LAUSR

OBJECTIVES We conducted a cluster-randomized trial of an enhancement to an existing parenting program in rural Colombia (called the Family, Women, and Infancy Program [FAMI]), and found benefits to parenting practices and child development. In this study, we examine the effects of the enhancement on the quality of intervention implementation and examine associations between quality and child and maternal outcomes. METHODS In Colombia, 340 FAMI mothers in 87 towns were randomly assigned to quality enhancement through the provision of structured curricula, play materials, and training and supervision from professional tutors, or to control (no enhancement). Children aged <12 months were enrolled (N = 1460). A subsample of 150 FAMI mothers (83 intervention, 67 control) in 29 towns (17 intervention, 12 control) participated in the assessment of the quality of group parenting sessions through independent observation. Child development and parenting practices were measured at endline (10.5 months after baseline). RESULTS In intention-to-treat analyses, we found significant benefits of intervention for the observed quality of group sessions (1.67 SD [95% confidence interval, 1.23-2.11]). An SD increase in session quality predicted an increase in treatment mothers' attendance of 4.68 sessions (95% confidence interval, 1.37-7.98). Session quality partially mediated the effect of the intervention on parental practices and child development. CONCLUSIONS Enhancing an existing parenting program led to large benefits to the observed quality of intervention implementation. Quality was associated with increased maternal engagement, parenting practices, and child development. The observational measure of quality has potential to promote and maintain quality at scale.