Testing Means to Sustain Short-term Early Childhood Development Impacts Long-term

维持短期早期儿童发展的测试手段会产生长期影响

• 批准号: 9896317
• 负责人: Jill Luoto
• 金额: $ 23.08万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9896317
• 关键词: Address; Adherence; Adopted; Adoption; Affective; Age; Attention; Behavior; Behavioral; Caring; Child; Child Development; Child Health; Child Rearing; Control Groups; Country; Cues; Data; Development; Dose; Early Intervention; Educational Curriculum; Effectiveness; Emotional; Ensure; Equilibrium; Exposure to; Family; Fathers; Funding; Health; Home environment; Home visitation; Household; Hygiene; Income; Infant; Intervention; Kenya; Knowledge; Learning; Low income; Malnutrition; Maternal Behavior; Measures; Mediator of activation protein; Modeling; Mothers; National Institute of Child Health and Human Development; Nutritional; Outcome; Parent-Child Relations; Parents; Policies; Positioning Attribute; Poverty; Program Development; Randomized; Randomized Controlled Trials; Readiness; Role; Rural; Schedule; Schools; Self Efficacy; Social support; Support Groups; Surveys; Testing; Time; Toddler; Variant; Visit; Well in self; aged; arm; base; comparative; cost effective; cost effectiveness; curriculum development; design; early childhood; falls; family support; follow-up; improved; multi-arm study; nutrition; nutrition education; peer support; programs; psychosocial; response; rural counties; scaffold; success; therapy development; treatment arm

Testing means to sustain short-term early childhood development impacts long-term Abstract An estimated 43% of the world’s children under age 5 in low-income and middle-income countries (LMICs) do not reach their full developmental potential due to poverty, nutritional deficiencies, and inadequate psychosocial stimulation. Early childhood development (ECD) interventions that promote parent-child interaction through psychosocial stimulation and nutrition activities can improve short-term child development outcomes in LMIC settings. However, despite some flagship successes, many studies have shown that early program benefits fade over time. These findings suggest that achieving parental adherence to new behaviors long-term is the next significant challenge for ECD interventions. Our parent R01 NICHD study is conducting a multi-arm clustered randomized controlled trial across 60 villages and 1200 households with children aged 6-24 months in rural Kenya. The trial tests different potentially cost-effective delivery models for an ECD intervention with a parent-focused curriculum that integrates child psychosocial stimulation and nutrition education in biweekly village-based sessions lasting seven months. In summer 2019, our parent study will conduct an endline survey to measure impacts on child developmental outcomes and parental behavioral changes immediately following the intervention period, as well as a follow-up survey two years later to measure sustained behavioral changes and impacts on children. Between the endline and follow-up surveys, one study arm is currently scheduled to receive two “booster” sessions within 6 months following the end of the biweekly village sessions to encourage families to sustain the behavioral changes. This leaves a 1.5 year gap with no planned activities under the parent study. In this R21 project, we propose an expansion to our parent study to extend these “booster” visits by an additional year and a half to fill this gap in one study arm, and randomly varying the number of boosters across households in this arm to test for a dose-response relationship between continued program support and sustained outcomes. This extension would enable selected households to receive bimonthly boosters for up to the full two-year period between the parent study’s endline and follow-up surveys. These boosters will be designed to address key barriers to sustained behavioral changes and feature curriculum that scaffolds on the earlier intervention in order to help parents adopt new strategies and activities that grow in complexity to match their children’s maturing capabilities. Overall, this extension offers 3 key benefits over the parent study: 1) it strengthens our ability to learn about the importance of continued program engagement and practice to engender sustained parental behavioral changes, as well as sustained child developmental impacts to overcome the problems of fade-out that have plagued earlier ECD trials; 2) it allows us to test the impact of differential exposure to such continued support, which is key to inform policy; and 3) it allows us to examine the role of an age-appropriate curriculum that adapts to children’s evolving needs over time in achieving sustained impacts.

维持短期幼儿发展的测试手段对长期 摘要 据估计，世界上低收入和中等收入国家（LMIC）的5岁以下儿童中有43% 由于贫困、营养不良和缺乏适当的 社会心理刺激促进亲子关系的幼儿发展干预措施 通过心理社会刺激和营养活动进行互动， 在低收入国家环境中的发展成果。然而，尽管取得了一些重大成功，但许多研究表明， 早期计划的好处会随着时间的推移而消失。这些研究结果表明，实现父母坚持新的 长期行为是幼儿发展干预措施的下一个重大挑战。 我们的母体R 01 NICHD研究正在进行一项多组随机对照试验， 在肯尼亚农村地区，有1200个村庄和1200个有6-24个月儿童的家庭。审判测试不同 幼儿发展干预的潜在成本效益交付模式，以家长为中心的课程， 将儿童心理社会刺激和营养教育纳入每两周一次的乡村课程， 七个月的在2019年夏天，我们的家长研究将进行一项终点调查，以衡量对儿童的影响。 干预期后立即发生的发育结果和父母行为变化， 以及两年后的后续调查，以衡量持续的行为变化和对儿童的影响。 在终点和随访调查之间，一个研究组目前计划接受两次“加强剂”治疗。 在每两周一次的村民会议结束后6个月内举行会议，以鼓励家庭 行为改变这就留下了1.5年的空白，在母研究下没有计划的活动。 在这个R21项目中，我们建议扩展我们的母研究，以延长这些“助推器”访视， 另外一年半的时间来填补一个研究组中的这一空白，并随机改变整个研究组中的助推器数量。 家庭在这一臂测试的剂量反应关系之间的持续计划支持， 持续的成果。这一延长将使选定的家庭能够每两个月得到一次补助， 母研究结束和后续调查之间的整整两年时间。这些助推器将是 旨在解决持续行为改变的关键障碍，并提供以 早期干预，以帮助父母采取新的策略和活动， 与孩子的成熟能力相匹配。总体而言，该扩展研究相对于母研究提供了3个关键获益： 1)它增强了我们了解持续参与计划和实践的重要性的能力， 产生持续的父母行为变化，以及持续的儿童发展影响，以克服 2）它使我们能够测试差分的影响， 接触这种持续的支持，这是告知政策的关键; 3）它使我们能够审查一个 与年龄相适应的课程，随着时间的推移，适应儿童不断变化的需求，以实现持续的影响。