Garcia Italo Lopez, Luoto Jill, Aboud Frances, Jervis Pamela, Mwoma Teresa, Alu Edith, Odhiambo Aloyce
Res Sq. 2024 Aug 16:rs.3.rs-4733054. doi: 10.21203/rs.3.rs-4733054/v1.
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. New approaches to deliver effective ECD parenting interventions that are low-cost, scalable, and sustainable are sorely needed.
Our study will experimentally test a traditional in-person group-based delivery model for an evidence-based ECD parenting intervention against a hybrid-delivery model that increasingly substitutes in-person meetings for a remote (mHealth) delivery via smartphones, featuring audiovisual content and WhatsApp social interactions and learning. We will assess the relative effectiveness and cost of this hybrid-delivery model against purely in-person delivery and will extend the interventions over two years to increase their ability to sustain changes in parenting behaviors and ECD outcomes longer-term. Our evaluation design is a cluster Randomized Controlled Trial (cRCT) across 90 villages and approximately 1200 households. Midline and endline surveys collected 12 and 24 months after the start of the interventions, respectively, will examine short- and sustained two-year intention-to-treat impacts on primary outcomes. We will also examine the mediating pathways using Mediation Analysis. We hypothesize that a hybrid-delivery ECD intervention will be lower cost, but remote interactions among participants may be an inferior substitute for in-person visits, leaving open the question of the most cost-effective program.
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 Community Health Promoters (CHPs) within Kenya's rural health care system, and utilizing new low-cost technology, our project has the potential to make important contributions towards discovering potentially scalable, sustainable solutions for resource-limited settings.
NCT06140017 (02/08/2024) AEARCTR0012704.
据估计，低收入和中等收入国家（LMICs）中43%的5岁以下儿童由于贫困、营养不良和心理社会刺激不足而发育受损。许多幼儿发展（ECD）育儿干预措施已被证明至少在短期内能有效改善ECD结果，但它们存在以下问题：a）在资源匮乏的农村地区大规模实施成本仍然过高；b）其早期影响往往会随着时间的推移而消退。迫切需要新的方法来提供低成本、可扩展且可持续的有效ECD育儿干预措施。
我们的研究将通过实验测试一种基于证据的ECD育儿干预措施的传统面对面小组交付模式，并与一种混合交付模式进行对比。在混合交付模式中，越来越多地通过智能手机进行远程（移动健康）交付来替代面对面会议，其中包括视听内容以及WhatsApp社交互动和学习。我们将评估这种混合交付模式相对于纯面对面交付的相对有效性和成本，并将干预措施延长至两年，以增强其长期维持育儿行为和ECD结果变化的能力。我们的评估设计是一项针对90个村庄和约1200户家庭的整群随机对照试验（cRCT）。分别在干预开始后12个月和24个月收集的中期和终期调查，将考察对主要结果的短期和持续两年的意向性治疗影响。我们还将使用中介分析来研究中介途径。我们假设混合交付的ECD干预成本会更低，但参与者之间的远程互动可能不如面对面访问，这就留下了最具成本效益方案的问题。
我们的目标是确定最佳模式，以最大限度地扩大干预措施覆盖面并产生持续影响，从而改善儿童状况。通过将交付整合到肯尼亚农村医疗系统中当地社区健康促进者（CHPs）的日常工作中，并利用新的低成本技术，我们的项目有潜力为在资源有限的环境中发现潜在可扩展、可持续的解决方案做出重要贡献。
NCT06140017（2024年8月2日）AEARCTR0012704。
