1
|
Hutchings J, Ferdinandi I, Janowski R, Ward CL, McCoy A, Lachman J, Gardner F, Williams ME. Parenting for Lifelong Health for Young Children in Montenegro: Preliminary Outcomes, Dissemination, and Broader Embedding of the Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:823-833. [PMID: 38758458 PMCID: PMC11322320 DOI: 10.1007/s11121-024-01682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
The quality of parenting program implementation significantly affects the extent to which a program is delivered effectively as well as the likelihood of it becoming embedded in everyday services. The group based Parenting for Lifelong Health for Young Children (PLH-YC) program for parents of children aged 2-9 years was developed specifically for implementation in low- and middle-income contexts, has been tested in five randomized trials, and incorporates a number of strategies to encourage fidelity of delivery. This paper reports on the introduction of PLH-YC to Montenegro, including initial work to engage government agencies and service providers, adapt the program and, following initial evidence of effectiveness, implement strategies to promote effective delivery and embed the program. Following program adaptation and initial facilitator training, eight groups were run, supported with resources and supervision and independently evaluated. The successful pilot led to program training accreditation by national professional agencies and a series of steps to successfully further embed it into routine settings in Montenegro, including by recognizing the program in national policy documents. This led to further facilitator trainings, now numbering 97 facilitators and the certification of ten coaches and two trainers. By the end of 2023, 1278 parents, across 13 municipalities (half of all municipalities in Montenegro) and a range of service providers, have received the program. The paper describes the project phases and key fidelity components that underpinned the successful introduction and embedding of the program in Montenegro. The plan has resulted in Montenegro having its own domestic resources to continue to implement the program effectively and further plan for widespread dissemination.
Collapse
Affiliation(s)
- Judy Hutchings
- Centre for Evidence-Based Early Intervention, Bangor University, Bangor, UK.
| | - Ida Ferdinandi
- UNICEF Country Office in Montenegro, Podgorica, Montenegro
| | - Roselinde Janowski
- Department of Psychology, and Safety and Violence Initiative, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Catherine L Ward
- Department of Psychology, and Safety and Violence Initiative, University of Cape Town, Cape Town, South Africa
| | | | - Jamie Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | | |
Collapse
|
2
|
Jensen CL, Sanga E, Kitt H, PrayGod G, Kunzi H, Setebe T, Filteau S, Webster J, Gladstone M, Olsen MF. Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. PLoS One 2024; 19:e0285240. [PMID: 38722956 PMCID: PMC11081340 DOI: 10.1371/journal.pone.0285240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.
Collapse
Affiliation(s)
- Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erica Sanga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Heather Kitt
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - George PrayGod
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Happiness Kunzi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Theresia Setebe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
3
|
Ahun MN, Ali NB, Hentschel E, Jeong J, Franchett E, Yousafzai AK. A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development. Ann N Y Acad Sci 2024; 1533:99-144. [PMID: 38354095 DOI: 10.1111/nyas.15110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.
Collapse
Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nazia Binte Ali
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Franchett
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Schepan ML, Jungmann T, Kliem S, Siegert C, Sandner M, Brand T. What contributes to the long-term implementation of an evidence-based early childhood intervention: a qualitative study from Germany. FRONTIERS IN HEALTH SERVICES 2024; 3:1159976. [PMID: 38313330 PMCID: PMC10834770 DOI: 10.3389/frhs.2023.1159976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024]
Abstract
Background Rigorous research trials have demonstrated that early childhood interventions can reach socially disadvantaged families and can have a lasting impact on the healthy development of their children. However, little is known about the internal and contextual factors that contribute to the long-term implementation of such interventions. In this study, we investigated the development of the home visiting program Pro Kind. The program was adapted from the evidence-based US-American Nurse-Family Partnership program and was implemented in Germany in 2006. Using an exploratory approach, we examined factors contributing to the long-term implementation of this program. Methods Qualitative interviews with program implementers (midwives, social workers, program managers) of the Pro Kind program and key stakeholders in two cities in Germany were conducted. Interview guides were developed to assess participants' perceptions and experiences on how the program had developed over time internally and in the interaction with its environment. Data were collected between March and September 2021. Drawing on the Consolidated Framework for Implementation Research (CFIR), data was coded according to the principles of thematic analysis. Results A total of 25 individuals (11 program implementers, 14 key stakeholders) were interviewed. The identified factors related to three out of five domains of the CFIR model in our analysis. First, regarding the intervention characteristics, the evidence of effectiveness and the relative advantage of the implementation of the program compared to similar interventions were viewed as contributors to long-term implementation. However, the program's adaptability was discussed as a constraining factor for reaching the target group. Second, concerning the inner setting, stakeholders and program implementers perceived the implementation climate, the leadership engagement and the program's size as relevant factors for networking strategies and program visibility. Third, as part of the outer setting, the degree of networking with external stakeholders was highlighted of great importance for the program. Conclusions We identified several factors of particular importance for the long-term implementation and sustainability of an early childhood intervention at the practice level, particularly in the local context in Germany. These findings should inform the design of impactful, scalable, and sustainable early childhood interventions targeting disadvantaged families.
Collapse
Affiliation(s)
- Marie Lisanne Schepan
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Department of Public Health, University of Bremen, Bremen, Germany
| | - Tanja Jungmann
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Sören Kliem
- Department of Social Work, Ernst-Abbe-Hochschule Jena, University of Applied Sciences, Jena, Germany
| | - Carolin Siegert
- Department of Social Work, Ernst-Abbe-Hochschule Jena, University of Applied Sciences, Jena, Germany
| | - Malte Sandner
- Department of Business Administration, Nuremberg Institute of Technology, Nuremberg, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| |
Collapse
|
5
|
Brien M, Coutinho F, Krishna D, van der Haar L, de Laat J, Srinivasan SR, Venkatachalapathy N. Leveraging monitoring, evaluation, and learning to scale the Enabling Inclusion ® program for children with disabilities in India and globally. Front Public Health 2023; 11:1165034. [PMID: 38162603 PMCID: PMC10757565 DOI: 10.3389/fpubh.2023.1165034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Children with disabilities in low- and middle-income countries face many challenges and lack adequate services, including access to rehabilitation professionals. To address this lack of access, Amar Seva Sangam Ayikudy (ASSA), a non-governmental organization (NGO) in India, designed a technology-leveraged rehabilitation program called Enabling Inclusion® (EI®), and implemented it in one state (Tamil Nadu, India) before scaling it. The model is supported by the EI® app, which enables organizations to screen, assess and monitor progress of children with disabilities via rehabilitation specialists and community rehabilitation workers, and to provide family-centered, goal-based interventions. An extensive monitoring, evaluation, and learning (MEL) framework is embedded into the program. This paper explores how this MEL system supported the scaling of the EI® model, reaching additional beneficiaries nationally and globally. Methods This paper describes ASSA's MEL framework and demonstrates its use for decision-making in the process of scaling. It also explores how collaborations with various government departments, NGOs, and private partners contributed to the scaling of the EI® model and technology. Results Scaling of the EI® program was achieved by (1) expansion of the program in rural Tamil Nadu (vertical scale-up) in partnership with the Tamil Nadu government and private partners, and (2) by licensing the EI® app and model to other NGOs in various states in India and globally (horizontal scale-up). Systematic examination of key program and performance indicators, as well as stakeholder feedback, informed decisions to modify the EI® app over time. This included further customizing to the needs of children and service providers, covering a greater range of age groups and contexts, and modifying service delivery models. Child functional independence, participation, and inclusion was further strengthened by mobilizing parent empowerment groups, community awareness programs, school advocacy, and entitlements from the government. Flexibility in the implementation model of the EI® app allowed for adaptation to local contexts and organizations, and facilitated its scale-up. Conclusion A dynamic, inclusive, and locally grounded MEL system, a flexible and collaborative approach, and an adaptive implementation model increased the accessibility of an early intervention and childhood rehabilitation program for children with disabilities and their families throughout the state of Tamil Nadu, across India, and internationally.
Collapse
Affiliation(s)
- Marie Brien
- Enabling Inclusion Program, Amar Seva Sangam, Tenkasi, Tamil Nadu, India
| | - Franzina Coutinho
- Enabling Inclusion Program, Amar Seva Sangam, Tenkasi, Tamil Nadu, India
| | - Dinesh Krishna
- Enabling Inclusion Program, Amar Seva Sangam, Tenkasi, Tamil Nadu, India
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Lotte van der Haar
- Utrecht Centre for Global Challenges, Utrecht School of Economics, Utrecht University, Utrecht, Netherlands
| | - Joost de Laat
- Utrecht Centre for Global Challenges, Utrecht School of Economics, Utrecht University, Utrecht, Netherlands
| | | | | |
Collapse
|
6
|
Liu XL, Lee W, Rolfhus E, Hutchings T, Yao L, Xie J, Xu Y, Peng Y, Villiers JD. The development of a parent report instrument of early communication and language skills of infants and toddlers in mainland China. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1887-1902. [PMID: 37025041 DOI: 10.1111/1460-6984.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study was designed to produce a new parent-report measure, the Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler Assessment of Communication and Language (DREAM-IT) in order to provide norms for the developmental skills of children aged 0-36 months in four areas: expressive language, receptive language, cognitive play and social skills. METHODOLOGY The scale was designed to be both broader and deeper than existing instruments that neglect one or more of these significant domains involved in early language. Items were chosen by a group of specialists with clinical experience working with the age group and with attention to the developmental literature. Caregivers were tested individually by a trained person who asked the questions and provided examples. In addition to an extensive health questionnaire, caregivers answered questions in Mandarin about their child's behaviour using a scale of 'not yet', 'sometimes' or 'always' or listing out words and/or sounds understood or said by the child. The 476 participating caregivers were recruited at maternal and child healthcare clinics centred in Chengdu, China, 191 of whom were tested a second time seven months later. The children were sampled in three-month age-bands from 0 to 36 months. The sample was balanced for child gender by age band, and parental education was balanced. Caregivers of 0-24-month-old children and caregivers of 12-36 months were each asked a different set of questions, to determine the appropriate age range and cutoff points for each question, requiring the sample size to be doubled for children aged 12-24 months. RESULTS The results were subject to item-response theory analysis to remove outlying items, and the resulting internal reliability was high for each domain (average Cronbach's alpha=0.87). The final instrument (between 67 and 113 questions in total) was refined to include the least redundant questions that had the highest intercorrelations, with attention paid to coverage of all domains across the age range. Two scales were developed: one for children 0-18 months, the second for children aged 18-36 months. The longitudinal design permitted the creation of growth curves and norms for each domain for six-month intervals from 0 to 36 months. A small sample of 32 parents of children with Down syndrome aged 18-36 months provided validation that the scales are highly sensitive to developmental delay. CONCLUSION The instrument shows considerable promise for detecting early communication problems in children in China. WHAT THIS PAPER ADDS What is already known on the subject In China, efforts were made in recent years to develop language assessments for infants and toddlers, but limitations existed with the domains included and number of items included per age group. Many clinical practitioners also continued to rely on language subtests of general developmental scales, which were limited in depth and breadth of language skills tested and were never intended for diagnosis of language delay. What this paper adds to existing knowledge This paper discusses the development of a valid caregiver report instrument for early communication and language skills of infants and toddlers in mainland China. The Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler (DREAM-IT) includes foundational domains necessary for language and communication development in young children (receptive language, expressive language, cognitive play and social communication domains). The results show strong internal reliability (Cronbach's alpha) for each domain on a sample of 716 children sampled in three-month age bands from 0 to 36 months. The external validity proved strong when tested on a group of 32 young children with Down syndrome. What are the potential or actual clinical implications of this work? Besides helping to inform the diagnosis of language delays in infants and toddlers in China, the caregiver report instrument has special features to support clinical practitioners in a field that is just emerging in China. The unique support features include the automatic generation of a profile of relative strengths and weaknesses of the child on the report and the recommendation of child-specific caregiver coaching videos on a companion app.
Collapse
Affiliation(s)
- Xueman Lucy Liu
- Hainan Boao Bethel International Medical Center, Boao, China
- University of Texas, Dallas, Texas, USA
| | - Wendy Lee
- Hainan Boao Bethel International Medical Center, Boao, China
| | - Eric Rolfhus
- Hainan Boao Bethel International Medical Center, Boao, China
| | | | - Liqun Yao
- Hainan Boao Bethel International Medical Center, Boao, China
| | - Jingqiu Xie
- Chengdu Qingyang District Maternal and Child Hospital, Chengdu, China
| | - Yaqing Xu
- Women's Hospital of Nanjing Medical University, Nanjing, China
- Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Yongmei Peng
- Shanghai Center for Women and Children's Health, Shanghai, China
| | - Jill de Villiers
- Hainan Boao Bethel International Medical Center, Boao, China
- Smith College, Northampton, Massachusetts, USA
| |
Collapse
|
7
|
Coore-Hall J, Smith J, Kelly M, Baker-Henningham H, Chang S, Walker S. Using lessons learnt from key stakeholders to increase support for scaling the Reach Up Early Childhood Parenting program. Front Public Health 2023; 11:1151826. [PMID: 37614447 PMCID: PMC10442950 DOI: 10.3389/fpubh.2023.1151826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Sustainable implementation of early childhood programs requires resources, materials and methods that are adaptable, scalable and feasible for delivery through multiple sectors. Additional or modified program resources may be required to meet emerging needs, as programs go to scale. An active and effective monitoring, evaluation and learning (MEL) process may enable programs to be responsive to demands. The Reach Up: Early Childhood Parenting program, is designed primarily for disadvantaged children under 4 years of age in low- and middle-income countries (LMICs) to promote their development through playful caregiver interactions. The curriculum, training manuals and other materials and resources support implementers in the adaptation of the intervention, implementation, workforce training, monitoring and evaluation. This paper reports on how data collected from key informants drove modifications to program processes, materials and resources. Methods We conducted in-depth interviews with 14 key informants (including program managers, lead trainers, academics, consultants and workforce personnel) on their experiences with Reach Up across 15 LMICs where the program has been implemented. We also reviewed written records generated from (i) structured small group discussions at a Knowledge Exchange meeting of 31 Reach Up partners and (ii) notes from working groups formed at the meeting and tasked to continue working post-meeting to find solutions to support ongoing implementation. The transcripts from the in-depth interviews and the meeting records were analysed using thematic analysis with a mixture of pre-defined categories and data-driven sub-themes. Results The main findings indicated that there was a need to: (i) develop advocacy and communication resources and materials to aid prospective implementers and other stakeholders, to make decisions for implementation, (ii) revise and/or add to the content and format of the curriculum and add content in the training and other supporting manuals and (iii) enhance the training process. Conclusion The feedback from the key global partners informed the development of new knowledge materials, resources and processes and modifications to existing program materials and resources. These will help to support advocacy, ongoing implementations, and the process of transitioning the Reach Up early childhood intervention to scale.
Collapse
Affiliation(s)
- Jacqueline Coore-Hall
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Joanne Smith
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | - Helen Baker-Henningham
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
| | - Susan Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| |
Collapse
|
8
|
Milovanović I, Mitrović D, Branovački B, Sadiković S, Riemann R, Kodžopeljić J. Personality traits and perception of parenting: The comparative twin study from Germany and Serbia. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:396-405. [PMID: 37002585 DOI: 10.1002/ijop.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/08/2023] [Indexed: 07/20/2023]
Abstract
This study examines the aetiology of the relationship between personality traits and perceived parenting in light of cross-cultural differences. The sample consisted of 188 Serbian and 394 German twin pairs. Personality traits were measured using the NEO-personality inventory. A Blocks Environmental Questionnaire (BEQ) was applied to measure two dimensions of perceived parenting: support and organisation. Genetic factors account for 63-79% of the variance for BEQ dimensions in both samples, while around 50-60% of the variance in Big Five personality scores could be attributed to genetic factors. The exception was Neuroticism in the Serbian sample, where the genetic effect was somewhat smaller. The results indicated similar etiological pathways of the relationship between personality traits and perceived parenting, with some cultural differences related to Neuroticism and Extraversion. Negative Neuroticism-Support and positive Extraversion-Organisation environmental relationships were stronger in the Serbian sample. Genetic overlaps were more significant in the German sample, except for the relationship of Organisation with Conscientiousness and Extraversion. This indicates that the relationship between personality and perceived parenting is largely genetically mediated, but that the environmental effect may play an important role in individual adaptation to the family setting.
Collapse
Affiliation(s)
- Ilija Milovanović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Dušanka Mitrović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Branovački
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Selka Sadiković
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Rainer Riemann
- Department of Psychology, Faculty for Psychology and Sport Science, Bielefeld University, Bielefeld, Germany
| | - Jasmina Kodžopeljić
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
9
|
Jayasinghe S, Hills AP. Strategies to Improve Physical Activity and Nutrition Behaviours in Children and Adolescents: A Review. Nutrients 2023; 15:3370. [PMID: 37571307 PMCID: PMC10420868 DOI: 10.3390/nu15153370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Despite widespread acknowledgement of the multifarious health benefits of physical activity (PA), including prevention and control of obesity, an overwhelming majority of children and adolescents are not sufficiently active to realise such benefits. Concurrently, young people are significantly impacted by the rapid global rise of sedentarism, and suboptimal dietary patterns during key phases of development. Regrettably, the cumulative effects of unhealthy behaviours during the growing years predisposes young people to the early stages of several chronic conditions, including obesity. Clear and consistent approaches are urgently needed to improve eating and activity behaviours of children and adolescents. Based on existing evidence of "best bets" to prevent and control obesity and its comorbidities, we present a set of non-negotiable strategies as a 'road map' to achieving prevention and improving the health of children and adolescents.
Collapse
Affiliation(s)
| | - Andrew P. Hills
- College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia;
| |
Collapse
|
10
|
Hill Z, Zafar S, Soremekun S, Sikander S, Avan BI, Roy R, Aziz S, Kumar D, Parveen N, Saleem S, Verma D, Sharma KK, Skordis J, Hafeez A, Rahman A, Kirkwood B, Divan G. Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan. Front Nutr 2023; 10:1152548. [PMID: 37404854 PMCID: PMC10315833 DOI: 10.3389/fnut.2023.1152548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. Methods and materials We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. Results Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. Discussion Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility.
Collapse
Affiliation(s)
- Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Seyi Soremekun
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siham Sikander
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Bilal Iqbal Avan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Reetabrata Roy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sangath, Goa, India
| | - Sarmad Aziz
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Nazia Parveen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shumaila Saleem
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Betty Kirkwood
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
11
|
Orlando JM, Cunha AB, Alghamdi ZS, Lobo MA. How do parents and early intervention professionals utilize educational resources about infant development and play? Early Hum Dev 2023; 180:105763. [PMID: 37028178 DOI: 10.1016/j.earlhumdev.2023.105763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Parents utilize online sources to learn about health information, however few studies have examined where parents look for information about development or play for young children. AIMS Investigate parents' and early intervention (EI) providers' practices and preferences regarding parent education about infant development and play. STUDY DESIGN Cross-sectional survey design. SUBJECTS 112 parents and 138 EI providers participated. OUTCOME MEASURES One survey probed where parents look for information and preferred methods for receiving information about infant development and play. A second survey identified the parent education sources used and perceived quality of sources available by EI providers. Descriptive and inferential analyses were conducted. RESULTS 112 parents and 138 EI providers participated. A greater proportion of parents sought information about development than play. Overall, parents used internet searches and preferred websites for education about development and play; however, parents of infants at risk for developmental delay preferred receiving developmental information through home visits or classes. Most EI providers have not asked parents where they look for information. A greater proportion of EI providers agreed existing sources about development, rather than about play, are high quality, but identified the need to develop high-quality sources about both topics. CONCLUSIONS There are a variety of methods that parents access and prefer for education about infant development and play. EI providers and other healthcare professionals should discuss the methods with parents to support parents in their quest for information and ensure parents receive high-quality information.
Collapse
Affiliation(s)
- Julie M Orlando
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
| | - Andrea B Cunha
- University of Nebraska Medical Center, Department of Physical Therapy, Omaha, NE, USA
| | - Zainab S Alghamdi
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
| | - Michele A Lobo
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA.
| |
Collapse
|
12
|
Dulal S, Saville NM, Merom D, Giri K, Prost A. Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001398. [PMID: 37115747 PMCID: PMC10146516 DOI: 10.1371/journal.pgph.0001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.
Collapse
Affiliation(s)
- Sophiya Dulal
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | | | - Dafna Merom
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | - Kalpana Giri
- Health Research and Development Forum, Kathmandu, Nepal
| | - Audrey Prost
- UCL Institute for Global Health, London, United Kingdom
| |
Collapse
|
13
|
de Melo NP, de Souza JM, Cordeiro SM, Veríssimo MDLÓR. Clinical validation of the nursing diagnosis "Risk for delayed child development". Rev Esc Enferm USP 2022; 56:e20220229. [PMID: 36541418 PMCID: PMC10081643 DOI: 10.1590/1980-220x-reeusp-2022-0229en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To validate clinically the risk factors of the nursing diagnosis "Risk for delayed child development". METHOD Cross-sectional quantitative study carried out in a specialty outpatient clinic and in family health units with 124 children. The data was collected through interviews with the children's guardians to investigate the risk factors for delay in child development. RESULTS The tested risk factors affected 108 of the evaluated children (87.1%). In the accuracy tests, most specificity values were above 80% and sensitivity values were lower than 30%. Most risk factors had odds ratio >1, three of which were noteworthy: genetic disorder (OR = 38, p < 0.05) and congenital disorder (OR = 4.4, p < 0.05), among child-related aspects, and impaired cognitive development in parents (OR = 27, p < 0.05), among caregiver-related aspects. CONCLUSION The study contributed to a refined diagnostic accuracy, identifying potential associated factors of the evaluated diagnosis.
Collapse
|
14
|
Long DA, Waak M, Doherty NN, Dow BL. Brain-Directed Care: Why Neuroscience Principles Direct PICU Management beyond the ABCs. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121938. [PMID: 36553381 PMCID: PMC9776953 DOI: 10.3390/children9121938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness and necessary interventions can affect their ability to meet crucial developmental milestones. Understanding the neuroscience of brain development and vulnerability can inform PICU clinicians of new ways to enhance and support the care of these most vulnerable children and families. This review paper first explores the evidence-based neuroscience principles of brain development and vulnerability and the impact of illness and care on children's brains and ultimately wellbeing. Implications for clinical practice and training are further discussed to help optimize brain health in children who are experiencing and surviving a critical illness or injury.
Collapse
Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-3138-3834
| | - Michaela Waak
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Nicola N. Doherty
- Regional Trauma Network, SPPG, DOH, Belfast BT2 8BS, Northern Ireland, UK
- School of Psychology, Faculty of Life and Health Sciences, Coleraine Campus, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Belinda L. Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
| |
Collapse
|
15
|
Lansford JE, Betancourt TS, Boller K, Popp J, Altafim ERP, Attanasio O, Raghavan C. The Future of Parenting Programs: II Implementation. PARENTING, SCIENCE AND PRACTICE 2022; 22:235-257. [PMID: 36439707 PMCID: PMC9683038 DOI: 10.1080/15295192.2022.2086807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer E Lansford
- Center for Child and Family Policy, Duke University, Box 90545, Durham, NC 27708, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Nuño N, Mäusezahl D, Hattendorf J, Verastegui H, Ortiz M, Hartinger SM. Effectiveness of a home-environmental intervention package and an early child development intervention on child health and development in high-altitude rural communities in the Peruvian Andes: a cluster-randomised controlled trial. Infect Dis Poverty 2022; 11:66. [PMID: 35668472 PMCID: PMC9169326 DOI: 10.1186/s40249-022-00985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unsafe drinking water, poor sanitation and hygiene, exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low- and middle-income countries. We implemented an integrated home-environmental intervention package (IHIP), comprising a kitchen sink, hygiene education and a certified improved biomass cookstove, and an early child development (ECD) programme to improve children´s health and developmental outcomes in the rural high-altitude Andes of Peru. METHODS We conducted a one-year cluster-randomised controlled trial among 317 children < 36 months divided into 4 arms (IHIP + ECD, IHIP, ECD, and Control) and 40 clusters (10 clusters per arm). ECD status (socio-emotional, fine and gross motor, communication, cognitive skills, and an overall performance) measured with the Peruvian Infant Development Scale and the occurrence of self-reported child diarrhoea from caretakers were primary outcomes. Secondary outcomes included the occurrence of acute respiratory infections and the presence of thermo-tolerant faecal bacteria in drinking water. The trial was powered to compare each intervention against its control arm but it did not allow pairwise comparisons among the four arms. Primary analysis followed the intention-to-treat principle. For the statistical analysis, we employed generalised estimating equation models with robust standard errors and an independent correlation structure. RESULTS We obtained ECD information from 101 children who received the ECD intervention (individually and combined with IHIP) and 102 controls. Children who received the ECD intervention performed better in all the domains compared to controls. We found differences in the overall performance (64 vs. 39%, odd ratio (OR): 2.8; 95% confidence interval (CI): 1.6-4.9) and the cognitive domain (62 vs 46%, OR: 1.9; 95% CI: 1.1-3.5). Data analysis of child morbidity included 154 children who received the IHIP intervention (individually and combined with ECD) and 156 controls. We recorded 110,666 child-days of information on diarrhoea morbidity and observed 1.3 mean episodes per child-year in the children who received the IHIP intervention and 1.1 episodes in the controls. This corresponded to an incidence risk ratio of 1.2 (95% CI: 0.8-1.7). CONCLUSIONS Child stimulation improved developmental status in children, but there was no health benefit associated with the home-environmental intervention. Limited year-round access to running water at home and the possible contamination of drinking water after boiling were two potential factors linked to the lack of effect of the home-environmental intervention. Potential interactions between ECD and home-environmental interventions need to be further investigated. TRIAL REGISTRATION ISRCTN, ISRCTN-26548981. Registered 15 January 2018-Retrospectively registered, https://doi.org/10.1186/ISRCTN26548981 .
Collapse
Affiliation(s)
- Néstor Nuño
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
| | - Daniel Mäusezahl
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland. .,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.
| | - Jan Hattendorf
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
| | - Hector Verastegui
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.,Unidad de Investigación en Desarrollo Integral, Ambiente y Salud, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, S.M.P., Lima, Peru
| | | | - Stella M Hartinger
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.,Unidad de Investigación en Desarrollo Integral, Ambiente y Salud, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, S.M.P., Lima, Peru
| |
Collapse
|
17
|
Barboza M, Marttila A, Burström B, Kulane A. Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden. BMC Public Health 2022; 22:1091. [PMID: 35650586 PMCID: PMC9158140 DOI: 10.1186/s12889-022-13492-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood. METHODS Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme. RESULTS The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme. CONCLUSIONS The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities. TRIAL REGISTRATION The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 ).
Collapse
Affiliation(s)
- Madelene Barboza
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.
| | - Anneli Marttila
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 80176, Gävle, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Region Stockholm, Centre for Epidemiology and Community Medicine, Box 45436, 104 31, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
| |
Collapse
|
18
|
Jeong J, Bliznashka L, Ahun MN, Karuskina-Drivdale S, Picolo M, Lalwani T, Pinto J, Frey M, Velthauz D, Donco R, Yousafzai AK. A pilot to promote early child development within health systems in Mozambique: a qualitative evaluation. Ann N Y Acad Sci 2022; 1509:161-183. [PMID: 34859451 PMCID: PMC8978755 DOI: 10.1111/nyas.14718] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Health systems offer unique opportunities for integrating services to promote early child development (ECD). However, there is limited knowledge about the implementation experiences of using health services to target nurturing care and ECD, especially in sub-Saharan Africa. We conducted a qualitative implementation evaluation to assess the delivery, acceptability, perceived changes, and barriers and facilitators associated with a pilot strategy that integrated developmental monitoring, nutritional screening, and early learning and nutrition counseling into the existing health facility, and community-based services for young children in rural Mozambique. We completed individual interviews with caregivers (N = 36), providers (N = 27), and district stakeholders (N = 10), and nine facility observational visits at three primary health facilities in October-November 2020. We analyzed data using thematic content analysis. Results supported fidelity to the intended pilot model and acceptability of nurturing care services. Respondents expressed various program benefits, including strengthened health system capacity and improved knowledge, attitudes, and practices regarding nurturing care and ECD. Government leadership and supportive supervision were key facilitators, whereas health system resource constraints were key barriers. We conclude that health systems are promising platforms for supporting ECD and discuss several programmatic recommendations for enhancing service delivery and maximizing potential impacts on nurturing care and ECD outcomes.
Collapse
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marilyn N. Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | | | | | | | | | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
19
|
Burger M, Einspieler C, Unger M, Niehaus D. Prioritising maternal mental health and infant neurodevelopment research in Africa – A call for action amidst the backdrop of the COVID‑19 pandemic. S Afr J Psychiatr 2022; 28:1716. [PMID: 35169511 PMCID: PMC8832021 DOI: 10.4102/sajpsychiatry.v28i0.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marlette Burger
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Christa Einspieler
- Research Unit (IDN) Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Marianne Unger
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dana Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
20
|
Melo NPD, Souza JMD, Cordeiro SM, Veríssimo MDLÓR. Validação clínica do diagnóstico de enfermagem “Risco de atraso no desenvolvimento infantil”. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0229pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Realizar a validação clínica dos fatores de risco do diagnóstico de Enfermagem “Risco de atraso no desenvolvimento infantil”. Método: Estudo transversal, de abordagem quantitativa, realizado em um ambulatório de especialidades e em unidades de saúde da família, com 124 crianças. A coleta de dados ocorreu por meio de entrevistas com os responsáveis pelas crianças e investigou os fatores de risco para atraso no desenvolvimento infantil. Resultados: Os fatores de risco sob teste estiveram presentes em 108 crianças avaliadas (87,1%). Nos testes de acurácia, a maioria dos valores de especificidade foi acima de 80%, e os de sensibilidade, inferiores a 30%. A maioria dos fatores de risco teve odds ratio >1, com destaque para três: distúrbio genético (OR = 38, p < 0,05) e distúrbio congênito (OR = 4,4, p < 0,05), entre os aspectos relativos à criança, e o desenvolvimento cognitivo dos pais prejudicado (OR = 27, p < 0,05), entre os aspectos dos cuidadores. Conclusão O estudo contribuiu para o refinamento da acurácia diagnóstica, identificando fatores potencialmente associados ao diagnóstico avaliado.
Collapse
|
21
|
Leckman JF, Ponguta LA, Pavarini G, Hein SD, McCarthy MF, Staiti H, Hanöz-Penney S, Rubinstein J, Pruett KD, Yazgan MY, Fallon NS, Hartl FJ, Ziv M, Salah R, Britto PR, Fitzpatrick S, Panter-Brick C. Love and peace across generations: Biobehavioral systems and global partnerships. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8:100092. [PMID: 35757671 PMCID: PMC9216554 DOI: 10.1016/j.cpnec.2021.100092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
Children's environments - especially relationships with caregivers - sculpt not only developing brains but also multiple bio-behavioral systems that influence long-term cognitive and socioemotional outcomes, including the ability to empathize with others and interact in prosocial and peaceful ways. This speaks to the importance of investing resources in effective and timely programs that work to enhance early childhood development (ECD) and, by extension, reach communities at-scale. Given the limited resources currently devoted to ECD services, and the devastating impact of COVID-19 on children and communities, there is a clear need to spur government leaders and policymakers to further invest in ECD and related issues including gender and racial equity. This essay offers concrete examples of scholarly paradigms and leadership efforts that focus on child development to build a peaceful, equitable, just, and sustainable world. As scholars and practitioners, we need to continue to design, implement, assess, and revise high-quality child development programs that generate much-needed evidence for policy and programmatic changes. We must also invest in global partnerships to foster the next generation of scholars, practitioners, and advocates dedicated to advance our understanding of the bio-behavioral systems that underlie love, sociality, and peace across generations. Especially where supported by structural interventions, ECD programs can help create more peaceful, just, and socially equitable societies.
Collapse
Affiliation(s)
- James F. Leckman
- Child Study Center, Yale University, New Haven, CT, USA
- Departments of Psychiatry, Psychology and Pediatrics, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liliana Angelica Ponguta
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - Gabriela Pavarini
- Early Childhood Peace Consortium, New York, NY, USA
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sascha D. Hein
- Early Childhood Peace Consortium, New York, NY, USA
- Freie Universität, Berlin, Germany
| | - Michael F. McCarthy
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
- Warner School of Education and Human Development, University of Rochester, Rochester, NY, USA
| | | | - Suna Hanöz-Penney
- Early Childhood Peace Consortium, New York, NY, USA
- Mother Child Education Foundation (AÇEV), Istanbul, Turkey
| | - Joanna Rubinstein
- Early Childhood Peace Consortium, New York, NY, USA
- United Nations Sustainable Development Solutions Network, Paris, France
| | - Kyle D. Pruett
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - M. Yanki Yazgan
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
- Güzel Günler Clinic, Istanbul, Turkey
| | - N. Shemrah Fallon
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - Franz J. Hartl
- Early Childhood Peace Consortium, New York, NY, USA
- University Web Operations, Yale University, New Haven, CT, USA
| | - Margalit Ziv
- The International Networking Group on Peacebuilding with Young Children, Belfast, Northern Ireland, UK
| | - Rima Salah
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - Pia Rebello Britto
- Early Childhood Peace Consortium, New York, NY, USA
- Country Representative, UNICEF, Lao’s People Democratic Republic (Lao PDR)
| | - Siobhán Fitzpatrick
- Early Childhood Peace Consortium, New York, NY, USA
- The International Networking Group on Peacebuilding with Young Children, Belfast, Northern Ireland, UK
- The Early Years – the Organization for Young Children, Belfast, Northern Ireland, UK
| | - Catherine Panter-Brick
- Early Childhood Peace Consortium, New York, NY, USA
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, New Haven, CT, USA
| |
Collapse
|
22
|
Dulal S, Prost A, Karki S, Saville N, Merom D. Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003872. [PMID: 34321232 PMCID: PMC8319976 DOI: 10.1136/bmjgh-2020-003872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Around 250 million children in low-income and middle-income countries are at risk of not fulfilling their developmental potential. There is a need to update syntheses investigating the effects of combined nutrition and stimulation interventions on children’s growth and development and identify intervention characteristics associated with positive effects. Methods We did a systematic review to: (1) understand the effects of integrated nutrition and stimulation interventions versus (i) usual care and (ii) standalone nutrition or stimulation interventions, on the growth and development of children under five; (2) explore intervention characteristics (delivery strategies, behaviour change techniques, intensity and personnel) associated with positive effects. We searched eight databases for studies published from inception to 16 November 2020. Eligible studies were randomised and non-randomised controlled trials of integrated nutrition and stimulation interventions examining growth and developmental outcomes. We performed meta-analyses for length-for-age/height-for-age, weight-for-age and weight-for-length/weight-for-height Z scores and cognitive, motor and language development scores, and subgroup analyses by intervention characteristics. We conducted random-effects metaregression to assess potential subgroup differences in outcomes by intervention characteristics. Results Twenty trials were included in the meta-analysis. Pooled effect sizes showed significant benefits of integrated interventions on developmental outcomes compared with usual care and standalone nutrition interventions (I2 >75%) but not on growth outcomes. Moreover, integrated interventions have non-significant effects on developmental outcomes compared with standalone stimulation interventions. Integrated interventions showed greater effects on cognitive (p=0.039) and language (p=0.040) outcomes for undernourished children compared with adequately nourished children. The effects of integrated interventions on developmental outcomes did not differ by intervention characteristics. Conclusion Integrated interventions have greater benefits for children’s development than usual care or standalone nutrition interventions, especially in settings with high levels of undernutrition. Future studies should use standardised reporting of implementation processes to identify intervention characteristics linked to positive effects.
Collapse
Affiliation(s)
- Sophiya Dulal
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Surendra Karki
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Research and Development, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Alexandria, New South Wales, Australia
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| |
Collapse
|
23
|
Sokolovic N, Rodrigues M, Tricco AC, Dobrina R, Jenkins JM. Teaching Parents to Be Responsive: A Network Meta-analysis. Pediatrics 2021; 148:peds.2020-033563. [PMID: 34261810 DOI: 10.1542/peds.2020-033563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children who receive more responsive care during their early childhood tend to exhibit stronger cognitive development, mental well-being, and physical health across their life course. OBJECTIVE Determine how to design effective responsivity training programs for caregivers. DATA SOURCES We searched seven electronic databases through October 2020. STUDY SELECTION Randomized trials (k = 120) of programs training parents of children ages 0 to 6 to be more responsive. DATA EXTRACTION Two reviewers independently extracted data. Data were pooled by using random-effects pairwise and network meta-analyses. RESULTS Programs had, on average, a medium effect (d = 0.56; 95% confidence interval [CI]: 0.47 to 0.65). The most effective programs included didactic teaching and opportunities for parents to observe models, practice skills, and receive feedback (d = 1.07; 95% CI: 0.37 to 1.77), or all these instructional methods in addition to reflection (d = 0.86; 95% CI: 0.64 to 1.09). Programs that had participants observe examples of responsivity (d = 0.70; 95% CI: 0.57 to 0.83), used researchers as facilitators (d = 0.89; 95% CI: 0.66 to 1.12), assigned homework (d = 0.85; 95% CI: 0.66 to 1.02), and had a narrow scope (d = 0.72; 95% CI: 0.57 to 0.87) were more effective than those that did not. LIMITATIONS Most samples included only mothers from Western countries and lacked follow-up data. CONCLUSIONS Having parents observe examples of responsive caregiving and complete home-practice in short, focused programs may be an effective, scalable approach to enhancing responsivity in the general population and reducing inequalities in child development.
Collapse
Affiliation(s)
- Nina Sokolovic
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario;
| | - Michelle Rodrigues
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario; and.,Division of Epidemiology and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Roksana Dobrina
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario
| | - Jennifer M Jenkins
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario
| |
Collapse
|
24
|
Guedes ATA, Soares AR, França DBLD, Vaz EMC, Collet N, Reichert APDS. Continuity of neuro-psychomotor stimulation of children with congenital Zika syndrome. Rev Bras Enferm 2021; 74:e20200694. [PMID: 34133669 DOI: 10.1590/0034-7167-2020-0694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Understand the continuity of stimulation of neuro-psychomotor development in children with congenital Zika syndrome. METHOD Descriptive-exploratory study with theoretical support in symbolic interactionism. Between August and November 2019, 12 health professionals were interviewed in depth; and to the focus group, seven caregivers of children with the syndrome. The analysis was thematic inductive. RESULTS The continuation of neuro-psychomotor stimulation of children with Zika syndrome goes through: organizational difficulties (lack of doctors, professional unpreparedness, dissatisfaction and search for other services); socioenvironmental aspects (low maternal education, low socioeconomic level, difficulty in moving and lack of support); and conditions inherent to children (hospitalizations for respiratory crises, seizures, hypoactivity and social stigma). FINAL CONSIDERATIONS A strengthened support network with qualified human resources is necessary in order to provide comprehensive care and avoid the discontinuity of neuro-psychomotor stimulation of children with congenital Zika syndrome.
Collapse
Affiliation(s)
| | | | | | | | - Neusa Collet
- Universidade Federal da Paraíba. João Pessoa, Paraíba, Brazil
| | | |
Collapse
|
25
|
Pathways to a more peaceful and sustainable world: The transformative power of children in families. Dev Psychopathol 2021; 33:409-420. [PMID: 32935656 DOI: 10.1017/s0954579420000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
Collapse
|
26
|
Laurenzi CA, Hunt X, Skeen S, Sundin P, Weiss RE, Kosi V, Rotheram-Borus MJ, Tomlinson M. Associations between caregiver mental health and young children's behaviour in a rural Kenyan sample. Glob Health Action 2021; 14:1861909. [PMID: 33397222 PMCID: PMC7801103 DOI: 10.1080/16549716.2020.1861909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa. Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample. Method: Cross-sectional data were collected from caregivers of children ages 4–5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor. Results: Caregiver anxiety (p = 0.01) and parenting stress (p < 0.001) were significantly associated with child behavioural problems. 245 caregivers (52.9%) had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored above the cut-off for both of these scales. A high proportion of our sample (60.6%) reported seeking some formal or informal psychosocial support services; however, less than one-third of these caregivers were symptomatic (30.9%). Conclusion: Anxiety and stress were associated with poorer child behavioural outcomes. Our sample reflected a higher prevalence of caregiving adults with mental health symptomology than previous estimates from Kenya, with few high-symptom caregivers seeking support. We discuss further implications for programming and health services delivery.
Collapse
Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Phillip Sundin
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | | | - Mary Jane Rotheram-Borus
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University , Belfast, UK
| |
Collapse
|
27
|
McCoy DC, Hanno EC, Ponczek V, Pinto C, Fonseca G, Marchi N. Um Compasso Para Aprender: A Randomized Trial of a Social-Emotional Learning Program in Homicide-Affected Communities in Brazil. Child Dev 2021; 92:1951-1968. [PMID: 33997964 DOI: 10.1111/cdev.13579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite global demand, the large-scale effects of social-emotional learning (SEL) programming in developing countries remain underexplored. Using a randomized control trial, this study examined the effectiveness of a school-wide SEL intervention-Programa Compasso (PC)-among 3,018 sociodemographically diverse, Portuguese-speaking children (Mage = 9.85 years) attending 90 public primary schools across Rio de Janeiro, Brazil in 2017. Average impacts of PC on children's executive function, emotion knowledge, and behavior problems after one school year were null. Moderation analyses did, however, reveal evidence for positive impacts of PC on children's labeling of emotional expressions and inhibitory control within low-homicide communities (d = 0.15 SDs), and null effects on these same outcomes in high-violence areas. Implementation and cultural considerations are discussed.
Collapse
|
28
|
Klingberg S, van Sluijs EMF, Jong ST, Draper CE. Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study. Pilot Feasibility Stud 2021; 7:60. [PMID: 33640007 PMCID: PMC7912559 DOI: 10.1186/s40814-021-00802-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00802-6.
Collapse
Affiliation(s)
- Sonja Klingberg
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK. .,SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.,SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie T Jong
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
29
|
Wu T, Niu J, Yin X, Zhao C, Huang X, Wang X. China's antenatal care promoting early childhood development: evidence from a cross-sectional survey. Ann N Y Acad Sci 2021; 1493:90-101. [PMID: 33455003 DOI: 10.1111/nyas.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
The Chinese government has established a three-tier maternal care system covering the entire country and providing integrated antenatal care (ANC) for pregnancies. This study aimed to analyze the direct and indirect effects of ANC services on early childhood development. A community-based cross-sectional survey was conducted for mothers' ANC visits and assessments of early childhood development in Shanxi and Guizhou provinces, China. A total of 1660 mother-child dyads were included in current analyses: 29.2% of mothers did not receive any ANC (ANC1), 23.3% of mothers received ANC three or fewer times (ANC2), and 47.5% of mothers received ANC four or more times (ANC3). Children whose mothers received ANC services had a significantly lower risk of overall developmental delay (OR = 0.60, 95% CI: 0.44-0.81 for ANC2; and OR = 0.44, 95% CI: 0.34-0.59 for ANC3) and social-emotional developmental delay (OR = 0.68, 95% CI: 0.49-0.94 for ANC3). Furthermore, a significant pathway relationship mediated by maternal depression and nurturing care was found between ANC and developmental delay. This study showed ANC services significantly reduced the risk of developmental delay in offspring. We also suggest that a nationwide ANC system can be a good delivery platform for scaled-up early childhood development interventions.
Collapse
Affiliation(s)
- Tianchen Wu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jieqiong Niu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Xiaohan Yin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Chunxia Zhao
- Section of Health, Nutrition, and Water, Environment and Sanitation, The United Nations Children's Fund in China Office, Beijing, China
| | - Xiaona Huang
- Section of Health, Nutrition, and Water, Environment and Sanitation, The United Nations Children's Fund in China Office, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.,Key Laboratory of Reproductive Health, National Health Commission, Beijing, China
| |
Collapse
|
30
|
Hollowell J, Belem M, Swigart T, Murray J, Hill Z. Age-related patterns of early childhood development practices amongst rural families in Burkina Faso: findings from a nationwide survey of mothers of children aged 0-3 years. Glob Health Action 2020; 13:1772560. [PMID: 32602792 PMCID: PMC7480591 DOI: 10.1080/16549716.2020.1772560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Around two thirds of children in Sub-Saharan Africa are at risk of not meeting their developmental potential. Scalable interventions, based on an understanding of local contexts, that promote nurturing care in children's early years are needed. OBJECTIVES To investigate age-related patterns of Early Childhood Development (ECD) practices amongst caretakers of children aged 0-3 years in rural households in Burkina Faso, in order to inform the design of a mass media campaign to be evaluated through a randomized controlled trial. METHODS A household survey using a structured questionnaire was used to collect data from 960 rural mothers of children aged 0-3 years in a regionally stratified random sample of 130 villages. RESULTS The mother was the main caretaker and engaged most in ECD-related activities at all ages (0-3 years). The father, grandmother and older children also engaged in ECD-related activities with older children (aged 1-3 years). Singing and playing occurred moderately frequently. Singing in the last three days: 36% at age 0-5 months increasing to 84% at age 3 years; playing in the last three days: 26% at age 0-5 months, increasing to 65% at age 3 years. Activities such as reading, counting, drawing, 'showing and naming' and 'chatting' were limited, particularly in the child's first year. Reasons for not engaging in these activities include lack of literacy, lack of books and toys or playthings and a belief that the child was too young. CONCLUSION Opportunities for learning, especially through verbal interactions, appeared to be limited during the developmentally crucial first three years, most notably in the first year of life. The challenge for ECD intervention development in Burkina Faso will be finding ways to promote more responsive interactions at an early age and finding ways of mobilizing other family members to become more engaged in stimulating activities in the child's early years.
Collapse
Affiliation(s)
| | - Mireille Belem
- Development Media International , Ouagadougou, Burkina Faso
| | | | | | - Zelee Hill
- Department of Epidemiology and Public Health, Institute for Global Health, University College London , London, UK
| |
Collapse
|
31
|
Alderman H, Friedman J, Ganga P, Kak M, Rubio-Codina M. Assessing the performance of the Caregiver Reported Early Development Instruments (CREDI) in rural India. Ann N Y Acad Sci 2020; 1492:58-72. [PMID: 33378099 PMCID: PMC8246540 DOI: 10.1111/nyas.14543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 12/25/2022]
Abstract
Although many education and health programs aim to improve early childhood development, it is challenging to assess developmental levels of infants and small children through large household surveys. The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost instrument for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development (Bayley‐III), a reliable and widely used instrument, albeit one not always suited to large‐scale data collection efforts given its length, cost, and complexity of administration. The CREDI validation exercise showed that caregivers can provide assessments in keeping with the more interactive (hence more time‐consuming and training‐intensive) Bayley‐III instrument. Noteworthy, there was no indication that concordance of the instruments differed by education of the caregiver. This is important as it points to alternate feasible tools to measure child development outcomes through large‐scale surveys.
Collapse
Affiliation(s)
- Harold Alderman
- International Food Policy Research Institute, Washington, DC
| | | | - Paula Ganga
- Department of Political Science, Columbia University, New York, New York
| | - Mohini Kak
- World Bank, South Asia Health, Washington, DC
| | - Marta Rubio-Codina
- Inter-American Development Bank, Social Protection and Health, Washington, DC
| |
Collapse
|
32
|
Jeukens-Visser M, Koldewijn K, van Wassenaer-Leemhuis AG, Flierman M, Nollet F, Wolf MJ. Development and nationwide implementation of a postdischarge responsive parenting intervention program for very preterm born children: The TOP program. Infant Ment Health J 2020; 42:423-437. [PMID: 33336859 PMCID: PMC8247046 DOI: 10.1002/imhj.21902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A previous randomized controlled trial has suggested the effectiveness of a Dutch postdischarge responsive parenting program for very preterm (VPT) infants, indicating that nationwide implementation was justified. This paper describes the development and nationwide implementation of the intervention, known as the TOP program, which consisted of three phases. In the preparation phase (2006-2010), a theory of change and the structure of the TOP program were developed, and funding for phase two, based on a positive Business Case, was obtained. In the pilot implementation phase (2010-2014), intervention strategies were developed for a real-world setting, capacity and adoption were increased, systematic evaluations were incorporated, and sustained funding was obtained. In the full-implementation phase (2014-2019), all Dutch Healthcare Insurers reimbursed the TOP program, enabling VPT infants to participate in the program without charge. By 2018, the number of interventionists that provided the TOP program had increased from 37 to 91, and all level III hospitals and 65% of regional hospitals in the Netherlands referred VPT infants. Currently, the program reaches 70% of the Dutch target population and parental satisfaction with the TOP program is high. After a 12-year implementation period, the TOP program forms part of routine care in the Netherlands.
Collapse
Affiliation(s)
- Martine Jeukens-Visser
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Koldewijn
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Emma Children's Hospital, Amsterdam UMC, Department of Neonatology, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Monique Flierman
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Jeanne Wolf
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Krishna D, Muthukaruppan SS, Bharathwaj A, Ponnusamy R, Poomariappan BM, Mariappan S, Beevi A, MacLachlan J, Campbell Z, Anthonypillai C, Brien M, Cameron C, Flatman M, Perlman L, Seilman S, Jeyapragash A, van der Haar L, Krapels J, Srinivasan SR. Rapid-Cycle Evaluation in an Early Intervention Program for Children With Developmental Disabilities in South India: Optimizing Service Providers' Quality of Work-Life, Family Program Engagement, and School Enrollment. Front Public Health 2020; 8:567907. [PMID: 33330314 PMCID: PMC7734086 DOI: 10.3389/fpubh.2020.567907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background: This paper explores how implementation and refinement of an early intervention (EI) program for children with delayed development was informed by an iterative, intentional and structured process of measurement. Providing access to early intervention therapy for children in rural areas of India is challenging due to a lack of rehabilitation therapists and programs. Following a biopsychosocial framework and principles of community-based rehabilitation, a non-governmental organization, Amar Seva Sangam (ASSA), overcame those barriers by designing a digital technology supported EI program in rural Tamil Nadu, India. Program objectives included providing service access; supporting program engagement, child development and school enrollment; and positioning the intervention for scale-up. This paper contributes to a growing body of literature on how program design and implementation can be informed through a cyclical process of data collection, analysis, reflection, and adaptation. Methods: Through several strands of data collection, the design and implementation of the EI program was adapted and improved. This included qualitative data from focus groups and interviews with caregivers and service providers, and a mobile application that collected and monitored longitudinal quantitative data, including program engagement rates, developmental progression, caregiver outcomes, and school enrollment status. Results: Measurements throughout the program informed decision-making by identifying facilitators and barriers to service providers' quality of work-life, family program engagement, and school enrollment. Consultation with key stakeholders, including caregivers and service providers, and data driven decision making led to continual program changes that improved service provider quality of work-life, program engagement and school enrollment. These changes included addressing gender-related work challenges for service providers; forming caregiver support networks; introducing psychological counseling for caregivers; providing medical consultations and assistive devices; creating community awareness programs; improving access to therapy services; focusing on caregiver education, motivation and support; and advocacy for accessibility in schools. Conclusion: The process of using evidence-informed and stakeholder driven adaptations to the early intervention program, led to improved service provider quality of work-life, greater program engagement, improved school enrollment and positioned the intervention for scale-up, providing lessons that may be beneficial in other contexts.
Collapse
Affiliation(s)
- Dinesh Krishna
- Early Intervention Program, Amar Seva Sangam, Ayikudy, India.,International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | | | | | | | | | | | - Ayesha Beevi
- Early Intervention Program, Amar Seva Sangam, Ayikudy, India
| | - Janna MacLachlan
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | | | | | - Marie Brien
- Early Intervention Program, Amar Seva Sangam, Ayikudy, India.,Handi-Care Intl., Toronto, ON, Canada
| | - Cathy Cameron
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Stephanie Seilman
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | - Abhinayaa Jeyapragash
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | | | | | | |
Collapse
|
34
|
Luoto JE, Lopez Garcia I, Aboud FE, Singla DR, Fernald LCH, Pitchik HO, Saya UY, Otieno R, Alu E. Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial. LANCET GLOBAL HEALTH 2020; 9:e309-e319. [PMID: 33341153 PMCID: PMC8054650 DOI: 10.1016/s2214-109x(20)30469-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 01/24/2023]
Abstract
Background Early childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya’s network of community health volunteers. Methods We implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03548558. Findings Between Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes. Interpretation Parenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability.
Collapse
Affiliation(s)
| | | | - Frances E Aboud
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Daisy R Singla
- Department of Psychiatry, Sinai Health and University of Toronto, Toronto, ON, Canada
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Edith Alu
- Safe Water and AIDS Project, Kisumu, Kenya
| |
Collapse
|
35
|
Shenderovich Y, Ward CL, Lachman JM, Wessels I, Sacolo-Gwebu H, Okop K, Oliver D, Ngcobo LL, Tomlinson M, Fang Z, Janowski R, Hutchings J, Gardner F, Cluver L. Evaluating the dissemination and scale-up of two evidence-based parenting interventions to reduce violence against children: study protocol. Implement Sci Commun 2020; 1:109. [PMID: 38624613 PMCID: PMC7719848 DOI: 10.1186/s43058-020-00086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs. Methods The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and after program implementation, (4) barriers and facilitators to sustained program delivery, and (5) costs and resources needed for implementation.Primary data collection, focused on three case study projects, will include interviews and focus groups with program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary data analysis of routine data collected within ongoing implementation and existing research studies will explore family enrolment and attendance, as well as family reports of parenting practices, violence against children, child behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on staff sociodemographic and professional background, and their competent adherence to the program, collected as part of staff training and certification. Discussion This project will be the first study of its kind to draw on multiple data sources and methods to examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study reports on the implementation of two specific parenting programs, we anticipate that our findings will be of relevance across the field of parenting, as well as other violence prevention and social programs.
Collapse
Affiliation(s)
- Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Catherine L. Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jamie M. Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Inge Wessels
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Kufre Okop
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Zuyi Fang
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Roselinde Janowski
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
36
|
van der Haar L, Holding PA, Krapels J, de Laat J, Slemming W. Measurement for Change: From Idea to Approach. Front Public Health 2020; 8:581756. [PMID: 33330322 PMCID: PMC7732670 DOI: 10.3389/fpubh.2020.581756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
Measurement for Change proposes an integration of monitoring, evaluation, and learning into decision-making systems that support sustainable transition of interventions to scale. It was developed using a cyclical, interactive 1-year dialogue between early childhood development (ECD) practitioners and academics from across the globe. Details are presented in Krapels et al. (1) as part of this special issue in Frontiers. In this paper, we trace the developments that inspired Measurement for Change and the novel ways in which the approach and the special issue was developed. The experience, and the reflections on this experience, are intended to inform those implementing initiatives that similarly seek to integrate practitioner- and academic experiences in support of sustainable transitions of interventions to scale.
Collapse
Affiliation(s)
- Lotte van der Haar
- Utrecht Centre for Global Challenges, Utrecht School of Economics, Utrecht University, Utrecht, Netherlands
| | - Penny A. Holding
- Saving Brains Collaborative Learning Team, Bromyard, United Kingdom
| | | | - Joost de Laat
- Utrecht Centre for Global Challenges, Utrecht School of Economics, Utrecht University, Utrecht, Netherlands
| | - Wiedaad Slemming
- Department of Pediatrics and Child Health, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
37
|
Krapels J, van der Haar L, Slemming W, de Laat J, Radner J, Sanou AS, Holding P. The Aspirations of Measurement for Change. Front Public Health 2020; 8:568677. [PMID: 33330315 PMCID: PMC7732529 DOI: 10.3389/fpubh.2020.568677] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
This Perspective presents the five key aspirations of an approach to data use, decision making and monitoring, evaluation, and learning (MEL) in Early Childhood Development (ECD) referred to as Measurement for Change. The core ideas of Measurement for Change gave rise to this series, and many of the papers submitted in this series speak to this approach, whether directly or indirectly. The five aspirations describe interconnected concepts that advocate for practitioners and researchers within ECD to build the capacity to use data in their decision making, by establishing a monitoring, evaluation, and learning system that strives to be: Dynamic; Inclusive; Informative; Interactive; and People-centered.
Collapse
Affiliation(s)
| | - Lotte van der Haar
- Utrecht Centre for Global Challenges, Utrecht School of Economics, Utrecht University, Utrecht, Netherlands
| | - Wiedaad Slemming
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Joost de Laat
- Utrecht Centre for Global Challenges, Utrecht School of Economics, Utrecht University, Utrecht, Netherlands
| | - James Radner
- Munk School of Global Affairs & Public Policy, University of Toronto, Toronto, ON, Canada
| | - Anselme Simeon Sanou
- Department of Public Health, Centre Muraz Biomedical Research Institute, Bobo Dioulasso, Burkina Faso
| | - Penny Holding
- Saving Brains Collaborative Learning Team, Bromyard, United Kingdom
| |
Collapse
|
38
|
Shea KA, Sellers TP, Smith SG, Bullock AJ. Self-guided behavioral skills training: A public health approach to promoting nurturing care environments. J Appl Behav Anal 2020; 53:1889-1903. [PMID: 33016333 DOI: 10.1002/jaba.769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 12/22/2022]
Abstract
The World Health Organization identified the promotion of "Nurturing Care Environments" as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population-level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population-level dissemination that targeted responsive caregiving. The self-guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on-line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior-specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population-level intervention design and evaluation.
Collapse
Affiliation(s)
- Kerry A Shea
- Department of Special Education and Rehabilitation, Utah State University
| | | | - Sandra G Smith
- Department of Special Education and Rehabilitation, Utah State University
| | - Andrea J Bullock
- Department of Special Education and Rehabilitation, Utah State University
| |
Collapse
|
39
|
Westgard C, Fleming WO. The Use of Implementation Science Tools to Design, Implement, and Monitor a Community-Based mHealth Intervention for Child Health in the Amazon. Front Public Health 2020; 8:411. [PMID: 32974257 PMCID: PMC7466738 DOI: 10.3389/fpubh.2020.00411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/10/2020] [Indexed: 01/04/2023] Open
Abstract
It is essential to analyze the local context and implementation components to effectively deliver evidence-based solutions to public health problems. Tools provided by the field of implementation science can guide practitioners through a comprehensive implementation process, making innovations more adaptable, efficient, and sustainable. It is equally important to report on the design and implementation process so others can analyze, replicate, and improve on the progress made from an intervention. The current study reports on the design and implementation of an mHealth intervention to improve child health in the Amazon of Peru. The study aims to provide insight into how an implementation science tool can be used to improve implementation and reporting of an evidence-based intervention in a global health setting. Methods: Implementation of a community-based mHealth intervention is analyzed and reported through the lens of the Active Implementation Frameworks (AIF). The AIF is used to analyze the design, implementation, adaptation, and monitoring of the intervention. The implementation process is categorized in the four stages of implementation. The results of the analysis and subsequent implementation activities are reported. Results: The exploration stage was used to learn about the local context in the Amazonian communities and identify an evidence-based solution to address poor child health. Several potential solutions were combined to create an innovative mHealth tool. During the installation stage, the stakeholders worked together to improve the intervention and plan for implementation through human-centered design. The providers in the field were trained and data was gathered to monitor implementation. During initial implementation stage, electronic tablets were distributed to community health agents and continuous quality improvement activities allowed for rapid improvements to be implemented. The intervention moved on to full implementation stage as acceptance and fidelity approached 100%. Conclusion: The AIF highlighted several potential barriers to implementation that may have been overlooked without the guidance of a science-based implementation tool. Reporting on the implementation process shows how implementation science tools can be used to foresee and address potential threats to successful implementation. The results of this study provide insight into the components of implementation in Amazonian communities, as well as the process of using implementation science tools in any global health setting.
Collapse
Affiliation(s)
- Christopher Westgard
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States.,Department of Research, Elementos, Lima, Peru
| | - W Oscar Fleming
- National Implementation Research Network, Frank Porter Graham Developmental Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
40
|
Aboud FE, Yousafzai AK. Scaling up child psychosocial stimulation programmes for young children. LANCET GLOBAL HEALTH 2020; 7:e294-e295. [PMID: 30784624 DOI: 10.1016/s2214-109x(19)30018-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Frances E Aboud
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada.
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
41
|
Draper CE, Howard SJ, Rochat TJ. Feasibility and acceptability of a home-based intervention to promote nurturing interactions and healthy behaviours in early childhood: The Amagugu Asakhula pilot study. Child Care Health Dev 2019; 45:823-831. [PMID: 31335976 DOI: 10.1111/cch.12714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/26/2019] [Accepted: 06/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to assess the feasibility and acceptability of a home-based intervention-Amagugu Asakhula-to promote nurturing interactions and healthy behaviours with the caregivers of preschool children. Amagugu Asakhula means "treasures that are still growing" and focuses on children's cognitive development, physical activity, screen time, diet and sleep while also promoting the caregiver-child relationship. METHODS This study took place in a low-income setting in Cape Town, South Africa. The 6-week intervention was implemented by community health workers (CHWs) with 20 caregivers of preschool children. CHWs provided written feedback on intervention sessions, and two focus groups were conducted, one with the CHWs involved (n = 4) and another with caregivers (n = 6), to obtain their feedback on the intervention and its implementation. Data were collated according to themes relating to implementation. In this pilot study, training and recruitment proved feasible and were facilitated by partnership with a community-based organization. RESULTS The intervention was generally implemented as intended, in terms of dose and delivery. Family support and active engagement of caregivers' preschool children in intervention activities were reported by CHWs and caregivers, and CHWs also reported mostly positive interactions with caregivers. CHWs and caregivers perceived the intervention to have benefits relating to the following: caregivers' awareness and knowledge of health behaviours, awareness of their role, changes in behaviours, and connection between the caregiver and child. The only change to the intervention suggested was the inclusion of some group sessions to promote support amongst intervention participants and sustain engagement in the intervention. CONCLUSIONS The findings of this pilot study indicate that Amagugu Asakhula was both feasible and acceptable with caregivers of preschool children in a low-income urban setting. Further research is needed to assess the extent to which this intervention has an objective and measurable effect on intended outcomes.
Collapse
Affiliation(s)
- Catherine E Draper
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.,South African MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Steven J Howard
- Early Start and School of Education, University of Wollongong, Wollongong, New South Wales, Australia
| | - Tamsen J Rochat
- South African MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| |
Collapse
|
42
|
Banerjee A, Britto PR, Daelmans B, Goh E, Peterson S. Reaching the dream of optimal development for every child, everywhere: what do we know about 'how to'? Arch Dis Child 2019; 104:S1-S2. [PMID: 30885960 PMCID: PMC6557222 DOI: 10.1136/archdischild-2019-317087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Anshu Banerjee
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Esther Goh
- Bernard van Leer Foundation, The Hague, The Netherlands
| | | |
Collapse
|
43
|
Milner KM, Bernal Salazar R, Bhopal S, Brentani A, Britto PR, Dua T, Gladstone M, Goh E, Hamadani J, Hughes R, Kirkwood B, Kohli-Lynch M, Manji K, Ponce Hardy V, Radner J, Rasheed MA, Sharma S, Silver KL, Tann C, Lawn JE. Contextual design choices and partnerships for scaling early child development programmes. Arch Dis Child 2019; 104:S3-S12. [PMID: 30885961 PMCID: PMC6557220 DOI: 10.1136/archdischild-2018-315433] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/18/2018] [Accepted: 01/18/2019] [Indexed: 12/29/2022]
Abstract
Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.
Collapse
Affiliation(s)
- Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Raquel Bernal Salazar
- Economics Department, Universidad de los Andes, Bogota, Colombia
- Centro de Estudios de Desarrollo Economico (CEDE), Universidad de los Andes, Bogota, Colombia
| | - Sunil Bhopal
- Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Northern School of Paediatrics, Newcastle-upon-Tyne, UK
| | - Alexandra Brentani
- Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Esther Goh
- Bernard van Leer Foundation, The Hague, The Netherlands
| | - Jena Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Rob Hughes
- Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Children's Investment Fund Foundation, London, UK
| | - Betty Kirkwood
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | | | | | | | - Cally Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Trust, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
44
|
Milman HM, Castillo CA, Sansotta AT, Delpiano PV, Murray J. Scaling up an early childhood development programme through a national multisectoral approach to social protection: lessons from Chile Crece Contigo. BMJ 2018; 363:k4513. [PMID: 30530499 PMCID: PMC6282756 DOI: 10.1136/bmj.k4513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Helia Molina Milman and colleagues describe how intersectoral collaboration between health, social protection, and education sectors enabled Chile Grows with You (Chile Crece Contigo) to help all children reach their full developmental potential
Collapse
|
45
|
Daniel AI, van den Heuvel M, Gladstone M, Bwanali M, Voskuijl W, Bourdon C, Potani I, Fernandes S, Njirammadzi J, Bandsma RHJ. A mixed methods feasibility study of the Kusamala Program at a nutritional rehabilitation unit in Malawi. Pilot Feasibility Stud 2018; 4:151. [PMID: 30258650 PMCID: PMC6151933 DOI: 10.1186/s40814-018-0347-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children admitted to nutritional rehabilitation units (NRUs) for inpatient treatment of severe acute malnutrition (SAM) are at high risk of poor developmental and nutritional outcomes. The Kusamala Program is an interactive hospital-based counseling program for primary caregivers of children with SAM that integrates three modules: nutrition and feeding; water, sanitation, and hygiene (WASH); and psychosocial stimulation. This mixed methods feasibility study aimed to evaluate the implementation of the Kusamala Program in an NRU setting and developmental outcomes in children with SAM 6 months after inpatient treatment. METHODS An internal pilot trial including the first 30 children and their primary caregivers enrolled to a cluster-randomized controlled trial of the Kusamala Program was performed. Barriers and enablers were identified in a qualitative study with a focus group discussion (FGD) and in-depth interviews (IDIs) with 12 hospital staff members, including five NRU nurses who deliver the Kusamala Program. RESULTS Results demonstrated high participant engagement (100%) and adherence (87%) of primary caregivers to the Kusamala Program. Potential barriers to implementation identified through the qualitative study were caregivers' perceived value of the program, prioritization of other ward activities, and shortages of staff. On the other hand, enablers to implementation were engaging other staff members, motivation and work ethic, and refresher training. CONCLUSIONS This mixed methods study demonstrates the feasibility of implementing the Kusamala Program in a real NRU setting. The full cluster-randomized controlled trial will be completed to evaluate the effectiveness of the Kusamala Program. TRIAL REGISTRATION ClinicalTrials.gov, NCT03072433. Registered on 7 March 2017-retrospectively registered.
Collapse
Affiliation(s)
- Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Meta van den Heuvel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Melissa Gladstone
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Mike Bwanali
- Moyo Nutritional Rehabilitation and Research Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Wieger Voskuijl
- Global Child Health Group, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Celine Bourdon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario Canada
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Isabel Potani
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sara Fernandes
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jenala Njirammadzi
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| |
Collapse
|