Framing qualitative research on early child development within family systems: a scoping review

• In Event: Broadening perspectives on parenting and caregiving environments

Abstract

Background: Children are embedded in family systems where different family members play culturally-determined roles. Most research on early child development (ECD) in low-and-middle-income countries (LMIC) assumes that the nuclear family is universal and does not investigate the roles of family members beyond biological parents. However, in many cultures, children live in extended, multi-generational families where caregiving involves various family members beyond parents.

Objective: This scoping review examined the extent to which qualitative research on maternal and child nutrition and ECD in LMIC utilized a family systems framework.

Methods: We systematically searched PubMed, Scopus, and Global Health databases for peer-reviewed articles and included studies based on these criteria: (1) examined maternal nutrition, child nutrition, or early child development, including responsive caregiving, parenting, and early learning; (2) focused on pregnancy through 3 years postpartum; (3) used qualitative study designs; (4) conducted in a LMIC defined by the World Bank; and (5) published between 2000-2020. We excluded studies that focused on medical or educational staff, severely malnourished children, mothers with disabilities or chronic conditions (including HIV) or hospitalized for birth complications, those living in conflict or disaster-afflicted settings, orphaned children, and imprisoned mothers and their children. Using Covidence, we screened 4,356 abstracts, evaluated 704 full-text articles, and included 234 articles. For each of the included articles, we determined whether the research described the importance of family members aside from biological parents in promoting ECD and whether it investigated the role and influence of other family members. This abstract presents findings focused on the ECD studies (n=38) (Figure 1).

Results: Studies investigated various topics including newborn feeding and care practices, parent-child and family-child interactions, parental sensitivity and responsivity, and first-time parenthood. Studies were conducted in urban, rural, hospital, and industrial settings. Every study, except one, conducted in-depth interviews or focus group discussions. Others utilized observations, ethnographies, and participatory methods. The importance of other family members in promoting ECD was explicitly described in 17 studies (45%), implicitly mentioned in 2 studies (5%), and not stated in 19 studies (50%). Twelve studies (32%) involved family members other than biological parents as study participants (e.g. grandmothers, aunts, and/or grandfathers). Seventeen studies (45%) collected data through interviews or observations on the role and influence of other family members. Only nine studies (24%) integrated family systems thinking in their research by explicitly describing the roles of family members beyond the biological parents in promoting ECD, including them as study participants, and collecting data on their influences. Figure 2 provides detailed results by geographic world region.

Discussion and Future Directions: Less than ¼ of qualitative ECD studies in LMIC fully integrated family systems thinking into their research design, specifically their conceptual framing and methods. A systemic view of families in ECD research is necessary to adequately understand caregiving environments in early life and develop appropriate interventions for children and their families. Ongoing analysis will examine the conceptual framing of the MCN studies, integrate results with ECD findings, and discuss implications for interventions.

Authors

• Esther Chung, University of North Carolina at Chapel Hill
  Presenting Author

• Keerti Kalluru, University of North Carolina at Chapel Hill

• Eleanor Hummel, University of North Carolina at Chapel Hill

• Malik Tiedt, University of North Carolina at Chapel Hill

• Stephanie Martin, University of North Carolina at Chapel Hill

• Judi Aubel, Grandmother Project—Change through Culture