Abstract
Background
An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) experience compromised development due to poverty, poor nutrition, and inadequate psychosocial stimulation. Numerous early childhood development (ECD) parenting interventions have been shown to be effective at improving ECD outcomes, at least in the short-term, but they are a) still too expensive to implement at scale in low-resource and rural settings, and b) their early impacts tend to fade over time in the absence of continued support. New ways to deliver effective ECD parenting interventions are sorely needed that are both low-cost to be potentially scalable, while also able to sustain impacts long-term.
Methods
Our proposed study experimentally tests a traditional in-person group-based delivery model for an evidence-based ECD parenting intervention against a delivery model that partially substitutes remote (mHealth) delivery for in-person meetings. We will assess the relative effectiveness and costs of this hybrid-delivery model against purely in-person delivery and will extend the interventions over two years to increase their ability to sustain changes in child outcomes longer-term. Our evaluation design is a clustered Randomized Control Trial across 90 villages and 1200 households. We hypothesize that a hybrid-delivery ECD intervention will be lower cost, but remote interactions among participants may be an inferior substitute for in-person visits, leaving open the question of the most cost-effective program.
Discussion:
Our goal is to determine the best model to maximize the intervention’s reach and sustained impacts to improve child outcomes. By integrating delivery into the ongoing operations of local community health workers within Kenya’s rural health care system, and utilizing new low-cost technology, our project has the potential to make important contributions towards discovering potentially scalable, sustainable solutions for resource-limited settings.