Integrating a Parenting Intervention With Routine Primary Health Care: A Cluster Randomized Trial
Integrating a Parenting Intervention With Routine Primary Health Care: A Cluster Randomized Trial
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DOI：
10.1542/peds.2015-0119
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发表时间：
2015-08-01
期刊：
影响因子：
8
通讯作者：
Walker, Susan P.
中科院分区：
文献类型：
--
作者：
Chang, Susan M.;Grantham-McGregor, Sally M.;Walker, Susan P.
全球有2亿多儿童无法实现其发展潜力。我们假设，父母的培训计划可以整合到初级卫生中心的访问和benefit child development.METHODS：我们进行了一个集群随机试验在加勒比海（牙买加，安提瓜和圣卢西亚）。15个中心被随机分配到对照组（n = 250对母子）和14个中心被随机分配到干预组（n = 251对母子）。参与者在6至8周的儿童健康访问中招募。干预措施在3至18个月的5次常规访问中使用了集体分娩，包括在等候区播放的儿童发展信息短片;由社区卫生工作者领导的讨论和演示;以及母亲的活动实践。护士们分发了信息卡和一些游戏材料。主要结果是儿童认知，语言，手眼协调和次要结果是照顾者的知识，做法，母亲抑郁症，和儿童的成长，测量后18个月visit.RESULTS：百分之八十五的入学儿童进行了测试（控制= 210，干预= 216）。各组的损失没有差异。多水平分析显示，认知发展有显著益处（3.09分; 95%置信区间：1.31至4.87分;效应量：0.3 SD）。没有其他儿童福利。有显着的好处，育儿知识（治疗效果：1.59; 95%置信区间：1.01至2.17;效果大小：0.4）。结论：一个创新的育儿干预，不需要额外的诊所工作人员或母亲的时间，被整合到卫生服务，有利于儿童的认知发展和父母的知识。这是一个有前途的战略，值得进一步大规模评估。
OBJECTIVE: More than 200 million children globally do not attain their developmental potential. We hypothesized that a parent training program could be integrated into primary health center visits and benefit child development.METHODS: We conducted a cluster randomized trial in the Caribbean (Jamaica, Antigua, and St Lucia). Fifteen centers were randomly assigned to the control (n = 250 mother-child pairs) and 14 to the intervention (n = 251 mother-child pairs) groups. Participants were recruited at the 6-to 8-week child health visit. The intervention used group delivery at 5 routine visits from age 3 to 18 months and comprised short films of child development messages, which were shown in the waiting area; discussion and demonstration led by community health workers; and mothers' practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child cognition, language, and hand-eye coordination and secondary outcomes were caregiver knowledge, practices, maternal depression, and child growth, measured after the 18-month visit.RESULTS: Eight-five percent of enrolled children were tested (control = 210, intervention = 216). Loss did not differ by group. Multilevel analyses showed significant benefits for cognitive development (3.09 points; 95% confidence interval: 1.31 to 4.87 points; effect size: 0.3 SDs). There were no other child benefits. There was a significant benefit to parenting knowledge (treatment effect: 1.59; 95% confidence interval: 1.01 to 2.17; effect size: 0.4).CONCLUSIONS: An innovative parenting intervention, requiring no additional clinic staff or mothers' time, was integrated into health services, with benefits to child cognitive development and parent knowledge. This is a promising strategy that merits further evaluation at scale.