A Mid-term Evaluation of a Home-based Parenting Program on Children's and Parents' Outcomes in Rural China

Parenting trainers, selected by the Family Planning Commission (FPC), deliver a structured curriculum through weekly home visits to households in treatment villages with children 18 to 30 months of age for a period of six months. The goal of the intervention is to train caregivers to interact with their children through stimulating and developmentally-appropriate activities.

The curriculum was developed by the research team in collaboration with the FPC and outside ECD experts in China. The curriculum is stage-based and fully scripted. Weekly age-appropriate sessions were developed targeting children from 18 months of age to 36 months of age. Each weekly session contains modules focused on two of four total developmental areas: cognition, language, socio-emotional, and (fine and gross) motor skills. Every two weeks, caregivers encounter one activity from each category. In addition to developmental activities, the curriculum also includes one weekly module on child health/nutrition. During sessions, parent trainers introduce caregivers to the activity and assist caregivers to engage in the activity with their child. At the end of each weekly session, the materials used for that week's activities (toys and books) are left in the household to be returned at the next visit.

2014-10-01

2015-04-30

Our primary outcome is children's time preference.

We use a classical Marshmallow Test to measure kids' time preference. The experimenter gives one cookie and tells the kid to eat the cookie at any time he/she wants. But kids who can resist the temptation for 15 minutes would be awarded the second cookie. We record kids' waiting time especially if they can wait for 15 minutes to measure their time preference.

The parenting curriculum is designed to affect child development by improving parenting practices and investment of caregivers in the development of their children. We measure parenting practices in three dimensions. (1) We use a short-version PSDQ (Parenting Style Dimension Questionnaire) to measure parenting style, which is suggested to be a main determinant of children's time preference. (2) We measure parental time investment by asking whether parents have played toys or sang songs with kids yesterday. (3) Monetary investment is assessed by spending on kids' books, toys, and clothes.

Another important set of outcomes is children's cognitive and non-cognitive skills. We employ WISC tests and SDQ to assess kids' cognitive, motor, and emotional development.

The impacts of village-based parenting centers on child development will be tested through a cluster-randomized controlled trial. In this trial, 100 villages will be randomly selected and allocated between an intervention group (50 villages) and a control group (50 villages) with no intervention.

Parenting centers will be based in a central location in each village, and all caregivers living in the village with children aged 6-36 months will be invited to visit centers at any time during operating hours. The parenting centers will be based in repurposed office spaces that will be renovated to be child friendly (eg: colorful walls, non-lead-based paint, soft floors).

All parenting centers will include a central playroom, and will be the same size, and have the same types of toys. All parenting center toys will be split into two types: (1) large, “free play” toys such as a small climbing structure, hula hoops, big plastic bouncy balls, a toy drum set, etc.; and (2) smaller toys associated with a week-by-week parenting curriculum (henceforth, “curriculum toys”).

The parenting curriculum that will be used in the parenting centers has been carefully developed according both to child development needs, and to the local environment in rural China. It consists of weekly interactive training courses targeting caregivers of babies aged 6 to 36 months (124 training courses total). Each month consists of activities (involving both caregivers and children) designed to teach caregivers how to interact with their children in ways that stimulate development in four dimensions considered essential by child development experts: a.) cognitive, b.) psychomotor, c.) language, and d.) social-emotional development. This parenting curriculum is fully designed and developed for a rural Chinese population and has already undergone preliminary field testing and evaluation in rural China by NHFPC and the research team.

Each center will have two staff members: a full-time center monitor, and a parenting instructor. The full-time center monitor will be a local villager who manages the center and takes care of day to day maintenance, such as regular disinfecting of the toys, tidying up, ensuring caregiver and child adherence to center rules, etc. The monitor will also run daily reading programs and assist the parenting instructor as needed. The parenting instructor will be a government worker from the township-level Health & Family Planning Commission (Local HFPC). He or she will undergo comprehensive training in child development and in the implementation of the NHFPC parenting curriculum by the Training & Communication Center of the NHFPC. Once a week, the parenting instructor will teach local caregivers the stage-based (age-appropriate) curriculum-based activity of the week. The parenting instructors’ goal is to teach caregivers how to interact with their child in such a way as to foster the child’s motor skills, cognition, language ability, and social-emotional development.

Randomization done in office by a computer

village level

Yes

131 villages

600 child-caregiver pairs

65 villages in treatment group, 66 villages in control group

Calculations indicated that a minimum of 123 clusters with five children per village would be required to detect a 0.2 standard deviation effect on the Bayley Mental Development Index at 80% power.