Perfecting Parenting: An evaluation of an integrated parenting program in rural China

Last registered on July 26, 2022

Pre-Trial

Trial Information

General Information

Title
Perfecting Parenting: An evaluation of an integrated parenting program in rural China
RCT ID
AEARCTR-0009789
Initial registration date
July 21, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
July 26, 2022, 1:34 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Primary Investigator

Affiliation

Other Primary Investigator(s)

PI Affiliation
Peking University

Additional Trial Information

Status
Completed
Start date
2015-06-01
End date
2017-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Background and study aims
Studies have shown that children growing up in poor, rural Chinese regions during the first years of life are at high risk of developmental delays. Given that approximately half of all Chinese infants in China are currently growing up in rural regions, a large share of all Chinese children are currently at risk of missing out on their full developmental potential.
These early delays have been linked to poor parenting practices. First, studies found that the average engagement of caregivers in interactive caregiver-child activities in rural China was low. For example, only 11 percent of parents reported that they told a story to the child on the day before. Second, common problematic feeding practices, such as feeding the child a diet with a low nutrient density, have also been linked to poor child development. Third, early development may be hampered by lacking health promoting behaviours of caregivers, for instance, late initiation of toothbrushing.
Earlier intervention studies in rural China have convincingly shown that parenting training programs focusing on caregiver-child interaction can effectively reduce the emergence of early cognitive delays. This study aims to assess whether a parenting program combining training on child psychosocial stimulation with information on child nutrition and health promotion can adjust problematic parenting skills and practices and improve early child development, health, nutrition, and physical growth outcomes.

Who can participate?
All 6-18 month olds that are living in the selected villages in rural Hebei Province and Yunnan Province, China at the start of the study, with their main caregivers

What does the study involve?
Participating villages are randomly assigned to intervention and control. All 6-18 month olds and their main caregivers living in villages assigned to intervention are selected to participate in a parenting program. Those in the control group will receive no intervention. Caregivers and children in the intervention group were invited to participate in biweekly parenting training sessions delivered at home by a community health worker. Caregivers are taught how to interact with their children in ways that can improve their cognition, language, motor, and social-emotional development. Caregivers also receive information on feeding practices (e.g. breastfeeding) and health promoting parenting practices (e.g. tooth brushing). Data collected for the study include measures of child development, health, nutrition, and growth, as well as measures of caregivers' knowledge on and behaviour towards best parenting and feeding practices. The study takes place over 31 months.

What are the possible benefits and risks of participating?
This study is expected to benefit children whose main caregivers participate in the intervention study. Child early development, health, nutrition, and physical growth status may improve in response to more stimulating home learning environments, better feeding practices and health promotion. It is also hoped that caregivers may apply taught parenting skills and practices to improve developmental outcomes of other children living in the household and neighbourhood. Moreover, this curriculum may be scalable if proven successful.
There are no known risks to participants taking part in this study.

Where is the study run from?
Centre for Chinese Agricultural Policy (CCAP), Chinese Academy of Sciences (CAS) (China)

When is the study starting and how long is it expected to run for?
June 2015 to December 2017

Who is funding the study?
Save the Children Hong Kong (China)

Who is the main contact?
Prof. Dr. Renfu Luo
[email protected]

Registration Citation

Citation
Emmers, Dorien and Luo Renfu. 2022. "Perfecting Parenting: An evaluation of an integrated parenting program in rural China." AEA RCT Registry. July 26. https://doi.org/10.1257/rct.9789
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
All of the communities (villages) in the sample were randomly assigned to intervention and control using a computerized random number generator.
Families assigned to the control group receive no intervention.
Families in the intervention group are invited to participate in biweekly parenting training sessions delivered at home over a period of two years. During each home visit, community health workers introduce 2 age-appropriate, interactive caregiver-child activities targeting development in four developmental domains: cognition, language, motor, and social-emotional development. Each activity is fully-scripted in an ECD curriculum that is loosely based on the "Jamaica curriculum" developed by Sally Grantham-McGregor and further developed by local child development psychologists and ECD experts. The curriculum previously underwent field testing and evaluation in rural China by our government partners at the National Health and Family Planning Commission (NHFPC) and our evaluation team. In addition to parenting training on interactive activities, caregivers receive stage-based information on child health and nutrition during each home visit. Community health workers provide information on child nutrition and health promotion based on fully-scripted, structured conversations developed by experts of the Capital Institute of Pediatrics (CIP) of the Chinese Academy of Medical Sciences (CAMS).
No further follow-up treatment is planned.
Intervention Start Date
2015-09-01
Intervention End Date
2017-11-30

Primary Outcomes

Primary Outcomes (end points)
The following will be assessed at the baseline and during three rounds of follow-up at the end of each intervention year:
1. Children's cognitive, language, motor, and social-emotional development, assessed using:
1.1. Cognition, language, motor and social-emotional scales of the third edition of the Bayley Scales of Infant and Toddler Development (Bayley-III)
1.2. Scales for communication, gross motor, fine motor, personal-social, problem solving, and overall development of the third edition of the Ages & Stages Questionnaire (ASQ-3)
1.3. The Ages & Stages Questionnaire: Social-Emotional (ASQ:SE)
2. Child health status, assessed using carer-reported health measures included in the household questionnaire
3. Child micronutrient status, assessed using haemoglobin values measured with fingerprick blood testing
4. Child weight, measured in kg using a scale
5. Child height, measured in cm using a recumbent baby length scale for 0-2 year olds and a child height scale for children over 2 years of age
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
The following are assessed prior to treatment assignment (baseline) and during two rounds of follow-up at the end of each intervention year:
1. Caregivers' attitudes, knowledge, and behaviour with regard to early child psychosocial stimulation, health promotion, hygiene, and feeding practices, assessed using a comprehensive household questionnaire administered to the primary caregiver of the child,
2. Quality of the home learning environment, assessed using the Family Care Indicators (FCI) survey
3. Caregivers' perceived social support and parental mental wellbeing, assessed using:
3.1. Parenting and Family Adjustment Scale (PAFAS)
3.2. Depression Anxiety and Stress Scale (DASS)
3.3. Office of National Statistics (ONS) subjective wellbeing survey
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Interventional single-centre non-masked cluster randomised controlled trial.
Experimental Design Details
Randomization Method
Clusters are randomly assigned to intervention and control using a computerized random number generator.
Randomization Unit
Villages
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
We aimed to include at least 40 villages with an estimated 10 participating households per village. After allowing for attrition, we expected to enroll at least 400 households in the study, amounting to around 800 individuals (400 caregivers + 400 children).
Sample size: planned number of observations
After allowing for attrition, we expected to enroll at least 400 households in the study, amounting to around 800 individuals (400 caregivers + 400 children).
Sample size (or number of clusters) by treatment arms
We planned to assign at least 20 villages to treatment and 20 villages to control.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Ethics Committee of Stanford
IRB Approval Date
2012-10-26
IRB Approval Number
25734

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
November 30, 2017, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
November 30, 2017, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
43 clusters
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
449 caregiver-child dyads
Final Sample Size (or Number of Clusters) by Treatment Arms
21 villages in treatment group and 22 villages in control group
Data Publication

Data Publication

Is public data available?
Yes

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Program Files

Program Files
Yes
Reports, Papers & Other Materials

Relevant Paper(s)

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 bi-weekly 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.
Citation
Luo, R., Emmers, D., Warrinnier, N., Rozelle, S., & Sylvia, S. (2019). Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Social Science & Medicine, 239, 112545.

Reports & Other Materials