of supervisors attending the sessions
Enablers -Health staff used many of the key training techniques while conducting the sessions including demonstrating the toy and book activities and the encouraging mothers to practice. - Health staff had a positive attitude to conducting the sessions and were willing to make time in their schedule to conduct the sessions.
Barriers - Language activities were often given insufficient emphasis. The health staff tended to be more didactic in introducing these activities and rarely asked mothers to practice the activities with their child. - There was too much time spent on discussion, especially in the group sessions and the children became tired, fussy and restless when they were not engaged in activities. - The health staff found it difficult to organize the materials for the session in the small space available. - There were too many toy activities in the curricula and the health staff sometimes mixed up the toys and activities and delivered age-inappropriate messages. - The curriculum manual was unwieldly to use as the CC staff needed to switch between several sections This led to pauses in the session as the CC staff found the correct page and children and mothers became distracted and bored. - At times mothers and children would be required to wait for the CC staff as they continued to deal with patients attending the clinic. - In the group clinics, it was difficult to gather all mothers at the same time and this could lead to long waits for mothers and children who arrived first.