Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT

Grantham‐McGregor, Sally; Adya, Akanksha; Attanasio, Orazio; Augsburg, Britta; Behrman, Jere R.; Caeyers, Bet; Day, Monimalika; Jervis, Pamela; Kochar, Reema; Makkar, Prerna; Meghir, Costas; Phimister, Angus; Rubio‐Codina, Marta; Vats, Karishma

doi:10.1542/peds.2020-002725

Cited by 65 publications

(63 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, the lack of statistically significant subgroup results by program duration, delivery modality, and setting are also consistent with the few prior meta-analyses that have conducted similar analyses and shown no associations between these program aspects and intervention effects on ECD and parent-level outcomes [62]. One recently published cluster RCT specifically compared the effectiveness of weekly home visits to weekly mother-child group sessions over a 2-year period in rural India [64]. Trial results revealed that group sessions were as effective as home visits in improving child cognition and language, and both delivery models similarly had null impacts on child motor, socioemotional, behavior development, and parenting knowledge and practices.…”

Section: Plos Medicinesupporting

confidence: 79%

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background Parents are the primary caregivers of young children. Responsive parent–child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. Methods and findings We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent–child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = −0.13, 95% CI: −0.18 to −0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent–child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = −0.07, 95% CI: −0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent–child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. Conclusions Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

show abstract

Section: Plos Medicinesupporting

confidence: 79%

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Child development scores, as assessed by the ASQi and CDI were higher in both intervention arms when compared with the control, with differences for 6 of the 7 domains significant for the group arm, but not for the combined arm. Differences in standardised child development scores for the group intervention arm are between 0.18 to 0.39, similar to those from a group intervention in rural India which found significant improvements in cognition scores of 0.28 SDs, 28 and an integrated home visiting programme in rural China, with intervention effects of 0.24 SDs. 13 The results from a supplementary analysis on a subset of participants demonstrate improved receptive communication and total Bayley-III scores among those who received any intervention compared with the control.…”

Section: Discussionsupporting

confidence: 68%

“…Though the current study was not powered to compare the group and combined arms directly, recent work from rural India finds similar effects on child development outcomes from group and individual home-based sessions. 28 Further, recent work from rural Kenya indicates that group sessions may outperform combined delivery in some settings. 29 Our work supports the delivery of multicomponent, mixed-age group sessions to improve risk factors for poor child development in rural Bangladesh.…”

Section: Discussionmentioning

confidence: 99%

“…Though the current study was not powered to compare the group and combined arms directly, recent work from rural India finds similar effects on child development outcomes from group and individual home-based sessions. 28 Further, recent Activities: number of play activities that the mother participated in with the child in the last three days (out of six). Materials: number of varieties of play materials observed available in the home (out of six).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh

et al. 2021

View full text Add to dashboard Cite

IntroductionIn low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention.MethodsWe conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers.ResultsIn July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54).ConclusionOur findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.Trial registration numberThe trial is registered in ISRCTN (ISRCTN16001234).

show abstract

“…7 These evaluation efforts require instruments to measure ECD that are feasible for use in a wide range of survey conditions, particularly for children under the age of 3 years. 1,7,8 However, many of the frequently used diagnostic instruments, such as the Bayley Scales of Infant Development, 9 while reliable 8,10 and sensitive to differences due to interventions, [11][12][13] are designed for use by clinically trained professionals in specific contextsprimarily high-income and westernized 14 -and are difficult and expensive to adapt to field settings in low-income environments. 15 Moreover, most of these tests are proprietary, involving expensive test kits and administration fees (copyrights), and their administration is long and requires the presence of the child-all of which makes them impractical for use at large scale.…”

Section: Introductionmentioning

confidence: 99%

Assessing the performance of the Caregiver Reported Early Development Instruments (CREDI) in rural India

Alderman

Friedman

Ganga

et al. 2020

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

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.

show abstract

Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT

Cited by 65 publications

References 26 publications

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis

A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh

Assessing the performance of the Caregiver Reported Early Development Instruments (CREDI) in rural India

Contact Info

Product

Resources

About