A Hybrid Effectiveness/Implementation Trial of the International Guide for Monitoring Child Development

NCT ID: NCT04665297

Last Updated: 2024-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

624 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-17

Study Completion Date

2026-04-30

Brief Summary

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The aim of this study is to conduct a hybrid effectiveness/implementation assessment of the International Guide for Monitoring Child Development (GMCD) in two LMIC settings, India and Guatemala, within established rural CHW programs. The primary objectives are (a) to evaluate the real-world effectiveness of the GMCD; (b) to use an implementation science framework to understand barriers and facilitators to effective population coverage, provider implementation, and maintenance; (c) to conduct an economic evaluation of the GMCD.

Detailed Description

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Specific Aim 1: Assess the effectiveness of the GMCD intervention to improve developmental outcomes and nurturing care in India and Guatemala. The investigators will conduct a parallel-arm cluster randomized trial within rural CHW programs. In the primary effectiveness phase, children under 2 years old will receive the GMCD intervention or control for 12 months. Subsequently, control clusters will cross into the intervention, and continue an additional 12 months (total 24 study months). The primary developmental effectiveness outcome will be change in age-adjusted scores at 12 months on the Bayley Scales of Infant Development, 4th Edition BSID4) (3). The secondary nurturing care effectiveness outcome will be change in mean Home Observation for Measurement of the Environment (HOME) score at 12 months (4).

Specific Aim 2: Assess barriers and facilitators to GMCD implementation using the RE-AIM evaluation framework (5). RE-AIM domains will be assessed as: (a) Reach: participation rates, comparison of participant/non-participant characteristics, attendance/drop-out; (b) Effectiveness: impact on development (BSID4) and nurturing environment (HOME) \[in Aim 1\]; (c) Adoption: proportion of workers/facilities participating, CHW characteristics; (d) Implementation: contact hours/visit completion, fidelity to delivery protocols; (e) Maintenance: patient outcomes and cost effectiveness analysis at 12-24 months \[in Aim 3\]; intent by decision makers and implementers to continue intervention. In addition, the investigators will conduct a sequential quantitative--\>qualitative explanatory analysis, using interviews and focus groups with implementers from clusters with highest/lowest impact outcomes (BSID4/HOME) to explore institutional inner and outer setting and implementation processes associated with intervention success, using the Consolidated Framework for Implementation Research (CFIR).

Specific Aim 3: Conduct an economic evaluation of the GMCD intervention. Evaluation will assess (a) costs of the interventions at 12 and 24 months; and (b) cost-effectiveness of the intervention (dollar per unit increase in BSID or HOME scores) at 12 months. This analysis will provide cost information to policymakers to help guide resource allocation decisions for ECD interventions.

Conditions

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Child Development

Keywords

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Guatemala India Early Child Development

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Nonblinded, two-arm cluster randomized controlled trial for 12 months. At 12 months, control arm crosses into the intervention, and both arms receive the intervention for an additional 12 months (total of 24 months)
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Given nature of study, blinding is not feasible.

Study Groups

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Intervention arm

Subjects from intervention clusters will receive the GMCD intervention, delivered in monthly visits to the home by frontline health workers, for 24 months. 0-12 months represents the primary effectiveness study, and 12-24 months a secondary maintenance study.

Group Type EXPERIMENTAL

International Guide for Monitoring Child Development

Intervention Type BEHAVIORAL

Monthly GMCD visits includes assessment of risk factors, open-ended exploration of caregiver concerns about development, assessment of functioning in seven developmental domains, and using mutual problem solving strategies to develop a nurturing care plan with the caregiver.

Control Arm

Subjects in control clusters will continue to receive usual care from their frontline health workers. After 12 months (primary effectiveness study) control will cross into the intervention for months 12-24.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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International Guide for Monitoring Child Development

Monthly GMCD visits includes assessment of risk factors, open-ended exploration of caregiver concerns about development, assessment of functioning in seven developmental domains, and using mutual problem solving strategies to develop a nurturing care plan with the caregiver.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* age 0-24 months at the time of enrollment visit
* receiving health services from frontline health workers of Maya Health Alliance (Guatemala), Mahatma Gandhi Institute (India) or their local partners

Exclusion Criteria

* children who are critically ill and are judged by the frontline health worker to require hospitalization or center-based care
* children whose caregivers do not provide informed consent for the study
Minimum Eligible Age

0 Months

Maximum Eligible Age

24 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mahatma Gandhi Institute of Medical Sciences

OTHER

Sponsor Role collaborator

Ummeed Child Development Center

UNKNOWN

Sponsor Role collaborator

Ankara University

OTHER

Sponsor Role collaborator

Wuqu' Kawoq, Maya Health Alliance

OTHER

Sponsor Role collaborator

Harvard Medical School (HMS and HSDM)

OTHER

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Peter J. Rohloff, M.D.,Ph.D.

Assistant Professor/Associate Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter Rohloff

Role: PRINCIPAL_INVESTIGATOR

Assistant Professor/Associate Physician

Locations

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Wuqu' Kawoq

Tecpán Guatemala, , Guatemala

Site Status RECRUITING

Mahatma Gandhi Institute of Medical Sciences

Sevāgrām, Maharashtra, India

Site Status NOT_YET_RECRUITING

Countries

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Guatemala India

Central Contacts

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Peter Rohloff

Role: CONTACT

Phone: 617-447-3034

Email: [email protected]

Facility Contacts

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Peter Rohloff

Role: primary

Subodh Gupta

Role: primary

References

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Ertem IO, Krishnamurthy V, Mulaudzi MC, Sguassero Y, Balta H, Gulumser O, Bilik B, Srinivasan R, Johnson B, Gan G, Calvocoressi L, Shabanova V, Forsyth BWC. Similarities and differences in child development from birth to age 3 years by sex and across four countries: a cross-sectional, observational study. Lancet Glob Health. 2018 Mar;6(3):e279-e291. doi: 10.1016/S2214-109X(18)30003-2.

Reference Type BACKGROUND
PMID: 29433666 (View on PubMed)

Ertem IO, Dogan DG, Gok CG, Kizilates SU, Caliskan A, Atay G, Vatandas N, Karaaslan T, Baskan SG, Cicchetti DV. A guide for monitoring child development in low- and middle-income countries. Pediatrics. 2008 Mar;121(3):e581-9. doi: 10.1542/peds.2007-1771.

Reference Type BACKGROUND
PMID: 18310178 (View on PubMed)

Raut A, Mustafayev R, Srinivasan R, Chary A, Ertem I, Grazioso MDP, Gupta S, Krishnamurthy V, Lu C, Maliye C, Miller AC, Wagenaar BH, Rohloff P. Hybrid type 1 effectiveness/implementation trial of the international Guide for Monitoring Child Development: protocol for a cluster-randomised controlled trial. BMJ Paediatr Open. 2021 Sep 15;5(1):e001254. doi: 10.1136/bmjpo-2021-001254. eCollection 2021.

Reference Type DERIVED
PMID: 34604546 (View on PubMed)

Other Identifiers

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2020P002143

Identifier Type: -

Identifier Source: org_study_id