Pathways and Mediators of Change in Early Childhood Development

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享受 由于贫困、营养不良和心理社会刺激不足，发展潜力不足。早期 儿童发展干预措施，通过社会心理促进亲子互动 激励和营养教育可以改善LMIC环境中的儿童结果。然而， 关于这些复杂的行为干预工作的中介途径，尽管有一些 虽然取得了一些重大成功，但早期的计划效益可能会随着时间的推移而消失。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因素是至关重要的 儿童基金会的工作重点是了解幼儿发展干预措施可能如何影响儿童，以帮助发现实现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研究进行了一项多组随机分组研究， 在肯尼亚农村60个村庄和1152个有6 - 24个月儿童的家庭进行对照试验， 测试不同的潜在成本效益交付模式，以父母为中心的幼儿发展干预， 在每两周一次的村一级培训中， 为期七个月的会议。2019年8月至10月，我们收集了儿童和家长的底线调查数据 在儿童认知（0.36SD）、接受性语言（0.27SD）、 和社会情感发展（0.21SD），以及父母的刺激和家庭质量 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 在两次调查之间的两年里，随机选择的一半治疗村将继续每两个月接受一次 “助推器”会议，以鼓励持续坚持新的做法，以及使我们能够测试 实验性地增加了持续但不太频繁的干预支持的价值。 在本R21中，我们建议在母R01研究的中间增加一轮调查， 两项后续调查，以加深我们对变革途径的理解， 导致父母行为改变和儿童结果的持续影响。此次扩展提供了四个关键 与母体研究相比的好处：1）它使我们能够扩展行为变化中介物的测量范围， 提高我们对改变的潜在过程的理解，将中介、行为和儿童联系起来 结果; 2）新的调查将在我们样本的孩子30 - 48个月大时进行， 收集更适合年龄较大儿童的儿童结果新措施，以扩大我们对 我们的干预引起的全套变化; 3）额外的波提高了我们的整体统计能力 4）总共四轮数据（包括2018年10月进行的基线）， 扩展的措施，我们可以估计非线性动态生产函数的儿童技能积累 以帮助揭示因果途径和动态互补的潜在存在。

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.