Putting families and local professionals at the hearth of implementation research: a qualitative implementation study on Greenland’s universal parenting programme MANU 0-1 Year

Background

The influence of context in implementation has received increasing attention in implementation research. This includes a discussion of the right fidelity-adaptation balance when interventions are to be implemented in a new context, a relevant discussion when looking at national public health interventions. In Greenland, public health interventions are typically adopted evidence-based programmes or developed based on general understandings of the country’s context. They rarely build on local resources and strengths of the different towns and villages. Evaluations show how interventions are not sustained after initiation, they are not adaptable to local context and the intervention recipients’ needs are barely explored prior to the intervention development. Arctic public health scholars are increasingly drawing attention to the importance of integrating cultural beliefs, values and local practices when developing and implementing interventions.

The Greenlandic parenting programme MANU 0–1 Year, which stands for Meeraq Angajoqqaat Nuannaarneq meaning “child’s and parent’s happiness” was developed to provide expectant and new parents with information and reflections on parenthood through pedagogical exercises. MANU is a universal programme that intends to be accessible to all expectant and new parents. Ultimately, MANU is expected to secure a healthy foundation for children’s development and to contribute to the prevention of adverse childhood experiences.

Objective

The aim of this PhD project was to study the local implementation of the parenting programme MANU 0–1 Year and parents’ experiences with the programme in regard to expectations, needs, culture and values.

Conceptual framework

The Consolidated Framework for Implementation Research (CFIR) by Damschroder et al. (2009) [1] was applied due to its breadth of included aspects that influence implementation. It provides an overarching systematic classification of implementation determinants in different contexts. Furthermore, the PhD project applied a community-based participatory research (CBPR) approach following the five stages introduced by Reimer and Rink (2020) [2] and based on the key principles by Wallerstein et al. (2018) [3]. CBPR focuses on creating partnerships and building trust between the researchers and the community people, who ultimately are meant to gain from the research. Finally, the framework outlining the potential adverse effects of public health interventions by Lorenc and Oliver (2014) [4] provided a retrospective perspective on MANU’s unintended effects.

Study design and methods

As a key CBPR element a reference group consisting of nine different stakeholders was established and involved throughout the PhD project. Different qualitative methods were applied, including open-ended and semi-structured interviews, observations, document analysis and a Sharing Circle. Data were collected in three of Greenland’s five health regions.

Results

Parents described the life changing experience it was to become a parent, and they point out toqqissisimaneq (English: security and care) and ataatsimoorneq (English: community or feeling of togetherness) to be important aspects in child-rearing. Both parents’ and professionals’ experiences with MANU related to strengths and challenges with MANU’s format, content and accessibility. For example, the MANU group sessions have the potential to create a space for parents to reflect, however, these sessions are not accessible to all parents and depend on how it is locally implemented and facilitated. Professionals’ perspectives on local implementation include aspects related to i) the organisational structure and context they are working in, ii) the circumstance of having to prioritise limited resources which leads to MANU not being a priority, and iii) the professionals need for support and skills to maintain motivation for implementation and sustainment of the programme.

Discussion

National programmes like MANU are often disconnected from local contexts, since they are based on the assumption that dissemination of materials and sending professionals to trainings will enable sustainable implementation of new interventions. Then the applicability of implementation frameworks, specifically the CFIR and the updates to the CFIR framework, are discussed in relation to the Arctic context, interventions recipients’ perspectives on implementation outcomes and sustaining interventions in a context with persistent high turnover. It is argued that by introducing CBPR as an integral part of implementation research equity in implementation can be reached. Intervention studies conducted in the Arctic describe how CBPR contributes to a culturally sensitivity intervention and to the community taking ownership of the intervention.

Conclusion

In the dissertation (Ingemann, 2023) [5] it is concluded that by putting families and local professionals at the heart of implementation research, interventions will more likely be culturally sensitive and increasingly relevant to local contexts. Furthermore, potential barriers in implementation and adverse effects of an intervention could be addressed early on and likely prevented.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Novo Nordisk Fonden [NNF19SA0035480].