Articles
Impact of the UNICEF Caring for the Caregiver intervention on mental health, social support, and parenting stress: a six-country pre–post evaluation Stephanie Redinger, Brian Houle, Boniface Kakhobwe, Caitlin Briedenhann, Pema Tshomo, Stephanie Bispo, Albert Ndagijimana, Mila Vukovic Jovanovic, Royston Wright, Gibson Nchimunya, Peter Hangoma, Alan Stein, Tamsen J Rochat, and the CFC group*
Summary
Background Caregivers facing mental and social stressors risk negative outcomes. The UNICEF Caring for the Caregiver package is a counselling approach and behaviour change intervention that can be integrated into routine home-visiting by frontline workers, in a demand-responsive way, at a population level. We aimed to evaluate caregiver outcomes and explore intervention experiences in six low-income and middle-income countries.
Lancet Glob Health 2026; 14: e723–33
Methods Using a non-randomised pragmatic design, we recruited caregivers of children using community-based sampling. Caregivers reported dose exposure and completed pre–post outcome measures of self-efficacy (General Self-Efficacy scale); social support (Multidimensional Scale of Perceived Social Support); depression (Patient Health Questionnaire-9); anxiety (General Anxiety Disorder 7-item scale); and parenting stress (Parenting Stress Index-36). Using pooled data, two-way fixed-effects regressions examined change and variations in outcomes, by dose. Perception data were collected from caregivers and frontline workers.
For the Dzongkha translation of the abstract see Online for appendix 1
Findings In Bhutan, Brazil, Serbia, Sierra Leone, Rwanda, and Zambia we trained 198 frontline workers and recruited 822 pregnant and postnatal caregivers receiving home-visiting from them (April, 2021, to July, 2022). At endline (3–6 months post-baseline) we assessed 682 (83%) of 822 caregivers. We observed higher self-efficacy (β=2·63 [95% CI 1·9 to 3·3]) and social support (4·17 [2·9 to 5·4]), and lower depression (–2·23 [–2·7 to –1·7]), anxiety (–1·43 [–1·8 to –1·0]), and parenting stress (–12·35 [–15·0 to –9·7]). Higher dose was associated with greater change across outcomes. The majority of caregivers and frontline workers reported positive intervention experiences. Interpretation Across settings, the UNICEF Caring for the Caregiver intervention was positively experienced by caregivers and frontline workers and was associated with positive changes in multiple outcomes. It has potential at population level, but evidence in controlled and longitudinal studies is needed. Funding UNICEF and the LEGO Foundation. Copyright © 2026 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Introduction In low-income and middle-income countries (LMICs), caregivers and families often raise their children in poverty, with limited access to health and social services.1 Caregivers who have partner, family, and community support have significant potential to promote resilience and buffer the effects of these adversities on children.2 However, there are barriers to this important role, including low emotional and practical support and parenting stress.3 Addressing these through community support to caregivers and families could potentially advance population health, wellbeing, and sustainable development.4,5 Research responding to these barriers has focused on caregiver mental health, parenting, and early childhood, including evaluating how frontline workers can enhance caregiver and child health services.6 Frontline workers can include nurses, midwives, lay counsellors, or community health-care workers who have direct contact www.thelancet.com/lancetgh Vol 14 May 2026
with caregivers, delivering care, health, or education in homes and community settings. Evidence suggests that appropriately trained and supervised frontline workers improve outcomes for children and families, but gaps remain in how this is translated to wider-scale implementation.7 The UNICEF Caring for the Caregiver (CFC) package is a prevention intervention responding to this gap.8 It is not a mental health treatment. It aims to mitigate the effects of adversities and prevent the development (or escalation) of psychological distress and social isolation. It takes a system-wide approach to improving the quality of general counselling skills relevant for a range of health interventions, encouraging integration of mental health and social support content within existing governmentled programmes. For additional information on the intervention see appendix 7 (p 3). We evaluate this intervention in six LMICs, testing the hypothesis that strengthening frontline worker
See Comment page e675 *Members are listed at the end of the Article
For the Portuguese translation of the abstract see Online for appendix 2 For the Krio translation of the abstract see Online for appendix 3 For the Serbian translation of the abstract see Online for appendix 4 For the Kinyarwanda translation of the abstract see Online for appendix 5 For the Chichewa translation of the abstract see Online for appendix 6 SAMRC/Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa (S Redinger PhD, Prof T J Rochat PhD); DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa (S Redinger, C Briedenhann MA); School of Demography, The Australian National University, Canberra, ACT, Australia (Prof B Houle PhD); SAMRC/ Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (Prof B Houle, Prof A Stein FRCPsych); Early Child Development, UNICEF, New York, NY, USA (B Kakhobwe PhD); UNICEF Bhutan Country Office, Kawajangsa-Thimphu, Bhutan (P Tshomo MA); UNICEF Brazil Country Office, Brasilia, Brazil (S Bispo PhD); College of Medicine and Health Sciences,
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