# An Individualized Approach to Promote Nurturing Care in Low and Middle Income Countries: A Hybrid Effectiveness/Implementation Trial of the International Guide for Monitoring Child Development

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2021 · $567,110

## Abstract

PROJECT SUMMARY
More than 40% of children under 5 years in low- and middle-income countries (LMICs) are
at risk of not reaching their developmental potential. One of the most effective and proven
strategies for supporting early child development in these settings is to empower
caregivers and communities to support their children’s development. However, evidence
on the effectiveness and the barriers and facilitators to implementation of interventions to
promote this nurturing care are need. In this study, we will use an implementation science
framework to evaluate an individualize intervention to promote nurturing care—the
international Guide for Monitoring Child Development (GMCD), in rural India and
Guatemala. We will conduct a hybrid effectiveness/implementation cluster randomized
trial, where children aged 0-2 years will receive individualized visits from frontline health
workers administering the GMCD. The study will have three parts: In Part 1, we will
randomize clusters to receive either the GMCD or usual care for 12 months. After 12
months, control clusters will cross-in and all children will receive an additional 12 months
of intervention. We will assess the impact of the intervention at 12 and 24 months on
developmental outcomes and on the home care environment. In Part 2, we will use the
RE-AIM implementation science framework to assess the Reach, Effectiveness, Adoption,
Implementation, Maintenance of the intervention. We will also use the CFIR (Consolidated
Framework for Implementation Research) framework to conduct in-depth complementary
qualitative evaluation of implementation barriers and facilitators in high- and low-
performing clusters from Part 1. In Part 3, we will assess cost effectiveness of the
intervention. In conclusion, the study will answer three important questions: (1) Is the
GMCD effective at improving developmental outcomes and the home care environment for
children at risk in rural India and Guatemala? (2) What real-world institutional and
contextual factors influence the impact of the intervention and might affect its potential
ability to sustainably reach children and families? (3) Is the intervention cost-effective? The
project will generate globally relevant evidence on community-based early child
development interventions in LMICs.

## Key facts

- **NIH application ID:** 10053799
- **Project number:** 1R01HD100984-01A1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Peter Rohloff
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $567,110
- **Award type:** 1
- **Project period:** 2021-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10053799

## Citation

> US National Institutes of Health, RePORTER application 10053799, An Individualized Approach to Promote Nurturing Care in Low and Middle Income Countries: A Hybrid Effectiveness/Implementation Trial of the International Guide for Monitoring Child Development (1R01HD100984-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10053799. Licensed CC0.

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