Inside the black box of a successful parent-infant intervention in a South African informal settlement : mothers' and counsellors' accounts of the process

[摘要] ENGLISH ABSTRACT: Extensive research over the past 30 years has shown that reliable, sensitive, responsive and empathic careof the infant by the mother or mother-substitute in the early months facilitates the development of secureattachments in infants, and ultimately their healthy development towards competent adulthood and futurerelationships with others. This study analyses interviews with 17 mothers selected from an interventionproven successful by means of a randomized controlled trial. The intervention took place in Khayelitsha, aperi-urban settlement close to Cape Town, South Africa, and was delivered by previously untrained laycounsellors to at risk mothers and infants. Supervision and training of the counsellors was provided by theauthor. Mothers were purposively selected on the basis of being experienced by counsellors as easy,difficult to reach, young/immature mothers and HIV-positive mothers, and were interviewed by aclinically trained interviewer not involved in the project individually and in groups. Counsellors' processnotes, exploring the impact, relevance and meaning that the intervention had for the recipient mothers, aswell as the supervisor's notes were also used as data. The findings identify what changes mothersreported, their experiences of the intervention, cultural issues in the intervention, and mothers' suggestionsfor modifications to the programme. The results are discussed in light of theories of change emerging fromthe literature on psychotherapy change research and research on community-based interventions. Thestudy shows that though results of randomized controlled trials are necessary for policy planning, in-depthinterrogation of the design and process issues at stake in complex community-based studies yieldcomplementary data which are also important to consider. Finally, the study considers the implications ofthis understanding of process for the future dissemination of the training and application of thisprogramme, as well as policy, research and funding challenges.

[发布机构] Stellenbosch University