Developing a Universal Indicator of Responsive Care and Early Learning for the Nurturing Care Framework

• In Event: Global Parenting Interventions: Advances in Measurement and Scale Up

Abstract

Study Objective. To develop evidence-informed tools for assessing responsive care and early learning that could be used in a diverse array of geographical and socio-cultural settings to support the evaluation of parenting programs for children in the birth to 36-month age range.
Background. The Nurturing Care Framework (NCF; 2018) was developed by the World Health Organization, United Nations Children’s Fund, and World Bank Group to provide a roadmap for attaining strategic action to strengthen public policies and strategic action to ensure (1) children’s good health, (2) adequate nutrition, (3) protection from threats, (4) support responsive care, and (5) to promote opportunities for early learning. Indicators exist to measure several domains of the NCF, but less attention has been given to the domains of responsive care and early learning.

Methods. For each tool, we conducted a literature review of the constructs measured in tools historically utilized to assess responsive caregiving and early learning activities. Selection criteria for the studies included: universal constructs, open access, and feasible for program monitoring and evaluation. For the responsive care indicator this also included a live, real-time observational measure. We systematically mapped out six retrieved tools by the name of their broad constructs, the specific indicators within each construct, and the indicators' definitions. Over several iterations, common constructs and indicators were methodically grouped together and short-listed to identify a core set of measurable constructs of responsive care and early learning. The tool was piloted on new and existing data to ensure that dimensions and indicators were mutually exclusive, exhaustive, and observable.

Results. The three short-listed constructs for responsive care were: responsive behavior, non-responsive stimulation, and negative behavior. The responsive behavior construct included indicators for positive affect/praise and responsive stimulation, the non-responsive stimulation construct included caregiver-initiated actions and affect, and the negative construct included negative affect and restrictiveness. Observation (video or in-person) of caregiver-child interactions, with a novel toy for play and with pictures for communication, were reliably coded. A responsive score was calculated as a percentage of all coded behaviors. Likewise, a non-responsive stimulation and negative interaction score can be calculated. For early learning, a 14-item checklist was developed, which can be caregiver-reported, and captures both playthings and play activities. A training guide for observers was created, along with supplemental material on how to train and monitor providers as they deliver services to promote responsive caregiving and early learning activities.

Discussion. The final indicator tools are informed by conceptual and operational definitions that describe responsive care and early learning as two distinct concepts that can be inter-related. Existing measures did not adequately distinguish between these two concepts. This tool provides programs with relevant information to make decisions in the areas of the NCF that require improvement, by promoting both responsive care and early learning as two distinct measures and measuring them in a uniform way. It will be important for those implementing nurturing care programs to train providers on responsive care and early learning, monitor their delivery, and measure parenting outcomes.

Group Authors

As per Anne Perdue please consider these flash talks as one session. They should either be accepted or rejected as a whole.

Flash talks should be ordered as follows: 1707093, 1705221, 1705962, 1707008, 1705220, 1705994, 1706107, 1706048"

Authors

• Elizabeth Hentschel, Harvard University
  Presenting Author

• Aisha Yousafzai, Harvard TH School of Public Health
  Non-Presenting Author

• Frances E Aboud, Centre universitaire de santé McGill
  Non-Presenting Author