Challenges to Sustaining Dyad Group Care During COVID-19: A Mixed-Methods Study of Implementation Across Eight...

CenteringParenting® is a dyad group care (DGC) model integrating well-child care with peer support. Many programs were paused during the COVID-19 pandemic, but the determinants of DGC sustainability have not been characterized. We examined barriers and facilitators that shaped DGC implementation during the pandemic, and how core components of the model fared across shifts in delivery.

The GROW.V.BABY Practice-Based Research Network conducted a multi-site, retrospective, mixed-methods study using an anonymous survey and follow-up focus groups to examine pandemic-related disruptions, implementation determinants, and sustainability of dyad group care.

Most organizations (75%) paused programs; one sustained virtual delivery and one discontinued. Facilitators included leadership support (62.5%), access to space (62.5%), and multiple trained providers (50.0%). Barriers included COVID-19 safety protocols affecting feasibility (87.5%), restrictions on in-person interaction (75.0%), limited provider time (37.5%), and few trained providers (37.5%). Focus groups indicated that virtual delivery weakened relational components of DGC, including peer connection, rapport, and cohesion, and complicated delivery of clinical components such as vaccinations. In-person groups were described as providing relational benefits for both families and staff. Greater clinician decision-making authority was perceived to support sustainability.

Common barriers included limited provider time and pandemic-related difficulties with recruitment and coordination. The program was difficult to implement virtually, as key relational components could not be fully replicated online. Clinicians emphasized that preserving the integrity of the model, which supports peer connection and engagement, is important for reducing staff burnout and sustaining the program as a pathway to high-quality preventive care.