Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
Department of Psychology, McGill University, Montreal, Canada.
BMC Public Health. 2024 Sep 5;24(1):2421. doi: 10.1186/s12889-024-19828-5.
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 with 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 compared to 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 in 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.
在中低收入国家（LMICs），估计有 43%的 5 岁以下儿童由于贫困、营养不良和缺乏适当的心理社会刺激而发育受损。众多儿童早期发展（ECD）养育干预措施已被证明在改善 ECD 结果方面是有效的，至少在短期内是有效的，但它们（a）在资源匮乏和农村地区实施的成本仍然过高，（b）它们的早期影响往往随着时间的推移而消失。急需新方法来提供低成本、可扩展和可持续的有效 ECD 养育干预措施。
我们的研究将对一种基于证据的 ECD 养育干预措施的传统面对面小组式交付模式进行实验测试，与混合式交付模式进行对比，该模式越来越多地用智能手机上的远程（移动健康）交付来替代面对面会议，其特点是视听内容和 WhatsApp 社交互动和学习。我们将评估这种混合式交付模式与面对面交付相比的相对有效性和成本，并将干预措施延长至两年，以增加它们在长期内维持养育行为和 ECD 结果变化的能力。我们的评估设计是一项跨越 90 个村庄和约 1200 户家庭的集群随机对照试验（cRCT）。在干预开始后 12 个月和 24 个月分别进行中期和终期调查，将分别检查短期和持续两年的主要结果的意向治疗影响。我们还将使用中介分析来检查中介途径。我们假设混合式 ECD 干预措施的成本较低，但参与者之间的远程互动可能是面对面访问的次优替代品，因此仍然存在最具成本效益的方案的问题。
我们的目标是确定最佳模式，以最大限度地扩大干预措施的覆盖面并产生持续影响，从而改善儿童的成果。通过将交付整合到肯尼亚农村医疗保健系统中当地社区卫生促进者（CHP）的现有运营中，并利用新的低成本技术，我们的项目有可能为发现资源有限环境下具有潜在可扩展性和可持续性的解决方案做出重要贡献。
NCT06140017（2024 年 02 月 08 日）AEARCTR0012704。
