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Nurturing Parents and Children: an early stimulation and father's engagement intervention in Indonesia
Last registered on August 27, 2020

Pre-Trial

Trial Information
General Information
Title
Nurturing Parents and Children: an early stimulation and father's engagement intervention in Indonesia
RCT ID
AEARCTR-0006360
Initial registration date
August 26, 2020
Last updated
August 27, 2020 10:44 AM EDT
Location(s)
Primary Investigator
Affiliation
Rutgers University
Other Primary Investigator(s)
PI Affiliation
Wake Forest, World Bank
PI Affiliation
National Team for the Acceleration of Poverty Reduction and Universitas Gadjah Mada
Additional Trial Information
Status
In development
Start date
2021-01-04
End date
2022-12-31
Secondary IDs
Abstract
The first years of life are characterized by a high degree of brain plasticity and form a critical period for skill development. Unfortunately, in developing countries, poverty and other risk factors undermine children’s full developmental potential due to the lack of stimulating, nurturing and responsive caregiving. Moreover, fathers are generally not actively engaged in co-parenting. Our goal is to implement a scalable group-based early childhood development (ECD) intervention and explore its complementarities with an additional father’s involvement component. This proposal seeks to conduct a feasibility and pilot study to adapt a proven ECD intervention (Reach-up and learn, RL) to the Indonesian context and design a complementary father’s co-parenting component by: i) identifying a scalable delivery mechanism; ii) adapting the RL curriculum to ensure cultural acceptability; iii) examining and adapting activities from proven father’s engagement programs; and iv) testing the interventions using a randomized control trial. This study will be conducted in 4 stages using focus-group discussions, in-depth interviews, and survey data collection. The results from this pilot will inform the design of a large-scale RCT, which will allow us to rigorously test the proposed interventions at a larger scale, paying special attention to feasibility, cost-effectiveness and sustainability of impacts.
External Link(s)
Registration Citation
Citation
Rosales, Maria Fernanda, Elan Satriawan and Margaret Triyana. 2020. "Nurturing Parents and Children: an early stimulation and father's engagement intervention in Indonesia ." AEA RCT Registry. August 27. https://doi.org/10.1257/rct.6360-1.0.
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Experimental Details
Interventions
Intervention(s)
Our first intervention will adapt and further test group-based Reach up and Learn (RL) to target 0 to 3 year olds from poor families in Indonesia. Poor families are identified as those eligible for the Indonesian CCT program.
Our second intervention corresponds to the adaptation of a complementary intervention that targets fathers' engagement in co-parenting. We will adapt activities from existing evidence-based programs. We will test if an intervention that targets mothers and fathers can produce complementarities to enhance child development.
Intervention Start Date
2021-12-01
Intervention End Date
2022-06-30
Primary Outcomes
Primary Outcomes (end points)
Improved family inputs and home environment should support child development, and they are key first-order outcomes of our proposed intervention. To capture family inputs, enumerators will record parenting attitudes and items from UNICEF’s Family Care Indicators (Kariger et al., 2012) to capture the quality of the home environment. To measure parental knowledge (mothers and fathers) about child development, we will select items from the Knowledge of Infant Development Inventory (KIDI) (MacPhee, 1981). We will also assess parental self-efficacy using the Self-efficacy in the Caregiver Role Test– Modified (Pedersen et al., 1989; Porter and Hsu, 2003), which evaluates parental feelings while taking care of their children.

We also expect that our proposed interventions will improve children's human capital outcomes. For children’s physical health outcomes, we will measure height and weight. To capture children’s development, we will use the Ages and Stages Questionnaire.

We will also measure parents’ well-being using the Center for Epidemiologic Studies Depression Scale (CES-D) scale, bargaining power, knowledge on child development and maltreatment, and social networks. To measure women’s empowerment, we will rely on the existing body of validated instruments and behavioral games developed and tested by researchers in economics and psychology. We will review and adapt the questions compiled by Glennester, Walsh, and Diaz-Martin (2017). Overall, we will pilot and assess the reliability of the instruments, taking into account the Indonesian context. The survey instruments will also include demographic characteristics following the Indonesian Family Life Survey (Strauss et al, 2016).
Primary Outcomes (explanation)
Please see the previous item.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Our project will conduct both a small scale pilot RCT (to pre-test the interventions) and a large-scale RCT.
Prior to the pilot, we will perform a feasibility study using a mixed-methods approach to examine potential facilitators to deliver our proposed interventions taking into account how we can utilize existing infrastructure and personnel for cost-effectiveness and scalability.
In the small scale pilot, villages will be randomly assigned to either the control group or the following treatment arms. One treatment arm will be the adapted RL curriculum delivered in a group-based setting, with 8-12 families per group through weekly meetings ofr 6 months and one home visit per month. The other treatment arm will be the adapted RL complemented with the father co-parenting component, which will be delivered through weekend sessions for 3 months. Then villages in each treatment arm will be randomized to receive the intervention by two of the most promising facilitators, who will be identified from the mixed-methods analyses.

Based on the findings from the pilot study, we will identify the most promising facilitator and test our proposed interventions at a larger-scale. In the large-scale RCT, villages will also be randomized in to the three groups described above, however, the interventions will be delivered for 18 months.
Experimental Design Details
Not available
Randomization Method
For the pilot RCT, we will determine a list of eligible villages in two provinces and randomly select 24 villages. Then each of the 24 villages with be assigned to each of the three groups using randomization done in office by a computer.
For the large scale RCT, we will use triplet matching to randomly allocate villages to each of the intervention arms.
Randomization Unit
The unit of randomization is the village
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
For the small pilot RCT, we will have 24 villages.
For the large-scale RCT, the treatment will be clustered, with 100 villages in each arm.
Sample size: planned number of observations
For the smal pilot RCT, the sample size is 720 poor households with children ages 0-3 in 24 villages (according to administrative data, potential villages have an average of 30 CCT eligible families with children ages 0-3). For the large-scale RCT, the sample size is: 9,000 poor families in 300 villages.
Sample size (or number of clusters) by treatment arms
For the small pilot RCT: 8 villages in the control group. 8 villages in T1: RL only (4 villages delivered by Facilitator 1 and 4 villages delivered by Facilitator 2). 8 villages in T2: RL plus father's involvement (4 villages delivered by Facilitator 1 and 4 villages delivered by Facilitator 2).
For the large scale RCT: 100 villages in the control, 100 in T1 and 100 villages in T2
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The main goal of the pilot RCT is to generate proof-of-concept evidence to design the large-scale RCT. For the large-scale RCT, assuming an intra-cluster correlation of 0.1-0.2 (based on data from other developing countries for similar outcomes), 80% power, 5% type I error and 10% attrition rate per cluster, the minimum detectable effect size is 0.15-0.2 SDs for parenting and children outcomes.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Institutional Review Board - Wake Forest University
IRB Approval Date
2020-02-10
IRB Approval Number
IRB00023740