Mechanisms of Change Underlying Effects of an Early Parenting Intervention on Child Development Among Vulnerable Families in Rwanda

TL;DR

A parenting program in Rwanda improved child development by enhancing caregivers' behaviors related to stimulation, play, and nutrition.

Contribution

This study empirically validates the Theory of Change for a home-based parenting intervention in rural Rwanda.

Findings

Improved caregiving behaviors like stimulation and early language learning were linked to better child development outcomes.

Increased dietary diversity was associated with improvements in gross motor and problem-solving skills in children.

Changes in harsh discipline and emotion regulation did not directly affect child development outcomes.

Abstract

What are the main findings?
By empirically testing the Theory of Change underlying a home-based parenting intervention, we show that the effects of a parenting intervention on children’s developmental outcomes among vulnerable families in rural Rwanda are explained by key changes in caregivers’ behaviors to improve the home environment and child nutrition.The Sugira Muryango parenting intervention successfully improved caregiving behaviors related to stimulation, play, and early language learning, which in turn were associated with improvements in child development.

By empirically testing the Theory of Change underlying a home-based parenting intervention, we show that the effects of a parenting intervention on children’s developmental outcomes among vulnerable families in rural Rwanda are explained by key changes in caregivers’ behaviors to improve the home environment and child nutrition.

The Sugira Muryango parenting intervention successfully improved caregiving behaviors related to stimulation, play, and early language learning, which in turn were associated with improvements in child development.

What are the implications of the main findings?
By understanding how interventions work, researchers can continuously refine interventions to better support families and early childhood development.By examining the Theory of Change, we were able to identify strengths (e.g., improved home environment and nutrition) and areas of improvement (e.g., identifying ways to link improved caregiver emotion regulation and violence reduction to better child development outcomes).

By understanding how interventions work, researchers can continuously refine interventions to better support families and early childhood development.

By examining the Theory of Change, we were able to identify strengths (e.g., improved home environment and nutrition) and areas of improvement (e.g., identifying ways to link improved caregiver emotion regulation and violence reduction to better child development outcomes).

Background: Intervention effectiveness studies rarely empirically assess Theories of Change (ToC) to determine how an intervention worked. We examine the ToC underlying the Sugira Muryango (SM) parenting program in rural Rwanda to understand whether the intervention improved child development outcomes via changes in caregivers’ behaviors to improve the home caregiving environment, as hypothesized. Methods: SM uses coaching of parents to create a safe, affectionate, stimulating, and violence-free home environment. A cluster randomized trial enrolled 1049 families with young children. SM had immediate effects on caregiver behaviors, improving scores on the Home Observation for Measurement of the Environment (HOME), harsh discipline, caregiver emotion regulation, and provision of dietary diversity. We use structural equation modeling to examine whether change in caregivers’ behaviors explains intervention-related improvements in child development (Ages and Stages Questionnaire) one year after the intervention ended. Results: Improvements in positive caregiving practices, including stimulation and early language learning as captured by the HOME, explained some of the intervention-related changes in child development, including gross motor, communication, problem-solving, and personal-social development. Increased dietary diversity explained intervention-related change in gross motor, problem-solving, and personal-social development. Change in harsh discipline and caregiver emotion regulation did not explain child outcomes. Conclusions: Intervention-related changes related to constructs captured on the HOME and dietary diversity were associated with changes in child development scores, but violent discipline and caregiver emotion regulation were not. Future research should examine whether these components of the intervention can be strengthened and may influence child development via other pathways, for example, via caregiver mental health.

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