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

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.