Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial

Abstract

Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during biweekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition-or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0•24 standard deviations (SD) [95% CI 0•04 SD-0•44 SD] in cognitive development and to a reduction of 8•1 [95% CI 3•8-12•4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6-30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.

Interrelationships of Parenting Information, Family Care, and Child Development: A Cross-Sectional Study in Rural China

“…As found by a growing body of literature, a child’s early development could bring high returns to his/her welfare in adulthood [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ] and the long-term economic growth of the country [ 9 ]. The key findings of this paper strongly indicated that delivering the information on positive parenting practices to the caregiver is indeed beneficial to the child’s ECD outcomes, which is in line with the findings of Sylvia et al [ 21 ] and Luo et al [ 22 ].…”

“…Similarly, in rural China, many caregivers never receive the information to help them to create a stimulating home environment, so they do not know how to successfully stimulate their children’s development [ 15 , 20 ]. Furthermore, some parenting programs that delivered parenting information to caregivers in rural areas found that, in the intervention group, family care in terms of parental investments increased by 0.35–0.72 standard deviation (SD), and the child’s cognitive development increased by 0.23–0.27 SD [ 21 , 22 ]. These findings indicated that family care might mediate in the links between parenting information and child development.…”

The Interrelationships between Parental Migration, Home Environment, and Early Child Development in Rural China: A Cross-Sectional Study

“…In some provinces of China, such as Shaanxi [42], Hebei, and Yunnan Provinces [43], several parenting intervention programs have been initiated to improve early child development of rural children. These programs have seen an increase in children's development outcomes by 0.23-0.27 SD in treatment households.…”

Relationships between Parenting Skills and Early Childhood Development in Rural Households in Western China

“…In some areas of rural China, such as Shaanxi Province [36], Yunnan and Hebei Province [37], some parenting intervention programs have been conducted to improve the child's development outcomes. The findings in this paper indicate that the improvement in a caregiver's parenting skills may be one important channel between parenting intervention and early childhood development.…”