Learning Clubs to improve women's perinatal health and early childhood development

A novel, evidence-informed, psycho-educational intervention: Learning Clubs for Women's Health and Infant Health and Development. The intervention comprises 20 educational modules, delivered in face-face groups at a community centre and in one home visit. All content is drawn from interventions shown in RCTs in resource-constrained settings to be effective in addressing either maternal nutrition, mental health, parenting capabilities, infant health and development, or gender-based violence and empowerment. These include the Thinking Healthy, What Were We Thinking, Sisters for Life and Care for Child Development programs; and World Health Organization (WHO) guidelines on nutrition and breastfeeding. Nutritional messages will be based on WHO recommendations including e-Library of Evidence for Nutrition Actions and Essential Nutrition Action, and include dietary diversity, the use of supplements and fortified foods, and the importance of adequate nutritional intake. Messages about water, sanitation and hygiene will use materials from the Water, Sanitation and Hygiene (WASH) program. These will be adapted to be consistent with current national perinatal programs in Vietnam and to be culturally appropriate for Vietnamese women. Each session will be facilitated by a member of the local Women's Union, who has had experience in conducting community programs and will also receive training specific to this trial. When required, a community health worker and/or a kindergarten teacher will also participate. Each module will increase perinatal stage-specific essential knowledge and skills though structured learning activities that have been translated, culturally adapted and field-tested for salience and comprehensibility. The program will be implemented in facilitated small groups of women meeting every two to four weeks in community centres from early pregnancy until the end of the first postpartum year (a total of 19 facilitated sessions) and one home visit during the first eight postpartum weeks when mothers and infants in this setting usually do not go out of the house. Each session will be from 60 to 90 minutes in duration, with shorter sessions scheduled for the first two postpartum meetings to accommodate infant feeding and sleeping requirements. A typical session would include greeting the participants, recording attendance by Learning Club participants and any accompanying family members, weighing the participants to record pregnancy weight gain, asking the participants if they have any questions or concerns they'd like to discuss, introducing the current session and delivering the module content. Educational information will be given to the participants through the use of videos, short talks and participatory learning activities. These will be varied to maintain interest and will include short quizzes, physical exercises for pregnancy, practising breathing techniques for birth, observation of their babies to understand child development, demonstrations of caregiving for optimal child development, discussing and solving scenario-based exercises to understand and promote gender empowerment and mental health and prevent gender-based violence. During each session, take-home materials will be distributed to each participant. These materials will provide a summary of the information the participants are given at each session, recommended activities they can do at home and two take-home messages, one of which is to promote mental health and the other is to promote healthy nutrition. A household visit will be conducted by a trained commune health station staff member. The purpose of the visit is to screen for postnatal complications and newborn warning signs and to guide women and their family members on how to soothe and settle the baby effectively and to promote the baby’s development through play and communication. Materials with summarised information, recommended activities and main messages for promoting mental health and healthy nutrition will be provided. The visit is expected to take 45 to 60 minutes. After completing all sessions, booster activities have been implemented to reinforce key messages delivered to intervention participants. Each intervention club has a social network (Zalo) to share key messages and to discuss the application of these messages. As a whole the intervention will meet the 'five pillars' recommended by the World Health Organisation for programs to improve maternal and child health: family support, empathic listening, guided discovery using culturally appropriate images and text-based materials, behavioural activation and collaborative problem solving. Intervention fidelity will be monitored by recording participants' attendance at each session. An attendance sheet will be distributed to each facilitator, who will record each participant's attendance at each session and whether there are any other family members joining her. In communes where the participation rate drops below 70%, facilitators in these communes will be contacted and participants' opinions will be sought to discuss if there are any problems or difficulties which may have led to a low participation rate that could be addressed.