Pathways and Mediators of Change in Early Childhood Development

儿童早期发展变化的途径和中介

• 批准号: 10057054
• 负责人: Italo Lopez Garcia
• 金额: $ 21.37万
• 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: 2020-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10057054
• 关键词: Adherence; Adoption; Affect; Affective; Age; Attention; Behavior; Behavior Therapy; Behavioral; Belief; Child; Child Development; Child Health; Child Rearing; Cognition; Collection; Complex; Country; Data; Development; Educational Curriculum; Educational process of instructing; Effectiveness; Emotional; Family; Funding; Health; Home environment; Household; Income; Informal Social Control; Intervention; Intervention Studies; Kenya; Language; Lead; Link; Low income; Malnutrition; Maternal Behavior; Measurement; Measures; Mediating; Mediation; Mediator of activation protein; Mental Health; Modeling; National Institute of Child Health and Human Development; Nonlinear Dynamics; Outcome; Parent-Child Relations; Parents; Pathway interactions; Poverty; Process; Production; Randomized Controlled Trials; Risk; Rural; Sampling; Social support; Structural Models; Surveys; Testing; Time; Translating; Work; aged; arm; base; behavior change; cost effective; curriculum development; early childhood; expectation; follow-up; health knowledge; improved; low and middle-income countries; nutrition; nutrition education; programs; psychosocial; skills; success; successful intervention; therapy development

Abstract An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) will not reach their full developmental potential due to poverty, nutritional deficiencies, and inadequate psychosocial stimulation. Early childhood development (ECD) interventions that promote parent-child interactions through psychosocial stimulation and nutrition education can improve child outcomes in LMIC settings. However, little is known about the mediating pathways through which these complex behavioral interventions work, and despite some flagship successes, early program benefits can fade over time. This suggests parental adherence to the associated behavioral changes is a significant challenge. It is critical to understand the determinants of parental behavior change and how ECD interventions may affect them to help uncover potential pathways to sustained impacts. Starting in November 2018, our parent NICHD-funded R01 study conducted a multi-arm clustered randomized controlled trial across 60 villages and 1152 households with children aged 6-24 months in rural Kenya that aimed to test 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 August-October 2019, we collected endline survey data on children and parents and found positive short-term intervention impacts in child cognition (0.36SD), receptive language (0.27SD), and socio-emotional development (0.21SD), as well as in parental stimulation and quality of the home environment (0.50SD). These outcomes will be collected again in two years to measure sustained impacts. In the two years between surveys, a randomly-selected half of treatment villages will continue to receive bi-monthly “booster” sessions to encourage sustained adherence to the new practices as well as to enable us to test experimentally the value added of continued, but less frequent, intervention support. In this R21 we propose to introduce one additional survey round to come midway between the parent R01 study's two follow-up surveys to deepen our understanding of the pathways of change for how our interventions might lead to sustained impacts in parental behavioral change and child outcomes. This expansion offers four key benefits over the parent study: 1) it allows us to expand the set of measures of mediators of behavioral change to improve our understanding of the underlying processes of change linking mediators, behaviors and child outcomes; 2) the new survey will come when our sample's children will be 30-48 months old, allowing the collection of new measures of child outcomes more suitable for older children to expand our understanding of the full suite of changes induced by our intervention; 3) the additional wave improves our overall statistical power to uncover the pathways; 4) with four total rounds of data (including a baseline undertaken October 2018) and expanded set of measures, we can estimate non-linear dynamic production functions of child skill accumulation to help uncover the causal pathways and the potential existence of dynamic complementarities.

抽象的 低收入和中等收入国家（LMIC）的5岁以下儿童中估计有43％的儿童将无法满足 由于贫困，营养缺乏和社会心理刺激不足而引起的发展潜力。早期的 儿童发展（ECD）干预措施，通过社会心理促进亲子互动 刺激和营养教育可以改善LMIC环境中的儿童结果。但是，鲜为人知 关于这些复杂行为干预措施的中介途径，以及目的地 旗舰成功，早期计划的收益会随着时间的流逝而消失。这表明父母坚持相关的 行为改变是一个重大挑战。了解父母行为的决定者至关重要 改变以及ECD干预措施如何影响他们，以帮助发现潜在的持续影响途径。 从2018年11月开始，我们的父母NICHD资助的R01研究进行了多臂聚类随机分组 在肯尼亚的60个村庄和1152个家庭中有6-24个月的儿童的对照试验，目标 测试以父母为中心的ECD干预的不同潜在具有成本效益的交付模型 将儿童的心理社会刺激和营养教育整合到两周的村庄 会议持续了七个月。 2019年8月至10月，我们收集了有关儿童和父母的终点调查数据 并发现儿童认知（0.36SD），接受语言（0.27SD），阳性的短期干预影响 和社会情感发展（0.21SD）以及家长刺激和质量 环境（0.50SD）。这些结果将在两年内再次收集以衡量持续的影响。在 在调查之间两年，随机选择的一半治疗村庄将继续接受双月 “助推器”会议，以鼓励持续遵守新实践，并使我们能够测试 在实验中，持续但频率较少的干预支持的增值。 在此R21中，我们建议在父母R01研究之间进行另外的调查回合。 两项后续调查，以加深我们对干预方式的变革途径的理解 导致对父母行为改变和儿童成果的持续影响。这个扩展提供了四个钥匙 对父母研究的好处：1）使我们能够将行为改变的调解人的一组措施扩展到 提高我们对联系调解人，行为和儿童的变革的基本过程的理解 结果； 2）当我们的样本的孩子30-48个月大时，新调查将进行 收集儿童成果的新措施，更适合年龄较大的孩子扩大我们对 我们的干预引起的全部变化套件； 3）额外的浪潮改善了我们的整体统计能力 揭开路径； 4）共有四轮数据（包括2018年10月的基准）和 扩展的测量集，我们可以估计儿童技能积累的非线性动态生产功能 帮助揭示因果途径和动态完成的潜在存在。