Applied Research and Evaluation EVALUATION OF A PARENTING SKILLS PROGRAM IN RUSSIA
LEE MACKINNON University of Massachusetts, Amherst
ABSTRACT
This article analyzes participant interviews and the photovoice project of 15 young disadvantaged mothers in Pskov, Russia. The women’s statements and photovoice were part of a formative evaluation of the Pskov Positive Parenting Program, designed by the University of Massachusetts Institute for Global Health (IGH) and funded by USAID. The evaluation revealed that the Program met its goal of helping the women learn sensitive caregiving behaviors. The mothers emphasized that the Program met their need for social connection. The young mothers’ participation in the positive social network of the group may have been a key ingredient to the Program’s success and may have implications for the design of parenting programs cross-culturally.
INTRODUCTION The Pskov Positive Parenting program (hereafter, the Program) was a parenting skills education program for young disadvantaged mothers implemented in Pskov, a city of approximately 180,000 located in northwestern Russia. The Program was one component in the Pskov Youth Reproductive Health Project (PYRHP). The PYRHP was designed by the University of Massachusetts Institute for Global Health (IGH) and funded by USAID. The Program sought to strengthen parenting skills as a means to build parental competency, confidence, and role satisfaction,
Int’l. Quarterly of Community Health Education, Vol. 34(4) 313-330, 2013-2014 Ó 2014, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/IQ.34.4.c http://baywood.com 313
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with the ultimate goal to prevent child abuse and neglect and to reduce the number of children abandoned to state-run orphanages. Independent evaluation of the Program was conducted in May 2012. In-depth interviews with the young mothers and a photovoice project were at the core of the evaluation. The results indicate the project met its goal of helping the women learn sensitive caregiving behaviors. In addition, the mothers shared that the Program helped reduce their isolation and helped them form valuable social connections. The similarities to U.S. and European parenting education models raise intriguing questions about the cross-cultural validity of parenting intervention programs.
SETTING The Program consisted of multiple series of 10-week classes for young mothers. Because most had dropped out of school with few educational skills or promising career opportunities, virtually all of these young women were considered disadvantaged. The program of 10-classes was offered consecutively with a different cohort of young mothers and infants each time. The Program coordinator was responsible for leading the group, with occasional guest speakers on select topics. The group format was based on mutual sharing among the participants. Mothers sat in a circle and spent the hour and a half in conversation together with the coordinator. They were encouraged to bring their infants to the sessions, and were supported in letting them play beside them. Snacks were offered. The coordinator provided topical information at each meeting, yet devoted most of the time to an open dialogue among the participants. These discussions were then used to shape subsequent classes to meet their expressed needs. The mothers shared personal stories, asked questions, and commiserated with each other. In addition, the coordinator, in response to requests from the participants, scheduled opportunities for them to learn about and meet with representatives from other services and organizations. For example, specialists, such as a pediatrician or lawyer, were invited to address the group with pertinent information and to help with access to resources.
METHODS The evaluation utilized a range of data collection methods in order to develop a thick description from a variety of perspectives that could adequately capture the process and outcomes of the Program. In addition to participant observation, in-depth interviews with all relevant project staff in the United States and Russia, and document review, core data were collected through:
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• Interviews of current and former participants: Fifteen current and former participants were interviewed. All interviewees were between the ages of 16 and 22 years, all had dropped out of school, and all were unemployed. Semi-structured, in-depth interviews were held in private with the evaluator and translator. Questions for participants focused on their perceptions of the Program’s usefulness to their experience as young, single mothers. They were asked to describe the challenges and rewards of motherhood and the ways in which participation in the Program impacted their parenting behavior, values, and role satisfaction. • Participant photovoice project: The mothers were given an opportunity to tell their stories through a photovoice project. Through photovoice, individuals take photographs to represent their experience and point of view. It provides a methodology for participatory needs assessment and evaluation, and provides a means for people to show their needs as well as their strengths (Wang & Burris, 1997). For this evaluation, the mothers received disposable cameras with instructions to select and capture moments over a 1-week period when they were with their infants. They also completed three statements: 1. One thing I love about being a mother is_____ 2. One thing I find challenging about being a mother is ______ 3. The thing I want most for my child is ________. Once collected and analyzed, the images and statements were organized into a book and sent back to the mothers as a token of appreciation for their participation. The choices that they highlighted communicated elements of their experience that could be understood across language and cultural boundaries. Their words and images provided rich contextual detail and varied perspectives that enhanced the data obtained from the more conventional data collection methods. The images of the Pskov mothers facilitated appraisal of the instrumental value of the Program, its ability to achieve the desired results, and the public expression of the needs, values and interests of a group of people who often do not have a public voice (Schwandt, 2008). See Photovoice Appendix. Participants received an overview of the evaluation process and completed informed consent forms, translated into Russian. Their signature indicated that they understood the evaluation process, they desired to participate in the recorded interviews and photovoice project, and understood that they could withdraw consent at any time. DATA ANALYSIS Data analysis began with identifying portions of the transcripts that addressed the different evaluation objectives. Data were then categorized into themes through analytical coding techniques based on procedural frameworks of qualitative research (Strauss & Corbin, 1990). Open coding involved breaking down,
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comparing, and categorizing interview data. Axial coding identified recurring patterns in the data. Categories were developed and recombined to be mutually exclusive and relevant to the purposes of the evaluation. Selective coding focused on the experiences of the young women in the group and their appraisal of its effectiveness. A number of techniques were used to assure the validity of the analysis, including triangulation, member-checking, establishing trust with the participants, and systematically searching for contrary evidence. The data were triangulated by comparing participant observation field notes, recorded interviews, and review of documents from multiple sources. The process of triangulation of the interview transcripts, field observations, and documents highlighted patterns or discrepancies in the respective perceived assessments of the project outcomes. In addition, emerging findings were shared with the participants to check whether the initial interpretations of the speakers’ intents, meanings, and motivations were correct. RESULTS The evaluation yielded six major findings: 1. maternal behaviors shifted to include more sensitive, responsive parenting behavior; 2. maternal competence and confidence in the mothering role increased; 3. Social connections between the participants strengthened and helped reduce their isolation; 4, the Program provided information about maternal rights and facilitated access to social and medical services; 5. the Program provided a forum and resources for participants experiencing domestic violence; and finally, 6. the Program had a non-hierarchical, participatory structure. In the interview and photovoice excerpts that follow, the names have been changed to protect the anonymity of the respondents. Changes in Maternal Behavior As a result of their participation, the participants and staff reported a shift in maternal behavior to include more sensitive responsive caregiving. Elements of their behavior included greater interaction and appropriate communication with their babies. In addition, they understood nonverbal cues better and developed more appropriate expectations consistent with the different stages of development. Almost all of the mothers identified interaction with their babies as something important that they had learned in the classes and were using at home:
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At home, I pay more attention to the baby. I play with her more. I am more patient when she cries. The most important thing for me was to learn how to build a relationship with my baby . . . how to connect with him and build a relationship.
Examples included being more patient and in control of anger: Sometimes when you are with your child, you get angry, which you must not do. When you come here, you calm down and relax, and start seeing all this from a different angle.
They expressed increased understanding of their babies’ developmental needs and cues: We were taught how to pay attention to the emotions of the child, to pay more attention to the baby, himself or herself. I used to go out more . . . but now I take into account the baby’s condition, the baby’s mood, and if he doesn’t want to, I don’t take him. I pay more attention to the baby’s world.
Mothers shared a greater understanding of child development and appropriate expectations of their children’s behavior: I have become more tolerant of my baby, more attentive to his needs, and I understand his development. Now it is not just taking care of his physical needs but more about psychological development. My baby is very active. It was very hard to get her dressed, for example. But now it is easier. We learned some tips in the group. It is not good to be too strict but to be more inventive, to be more flexible and in some ways it is like . . . making it more like a game.
Mothers reported engaging in more talking and reading to their babies: In the group . . . Olga [the Program coordinator] discussed with us what kind of books, the size and the pictures that were best. After that when I got home, my communication with my child became much better and I started to share books with him. . . . I explain what is drawn in this or that picture and he makes some comments. He often fetches some books and he points at this or that picture and I explain it to him.
Change in maternal behavior was not universal. The coordinator noted that some mothers struggled with anxiety and anger. She explained, “They are traumatized people and it is difficult to find connection and to build a relationship with them. By the end of the series, it is possible but still they keep their distance.” In such cases, behavioral change was small or non-existent. She was hopeful, however, that the experience of coming to the group had laid a foundation for future trust and confidence that they might someday be able to access.
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Maternal Competence and Confidence The Program coordinator commented that the most significant change in parenting behavior was the mothers’ growing appreciation of themselves as mothers. Over time, they were able to integrate what they had learned in the program to gain a better understanding of what their babies needed and what they needed to be better mothers. The mothers credited their participation in the program as a major factor that built their confidence and competence: When I came to the group, other mothers could share my problems. . . . Now I am not ashamed of having a baby at such a young age and I can say that to anybody. (Here) there are people with the same problems and similar problems and that is why it is easier to overcome them. The group has made me more sociable. It became easier for me to communicate not only with my child but with other people.
Each mother expressed role satisfaction as a mother, most with great enthusiasm. They frequently shared that motherhood was the most positive aspect of their lives, and they identified it as a motivator to better their own situations and to create more successful lives for their children: All in all, I love my baby very much. I would say to a pregnant mother, love your child because it is a new page, a second chance for yourself, for you to change something, to correct your own mistakes for the many times when you were younger and you didn’t achieve something or you did something wrong.
These young mothers identified a number of challenges in their lives, including poverty, lack of paternal support, inadequate housing, lack of employment opportunities, and difficulties accessing medical care, yet no mother voiced any regret about her role as a mother nor voiced any warning to potential peers embarking on the same path: In spite of all difficulties you might face, even financial difficulties, it is a great happiness to have a child. When the baby makes achievements, it is also an achievement for the mother, for she helps the baby grow. This group helps you raise your child.
Social Support The mothers universally commented on the value of being with other mothers in the same situation. In the interviews, every mother began by stating her appreciation of the group and acknowledged how it had offered a unique opportunity to connect with other young mothers. They repeatedly voiced concerns about their isolation and described the void the group filled.
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The relationships that they forged with each other and with the coordinator offered different types of social support: I feel great support here. I feel better psychologically now because I know that I am not alone with my problems. There are many people I can share them with and we help each other. (psychological support) The most important thing has been communication with other mothers and with Olga and with the specialists. All of them have been helpful. I write down questions at home and I come here and get answers. (informational support)
As a consequence of group interaction, the Program provided an intentional and deliberate opportunity for the mothers to practice, get feedback, and improve their communication skills, with the goal of promoting additional relationships outside of the group. Former participants all cited that the connection with other mothers and the coordinator was what they missed most after the series ended: What I miss most since the group ended . . . is communication with other young mothers. Attending the classes gave me a push forward and supported me in stressful experiences. It was like a snowball. I drew from the positive experiences here that I could use in other parts of my life.
In looking ahead to the ending of the series, current participants recognized that losing connection with others would be a great loss: Of course I will miss this group a lot, especially the communication with other mothers. . . . [When] women are confined at home in their flats with children, they miss this communication a lot.
Information and Access to Services Information about maternal rights and eligibility for various government services was also cited as being extremely useful. As one mother explained, “We have different sources of information but still we know so little about our rights and the rights of our children.” For many, the Program provided information that they knew little about and had no idea of how to find. In the words of one participant, “My family qualifies for social services based on our income. The information on allowances was very helpful because I did not know this.” Often the mothers made personal contact with guest speakers to gain on-site help or arrange personalized follow-up: I am looking forward to next week’s group very much. A hematologist is coming. This is important to me because my children have anemia and it is very difficult to get to see the hematologist in hospital. This is a great opportunity to come to this group and meet with this specialist. My baby was premature and I needed a special doctor for him. Olga was very helpful. She organized it so we could be seen very quickly.
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Domestic Violence Support An unanticipated finding was that the Program provided the opportunity for the mothers to disclose their experiences with domestic violence. In a culture where the problem of domestic violence is not openly discussed, the Program created a safe space for the mothers to talk about these issues and offered information and referrals to services about which they had no prior knowledge. After the series ended, Olga, the coordinator, was available to provide additional counseling and referrals to former participants living in threatening environments. According to her: Every second mother here has problems with violence. Actually, they get used to that. First, their fathers beat them, then their husbands beat them. They share these problems, especially toward the end of the series. And it is like therapy—talking and listening.
A former participant identified this as the most important issue addressed in the Program. In her words: Abuse and violence in the family . . . [We discussed how to] be active, not hush things up. Phone the local police and they would take action. The most important thing is not to stay home and do nothing and forget it and pretend that nothing happened.
The opportunity to share these experiences in the groups was critical to the mothers’ ability to positively parent their children. Understanding the negative outcomes associated with childhood witnessing of violence and becoming aware of options are essential first steps towards changing the situation. I realize it has negative impact on the baby because she sees everything that is going on—all the shouting and fighting. I understand it has a psychological impact on her. I feel an emotional change by coming to this group. I let out my feelings and that helps my baby too. When a mother feels better, so does the baby.
While interventions to address family violence are important in their own right, they take on added significance in protecting the well being of children’s emotional and physical health. Non-Hierarchical, Individualized Structure While the mothers expressed respect for the coordinator’s skills and knowledge, they also enjoyed an informal and nonhierarchical relationship with her. The way Olga structures the group, it is easy to find a common language. It is not just one specialist talking—it is about all of us communicating and sharing.
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In addition to addressing general topics through materials and activities, the coordinator encouraged individual sharing and presented opportunities for the mothers to discuss their particular needs and concerns. Referrals to community resources and the topics presented by guest presenters often grew from the needs of participants. DISCUSSION Results of the evaluation indicate that the mothers’ caregiving behavior changed in line with the objectives stated in the original proposal. The findings aligned with an increase in five protective factors, shown by the Center of the Study of Social Policy (2012) to reduce the likelihood of child abuse and neglect: 1. promotion of maternal behaviors that support development of emotional competence of children; 2. advancement of maternal knowledge of child development; 3. opportunity for enhanced resiliency resulting from the participants’ increased confidence and competence and their positive self-regard as mothers; 4. social connections between participants and with the Program coordinator; and 5. concrete support from the Program in times of need. Through the interviews and photovoice, the mothers enthusiastically endorsed the Program and stated that it was meeting their self-identified needs. They cited the relevance of the information, access to other services, and, most especially, reduced isolation. Although living in a more collectivist culture with extended family support and public valuing of fertility, the Pskov young mothers regarded the opportunity to connect with each other and to the coordinator as key to the Program’s success. The Program fostered the development of intimate ties by directing outreach to a narrow subset of parents, namely young, first-time, disadvantaged mothers. The ensuing homophily, the tendency of people to form intimate ties with others like themselves, encouraged connections between group members (Small, 2009). Additionally, the interactive structure of the model allowed participants to get to know each other. Features included the lay-out of the room, the accessibility of the coordinator, who even shared her private telephone number, and individualized follow-up after the series ended. All played a pivotal role in building social connections for the young mothers. For the Pskov mothers, the opportunity to participate in a process that advocated respectful listening and sharing of the intimacies of parenting and family life contrasted to the traditional didactic style of Russian interventions. As in the interviews and photovoice, sharing personal stories gave the mothers a voice that is not often tapped in Russian policy-making and program development (Rivkin-Fish, 2004).
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By creating a more participatory structure, this Russian program resembled U.S. and European interventions that rely on participant interaction to overcome the isolation that young mothers face. The Program had many similarities to U.S.-based parenting education and support models. These include nonhierarchical relationships, informal norms that encouraged solidarity and social support among the members, and a responsive focus on individual situations. Materials were interactive and information discussed was consistent with the topics identified in U.S. curricula, including child development, parent-child interaction, and emotional development (George & Solomon, 2008; Shonkoff & Meisels, 2000). While addressing the isolation of young disadvantaged mothers was not an explicit objective of the Program, it appeared that, by meeting that need, the Program became a vehicle for the mothers to learn to integrate new caregiving behaviors from each other, the coordinator, and specialists who visited the group. The young mothers’ participation in the positive social network of the group may have been a key ingredient to the Program’s success in meeting its objectives. Future research is needed to determine if connecting with others is critical to the success of parenting intervention programs or if other factors are essential to promote behavior change. Does the development of positive caregiving behavior depend on the presence of social support? Is the group relational process as important, or even more important, than the information and skills imparted? Should building social support be the starting place of all parenting interventions? The issue of isolation for parents, especially new, young parents, must be explored more fully to better understand its significance. If isolation is a widespread experience of new mothers across cultures, building social networks may be a critical component to any parenting intervention. The Program illustrated a model of social capital in which organizations can act as brokers of connections to other organizations. By bringing in specialists from outside agencies, the coordinator helped the mothers access additional social services and resources. They often received expedited access, an asset in a system where individuals may experience long waiting lists for specialized services. Such organizational ties are especially beneficial to families who may not have the financial resources to access needed services and to socially isolated families who do not have the personal connections (Small, 2009). The prevalence of domestic violence was an unforeseen finding and one that the Program was not set up to address. This is a key area for further exploration. How prevalent is it in the lives of young, disadvantaged women in Pskov and other parts of Russia? What appears to help them change their situations? What is the role of social capital in helping them transform their conditions? While the results of the evaluation were generally positive, limitations include a small sample size and observations in only one Russian provincial city. Further study is needed to determine if the results found here are applicable in other settings.
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In conclusion, given that the Program’s success can be at least partly attributed to the opportunity for the mothers to participate in a positive social network and reap the ensuing benefits, social capital theory may offer a framework for intervention programs in a range of cultural contexts. The value of building relationships may extend beyond cultural differences and be an important means to promote behavioral change and access to resources for families. If this is the case, models that emphasize extension of social networks may be useful when designing international programming. More research is needed in this area, but if shown to be a significant factor, building social capital into early childhood and family interventions may hold benefits that transcend the particulars of place and situation.
PHOTOVOICE APPENDIX
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REFERENCES Center for the Study of Social Policy. (2012). Strengthening families. Retrieved from http://www.cssp.org/reform/strengthening-families George, C., & Solomon, J. (2008). The caregiving system: A behavioral systems approach to parenting. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2nd ed.). New York, NY: The Guilford Press. ISBN-13: 978-1606230282 Rivkin-Fish, M. (2004). “Change yourself and the whole world will become kinder”: Russian activists for reproductive health and the limits of claims making for women. Medical Anthropology Quarterly, 18(3), 281-304. doi: 10.1525/maq.2004.18.3.281 Schwandt, T. A. (2008). Educating for intelligent belief in evaluation. American Journal of Evaluation, 29(2), 139-150. doi: 10.1177/1098214008316889 Shonkoff, J. P., & Meisels, S. J. (Eds.). (2000). Handbook of early childhood intervention (2nd ed.). New York, NY: Cambridge University Press. ISBN-13: 978-0521585736 Small, M. L. (2009). Unanticipated gains: Origins of inequality in everyday life. New York, NY: Oxford University Press. ISBN: 978-0-19-976409-9 Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage. Wang, C., & Burris, M. A. (1997). Photo voice: Concept, methodology, and use for participatory needs assessment. Health Education and Behavior, 24(3), 368-387. doi: 10.1177/109019819702400309
Direct reprint requests to: Lee MacKinnon 31 Dryads Green Northampton, MA 01060 e-mail: [email protected]
LEE MACKINNON University of Massachusetts, Amherst
ABSTRACT
This article analyzes participant interviews and the photovoice project of 15 young disadvantaged mothers in Pskov, Russia. The women’s statements and photovoice were part of a formative evaluation of the Pskov Positive Parenting Program, designed by the University of Massachusetts Institute for Global Health (IGH) and funded by USAID. The evaluation revealed that the Program met its goal of helping the women learn sensitive caregiving behaviors. The mothers emphasized that the Program met their need for social connection. The young mothers’ participation in the positive social network of the group may have been a key ingredient to the Program’s success and may have implications for the design of parenting programs cross-culturally.
INTRODUCTION The Pskov Positive Parenting program (hereafter, the Program) was a parenting skills education program for young disadvantaged mothers implemented in Pskov, a city of approximately 180,000 located in northwestern Russia. The Program was one component in the Pskov Youth Reproductive Health Project (PYRHP). The PYRHP was designed by the University of Massachusetts Institute for Global Health (IGH) and funded by USAID. The Program sought to strengthen parenting skills as a means to build parental competency, confidence, and role satisfaction,
Int’l. Quarterly of Community Health Education, Vol. 34(4) 313-330, 2013-2014 Ó 2014, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/IQ.34.4.c http://baywood.com 313
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with the ultimate goal to prevent child abuse and neglect and to reduce the number of children abandoned to state-run orphanages. Independent evaluation of the Program was conducted in May 2012. In-depth interviews with the young mothers and a photovoice project were at the core of the evaluation. The results indicate the project met its goal of helping the women learn sensitive caregiving behaviors. In addition, the mothers shared that the Program helped reduce their isolation and helped them form valuable social connections. The similarities to U.S. and European parenting education models raise intriguing questions about the cross-cultural validity of parenting intervention programs.
SETTING The Program consisted of multiple series of 10-week classes for young mothers. Because most had dropped out of school with few educational skills or promising career opportunities, virtually all of these young women were considered disadvantaged. The program of 10-classes was offered consecutively with a different cohort of young mothers and infants each time. The Program coordinator was responsible for leading the group, with occasional guest speakers on select topics. The group format was based on mutual sharing among the participants. Mothers sat in a circle and spent the hour and a half in conversation together with the coordinator. They were encouraged to bring their infants to the sessions, and were supported in letting them play beside them. Snacks were offered. The coordinator provided topical information at each meeting, yet devoted most of the time to an open dialogue among the participants. These discussions were then used to shape subsequent classes to meet their expressed needs. The mothers shared personal stories, asked questions, and commiserated with each other. In addition, the coordinator, in response to requests from the participants, scheduled opportunities for them to learn about and meet with representatives from other services and organizations. For example, specialists, such as a pediatrician or lawyer, were invited to address the group with pertinent information and to help with access to resources.
METHODS The evaluation utilized a range of data collection methods in order to develop a thick description from a variety of perspectives that could adequately capture the process and outcomes of the Program. In addition to participant observation, in-depth interviews with all relevant project staff in the United States and Russia, and document review, core data were collected through:
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• Interviews of current and former participants: Fifteen current and former participants were interviewed. All interviewees were between the ages of 16 and 22 years, all had dropped out of school, and all were unemployed. Semi-structured, in-depth interviews were held in private with the evaluator and translator. Questions for participants focused on their perceptions of the Program’s usefulness to their experience as young, single mothers. They were asked to describe the challenges and rewards of motherhood and the ways in which participation in the Program impacted their parenting behavior, values, and role satisfaction. • Participant photovoice project: The mothers were given an opportunity to tell their stories through a photovoice project. Through photovoice, individuals take photographs to represent their experience and point of view. It provides a methodology for participatory needs assessment and evaluation, and provides a means for people to show their needs as well as their strengths (Wang & Burris, 1997). For this evaluation, the mothers received disposable cameras with instructions to select and capture moments over a 1-week period when they were with their infants. They also completed three statements: 1. One thing I love about being a mother is_____ 2. One thing I find challenging about being a mother is ______ 3. The thing I want most for my child is ________. Once collected and analyzed, the images and statements were organized into a book and sent back to the mothers as a token of appreciation for their participation. The choices that they highlighted communicated elements of their experience that could be understood across language and cultural boundaries. Their words and images provided rich contextual detail and varied perspectives that enhanced the data obtained from the more conventional data collection methods. The images of the Pskov mothers facilitated appraisal of the instrumental value of the Program, its ability to achieve the desired results, and the public expression of the needs, values and interests of a group of people who often do not have a public voice (Schwandt, 2008). See Photovoice Appendix. Participants received an overview of the evaluation process and completed informed consent forms, translated into Russian. Their signature indicated that they understood the evaluation process, they desired to participate in the recorded interviews and photovoice project, and understood that they could withdraw consent at any time. DATA ANALYSIS Data analysis began with identifying portions of the transcripts that addressed the different evaluation objectives. Data were then categorized into themes through analytical coding techniques based on procedural frameworks of qualitative research (Strauss & Corbin, 1990). Open coding involved breaking down,
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comparing, and categorizing interview data. Axial coding identified recurring patterns in the data. Categories were developed and recombined to be mutually exclusive and relevant to the purposes of the evaluation. Selective coding focused on the experiences of the young women in the group and their appraisal of its effectiveness. A number of techniques were used to assure the validity of the analysis, including triangulation, member-checking, establishing trust with the participants, and systematically searching for contrary evidence. The data were triangulated by comparing participant observation field notes, recorded interviews, and review of documents from multiple sources. The process of triangulation of the interview transcripts, field observations, and documents highlighted patterns or discrepancies in the respective perceived assessments of the project outcomes. In addition, emerging findings were shared with the participants to check whether the initial interpretations of the speakers’ intents, meanings, and motivations were correct. RESULTS The evaluation yielded six major findings: 1. maternal behaviors shifted to include more sensitive, responsive parenting behavior; 2. maternal competence and confidence in the mothering role increased; 3. Social connections between the participants strengthened and helped reduce their isolation; 4, the Program provided information about maternal rights and facilitated access to social and medical services; 5. the Program provided a forum and resources for participants experiencing domestic violence; and finally, 6. the Program had a non-hierarchical, participatory structure. In the interview and photovoice excerpts that follow, the names have been changed to protect the anonymity of the respondents. Changes in Maternal Behavior As a result of their participation, the participants and staff reported a shift in maternal behavior to include more sensitive responsive caregiving. Elements of their behavior included greater interaction and appropriate communication with their babies. In addition, they understood nonverbal cues better and developed more appropriate expectations consistent with the different stages of development. Almost all of the mothers identified interaction with their babies as something important that they had learned in the classes and were using at home:
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At home, I pay more attention to the baby. I play with her more. I am more patient when she cries. The most important thing for me was to learn how to build a relationship with my baby . . . how to connect with him and build a relationship.
Examples included being more patient and in control of anger: Sometimes when you are with your child, you get angry, which you must not do. When you come here, you calm down and relax, and start seeing all this from a different angle.
They expressed increased understanding of their babies’ developmental needs and cues: We were taught how to pay attention to the emotions of the child, to pay more attention to the baby, himself or herself. I used to go out more . . . but now I take into account the baby’s condition, the baby’s mood, and if he doesn’t want to, I don’t take him. I pay more attention to the baby’s world.
Mothers shared a greater understanding of child development and appropriate expectations of their children’s behavior: I have become more tolerant of my baby, more attentive to his needs, and I understand his development. Now it is not just taking care of his physical needs but more about psychological development. My baby is very active. It was very hard to get her dressed, for example. But now it is easier. We learned some tips in the group. It is not good to be too strict but to be more inventive, to be more flexible and in some ways it is like . . . making it more like a game.
Mothers reported engaging in more talking and reading to their babies: In the group . . . Olga [the Program coordinator] discussed with us what kind of books, the size and the pictures that were best. After that when I got home, my communication with my child became much better and I started to share books with him. . . . I explain what is drawn in this or that picture and he makes some comments. He often fetches some books and he points at this or that picture and I explain it to him.
Change in maternal behavior was not universal. The coordinator noted that some mothers struggled with anxiety and anger. She explained, “They are traumatized people and it is difficult to find connection and to build a relationship with them. By the end of the series, it is possible but still they keep their distance.” In such cases, behavioral change was small or non-existent. She was hopeful, however, that the experience of coming to the group had laid a foundation for future trust and confidence that they might someday be able to access.
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Maternal Competence and Confidence The Program coordinator commented that the most significant change in parenting behavior was the mothers’ growing appreciation of themselves as mothers. Over time, they were able to integrate what they had learned in the program to gain a better understanding of what their babies needed and what they needed to be better mothers. The mothers credited their participation in the program as a major factor that built their confidence and competence: When I came to the group, other mothers could share my problems. . . . Now I am not ashamed of having a baby at such a young age and I can say that to anybody. (Here) there are people with the same problems and similar problems and that is why it is easier to overcome them. The group has made me more sociable. It became easier for me to communicate not only with my child but with other people.
Each mother expressed role satisfaction as a mother, most with great enthusiasm. They frequently shared that motherhood was the most positive aspect of their lives, and they identified it as a motivator to better their own situations and to create more successful lives for their children: All in all, I love my baby very much. I would say to a pregnant mother, love your child because it is a new page, a second chance for yourself, for you to change something, to correct your own mistakes for the many times when you were younger and you didn’t achieve something or you did something wrong.
These young mothers identified a number of challenges in their lives, including poverty, lack of paternal support, inadequate housing, lack of employment opportunities, and difficulties accessing medical care, yet no mother voiced any regret about her role as a mother nor voiced any warning to potential peers embarking on the same path: In spite of all difficulties you might face, even financial difficulties, it is a great happiness to have a child. When the baby makes achievements, it is also an achievement for the mother, for she helps the baby grow. This group helps you raise your child.
Social Support The mothers universally commented on the value of being with other mothers in the same situation. In the interviews, every mother began by stating her appreciation of the group and acknowledged how it had offered a unique opportunity to connect with other young mothers. They repeatedly voiced concerns about their isolation and described the void the group filled.
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The relationships that they forged with each other and with the coordinator offered different types of social support: I feel great support here. I feel better psychologically now because I know that I am not alone with my problems. There are many people I can share them with and we help each other. (psychological support) The most important thing has been communication with other mothers and with Olga and with the specialists. All of them have been helpful. I write down questions at home and I come here and get answers. (informational support)
As a consequence of group interaction, the Program provided an intentional and deliberate opportunity for the mothers to practice, get feedback, and improve their communication skills, with the goal of promoting additional relationships outside of the group. Former participants all cited that the connection with other mothers and the coordinator was what they missed most after the series ended: What I miss most since the group ended . . . is communication with other young mothers. Attending the classes gave me a push forward and supported me in stressful experiences. It was like a snowball. I drew from the positive experiences here that I could use in other parts of my life.
In looking ahead to the ending of the series, current participants recognized that losing connection with others would be a great loss: Of course I will miss this group a lot, especially the communication with other mothers. . . . [When] women are confined at home in their flats with children, they miss this communication a lot.
Information and Access to Services Information about maternal rights and eligibility for various government services was also cited as being extremely useful. As one mother explained, “We have different sources of information but still we know so little about our rights and the rights of our children.” For many, the Program provided information that they knew little about and had no idea of how to find. In the words of one participant, “My family qualifies for social services based on our income. The information on allowances was very helpful because I did not know this.” Often the mothers made personal contact with guest speakers to gain on-site help or arrange personalized follow-up: I am looking forward to next week’s group very much. A hematologist is coming. This is important to me because my children have anemia and it is very difficult to get to see the hematologist in hospital. This is a great opportunity to come to this group and meet with this specialist. My baby was premature and I needed a special doctor for him. Olga was very helpful. She organized it so we could be seen very quickly.
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Domestic Violence Support An unanticipated finding was that the Program provided the opportunity for the mothers to disclose their experiences with domestic violence. In a culture where the problem of domestic violence is not openly discussed, the Program created a safe space for the mothers to talk about these issues and offered information and referrals to services about which they had no prior knowledge. After the series ended, Olga, the coordinator, was available to provide additional counseling and referrals to former participants living in threatening environments. According to her: Every second mother here has problems with violence. Actually, they get used to that. First, their fathers beat them, then their husbands beat them. They share these problems, especially toward the end of the series. And it is like therapy—talking and listening.
A former participant identified this as the most important issue addressed in the Program. In her words: Abuse and violence in the family . . . [We discussed how to] be active, not hush things up. Phone the local police and they would take action. The most important thing is not to stay home and do nothing and forget it and pretend that nothing happened.
The opportunity to share these experiences in the groups was critical to the mothers’ ability to positively parent their children. Understanding the negative outcomes associated with childhood witnessing of violence and becoming aware of options are essential first steps towards changing the situation. I realize it has negative impact on the baby because she sees everything that is going on—all the shouting and fighting. I understand it has a psychological impact on her. I feel an emotional change by coming to this group. I let out my feelings and that helps my baby too. When a mother feels better, so does the baby.
While interventions to address family violence are important in their own right, they take on added significance in protecting the well being of children’s emotional and physical health. Non-Hierarchical, Individualized Structure While the mothers expressed respect for the coordinator’s skills and knowledge, they also enjoyed an informal and nonhierarchical relationship with her. The way Olga structures the group, it is easy to find a common language. It is not just one specialist talking—it is about all of us communicating and sharing.
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In addition to addressing general topics through materials and activities, the coordinator encouraged individual sharing and presented opportunities for the mothers to discuss their particular needs and concerns. Referrals to community resources and the topics presented by guest presenters often grew from the needs of participants. DISCUSSION Results of the evaluation indicate that the mothers’ caregiving behavior changed in line with the objectives stated in the original proposal. The findings aligned with an increase in five protective factors, shown by the Center of the Study of Social Policy (2012) to reduce the likelihood of child abuse and neglect: 1. promotion of maternal behaviors that support development of emotional competence of children; 2. advancement of maternal knowledge of child development; 3. opportunity for enhanced resiliency resulting from the participants’ increased confidence and competence and their positive self-regard as mothers; 4. social connections between participants and with the Program coordinator; and 5. concrete support from the Program in times of need. Through the interviews and photovoice, the mothers enthusiastically endorsed the Program and stated that it was meeting their self-identified needs. They cited the relevance of the information, access to other services, and, most especially, reduced isolation. Although living in a more collectivist culture with extended family support and public valuing of fertility, the Pskov young mothers regarded the opportunity to connect with each other and to the coordinator as key to the Program’s success. The Program fostered the development of intimate ties by directing outreach to a narrow subset of parents, namely young, first-time, disadvantaged mothers. The ensuing homophily, the tendency of people to form intimate ties with others like themselves, encouraged connections between group members (Small, 2009). Additionally, the interactive structure of the model allowed participants to get to know each other. Features included the lay-out of the room, the accessibility of the coordinator, who even shared her private telephone number, and individualized follow-up after the series ended. All played a pivotal role in building social connections for the young mothers. For the Pskov mothers, the opportunity to participate in a process that advocated respectful listening and sharing of the intimacies of parenting and family life contrasted to the traditional didactic style of Russian interventions. As in the interviews and photovoice, sharing personal stories gave the mothers a voice that is not often tapped in Russian policy-making and program development (Rivkin-Fish, 2004).
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By creating a more participatory structure, this Russian program resembled U.S. and European interventions that rely on participant interaction to overcome the isolation that young mothers face. The Program had many similarities to U.S.-based parenting education and support models. These include nonhierarchical relationships, informal norms that encouraged solidarity and social support among the members, and a responsive focus on individual situations. Materials were interactive and information discussed was consistent with the topics identified in U.S. curricula, including child development, parent-child interaction, and emotional development (George & Solomon, 2008; Shonkoff & Meisels, 2000). While addressing the isolation of young disadvantaged mothers was not an explicit objective of the Program, it appeared that, by meeting that need, the Program became a vehicle for the mothers to learn to integrate new caregiving behaviors from each other, the coordinator, and specialists who visited the group. The young mothers’ participation in the positive social network of the group may have been a key ingredient to the Program’s success in meeting its objectives. Future research is needed to determine if connecting with others is critical to the success of parenting intervention programs or if other factors are essential to promote behavior change. Does the development of positive caregiving behavior depend on the presence of social support? Is the group relational process as important, or even more important, than the information and skills imparted? Should building social support be the starting place of all parenting interventions? The issue of isolation for parents, especially new, young parents, must be explored more fully to better understand its significance. If isolation is a widespread experience of new mothers across cultures, building social networks may be a critical component to any parenting intervention. The Program illustrated a model of social capital in which organizations can act as brokers of connections to other organizations. By bringing in specialists from outside agencies, the coordinator helped the mothers access additional social services and resources. They often received expedited access, an asset in a system where individuals may experience long waiting lists for specialized services. Such organizational ties are especially beneficial to families who may not have the financial resources to access needed services and to socially isolated families who do not have the personal connections (Small, 2009). The prevalence of domestic violence was an unforeseen finding and one that the Program was not set up to address. This is a key area for further exploration. How prevalent is it in the lives of young, disadvantaged women in Pskov and other parts of Russia? What appears to help them change their situations? What is the role of social capital in helping them transform their conditions? While the results of the evaluation were generally positive, limitations include a small sample size and observations in only one Russian provincial city. Further study is needed to determine if the results found here are applicable in other settings.
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In conclusion, given that the Program’s success can be at least partly attributed to the opportunity for the mothers to participate in a positive social network and reap the ensuing benefits, social capital theory may offer a framework for intervention programs in a range of cultural contexts. The value of building relationships may extend beyond cultural differences and be an important means to promote behavioral change and access to resources for families. If this is the case, models that emphasize extension of social networks may be useful when designing international programming. More research is needed in this area, but if shown to be a significant factor, building social capital into early childhood and family interventions may hold benefits that transcend the particulars of place and situation.
PHOTOVOICE APPENDIX
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REFERENCES Center for the Study of Social Policy. (2012). Strengthening families. Retrieved from http://www.cssp.org/reform/strengthening-families George, C., & Solomon, J. (2008). The caregiving system: A behavioral systems approach to parenting. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2nd ed.). New York, NY: The Guilford Press. ISBN-13: 978-1606230282 Rivkin-Fish, M. (2004). “Change yourself and the whole world will become kinder”: Russian activists for reproductive health and the limits of claims making for women. Medical Anthropology Quarterly, 18(3), 281-304. doi: 10.1525/maq.2004.18.3.281 Schwandt, T. A. (2008). Educating for intelligent belief in evaluation. American Journal of Evaluation, 29(2), 139-150. doi: 10.1177/1098214008316889 Shonkoff, J. P., & Meisels, S. J. (Eds.). (2000). Handbook of early childhood intervention (2nd ed.). New York, NY: Cambridge University Press. ISBN-13: 978-0521585736 Small, M. L. (2009). Unanticipated gains: Origins of inequality in everyday life. New York, NY: Oxford University Press. ISBN: 978-0-19-976409-9 Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage. Wang, C., & Burris, M. A. (1997). Photo voice: Concept, methodology, and use for participatory needs assessment. Health Education and Behavior, 24(3), 368-387. doi: 10.1177/109019819702400309
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