Achieving Sustained Early Child Development Impacts at Scale: a Kenyan RCT

大规模实现持续的儿童早期发展影响：肯尼亚随机对照试验

• 批准号: 10522682
• 负责人: Italo Lopez Garcia
• 金额: $ 65.14万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10522682
• 关键词: Address; Age; Behavior; Car Phone; Child; Child Development; Child Rearing; Clinical Trials Design; Cluster randomized trial; Cognitive; Communication; Community Health Aides; Consensus; Cost Effectiveness Analysis; Country; Development; Disadvantaged; Early Intervention; Educational Curriculum; Effectiveness; Environment; Evaluation; Feedback; Goals; Group Meetings; Health; Health Services; Healthcare Systems; Household; Hybrids; Income; Intervention; Kenya; Knowledge; Language; Measures; Modeling; Mothers; National Institute of Child Health and Human Development; Outcome; Penetration; Personal Satisfaction; Persons; Policies; Poverty; Program Development; Randomized; Randomized Controlled Trials; Research; Resource-limited setting; Resources; Rural; Sampling; Services; Surveys; Technology; Testing; Time; Training; Work; aged; base; cost; cost effective; cost effectiveness; design; development policy; early childhood; experience; experimental study; health care service; implementation process; improved; intervention delivery; low and middle-income countries; mHealth; meetings; nutrition; nutrition education; operation; process evaluation; programs; psychosocial; randomized trial; rapid growth; relative cost; relative effectiveness; remote delivery; remote intervention; rural healthcare; rural setting; systematic review; therapy development; treatment arm; trial design

Abstract An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) experience compromised development due to poverty, poor nutrition, and inadequate psychosocial stimulation. Numerous early childhood development (ECD) parenting interventions have been shown to be effective at improving ECD outcomes, at least in the short-term, but they are a) still too expensive to implement at scale in low-resource and rural settings, and b) their early impacts tend to fade over time in the absence of continued support. New ways to deliver effective ECD parenting interventions are sorely needed that are both low-cost to be potentially scalable, while also able to sustain impacts long-term. The rapid growth and low cost of mobile communications in LMIC settings presents a potentially promising solution to the competing problems of scalability and sustainability. Yet there is no rigorous research on mobile-health (mHealth) interventions for ECD outcomes in LMIC settings. We recently showed that an 8- month ECD parenting intervention featuring fortnightly group meetings delivered by Community Health Workers (CHWs) from Kenya's rural health care system significantly improved child cognitive, language, and socioemotional development as well as parenting practices, and our group-based delivery model was more cost-effective than previous ECD interventions. Yet it is still too expensive for scaling in a rural LMIC setting such as ours, particularly if we need interventions that can be extended for longer periods of time to increase their ability to sustain impacts. Our proposed study experimentally tests a traditional in-person delivery model for an ECD parenting intervention against two mHealth-based delivery models that partially or almost fully substitute remote delivery for in-person meetings. Kenya is an ideal setting for testing mHealth programs given its high penetration of mobile phones (94%). We will assess the relative effectiveness and costs of these mHealth delivery models against a purely in-person model, and extend the interventions over two years to increase their ability to sustain changes in child outcomes longer term. Our evaluation design is a non- inferiority clustered Randomized Control Trial across 60 CHWs and 1200 households in which we will use an adaptive trial design to allow for midcourse review and feedback on the remote delivery models. By testing three interventions that vary in how much in-person delivery is substituted by remote-delivery, we can assess the degree of substitutability or complementarity to inform the design of more scalable and sustainable interventions. Our goal is to determine the best model to maximize the intervention's reach and sustained impacts to improve child outcomes. By integrating delivery into the ongoing operations of local CHWs within Kenya's rural health care system, utilizing new low-cost technology, and involving local ECD policymakers and stakeholders as key collaborators from the project's inception, our project has the potential to make important contributions towards discovering potentially scalable, sustainable solutions for resource-limited settings.

抽象的 据估计，低收入和中等收入国家 (LMIC) 5 岁以下儿童中有 43% 经历过这种情况 由于贫困、营养不良和社会心理刺激不足，发展受到损害。很多的 儿童早期发展 (ECD) 育儿干预已被证明可有效改善 ECD 至少在短期内，但它们 a) 在资源匮乏的地区大规模实施仍然过于昂贵 和农村环境，b) 如果没有持续的支持，它们的早期影响往往会随着时间的推移而减弱。新的 迫切需要提供有效的 ECD 育儿干预措施，并且成本低廉且有潜力 可扩展，同时也能够长期维持影响。 中低收入国家移动通信的快速增长和低成本带来了潜在的前景 解决可扩展性和可持续性的竞争问题。但目前还没有严格的研究 移动医疗 (mHealth) 干预措施可改善中低收入国家 (LMIC) 环境下的早期儿童发展 (ECD) 结局。我们最近证明了 8- 月 ECD 育儿干预，包括由社区健康中心举办的每两周一次的小组会议 来自肯尼亚农村医疗保健系统的工作人员 (CHW) 显着改善了儿童的认知、语言和能力 社会情感发展以及育儿实践，我们基于小组的交付模式更 比以前的 ECD 干预措施更具成本效益。然而，在中低收入国家农村地区扩大规模仍然过于昂贵 像我们这样的，特别是如果我们需要可以延长更长时间的干预措施以增加 他们维持影响的能力。我们提出的研究通过实验测试了传统的面对面交付模式 针对两种基于移动医疗的交付模式的 ECD 育儿干预，部分或几乎完全 以远程交付代替面对面会议。鉴于肯尼亚是测试移动医疗项目的理想环境 手机普及率很高（94%）。我们将评估这些措施的相对有效性和成本 移动医疗交付模式与纯粹的面对面模式相比较，并将干预措施延长两年至 提高他们长期维持儿童结局变化的能力。我们的评估设计是非 在 60 个社区卫生工作者和 1200 个家庭中进行的自卑聚类随机对照试验，我们将使用 适应性试验设计允许对远程交付模型进行中途审查和反馈。通过测试 三种干预措施的不同之处在于有多少现场交付被远程交付取代，我们可以评估 可替代性或互补性的程度，为更具可扩展性和可持续性的设计提供信息 干预措施。我们的目标是确定最佳模型，以最大限度地扩大干预范围并持续 改善儿童成果的影响。通过将交付整合到当地社区卫生工作者的持续运营中 肯尼亚的农村医疗保健系统利用新的低成本技术，并让当地儿童早期发展政策制定者和 从项目一开始，利益相关者就是主要合作者，我们的项目有潜力发挥重要作用 为资源有限的环境寻找潜在的可扩展、可持续的解决方案做出贡献。