Quality Improvement Process in Childcare Facilities: Results of a Qualitative Study

INTRODUCTION: Access to quality educational facilities is a major determinant of children's well-being and a means to tackle social health inequalities. In France, ‘Accompagne-moi...!’ (AM) intervention, tested in a pilot study, was adapted from evidence-based interventions developed in Quebec. The objective of AM was to improve professional practices allowing children to develop their social and emotional skills. This research aimed to assess viable validity of AM. Viable validity “refers to stakeholders’ views and experience regarding whether an intervention program is practical, affordable, suitable, evaluable and helpful in the real-world” (Chen, 2010). METHODS: A qualitative study was realised in 13 childcare facilities from 4 French deprived areas (2019-22). Eight exploratory interviews, 33 semi-structured interviews with professionals were conducted. A comprehensive thematic analysis was performed. RESULTS: Childcare facilities were systems characterised by involved professionals evolving in difficult working conditions amplified in times of health crisis. The interviews showed the potential of the approach to address needs (e.g. professional training, increased awareness of children's emotions) and perceived positive effects (e.g. support for management in implementing change in the facilities, perceived effects on children). Professionals expressed a negative experience of AM (e.g. sense of failure, insufficient appropriation of the approach by the group) linked to the challenges of deploying an intervention in highly stressed environments. CONCLUSIONS: This study highlights: i) potential of AM, ii) that children's well-being cannot be separated from the professional's well-being, iii) inflluence of certain structural determinants on educational practices and the quality of childcare facilities, iv) need to address these structural determinants prior to the intervention implementation. Prior to the deployment of AM on a larger scale, adaptations were proposed. KEY MESSAGES: • The well-being of children and professionals in childcare facilities are interdependent. • Structural determinants are key determinants of the quality of childcare facilities.