■2016年，巴西扩大了CriançaFeliz计划(PCF，来自葡萄牙语的首字母缩写)，使其成为全球最大的幼儿发展（ECD）计划之一。然而,PCF未能实现其预期的影响。我们旨在确定在RE-AIM维度上实现PCF实施成果的障碍和促进者(达到，有效性或功效，收养,实施和维护）在COVID-19大流行期间。
■此比较案例研究分析根据人口规模选择了五个对比城市，该地区的国家，实施模型，以及实施PCF的时间长度。我们对PCF市政团队进行了244次采访(市政经理，supervisors,家庭访客)，家庭,和跨部门专业人员。快速定性分析用于识别RE-AIM维度的主题。
■家庭对PCF目标的有限知识和信任是其实现的障碍。虽然PCF对育儿技能和ECD的感知好处使人们能够达到，缺乏解决社会需求的推荐协议，例如将粮食不安全的家庭与粮食资源联系起来，削弱了效力。关于社会援助部门是否应负责PCF的问题对其采用提出了质疑。COVID-19大流行加剧的实施障碍包括低工资，临时合同,高营业额,不经常监督，缺乏有效的监控系统，以及不存在或不运作的多部门委员会。缺乏制度化的资金是可持续性的挑战。
■复杂的相互交织的系统级障碍可能解释了PCF的不成功实施。巴西必须解决这些障碍，才能从PCF的巨大影响力及其所基于的循证护理原则中受益。
■NIH/NICHD。
UNASSIGNED: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic.
UNASSIGNED: This comparative
case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions.
UNASSIGNED: Families\' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability.
UNASSIGNED: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon.
UNASSIGNED: NIH/NICHD.
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