Scaling up home‐visiting to promote early childhood development and prevent violence in Rwanda: a hybrid type‐2 effectiveness‐implementation trial.
Background: Children in impoverished families–especially those affected by violence–face risks to healthy development. In the years of strong economic recovery since the 1994 Genocide Against the Tutsi, the Rwandan Government has invested in early child development, social and child protection and v...
| Publicado en: | Journal of Child Psychology & Psychiatry Vol. 66; no. 10; pp. 1484 - 1500 |
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| Autores principales: | , , , , , , , , , , , , , , |
| Formato: | Artículo |
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Wiley-Blackwell
Oct2025
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=188098422&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 188098422 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00219630 JYY jtl: Journal of Child Psychology & Psychiatry issn: 00219630 maglogo: Y pubinfo: dt: Oct2025 vid: 66 iid: 10 pid: 480 pub: Wiley-Blackwell artinfo: ui: 188098422 10.1111/jcpp.14160 ppf: 1484 ppct: 16 formats: tig: atl: Scaling up home‐visiting to promote early childhood development and prevent violence in Rwanda: a hybrid type‐2 effectiveness‐implementation trial. aug: au: Black, Candace J. Placencio‐Castro, Matias Phend, Gabriela Havugimana, Jean Marie Vianney Umulisa, Grace Uwamahoro, Pacifique Nyirahabimana, Marie Gaudence Bond, Laura Hernandez, Kayla Jensen, Sarah KG Kajani, Ursula Murray, Shauna M. Rawlings, Laura B. Sezibera, Vincent Betancourt, Theresa S. affil: Boston College, School of Social Work, Chestnut Hill MA,, USA FXB Rwanda, Kigali, Rwanda Boston Children's Hospital, Boston MA,, USA Harvard Medical School, Boston MA,, USA The Carter Centre, Emory University, Atlanta GA,, USA World Bank, Washington DC,, USA College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda su: Rwanda Home care services Mental health Government agencies Evaluation of human services programs Parenting Father-child relationship Water supply Early intervention (Education) Domestic violence Child development Health promotion Poverty Discipline of children Poisson distribution Cronbach's alpha Research funding Questionnaires Child nutrition Descriptive statistics Odds ratio Data analysis software Confidence intervals sug: subj: Home care services Mental health Government agencies Evaluation of human services programs Parenting Father-child relationship Water supply Early intervention (Education) Domestic violence Child development Health promotion Poverty Discipline of children Rwanda Other General Government Support Other local, municipal and regional public administration Other provincial and territorial public administration Other federal government public administration Services for the Elderly and Persons with Disabilities Offices of all other health practitioners Home Health Care Services Offices of All Other Miscellaneous Health Practitioners Offices of Mental Health Practitioners (except Physicians) Water Supply and Irrigation Systems Poisson distribution Cronbach's alpha Research funding Questionnaires Child nutrition Descriptive statistics Odds ratio Data analysis software Confidence intervals keyword: early child development father engagement global health home‐visiting Hybrid Type‐2 Trial Implementation science implementation strategy poverty social protection violence prevention early child development father engagement global health home‐visiting Hybrid Type‐2 Trial Implementation science implementation strategy poverty social protection violence prevention ab: Background: Children in impoverished families–especially those affected by violence–face risks to healthy development. In the years of strong economic recovery since the 1994 Genocide Against the Tutsi, the Rwandan Government has invested in early child development, social and child protection and violence prevention, but few strategies for scaling evidence‐based interventions (EBIs) in these areas have been studied. Methods: We present a Hybrid Type‐2 Implementation‐Effectiveness study of the PLAY Collaborative implementation strategy to engage government and other stakeholders in scaling Sugira Muryango (SM, "Strong Family") to families eligible for social protection in three rural districts. SM promotes nurturing care of children under three while reducing family violence. We assessed delivery quality (fidelity, competence) and perceptions of the PLAY Collaborative (e.g, feasibility, leadership, organisation, sustainability). An embedded trial of 538 households (778 caregivers, 555 children) tested SM effectiveness when delivered by child protection volunteers. Results: Child protection volunteers delivered SM with high fidelity and competence that improved with time and routine supervision. The PLAY Collaborative was rated moderately to highly across implementation outcomes. The embedded trial revealed improvements in children's stimulation at home (d = 0.20, 95% CI: 0.04–0.36) as caregivers involved them more in daily activities (d = 0.37, 95% CI: 0.18–0.57) and provided more learning materials (d = 0.37, 95% CI: 0.16–0.59). SM families increased stimulating care (e.g. singing, playing; d = 0.26, 95% CI: 0.07–0.46); involved fathers more in caregiving (IRR = 1.18, 95% CI: 1.03–1.37); reduced harsh discipline (OR = 0.34, 95% CI: 0.14–0.82); and increased dietary diversity (d = 0.25, 95% CI: 0.04–0.45). SM caregivers reported improved mental health (d = −0.13, 95% CI: −0.26 to −0.01). SM households increased safe water storage (OR = 3.14, 95% CI: 1.64–6.03) and water treatment (OR = 3.56, 95% CI: 1.80–7.05) practices. Conclusions: The PLAY Collaborative successfully overcame implementation barriers and maintained effectiveness across most outcomes while scaling delivery to N = 8,745 families, highlighting the value of systematically investigating implementation strategies while scaling an EBI as integrated into existing social and child protection systems. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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