IMPROVE HEALTH LITERACY OF MOTHERS IN TERM OF EARLY CHILD DEVELOPMENT IN RURAL VIETNAM: PROGRAM DEVELOPMENT AND EVALUATION OF ACCEPTABILITY AND FEASIBILITY Prof Jane Fisher*, Tuan Tran, Ha Tran, Thach Tran Jean Hailes Research Unit, Monash University, Australia Research and Training Center for Community Development (RTCCD)

8 major risks to optimal early childhood development in rural Vietnam Early child development 20% low birthweight 7.4% stunted (6 months) 22% moderate or severe anaemia 80% iodine deficiency 17% iron deficiency anaemia (pregnancy) Lack of parenting skills Unresponsive caregiving < 1 SD lower in cognitive development (6 months) 30% having common mental disorders 32.7% having physical and sexual violence

Comprehensive primary care intervention in English Project phases Comprehensive primary care intervention in English Translation and culture adaptation Pilot testing Phase 1 Phase 2 Phase 3

Phase 1 - Learning club for early child development 4

Phase 1 - Intervention included Literature review: Interventions All types of study design Conducted in resource-constrained settings Intraute-rine growth restriction Stunting Iron deficiency anaemia Iodine deficiency Unrespon-sive caregiving Insufficient cognitive Develop-ment Common mental disorders Domestic violence Micro-nutrient supplement Micro-credit scheme Care for child development Thinking healthy Sister for Life What were we thinking

Phase 2 – Theory of change Early-mid preg Late preg & newborn 3-6 month infant 7-12 month infant 13-24 month infant Phase 2 – Theory of change

Phase 2 – 24 session content Focus on 1000 days Community-based intervention Women Union staff as facilitators Visual package for low literacy people

Phase 3 – Pilot testing in rural Vietnam Participants n= 270 Intervention 3 communes in Hanam province 2014-2015 Outcome Club meetings Learning Club Consultation and referral Household visits  Child development Acceptability, feasibility, fidelity 8

Baby bathing & diaper change Caring newborns by grandmothers Exercises during pregnancy

Phase 3 – Acceptability Information was sufficient Able to apply on a daily basis “I practiced breathing exercises while in labor with my youngest child and I was happy to give birth naturally without pain”. A 24-year-old teacher in Liem Can commune. “I was able to learn more about proper infant hygiene and sleeping schedules DVD instructional videos and practice role-plays but also through other members’ experiences”. A 21-year old new mother in Doi Son commune.

Facilitators’ capacity: Phase 3 – Feasibility Participation rate: 196 pregnant women 175 mothers having children under 2 years old On average, adherence rate was 4.7 sessions (out of total 24 sessions) Facilitators’ capacity: Women Union + commune health station staff Confidence in health and social topics Teaching method: DVDs video instruction  attracts participants

Phase 3 – Alignment with the strategic context Learning club Social sector/mass organizations - Assist women in building prosperous, equal, progressive, happy families and income generation - Collaboration of mass organizations Local authorities - Improving quality of human resources - Poverty alleviation Health sector - National program of nutrition - Breast feeding program - Reproductive health and maternal and child health program Education sector - Early child education

Phase 3 – Fidelity Study design Intervention package Baseline participants refused to join intervention Fail to conduct economic evaluation Change from randomized controlled trial  repeated cross-sectional studies Intervention package Lack of domestic violence prevention component Lack of micro-credit scheme

DISCUSSION – Content revision Include component of gender empowerment Activity –based meetings Take home materials Establish “Playing corner” Competitions and awards among club participants Broad term of “mothers”  “main caregivers”

DISCUSSION – Revision of intervention design Conditional cash transfer Include micro-finance scheme Teach method: DVDs instruction and visual documents Facilitators: Women’s Union staff Kindergarten teachers Commune health station staff

CONCLUSION Psychoeducational intervention to improve health literacy of women in term of early child development Acceptable + feasible + alignment with the strategic context in rural Vietnam Minor modification for scaling up in Vietnam

Acknowledgement Grand Challenges Canada Research and Training Community Development (RTCCD) Jean Hailes Research Unit I would like to thank my supervisors for their enormous support and great guidance, to all staff and students at JHRU and the Review committees of SPHPM for very helpful comments, to Monash Uni and Graduate Women Victoria for financial support, to all heads of schools and directs of selected centres and adolescents, and to my family members without whom this project is impossible.