# Pathways and Mediators of Change in Early Childhood Development

> **NIH NIH R21** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2021 · $206,250

## Abstract

Abstract
An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) will not reach their full
developmental potential due to poverty, nutritional deficiencies, and inadequate psychosocial stimulation. Early
childhood development (ECD) interventions that promote parent-child interactions through psychosocial
stimulation and nutrition education can improve child outcomes in LMIC settings. However, little is known
about the mediating pathways through which these complex behavioral interventions work, and despite some
flagship successes, early program benefits can fade over time. This suggests parental adherence to the associated
behavioral changes is a significant challenge. It is critical to understand the determinants of parental behavior
change and how ECD interventions may affect them to help uncover potential pathways to sustained impacts.
Starting in November 2018, our parent NICHD-funded R01 study conducted a multi-arm clustered randomized
controlled trial across 60 villages and 1152 households with children aged 6-24 months in rural Kenya that aimed
to test different potentially cost-effective delivery models for an ECD intervention with a parent-focused
curriculum that integrates child psychosocial stimulation and nutrition education in biweekly village-based
sessions lasting seven months. In August-October 2019, we collected endline survey data on children and parents
and found positive short-term intervention impacts in child cognition (0.36SD), receptive language (0.27SD),
and socio-emotional development (0.21SD), as well as in parental stimulation and quality of the home
environment (0.50SD). These outcomes will be collected again in two years to measure sustained impacts. In the
two years between surveys, a randomly-selected half of treatment villages will continue to receive bi-monthly
“booster” sessions to encourage sustained adherence to the new practices as well as to enable us to test
experimentally the value added of continued, but less frequent, intervention support.
In this R21 we propose to introduce one additional survey round to come midway between the parent R01 study's
two follow-up surveys to deepen our understanding of the pathways of change for how our interventions might
lead to sustained impacts in parental behavioral change and child outcomes. This expansion offers four key
benefits over the parent study: 1) it allows us to expand the set of measures of mediators of behavioral change to
improve our understanding of the underlying processes of change linking mediators, behaviors and child
outcomes; 2) the new survey will come when our sample's children will be 30-48 months old, allowing the
collection of new measures of child outcomes more suitable for older children to expand our understanding of
the full suite of changes induced by our intervention; 3) the additional wave improves our overall statistical power
to uncover the pathways; 4) with four total rounds of data (including a baseline ...

## Key facts

- **NIH application ID:** 10532971
- **Project number:** 7R21HD099488-03
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** Italo Lopez Garcia
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $206,250
- **Award type:** 7
- **Project period:** 2020-08-15 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10532971

## Citation

> US National Institutes of Health, RePORTER application 10532971, Pathways and Mediators of Change in Early Childhood Development (7R21HD099488-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10532971. Licensed CC0.

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