Care for left-behind children in rural China: A realist evaluation of a community-based intervention

In many countries, large numbers of left-behind children (LBC) grow up experiencing prolonged separation from their migrant worker parents. These children are known to be vulnerable to psychological and developmental problems. Drawing on qualitative interview data as well as ethnographic observations, a realist approach was applied in this study to evaluate the feasibility, acceptance, preliminary outcomes and potential sustainability of a community-based intervention to provide care and support to LBC, in a migrant-sending area of rural China. The intervention program comprised “Children's Clubs” in local communities, in which LBC participate in play and educational activities under the care and supervision of local volunteers. Twelve Clubs in 12 different villages were evaluated for the study. In each village, semi-structured interviews were conducted with three community stakeholders, and children and primary caregivers from two families, to examine their perceptions and experiences with regard to the intervention. Our findings indicated that most Clubs adapted the initial program theory and implementation plan to specific community contexts, particularly the socio-economic situation and the support from village leadership and other community members. Program implementation mechanisms consisted of integrating available resources, engaging local volunteers, and delivering various Club activities. Preliminary outcomes indicated the success in establishing a community care platform to benefit the emotional and behavioral wellbeing of LBC, and to enhance the community support networks. To ensure program sustainability, the Children's Clubs should explore new funding schemes, expand the pool of qualified volunteers, and improve the curricular and activities at the Clubs. • First documented program of “Children's Clubs” for left-behind children (LBC) in rural China • Adaptation to local contexts led to high level of acceptance and potential for sustainability. • Benefits are shown for children, caregivers and parents, as well as the community. • The program established a community care approach to improving the wellbeing of LBC.