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CASITA: a controlled pilot study of community-based family coaching to stimulate early child development in Lima, Peru
  1. Adrienne Katrina Nelson1,
  2. Ann C Miller2,
  3. Maribel Munoz3,
  4. Nancy Rumaldo3,
  5. Betsy Kammerer4,
  6. Martha Vibbert5,6,
  7. Shannon Lundy7,8,
  8. Guadalupe Soplapuco3,
  9. Leonid Lecca2,3,
  10. Alicia Condeso3,
  11. Yesica Valdivia3,
  12. Sidney A Atwood1,
  13. Sonya S Shin1,9
  1. 1 Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  2. 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Socios En Salud Sucursal, Lima, Peru
  4. 4 Department of Psychiatry, Children’s Hospital Boston, Boston, Massachusetts, USA
  5. 5 Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
  6. 6 SPARK Center, Boston Medical Center, Boston, Massachusetts, USA
  7. 7 Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
  8. 8 UCSF Benioff Children’s Hospital, San Francisco, California, USA
  9. 9 Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Ann C Miller; ann_miller{at}hms.harvard.edu

Abstract

Objective To determine whether the 3-month, community-based early stimulation coaching and social support intervention ‘CASITA’, delivered by community health workers, could improve early child development and caregiver-child interaction in a resource-limited district in Lima, Peru.

Design A controlled two-arm proof-of-concept study.

Setting Six neighbourhood health posts in Carabayllo, a mixed rural/urban district in Lima. Sessions were held in homes and community centres.

Participants Children aged 6–24 months who screened positive for risk of neurodevelopmental delay (using validated developmental delay tool) and poverty (using progress out of poverty tool) were enrolled with their caregivers. Dyads with children born >21 days early were excluded.

Intervention 12-week parenting/support intervention plus nutritional support (n=41) or nutrition alone (n=19).

Outcome measures Development and home environment differences and mean changes from baseline to 3 months postintervention were evaluated using age-adjusted z-scores on the Extended Ages and Stages Questionnaire (EASQ) and the Home Observation Measurement of the Environment (HOME) scores, respectively.

Results Development in CASITA improved significantly in all EASQ domains, whereas the control group’s z-scores did not improve significantly in any domain. The mean adjusted difference (MAD) in change in EASQ age-adjusted z-scores between the two study arms was 1.39 (95% CI 0.55 to 2.22); Cohen’s d effect size of 0.87 (95% CI 0.23 to 1.50). Likewise, intervention significantly improved global HOME scores versus control group (MAD change of 6.33 (95% CI 2.12 to 10.55); Cohen’s d of 0.85 (95% CI 0.28 to 1.41)).

Conclusions An evidence-based early intervention delivered weekly during 3 months by a community health worker significantly improved children’s communication, motor and personal/social development in this proof-of-concept study.

  • neurodevelopment
  • comm child health
  • health services research

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • AKN and ACM contributed equally.

  • Contributors AKN helped to design the study, co-wrote the protocol, provided training and data collection oversight during the project, helped to analyse data, co-drafted the initial manuscript and co-wrote the final manuscript. ACM helped to design the analysis plan and the study design, collaborated on the protocol, conducted all quantitative analysis and provided interpretation, co-drafted the initial manuscript and co-wrote the final manuscript. MM oversaw the implementation of the project as Program Manager and Co-Principal Investigator, helped to design the CASITA protocol, trained the community health workers, oversaw data collection reviewed and approved the final manuscript as submitted. NR as Project Coordinator coordinated and supervised all study activities including data collection and quality control in Peru, assisted with early drafts of the manuscript, reviewed and revised all versions of the manuscript and approved the final manuscript as submitted. BK contributed to the selection of instruments, conducted training and data collection oversight, provided interpretation of data analysis, reviewed and revised all versions of the protocol and manuscript and approved the final manuscript as submitted. MV helped to design the initial intervention, helped to select tools for evaluation, participated in the adaptation of the intervention to the local setting, reviewed and revised all versions of the manuscript and approved the final manuscript as submitted. SL contributed to the selection of instruments, conducted training and data collection oversight, provided interpretation of data analysis, reviewed and revised all versions of the protocol and manuscript and approved the final manuscript as submitted. GS contributed significantly to the design of the CASITA intervention and the fidelity and monitoring activities of the CHWs, assisted in data collection, reviewed and revised the manuscript and approved the final manuscript as submitted. LL is the Co-Principal Investigator for the CASITA study. He collaborated on the protocol, contributed significant knowledge of the political landscape in Carabayllo to the study, reviewed and revised the final version of the manuscript and approved it as submitted. AC: collaborated on the protocol and helped to adapt and implement study instruments such as the HOME and EASQ in Carabayllo to the local setting, provided interpretation of results and reviewed and revised the final version of the manuscript and approved it as submitted. YV: contributed to data collection, assisted to modify study instrument application to suit local context, contributed to the early draft sections of the manuscript, reviewed and revised the final version of the manuscript and approved it as submitted. SAA designed statistical programs for analysis, assisted in conducting analyses and reviewed and revised all versions of the manuscript and approved the final manuscript for submission. SSS conceptualised and designed the study, wrote the protocol, provided analysis interpretation, co-wrote the first version of the manuscript and reviewed and revised all versions of the manuscript.

  • Funding Support for this study was provided by Grand Challenges Canada, Saving Brains Seed Grant 0351-03. ‘Community-based Family Coaching for Children with Developmental Risks in Lima, Peru’. MV was also supported by the Griffin Foundation, for SPARK global knowledge exchange activities.

  • Disclaimer The funders had no role in study design, the collection, analysis and interpretation of data, the writing of the report or the decision to submit the manuscript for publication.

  • Competing interests All authors (excepting SAA) had financial support from Grand Challenges Canada for the submitted work; MV is the executive director of the SPARK center; MM, NR, GS, LL, AC and YV are all employed by Socios en Salud. The authors declare no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent Not required.

  • Ethics approval Partners Institutional Review Board at Brigham and Women’s Hospital and by the Institute Nacional de la Salud del Nino (National Children’s Institute) in Peru.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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