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.

摘要 据估计，在低收入和中等收入国家(LMIC)，43%的5岁以下儿童将无法充分发挥他们的能力 贫穷、营养不足和社会心理刺激不足带来的发展潜力。早些时候 通过心理社会促进亲子互动的儿童发展(ECD)干预 刺激和营养教育可以改善LMIC环境中的儿童结局。然而，人们对此知之甚少 关于这些复杂的行为干预起作用的中介途径，尽管有一些 旗舰项目的成功，早期计划的好处可能会随着时间的推移而消退。这表明父母对相关的 行为的改变是一个巨大的挑战。理解父母行为的决定因素是至关重要的 变化和幼儿发展干预措施可能如何影响他们，以帮助发现可持续影响的潜在途径。 从2018年11月开始，我们的母公司NICHD资助的R01研究进行了一项多臂随机分组研究 在肯尼亚农村60个村庄和1152户有6-24个月大孩子的家庭进行了对照试验，目的是 测试不同的潜在成本效益交付模式，以家长为重点的ECD干预 整合儿童心理社会刺激和营养教育的课程，以乡村为基础，每两周一次 为期七个月的会议。2019年8月至10月，我们收集了Endline关于儿童和家长的调查数据 并发现短期干预对儿童认知(0.36SD)、接受性语言(0.27SD)、 和社会情感发展(0.21SD)，以及父母的激励和家庭质量 环境(0.50SD)。这些结果将在两年后再次收集，以衡量持续的影响。在 调查间隔两年，随机选择的一半治疗村将继续接受双月一次的治疗 “助推器”会议，以鼓励持续遵守新做法，以及使我们能够测试 在实验上，持续的、但不太频繁的干预支持的附加值。 在本R21中，我们建议在父R01研究的中间引入另一轮调查 两项后续调查，以加深我们对我们的干预措施如何改变的理解 会对父母的行为改变和孩子的结果产生持续的影响。这一扩展提供了四个关键 与父母研究相比的好处：1)它允许我们将行为变化的中介指标集扩展到 提高我们对将中介、行为和儿童联系在一起的变化潜在过程的理解 结果；2)新的调查将在我们样本的孩子30-48个月大时到来，允许 收集更适合年龄较大的儿童的新的儿童结果衡量标准，以扩大我们对 由我们的干预引起的全套变化；3)额外的浪潮提高了我们的整体统计能力 发现途径；4)总共四轮数据(包括2018年10月进行的基线调查)和 扩展的度量集，我们可以估计出儿童技能积累的非线性动态生产函数 帮助揭示因果路径和动态互补性的潜在存在。