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: 10709567
• 负责人: Italo Lopez Garcia
• 金额: $ 62.13万
• 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/10709567
• 关键词: Address; Age; Behavior; Cellular 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; Emotional; 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; Policy Maker; Poverty; Program Development; Randomized; Randomized, Controlled Trials; Research; Resource-limited setting; Resources; Rural; Sampling; Services; Surveys; Technology; Testing; Time; Training; Work; aged; 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 低收入和中等收入国家（LMIC）经验中，估计有43％的5岁以下儿童（5岁儿童） 由于贫困，营养不良和社会心理刺激不足而导致的发展。很多的 幼儿发展（ECD）育儿干预措施已被证明有效地改善ECD 结果，至少在短期内，但是它们仍然太昂贵了，无法在低资源中进行大规模实施 以及农村环境以及b）在没有持续支持的情况下，它们的早期影响往往会随着时间的流逝而消失。新的 迫切需要提供有效的ECD育儿干预措施，这两者都是低成本的 可扩展，同时也能够长期维持影响。 LMIC环境中移动通信的快速增长和低成本提出了一个潜在的有希望的 解决可伸缩性和可持续性的竞争问题。但是没有严格的研究 在LMIC环境中对ECD结果的移动健康（MHealth）干预措施。我们最近表明一个8- ECD的ECD育儿干预措施由社区卫生举行的每两周举行的小组会议。 肯尼亚农村医疗系统的工人（CHW）显着改善了儿童认知，语言和 社会情感发展以及育儿实践，我们的基于小组的交付模式更多 比以前的ECD干预措施具有成本效益。然而，在农村LMIC环境中扩展仍然太贵了 例如我们的 他们维持影响的能力。我们提出的研究通过实验测试传统的面对面交付模型 用于针对两个基于MHealth的交付模型的ECD育儿干预措施，该模型部分或几乎完全完全 替代远程交付以进行面对面的会议。肯尼亚是测试MHealth计划的理想环境 它的移动电话渗透高（94％）。我们将评估这些相对有效性和成本 MHealth交付模型是针对纯粹的面对面模型的，并将干预措施在两年内扩展到 提高他们长期维持儿童结果改变的能力。我们的评估设计是非 跨60个CHW和1200户家庭聚类的随机对照试验，我们将在其中使用 自适应试验设计允许对远程交付模型进行中课程审查和反馈。通过测试 三种干预措施在远程交付中代替了多少人交付的干预措施，我们可以评估 替代性或互补性的程度，以告知设计更可扩展和可持续性的设计 干预措施。我们的目标是确定最大化干预措施并持续的最佳模型 对改善儿童结局的影响。通过将交付纳入本地CHW的正在进行的运营中 肯尼亚的农村医疗保健系统，利用新的低成本技术，涉及当地的ECD决策者和 利益相关者是项目成立的主要合作者，我们的项目有可能使重要 为了发现潜在的可扩展，可持续的解决方案的资源有限设置的贡献。