1.
The effect of a community-based, integrated and nurturing care intervention on early childhood development in rural China.
Zhou, S, Zhao, C, Huang, X, Li, Z, Ye, R, Shi, H, Zhao, Q, Zhou, Y, Chen, X, O'Sullivan, M, et al
Public health. 2019;:125-135
Abstract
OBJECTIVES This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural China. STUDY DESIGN A quasi-experimental design was applied, with data collection before and after a 2-year programme implementation, in both intervention and comparison (control) areas. METHODS From July 2014, the Integrated Early Childhood Development (IECD) programme was implemented in poverty-stricken areas in four counties of China. Nurturing care intervention focusing on five components (child health, nutrition, responsive care, protection and early learning support) was delivered mainly by the village early childhood development centre and township/village clinic. Another two counties of similar per capita gross domestic product, geographical characteristics, under-five mortality rate, under-five underweight prevalence and ethnicity to the four programme counties were selected as the comparison and received no IECD programme intervention. The Ages & Stages Questionnaire was used to evaluate the neurodevelopmental outcome of children; the overall suspected developmental delay (SDD) referred to any developmental delay in the communication, gross-motor, fine-motor or problem-solving or personal-social domains of the questionnaire. Children underwent anthropometric measurements and haemoglobin concentration testing through peripheral blood. Face-to-face interviews of caregivers were conducted to collect intervention use, cognitive stimulation and child-protection behaviours. A difference-in-differences regression approach, adjusting for confounding factors, was applied to estimate intervention impact on the neurodevelopmental outcomes in the children. Path analysis was employed to examine the mediating effects of growth, nutrition status, cognitive stimulation and child-protection behaviours through which the IECD intervention predicted children's developmental health. RESULTS In total, 2953 children aged under 3 years and their caregivers were enrolled at baseline, and 2745 child-caregiver pairs completed the postintervention assessment. Prevalence of overall SDD was reduced by 18% (from 37% at baseline to 19% at postintervention) in intervention counties, which is a significant difference compared with the 10% reduction in control counties (from 30% to 20%), with an adjusted odds ratio of 0.69 (95% confidence interval: 0.54-0.89). Consistent findings were found across domains. Path analysis indicated that the effect of the intervention on promoting developmental health was mediated by multiple nurturing care-associated factors, including cognitive stimulation frequency, positive discipline, length-for-age growth and haemoglobin concentration. CONCLUSIONS The community-based integrated intervention could significantly prevent developmental delay in children aged under 3 years in rural China.
2.
Translation of an Action Learning Collaborative Model Into a Community-Based Intervention to Promote Physical Activity and Healthy Eating.
Schifferdecker, KE, Adachi-Mejia, AM, Butcher, RL, O'Connor, S, Li, Z, Bazos, DA
Health promotion practice. 2016;(1):70-9
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Abstract
UNLABELLED Action Learning Collaboratives (ALCs), whereby teams apply quality improvement (QI) tools and methods, have successfully improved patient care delivery and outcomes. We adapted and tested the ALC model as a community-based obesity prevention intervention focused on physical activity and healthy eating. METHOD The intervention used QI tools (e.g., progress monitoring) and team-based activities and was implemented in three communities through nine monthly meetings. To assess process and outcomes, we used a longitudinal repeated-measures and mixed-methods triangulation approach with a quasi-experimental design including objective measures at three time points. RESULTS Most of the 97 participants were female (85.4%), White (93.8%), and non-Hispanic/Latino (95.9%). Average age was 52 years; 28.0% had annual household income of $20,000 or less; and mean body mass index was 35. Through mixed-effects models, we found some physical activity outcomes improved. Other outcomes did not significantly change. Although participants favorably viewed the QI tools, components of the QI process such as sharing goals and data on progress in teams and during meetings were limited. Participants' requests for more education or activities around physical activity and healthy eating, rather than progress monitoring and data sharing required for QI activities, challenged ALC model implementation. CONCLUSIONS An ALC model for community-based obesity prevention may be more effective when applied to preexisting teams in community-based organizations.