Implementation Assessment of an Integrated Early Childhood Development and Violence Prevention Program: Evidence from Conflict-Affected Antioquia, Colombia (2013-2022)

Abstract Introduction Programs that integrate early childhood and violence prevention should be assessed for implementation, particularly in low- and middle-income countries and conflict settings. We assessed participants’ satisfaction and the implementation barriers and facilitators of a program to promote child development and prevent early aggressive behaviors from the prenatal period through 36 months in Antioquia, Colombia. Materials and methods A mixed-method design was used. A quantitative survey was conducted with child caregivers (n = 5,919) to assess caregiver satisfaction. In addition, a qualitative study assessed barriers to and facilitators of program implementation. We analyzed longitudinal fieldwork diaries collected during implementation (n=84) and semi-structured interviews with healthcare professionals (n=5) and caregivers (n=6). Results Caregivers reported 95% satisfaction across all activities. Barriers and facilitators were identified: 1) Outer settings (Context): lack of implementation of public policies and violence in communities. Some transversal categories include health system financial crisis, lack of cooperation between institutions, beliefs and attitudes toward health promotion programs, and the predominance of the biomedical paradigm over the health promotion approach. 2) Inner stings (Health service): lack of health promotion programs and financial difficulties within health services. 3) Individual characteristics: caregiver characteristics, including being a first-time mother, having prior positive experiences with health services, and sharing experiences with other caregivers through program activities. Healthcare worker characteristics: lack of training in health promotion activities and precarious working conditions. 4) Program: number of activities, online training, adaptation, and theoretical support. Conclusions Barriers to implementing a program to promote child development and prevent early aggressive behavior included living in low-income communities, financial instability in the health system, limited cooperation among health institutions, poor working conditions for healthcare workers, and beliefs about prevention approaches.