Feasibility, acceptability, and appropriateness of the Familia Bora parenting program for couples with young children in Mwanza, Tanzania: a pilot mixed-methods process evaluation

ABSTRACT Through a research-practice partnership with collaborators and community members in Tanzania, we co-designed Familia Bora, a 17-session father-inclusive parenting intervention delivered weekly to couples in mixed-gender groups to promote responsive caregiving, couples’ relationships, caregiver mental health, and gender equity and holistically improve early child development. From July to November 2024, we piloted Familia Bora and conducted a mixed-methods process evaluation to assess its feasibility, acceptability, and appropriateness, and to identify opportunities for strengthening program delivery and implementation. Sixty-two couples with a child under 2 years were enrolled into the program across six communities in Ilemela District, Mwanza, Tanzania, from July to November 2024. Feasibility, acceptability, and appropriateness were assessed using multiple data sources: 90 session attendance records, 75 structured session observations, 79 facilitator feedback forms, 167 participant exit interviews (68 mothers and 99 fathers), endline surveys with 58 fathers, and 37 qualitative interviews at midline and 47 at endline with a purposively selected subsample of mothers, fathers, and group leaders. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic content analysis. Findings were triangulated across data sources to provide a comprehensive assessment of program implementation across multiple dimensions. We found that the program was feasible to deliver and highly acceptable to both fathers and mothers. Attendance rates were satisfactory among both mothers and fathers. The majority of participants rated the program positively, highlighting its content relevance, cultural appropriateness, and perceived benefits. Sessions on responsive caregiving, economic strengthening, and mental health were rated most favorably, whereas topics like non-violent discipline and fathers’ engagement in household chores met some initial resistance due to gender and cultural norms. Parents valued the mixed-gender group format, interactive materials, and participatory delivery, noting that these aspects fostered learning, reflection, and message sharing within their communities. Transport reimbursements were also valued by participants and identified as a key facilitator of attendance. Overall, this pilot evaluation demonstrates that Familia Bora was feasible, highly acceptable, and well received by both mothers and fathers. Findings highlight the promise of co-designed, gender-transformative, couples-based parenting programs for reducing barriers, promoting equitable caregiving, and fostering supportive caregiving environments for early child development. These findings support further testing of this program through a larger implementation study in Tanzania and potentially other similar contexts. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R00HD105984 to JJ). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Emory University (STUDY00006498) and the National Health Research Ethics Committee of the National Institute of Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4676) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors.