Parenting

Science and Practice

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The Future of Parenting Programs: III Uptake and

Scale

Pia Rebello Britto, Robert H. Bradley, Hirokazu Yoshikawa, Liliana A.

Ponguta, Linda Richter & Jennifer A. Kotler

To cite this article: Pia Rebello Britto, Robert H. Bradley, Hirokazu Yoshikawa, Liliana A. Ponguta,
Linda Richter & Jennifer A. Kotler (2022) The Future of Parenting Programs: III Uptake and Scale,
Parenting, 22:3, 258-275, DOI: 10.1080/15295192.2022.2086809

To link to this article: https://doi.org/10.1080/15295192.2022.2086809

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Published online: 05 Aug 2022.

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PARENTING
2022, VOL. 22, NO. 3, 258–275
https://doi.org/10.1080/15295192.2022.2086809

The Future of Parenting Programs: III Uptake and Scale

Pia Rebello Britto , Robert H. Bradley , Hirokazu Yoshikawa ,
Liliana A. Ponguta , Linda Richter , and Jennifer A. Kotler

SYNOPSIS
This article focuses on the demand side of parenting programs,
in addition to the traditionally studied supply side and argues
that a path to scale of parenting programs must align and
equally acknowledge supply and demand side domains and
characteristics, whereas historically they are addressed in silos.
Evidence suggests that a core set of factors such as policy and
contextual affordances and personal characteristics, skills, and
motivations influence entry and engagement. For effective scal­
ing, the article argues for the synergy between systems coher­
ence, workforce, governance, and social-political mobilization of
parents.

INTRODUCTION
Parenting is, biologically and psychologically, the most important determinant
of child development (National Academy of Sciences, 2016; OECD, 2020).
While we have instinctive tendencies to protect our young, parenting is, in
important respects, a learned behavior, affected by knowledge, attitudes, and
emotional states (Breiner, Ford, & Gadsden, 2016). As demonstrated in the
introduction and articles I and II, parenting support programs around the
world have been designed to provide learning opportunities and support that
help parents fulfill the tasks of parenting across contexts and cultures.
Reviews of parenting support programs demonstrate the importance of
design and implementation in terms of the “supply” side of the program
(i.e., what the program can offer) – focusing on design, curriculum, service
delivery, staff capacity, and so forth. Accordingly, the supply side is given
considerable attention in the first two articles in this series. In this article, we
focus on the demand side of parenting programs and argue that a path to scale
of parenting programs must align and equally acknowledge supply and
demand side domains and characteristics, whereas historically they are
addressed in silos. While the evidence in support of this hypothesis is nascent,
the emerging trends are supportive, and primarily drawn from programs that
address parenting for younger children. Our definition of scale in this regard
focuses on the national level (assuming the goal is for national coverage of
intended target populations for particular programs) while integrating atten­
tion to subnational and local/community processes. We conceptualize scale as

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 PARENTING 259

occurring in two ways – “small to bigger” efforts that expand programs

initially provided to a certain population to larger and larger populations;
and “big to better” efforts that leverage existing at-scale systems and supple­
ment or enhance them (in this case, to build in a focus on parenting or
caregiving; Yoshikawa, Wuermli, Raikes, Kim, & Kabay, 2018). The author
of The Voltage Effect argues that taking an idea to scale is both creating the
right product, but also ensuring that take up of it, in other words achieving
“high voltage” indicates that an idea can have impact when replicated at scale
(List, 2022). The premise of this article is built on a similar argument, that the
scalable ingredients of a program are both on the supply and the demand side.
An example to illustrate this point occurred almost as a natural experiment
during the COVID 19 pandemic. Support for parents in their efforts to parent
has always been important but the global pandemic showed us firsthand the
significance of how the demand side can scale up parenting support; in this
case, the demand by parents was for information. With the onset of the
pandemic, parents started to demand information and support to help them
cope with the expansion of the new parameters of their parenting role imposed
by COVID 19 related restrictions, which in effect made them first-line respon­
ders (Bornstein, 2021). One example comes from UNICEF which rapidly
scaled up its digital parenting content to respond, providing families around
the world with trustworthy information on how to protect themselves and
their loved ones. UNICEF developed content hand-in-hand with experts, on
a range of topics, including those that were being asked for by parents (https://
www.unicef.org/parenting/). In a conversation with Britto, 2021, we learned
that by the end of 2020, UNICEF had recorded a 1,000% increase in traffic to
its parenting content on its global website. For early childhood topics speci­
fically, there were 16 million unique pageviews in 2020 for early childhood and
COVID-19 parenting content combined, up from 1.5 million for just early
childhood content in 2019. This current instance is almost a natural experi­
ment demonstrating how demand can drive uptake leading to scale.

PROPOSED FRAMEWORK FOR UNDERSTANDING DEMAND WHICH LEADS

TO UPTAKE AND SCALE
Research on the sustainability of the effectiveness of evidence-based parenting
programs once they transition to scale is scant (Gray, Totsika, & Lindsay, 2018;
Moore, Mascarenhas, Bain, & Straus, 2017). However, there is general agree­
ment that programs can only be effective if parents initiate involvement (sign
up and enter), attend program sessions (engage), and continue attending
throughout the duration of the program (retain; Axford, Lehtonen, Kaoukji,
Tobin, & Berry, 2012). This suggests that there are three pivotal points of
involvement where understanding parental needs and preferences are critical
to uptake and scale: enter, engage, and retain. Evidence suggests that
260 BRITTO ET AL.

a common set of core factors (described in our framework) influence all three
points and that tailoring support at each of these junctures/pivots to individual
parents will increase effectiveness.
We propose a framework to shift the paradigm of a path to scale that focuses
on the supply-side characteristics to one that focuses on the intersection
between supply and demand-side characteristics. See Table 1. The “demand
side” (the second and third columns of the table) primarily entails extrinsic
contextual affordances (e.g., norms & policies, time, child care) and intrinsic
personal characteristics (e.g., motivation, self-efficacy, and mental health). We
propose how program characteristics have been and could continue to be
adapted and differentiated based on parents’ contextual and individual char­
acteristics. The bottom of the table highlights how both program character­
istics and the people participating in successful programs intersect to promote
effective scale-up.

Policy and Contextual Affordances

Those implementing parenting programs must appreciate that individual
participants in any program have not developed their current beliefs and
practices in a vacuum. Individual and family level behaviors are deeply rooted
in cultural norms, and they reflect the contextual affordances of the environ­
ment and times in which a family lives (Harkness & Super, 1995).

Cultural Norms and Attitudes. In every community and culture there are
expectations pertaining to parenting cognitions and parenting practices. Such
expectations can be seen through the expression of parenting styles and
practices which in turn perpetuate cultural and community values
(Bornstein, 2012; Keller et al., 2004). Cultural beliefs about the role parents
need to play in children’s lives, the form parenting behaviors should take as
well as receptivity to get help with parenting shape how parents within the
culture see their roles as well as the degree to which they may be eager or
receptive to receiving help in carrying out that role (Ashdown & Faherty,

Table 1 Framework for engagement, uptake and scale of parenting programs.

Supply Side Demand Side
Program Characteristics (refers to 1. Policy & Contextual 2. Personal Characteristics, Skills, and
Articles I & II) Affordances Motivations
Accessibility a. Cultural norms & attitudes a. Gender & age
Requirements of the program b. Family friendly policies b. Education & competencies
Formats c. Community resources & c. Disposition & motivation
Incentives barriers d. Perceptions of child’s needs
Connection to other support services d. Family resources & family
Perception of the service provider barriers
Delivery platform
Establishing trust
 PARENTING 261

2020). Correspondingly, they help determine the degree to which parents enter
into a program to support them versus the support they may already be getting
from family, faith communities, and traditional authorities (e.g., physicians
and teachers) with the personal and intimate task of parenting (Mejia, Leijten,
Lachman, & Parra-Cardona, 2017). The importance of cultural and commu­
nity expectations in informing parental decisions regarding retainment in
a program notwithstanding, it is important for program developers to under­
stand that there are variations in parental expectations within cultural and
community groups. In effect, appreciating cultural influences on program
content and style, is only one step in the process of assuring parental
engagement.

Family Friendly Policies. During the child bearing and rearing years,
a majority of parents (both men and women) are likely to be employed, to
be looking for work, or to be economically active in the informal sector. These
activities may keep them away from their children or home setting. Family
friendly policies are those policies within locales that help parents balance and
benefit from both work and family life and engage in programs (UNICEF,
2019). These policies typically fall into three categories: those that provide 1)
resources (e.g., child benefit grants), 2) time (e.g., parental leave), and/or 3)
services (e.g., child care). When properly implemented, these policies are
known to facilitate better child outcomes, parental life satisfaction and pro­
ductivity, and equitable social and economic growth (Richter et al., 2017;
UNICEF, 2019).

Community Resources and Barriers. There is enormous variation in the

kinds of resources present in communities that parents can draw upon to
address their needs and the needs of their children. Importantly, commu­
nities vary greatly in the kinds of basic material and financial resources
parents can access to help them meet family needs (Baumann et al., 2019).
Communities also vary greatly with respect to the kinds of human
resources that are available to parents and to those who wish to imple­
ment programs. In some communities, there are both policies and pro­
grams that support parents’ ability to manage the tasks of daily life
(including parenting), whereas in other communities such support is
lacking. Such supports include assistance with employment and physical
and mental health services (Puchalski Ritchie et al., 2016). In communities
with limited resources, it can be difficult to engage parents and to scale up
programs even for parents who might be willing to participate. More
specifically, many communities do not have a strong and affordable
transportation system; and many lack space to hold programs and per­
sonnel who might be available to help implement such programs.
Furthermore, in LMICs, adequate community or governmental financing
262 BRITTO ET AL.

of programs is frequently a problem as are policies that impair retaining

with the program, including marginalization of particular groups
(Puchalski Ritchie et al., 2016).
In considering ways of scaling up programs, it can be productive for
program developers to consider forms of resources present in communities
in addition to community financial resources and employed human
resources. For example, studies in sub-Saharan Africa, Latin America and
elsewhere of specific cultural communities show traditions of multi-party
socialization; that is, older siblings, peers, extended households, and com­
munity members are normally involved in the socialization of young chil­
dren (Morelli, Rogoff, & Angelillo, 2003; Rogoff, 2014). Accordingly, in some
contexts, the focus of parenting programs can extend to the entire household
and clusters of households and communities. On the other side, community-
level adversities such as exposure to armed conflict can threaten socialization
practices (Mariam, Ahmad, & Sarwar, 2021). In some of these situations,
parental engagement and retention may be fostered through the integration
of mental health and psychosocial support services (e.g., in current program­
ming for Rohingya refugees in Bangladesh). Indeed, strength of neighbor­
hood networks and support is positively related to program engagement (cf.
Eisner & Meidert, 2011).

Family Resources and Barriers. Parents who have family members to

help with rearing their children may be more likely to attend parenting
programs as they may have someone else to look after their children if
they need to attend such programs alone. However, one of the biggest
impediments to engagement is other family obligations (Butler, Gregg,
Calam, & Wittkowski, 2020; Mytton, Ingram, Manns, & Thomas, 2014).
This barrier can be particularly challenging for retainment. Parenting
programs can help alleviate such barriers such as providing child care
(including care for siblings who may or may not be also participating in
the program), offering programs at multiple times of the day and different
days of the week to accommodate different work schedules and provide
accessible locations closer to participants’ homes.
Underlying what may appear to be logistical challenges (e.g., time, money)
might actually be gender role expectations. In some families, mothers may feel
restricted in their decision to become engaged in activities that take place
outside the family, particularly if their husband does not recommend their
involvement. In such families, mothers may also feel that they have to consult
with the husband’s family in deciding what to do with respect to entering
parenting programs.
 PARENTING 263

Personal Characteristics

As research and theory make clear, a parent’s personal characteristics and

a parent’s personal history of being parented, enacting the role of parent, and
watching others parent loom large in how the parent views the role of parent­
ing. Their personal experiences heavily influence how productively parents do
and are willing to engage in parenting programs (Belsky & Jaffee, 2015;
Bornstein, 2016).

Gender and Age of Parent. We know much more about the participation of
mothers in parenting programs than what we know about fathers because
mothers are much more likely to be participants in such programs. This is true
for two potential reasons: 1) cultural norms perceive mothers as being central
caregivers more so than fathers and 2) those same norms dictate that it is
harder to get buy-in from fathers that their participation in such a program is
necessary (Panter-Brick et al., 2014). However, findings from the few evalua­
tions of fatherhood-focused programs suggest promising results in increasing
father engagement in maternal and reproductive health, neonatal health and
nutrition, and parenting (Doyle, Kato-Wallace, Kazimbaya, & Barker, 2014;
Erulkar & Tamrat, 2014; Lachman et al., 2020). In Uganda, for example, one
successful program focused its messaging to fathers as increasing family
respectability and the evaluators indicate this framing was a main reason
why fathers participated (Siu et al., 2017).
Another factor that is likely to figure into a parent’s belief that they need
additional competence in parenting is age. Younger mothers tend to have less
knowledge about children’s needs and how to parent effectively (Bartlett,
Guzman, & Ramos-Olazagasti, 2018; Duncan, Lee, Rosales-Rueda, & Kalil,
2018; Wuermli, Yoshikawa, & Hastings, 2021). Parenting programs have
begun to be implemented and evaluated specifically for this population (e.g.,
in Brazil and Ethiopia (Erulkar & Tamrat, 2014; Fatori et al., 2020). A related
factor is whether the parent is not a first-time parent but has reared one or
more children prior to the one that would be the focus of a parent training
program (Bartlett et al., 2018). In the latter case, a parent’s belief regarding the
need for assistance may reflect the parent’s sense of how successful they have
been in rearing their children thus far. These generalizations notwithstanding,
most of the research on parental age has been done in high-income countries.
A study done in rural China did not find a strong relation between maternal
age and knowledge, but the authors speculated that younger mothers may be
more inclined to seek knowledge about child development than is the case for
older mothers (Yue et al., 2017).
264 BRITTO ET AL.

Education and Competencies. According to the World Population Review

(2021) literacy rates in many low- and middle-income countries (LMIC)
remain below 60%. Parents with limited literacy may find it difficult to stay
enrolled in a program if they struggle to understand certain ideas or have
difficulties with certain training approaches (e.g., use of the internet or read­
ings that require significant comprehension). According to Hackworth et al.
(2018) parents with lower levels of education are harder to enroll into parent­
ing programs. Their ability to maintain engagement may depend on the degree
to which trainers or educators can offer more focused attention and alter key
strategies to help them. As it happens, some programs require that attendees
master a certain set of skills before they can move to the next level or next
component of the program. Thus, continued engagement in such programs
may be difficult for parents with low levels of literacy. On the other hand, other
researchers have found little or no relationship between education level of
parents and entry and engagement in parenting programs (cf. Dumas, Nissley-
Tsiopinis, & Moreland, 2007) with one hypothesis that higher educated
parents might be more resistant to being in such programs (MacKenzie,
Fite, & Bates, 2004).

Disposition and Motivation. Part of what determines whether one will

engage in an activity or retain in an activity is one’s personality or disposition
(Bornstein, 2016; Hackworth et al., 2018; Taraban & Shaw, 2018). Having
a generally more optimistic personality or more positive attitudes about help
seeking (Hackworth et al., 2018; Scheier, Carver, & Bridges, 2001) appear
significant in enrolling into a parenting program and staying engaged. As
research on resilience has shown, personality can be a particularly significant
factor in maintaining commitment to an activity when faced with adversity –
which is often the case with parents living in LMICs (Oshio, Taku, Hirano, &
Saeed, 2018).
Depression among parents (mothers in particular) tends to be quite high in
LMICs (Gelaye, Rondon, Araya, & Williams, 2016). Depression decreases the
likelihood parents will be productively involved in caregiving generally and
continue engagement in goal-directed activity (Carver & Scheier, 2005). There
is a long history of research showing that parents with depression and other
forms of mental illness often struggle with caregiving generally (Thomas &
Kalucy, 2003) and with participation in parent education programs specifically
(Hackworth et al., 2018). However, the extent of impact appears to vary due to
contextual factors, including how much social and economic support the
parent has (Reupert, Maybery, & Kowalenko, 2013). In some cases, initial
parenting stress may actually lead to greater program completion (Rostad,
Moreland, Valle, & Chaffin, 2018).
 PARENTING 265

As Carver and Scheier (2005) argue in their treatise on engagement, moti­

vation is key to whether a person will engage in a learning activity and stay
committed to it. More specifically, a person needs to believe that developing
greater competence with respect to some goal is central to their life (and their
identity); and thus, it would be worth their time and energy to commit to the
learning activities required to become competent. According to Self-
Determination Theory, becoming a competent parent has the potential to
fulfill all three basic human needs: the need for competence, the need for
autonomy, and the need for connectedness (Joussemet, Landry, & Koestner,
2008). Thus, many parents would tend to be intrinsically motivated to learn
more about how to parent. However, not all parents perceive the same level of
need for learning particular parenting skills. Moreover, not all parents are
equally convinced that they have the prerequisite skills to engage productively
in a given learning activity or that a particular learning activity will enable
them to attain the competence they desire. Research shows that not all parents
feel a strong sense of efficacy as a parent or as a learner (Jones & Prinz, 2005)
and parents do not all agree on what parenting practices are important
(Bornstein, 2016). If a parent does not feel confident that they will benefit
from a learning activity, according to Carver and Scheier (2005), they would be
less likely to engage with or retain in the activity.

Perception of Child Needs. A parent’s belief regarding the need for assis­
tance is also likely to derive from their sense of a particular child’s needs. If the
child has a developmental disability, a behavior problem or a health problem,
the parent is more likely to feel the need for assistance. The decision to enter in
a parenting program is also likely to depend on whether parenting a child with
a developmental or health need has increased the parent’s depression (Singer,
2006). Parents who report higher levels of difficulties in their children are
more likely to show an interest in parenting programs (Thornton & Calam,
2011) and that this is mainly because parents of more difficult children
perceive parenting programs as more beneficial (Salari & Filus, 2017).
Therefore, a parent’s disposition to seek help, engage, and retain is likely to
depend on how they appraise the child’s needs, their own sense of parenting
efficacy, and cultural views of disability (Neely-Barnes & Dia, 2008).

ADAPTING TO CONTEXT AND PERSONAL NEEDS: WHAT PROGRAMS CAN

DO
There are certain core components of parenting programs that can work
across various contexts and cultures without major adaptations (cf.
Gardner, Montgomery, & Knerr, 2016), but within any one program
there are likely a variety of ways to engage different parents. Researchers
and practitioners have long known that “one size does not fit all” and that
266 BRITTO ET AL.

it is important to have an alignment between the needs and characteristics

of parents as users or beneficiaries and the requirements of a parenting
program (Posey-Maddox & Haley-Lock, 2020). There are many activities
and provisions that can comprise parenting programs to address the
contextual and personal challenges and/or barriers that participants face.
The nurturing care framework advanced by WHO, UNICEF and the
World Bank, makes clear the importance of supporting individual parents
in their role as caregivers. Accordingly, UNICEF (2017) formalized the
importance of adapting programs to parent culture and context. Support
for parents can span from practical considerations of the modality (e.g.,
time, setting) to more abstract preferences regarding implementation fac­
tors documented to predict enrollment to cash programs and social pro­
tection interventions (Hindman, Brooks, & van der Zwan, 2012).
Addressing and challenging gender norms and roles is one area that
programs may consider. The World Bank, for example, has pressed for
changing norms regarding decisions made by women and to moving toward
equality for women. In doing so, they hope to increase women’s sense of
agency – and, in turn, increase the likelihood women will become involved
in programs that support them in their role as parents (World Bank Group,
2014).
Providing more flexibility in program offerings is another way to be
more responsive to parents. For example, programs have sometimes
opted to reduce the number of sessions, break down sessions into two or
more components, or repeat key sessions. Some programs offer alternative
(more targeted) approaches for particular learning goals, provide for fol­
low-up for selected or all participants, utilize various forms of support
groups, and urge trainers to act in a supportive manner. Contextual
affordances, such as those described above, in some sense make a person
who they are in the moment. They help determine how a person feels about
themselves and the meaning of particular objects, actions, and goals.
Critically, a parent’s personal context and the context provided by
a program will help determine the likelihood and manner of engagement
in parenting program activities.
Ensuring that caregivers receive the necessary mental health support is
critical in helping them in their parenting endeavors. The integration of
mental health and psychosocial support is particularly important when imple­
menting programs in crisis situations (e.g., in current programming for
Rohingya refugees in Bangladesh (Mariam et al., 2021)). programs could
consider helping parents build their resiliency skills as a part of the program
roll-out. Helping parents develop more self-efficacy and confidence may be
particularly helpful. Programs could provide parents with encouragement that
each participant has the necessary skills to be effective. Moreover, programs
 PARENTING 267

that emphasize that all parents are welcome and have something to learn
regardless of their child’s abilities and skills might be particularly effective in
drawing a range of parent participation.

FROM UPTAKE TO SCALE: PARENTS’ AND CAREGIVERS’ ROLES IN

SUCCESSFUL NATIONAL SCALE
We have thus far described demand-side characteristics that may be key to
enhancing uptake, engagement and retention, which in turn are prerequisites
to program scale-up. Both the demand factors described previously in this
article and supply factors (of programs and their associated human and
material resources as described in articles I & II) are critical in understanding
how parenting programs may best work at scale (Richter et al., 2017). We now
describe four large themes, that emerged from the analyses of the review of the
literature that highlight such an interplay between supply and demand in
creating effective scaled interventions (cf. Milat, King, Bauman, & Redman,
2013; Pritchett, 2015; Robinson, Winthrop, & McGivney, 2016; Willis et al.,
2016; Yoshikawa et al., 2018).

Systems Coherence and Orientation to Caregiver and Child Outcomes

Parenting programs at scale are embedded in complex social systems that may
or may not work together toward the goals of facilitating caregiver and child
learning and development. That is, the major stakeholders and their associated
institutions – from national to subnational and local administrative structures
to frontline workers, communities, and families – are interdependent, func­
tion in dynamic ways in response to changing conditions, and are linked with
communication, feedback loops and incentives that may or may not provide
information that advances the entire set of systems toward the intended out­
comes of improved caregiver and child outcomes. System coherence has been
referred to as the concept that is the end goal of particular social systems such
as education, health, or nutrition (Pritchett, 2015). In the case of parenting
programs at scale, the relevant systems – for example, a maternal and child
health system; national to local finance systems; community governance
structures – should be oriented toward improving the targeted caregiver and
child outcomes in a particular country, sociopolitical and cultural context.
Parents as an important stakeholder group are not typically conceptualized
as part of the systems coherence that will enhance the outcomes of social
programs. Yet they are perhaps the primary group that will determine the
reception and effectiveness of parenting programs (as they are, for example,
for education programs; Robinson et al., 2016). The match between
a program’s approach – including targeted behaviors in the theory of change,
workforce, modality of services, intensity, duration and other aspects of design
and implementation – contextual affordances and personal characteristics and
268 BRITTO ET AL.

motivations as central additional aspects of systems coherence. If there is not

a match between daily routines and cultural socialization practices on the one
hand and the design of the program on the other, for example, a program is
bound to fail when brought to scale (Motta & Yoshikawa, 2018). Parents not
only “vote with their feet” but also act as advocates, holding systems accoun­
table for their relevance and quality.

Workforce
As Lansford et al. (this issue) note, when parenting programs are implemented
at scale, they generally leverage existing at-scale service systems such as those
in health, nutrition, or social protection. Embedding a parenting or caregiving
focus to an at-scale service sector in this way almost always involves workforce
capacity issues, as the workforce in a particular system is trained to cover that
sector’s key tasks. Thus, moving parenting programs to scale often involves
considerations of workforce capacity and how to shift tasks for staff, the latter
of which entails implementing training (for overviews of task shifting in health
see Van Damme, Kober, & Kegels, 2008). Parenting programs at scale have
recruited caregivers into their workforces. The Hogares Comunitarios (pre­
viously Madres Comunitarias) program in Colombia initially recruited volun­
teer community mothers as facilitators of group ECD programs for children
and parents. The program now pays these community leaders (lideres) and has
embedded it into the national family modality of the national ECD policy, De
Cero a Siempre (Instituto Colombiano de Bienestar Familiar, 2021). Even
when the workforce does not consist of parents themselves, successful national
programs in ECD have involved parents in their local, subnational and
national governance.

Governance

At-scale programs – whether they reached scale through “small to bigger” or

“big to better” mechanisms – engage systems of governance. Whether these are
public, private or hybrid systems, administration and governance for a national
program involve challenges of coordination, either horizontal, i.e., across sectors
and agencies, or vertical, and across administrative levels (Britto et al., 2014).
Parents may be productively involved at multiple levels of governance in
parenting and more broadly ECD programming. The national Head Start
program in the United States has integrated parents into program-level gov­
ernance since its inception more than 55 years ago. Moreover, much of the
leadership of the program at the state and federal levels includes former
parents served by the program (Zigler & Styfco, 2010). In education, school
management systems almost always include mechanisms for parent and care­
giver engagement in management and accountability. These approaches,
 PARENTING 269

however, have rarely been studied in parenting programs at scale; there is

a need for evaluation and research on the most effective ways to integrate
parents and caregivers in governance of parenting programs.

Social and Political Mobilization for Policy and Financial Sustainability

Parenting programs have historically not been national priorities of govern­

ments. Relatively few parenting programs have achieved national scale. Cuna
Mas in Peru is a national program that has focused on parenting as part of
family support provided to caregivers of 0- to 3-year-olds in disadvantaged
communities (Josephson, Guerrero, & Coddington, 2017). It has shown posi­
tive impacts on children’s early development in a national controlled study
(Araujo et al., 2021). Cuna Mas was established after years of advocacy for
ECD as an antipoverty strategy, on the part of coalitions of government,
former government, civil society, and political and social leadership in the
country (including parents and caregiver coalitions), and was a flagship initia­
tive of the new ministry of social development in Peru that was created in 2011
to advance integrative policies for poverty reduction and social inclusion. To
achieve the social and political mobilization to integrate parenting programs at
scale into policy as well as sustainable funding, parent and caregiver coalitions
should be leveraged and expanded for the purpose of influence and advocacy
(Richter et al., 2017). The goal of such advocacy must encompass not only
explicit inclusion of parenting programs into health, nutrition, and/or other
ECD policies, but also advocacy for adequate financial resources and budget­
ing of programs.

CONCLUSIONS
Parents need to feel supported and have the opportunity to teach their
children with the best possible knowledge from developmental science. End
user preferences, beneficiary priorities and reaching parents where they are is
important for equitable expansion of parenting programs. As researchers, our
job is to ensure we work with a variety of different sectors to help ensure that
all solutions are tested toward scalability. In this article we have focused on the
importance of focusing on the needs and contributions of parents in deter­
mining effective uptake and scale and encourage future parenting program
developers to pay just as much attention to the contributions to the demand
side as the supply side.
Tailoring and personalizing interventions for different parents and including
their participation and advocacy at every level might be ideal, but it is a new and
complex endeavor. The process requires evidence, which is nascent, as well as
time and resources. However, the time is now to consider the demand side
seriously, given the growth in services around the world is being driven by user
270 BRITTO ET AL.

preferences. How might we help program designers consistently create in-take

assessment frameworks that help determine what supports and programs would
work best for parents? One possibility is for governments, international orga­
nizations such as WHO, UNICEF and the World Bank, as well as international
and national implementing agencies to offer information and support to parents
through the channels that best suit parent preferences, e.g., online sources, TV,
radio, and other media. This would seem increasingly feasible given what is now
being done by an array of organizations and governmental bodies (via various
media platforms) in their effort to support individuals and agencies in the areas
of education and health (OECD, 2020; Wong & Greenhalgh, 2014). It would also
seem feasible for such organizations to design apps or other digital services that
could be accessed by potential planners and providers, given that smart devices
are now more widely available and there are exemplars of apps being used by
a diverse array of providers in education, health, and business (Centers for
Disease Control and Prevention, 2018; Smith, 2016; Ventola, 2014). We can
consider using the power of technology to leverage artificial intelligence (AI),
and algorithms to understand how different messages resonate with different
parents and may help parenting interventions actually look and feel like perso­
nalized interventions that serve them specific content that speaks to their very
situation and may connect them with others in the same situation. Technology
could also be leveraged to mobilize parents to demand services and support to
meet their needs. In doing so, the key touch points of entry, engagement and
follow up by parents could create the pathway to scale and sustainability of
parenting support programs.

AFFILIATIONS AND ADDRESSES

Pia Rebello Britto, United Nations Children’s Fund, P.O. Box 1080. Vientiane, Lao PDR,
pbritto@unicef.org. Robert H. Bradley is at Arizona State University, Hirokazu Yoshikawa is
at New York University, Liliana A. Ponguta is at Yale University, Linda Richter is at University
of Witwatersrand, and Jennifer A. Kotler is at Google Inc.

ARTICLE INFORMATION

Conflict of Interest Disclosures

Each author signed a form for disclosure of potential conflicts of interest. No authors reported
any financial or other conflicts of interest in relation to the work described.

Ethical Principles
The authors affirm having followed professional ethical guidelines in preparing this work. This
ms. did not have any patient involvement or require ethics approval.
 PARENTING 271

Funding
None.

Role of the Funders/Sponsors

None.

Acknowledgments
We thank UNICEF and the LEGO Foundation for generous support of the preparation of this
Special Issue on The Future of Parenting Programs. The ideas and opinions expressed herein
are those of the authors alone, and endorsement by the authors’ institutions or funding
agencies is not intended and should not be inferred.

ORCID
Pia Rebello Britto http://orcid.org/0000-0003-3561-0557
Robert H. Bradley http://orcid.org/0000-0001-7098-1818
Hirokazu Yoshikawa http://orcid.org/0000-0001-5607-8526
Liliana A. Ponguta http://orcid.org/0000-0003-3576-1507
Linda Richter http://orcid.org/0000-0002-3654-3192
Jennifer A. Kotler http://orcid.org/0000-0001-9085-5528

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