Research Project
10237381
Abstract An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) will not reach their full developmental potential due to poverty, nutritional deficiencies, and inadequate psychosocial stimulation. Early childhood development (ECD) interventions that promote parent-child interactions through psychosocial stimulation and nutrition education can improve child outcomes in LMIC settings. However, little is known about the mediating pathways through which these complex behavioral interventions work, and despite some flagship successes, early program benefits can fade over time. This suggests parental adherence to the associated behavioral changes is a significant challenge. It is critical to understand the determinants of parental behavior change and how ECD interventions may affect them to help uncover potential pathways to sustained impacts. Starting in November 2018, our parent NICHD-funded R01 study conducted a multi-arm clustered randomized controlled trial across 60 villages and 1152 households with children aged 6-24 months in rural Kenya that aimed to test different potentially cost-effective delivery models for an ECD intervention with a parent-focused curriculum that integrates child psychosocial stimulation and nutrition education in biweekly village-based sessions lasting seven months. In August-October 2019, we collected endline survey data on children and parents and found positive short-term intervention impacts in child cognition (0.36SD), receptive language (0.27SD), and socio-emotional development (0.21SD), as well as in parental stimulation and quality of the home environment (0.50SD). These outcomes will be collected again in two years to measure sustained impacts. In the two years between surveys, a randomly-selected half of treatment villages will continue to receive bi-monthly ?booster? sessions to encourage sustained adherence to the new practices as well as to enable us to test experimentally the value added of continued, but less frequent, intervention support. In this R21 we propose to introduce one additional survey round to come midway between the parent R01 study's two follow-up surveys to deepen our understanding of the pathways of change for how our interventions might lead to sustained impacts in parental behavioral change and child outcomes. This expansion offers four key benefits over the parent study: 1) it allows us to expand the set of measures of mediators of behavioral change to improve our understanding of the underlying processes of change linking mediators, behaviors and child outcomes; 2) the new survey will come when our sample's children will be 30-48 months old, allowing the collection of new measures of child outcomes more suitable for older children to expand our understanding of the full suite of changes induced by our intervention; 3) the additional wave improves our overall statistical power to uncover the pathways; 4) with four total rounds of data (including a baseline undertaken October 2018) and expanded set of measures, we can estimate non-linear dynamic production functions of child skill accumulation to help uncover the causal pathways and the potential existence of dynamic complementarities.
