Development, implementation and short-term impact of capacity building workshops on nurturing care for paediatricians across India: a triphasic mixed-methods study

Background The Nurturing Care Framework (NCF) is a comprehensive approach that enhances early childhood development (ECD). Due to the paucity of personnel skilled in nurturing care for ECD (NC-ECD), Indian Academy of Pediatrics (IAP) developed IAP-NURTURE (NC-ECD) aimed at training paediatricians to incorporate nurturing care into office practice. A systems approach was employed: needs assessment; development of resources and training strategy; implementation of 200 workshops across India (2022–2024), and; impact evaluation. The study objectives were to (a) document the context of IAP NURTURE (NC-ECD); (b) assess trainee capacity enhancement and (c) identify challenges and suggestions for improvement.Methods A triphasic mixed-methods study was conducted based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation- Maintenance) framework. The study population included organisers, trainers and trainees, recruited by purposive sampling. Phase 1 (qualitative) used key informant interviews (KIIs) of organisers to understand context. Phase 2 focused on participants’ training. In the quantitative component, workshop documents and online survey findings were reviewed. The qualitative component included in-depth interviews (IDIs) of trainees. Phase 3 (qualitative) employed focused group discussions (FGDs) of trainers. Data management included descriptive statistics (quantitative) and Braun and Clarke’s methodology for thematic analysis (qualitative). Data integration identified areas of convergence, complementarity and expansion.Results IAP NURTURE (NC-ECD) trained 7047 paediatricians. Data was retrieved from: 9 KII (phase 1); 4155 (58.9%) pretests, 2596 (36.8%) post-tests, 1506 (21.3%) feedback forms, 205 (5%) online survey respondents, and 18 (36.7%) IDIs (phase 2) and 15 FGDs (phase 3). Data integration indicates IAP NURTURE (NC-ECD) had a positive impact on the trainees: high satisfaction with training and resources provided; helpful in practice (skill enhancement, involving staff, using well-child visit schedule), and; receiving positive feedback from clientele. Challenges and solutions were identified.Conclusions The IAP NURTURE (NC - ECD) model (based on systems approach, NCF strategic actions and principles of adult learning) and lessons learnt from this study can guide development of similar capacity building initiatives.