Implementing SafeCare Kenya to Reduce Noncommunicable Disease Burden: Building Community Health Workers' Capacity to Support Parents with Young Children

项目摘要/摘要 2021年，肯尼亚卫生部非传染性疾病司(NCD)发布了一项战略 计划“阻止和扭转”国家不断增加的非传染性疾病负担。在世界范围内，最常见的非传染性疾病形式 儿童和青少年中有精神健康障碍和伤害/暴力。充足的研究支持 儿童早期逆境，特别是儿童虐待，与易受虐待之间的因果关系 通过毒害应激和生物嵌入，NCD在晚年生活中的范围。肯尼亚非传染性疾病的主要危险因素 是儿童期虐待，高达70%的肯尼亚人报告说在童年期间经历过虐待 通常是由于缺乏适当的育儿技能、对儿童发展的误解、 没有提供适当的医疗护理，以及提供基本需求和适当监督的障碍。 虽然为人父母的预防计划是基于证据的方法，以补救非传染性疾病的风险因素，并且 肯尼亚已开始解决非传染性疾病负担的艰巨任务，公共卫生仍存在重大差距 以最年轻的肯尼亚人为目标的预防工作方法。本R01提案的目的是 进行混合类型2研究，以检查最近改编的 以证据为基础的计划，SafeCare，作为解决该国非传染性疾病负担的主要预防方法。 安全护理肯尼亚(SCK)提高了育儿技能，降低了虐待儿童和随后 非传染性疾病的风险。该项目将继续非洲精神卫生研究和研究机构之间为期六年的合作 培训基金会(AMHRTF；设在内罗毕的合作伙伴)、太平洋大学、佐治亚州立大学及其 国家SafeCare培训和研究中心(SafeCare开发者)，以及主要国家和地区 利益相关者，包括家庭、专业人员、政府和研究人员，扩大和传播SCK。 该项目利用肯尼亚的社区卫生志愿者(CHV)，成熟的和初级的 为肯尼亚妇幼保健工作人员实施干预措施。虚拟的和在- 将审查人员交付方式，以确定可持续发展的最佳方法。三个具体目标 将在这项为期5年的研究中完成：(1)使用平行组确定SCK的临床有效性 多水平随机试验。(2)确定SCK实施的可行性和可能的效用。(3)发起 开始在肯尼亚各地扩大和维持SCK的努力。我们将招募312个家庭与24个CHV配对 随机分配提供SCK(16个提供者；208个家庭)或照常护理(8个提供者；104个家庭)。我们的 项目的长期目标是：(1)在肯尼亚建立可持续的研究和实施能力，并 非洲和(2)传播与文化相关的循证育儿计划，以促进儿童的 增进健康，降低一生中患非传染性疾病的风险。

Project Summary/Abstract In 2021, Kenya’s Ministry of Health’s Department of Non-Communicable Diseases (NCD) issued a strategic plan to “halt and reverse” the country’s rising NCD burden. Worldwide, the most common forms of NCD among children and adolescents are mental health disorders and injuries/violence. Ample research supports the causal pathway between early childhood adversity, in particular child maltreatment, and vulnerability to a range of NCD in later life through toxic stress and biological embedding. A major risk factor for NCD in Kenya is childhood maltreatment, with up to 70% of Kenyans report experiencing maltreatment during childhood typically by their parents due to lack of appropriate parenting skills, misunderstanding of child development, not providing proper medical attention, and obstacles to providing basic needs and adequate supervision. While parenting prevention programs are evidence-based approaches to remedy risk factors for NCD, and Kenya has begun the arduous task of addressing NCD burden, a significant gap remains in public health approaches to prevention work targeting the youngest Kenyans. The purpose of this R01 proposal is to conduct a Hybrid Type 2 study to examine the implementation and effectiveness of the recently adapted evidenced-based program, SafeCare, as a primary prevention approach to address the country’s NCD burden. SafeCare Kenya (SCK) improves parenting skills, reducing the likelihood of child maltreatment and subsequent risk for NCD. This project will continue the six-year partnerships amongst Africa Mental Health Research and Training Foundation (AMHRTF; Nairobi-based partner), Pacific University, Georgia State University and its National SafeCare Training and Research Center (SafeCare developers), and key country and regional stakeholders, including families, professionals, government, and researchers to scale-up and disseminate SCK. This project leverages Kenya’s Community Health Volunteers (CHV), the well-established and primary workforce for maternal and child physical health in Kenya, to implement the intervention. Virtual and in- person delivery modes will be examined to identify the best method for sustainability. Three specific aims will be accomplished in this 5-year study: (1) Determine clinical effectiveness of SCK using a parallel group multilevel-randomized trial. (2) Determine feasibility and probable utility of SCK implementation. (3) Initiate efforts to begin scale-up and sustainment of SCK across Kenya. We will recruit 312 families paired with 24 CHV randomly assigned to deliver SCK (16 Providers; 208 families) or care as usual (8 Providers; 104 families). Our project’s long-term goals are to: (1) build sustainable research and implementation capacity in Kenya and Africa and (2) disseminate a culturally relevant, evidence-based parenting program to promote children’s wellbeing and reduce risk of NCD across the lifespan.