Implementing SafeCare Kenya to Reduce Noncommunicable Disease Burden: Building Community Health Workers' Capacity to Support Parents with Young Children

实施 SafeCare Kenya 以减少非传染性疾病负担：建设社区卫生工作者支持有幼儿的父母的能力

• 批准号: 10672785
• 负责人: LISA P ARMISTEAD
• 金额: $ 39.49万
• 依托单位: PACIFIC UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672785
• 关键词: AIDS prevention; Address; Adolescent; Adoption; Adult; Advisory Committees; Africa; Area; Behavioral; Biological; COVID-19; Cellular Phone; Cessation of life; Child; Child Abuse; Child Abuse and Neglect; Child Behavior; Child Development; Child Health; Child Rearing; Child Welfare; Childhood; Childhood Injury; Chronic Disease; Clinical effectiveness; Communities; Community Health; Community Health Aides; Country; Disease; Distal; Effectiveness; Elderly; Equity; Evaluation; Evidence based program; Failure; Family; Foundations; Funding; Goals; Government; Health; High Prevalence; Home; Human Resources; Hybrids; Infrastructure; Injury; Intervention; Kenya; Knowledge; Language; Life; Longevity; Manuals; Mental Health; Mental disorders; Methods; Mission; Modality; Mothers; National Institute of Child Health and Human Development; Outcome; Parent-Child Relations; Parents; Pathway interactions; Persons; Prevention approach; Prevention program; Preventive service; Primary Prevention; Probability; Problem behavior; Provider; Public Health; Quality of life; Randomized; Reporting; Research; Research Personnel; Research Project Grants; Research Support; Resource-limited setting; Risk; Risk Factors; Risk Reduction; Safety; Services; Strategic Planning; Stress; Supervision; System; Testing; Training; Translating; Universities; Violence; Work; abuse liability; burden of illness; childhood adversity; community building; community engagement; cost effectiveness; disorder risk; early life adversity; effectiveness study; evidence base; experience; family support; field study; health knowledge; implementation process; implementation research; improved; low and middle-income countries; maltreatment; medical attention; physical conditioning; post intervention; prevent; programs; randomized trial; recruit; response; scale up; skills; success; treatment as usual; virtual; virtual delivery; volunteer

Project Summary/Abstract In 2021, Kenya’s Ministry of Health’s Department of Non-Communicable Diseases (NCD) issued a strategic plan to “halt and reverse” the country’s rising NCD burden. Worldwide, the most common forms of NCD among children and adolescents are mental health disorders and injuries/violence. Ample research supports the causal pathway between early childhood adversity, in particular child maltreatment, and vulnerability to a range of NCD in later life through toxic stress and biological embedding. A major risk factor for NCD in Kenya is childhood maltreatment, with up to 70% of Kenyans report experiencing maltreatment during childhood typically by their parents due to lack of appropriate parenting skills, misunderstanding of child development, not providing proper medical attention, and obstacles to providing basic needs and adequate supervision. While parenting prevention programs are evidence-based approaches to remedy risk factors for NCD, and Kenya has begun the arduous task of addressing NCD burden, a significant gap remains in public health approaches to prevention work targeting the youngest Kenyans. The purpose of this R01 proposal is to conduct a Hybrid Type 2 study to examine the implementation and effectiveness of the recently adapted evidenced-based program, SafeCare, as a primary prevention approach to address the country’s NCD burden. SafeCare Kenya (SCK) improves parenting skills, reducing the likelihood of child maltreatment and subsequent risk for NCD. This project will continue the six-year partnerships amongst Africa Mental Health Research and Training Foundation (AMHRTF; Nairobi-based partner), Pacific University, Georgia State University and its National SafeCare Training and Research Center (SafeCare developers), and key country and regional stakeholders, including families, professionals, government, and researchers to scale-up and disseminate SCK. This project leverages Kenya’s Community Health Volunteers (CHV), the well-established and primary workforce for maternal and child physical health in Kenya, to implement the intervention. Virtual and in- person delivery modes will be examined to identify the best method for sustainability. Three specific aims will be accomplished in this 5-year study: (1) Determine clinical effectiveness of SCK using a parallel group multilevel-randomized trial. (2) Determine feasibility and probable utility of SCK implementation. (3) Initiate efforts to begin scale-up and sustainment of SCK across Kenya. We will recruit 312 families paired with 24 CHV randomly assigned to deliver SCK (16 Providers; 208 families) or care as usual (8 Providers; 104 families). Our project’s long-term goals are to: (1) build sustainable research and implementation capacity in Kenya and Africa and (2) disseminate a culturally relevant, evidence-based parenting program to promote children’s wellbeing and reduce risk of NCD across the lifespan.

项目概要/摘要 2021年，肯尼亚卫生部非传染性疾病司（NCD）发布了战略 计划“制止和扭转”该国不断上升的非传染性疾病负担，这是全球最常见的非传染性疾病形式。 儿童和青少年面临的问题包括心理健康障碍和伤害/暴力。 幼儿期逆境（特别是虐待儿童）与易受伤害之间的因果关系 通过毒性应激和生物嵌入，在以后的生活中罹患非传染性疾病是肯尼亚非传染性疾病的主要危险因素。 是儿童期虐待，高达 70% 的肯尼亚人表示在儿童期遭受过虐待 通常是由父母由于缺乏适当的养育技能、对儿童发展的误解、 没有提供适当的医疗护理，并且在提供基本需求和充分监督方面存在障碍。 虽然育儿预防计划是纠正非传染性疾病风险因素的循证方法，并且 肯尼亚已开始解决非传染性疾病负担的艰巨任务，公共卫生方面仍存在巨大差距 针对最年轻肯尼亚人的预防工作方法 本 R01 提案的目的是： 进行混合类型 2 研究，以检查最近调整的实施情况和有效性 SafeCare 循证计划作为解决该国非传染性疾病负担的一级预防方法。 SafeCare Kenya (SCK) 提高育儿技能，减少儿童虐待和后续事件的可能性 该项目将继续非洲精神卫生研究和非传染性疾病风险之间的六年合作关系。 培训基金会（AMHRTF；内罗毕合作伙伴）、太平洋大学、佐治亚州立大学及其 国家SafeCare培训研究中心（SafeCare开发商）以及重点国家和地区 利益相关者，包括家庭、专业人士、政府和研究人员，以扩大和传播 SCK。 该项目利用了肯尼亚的社区健康志愿者 (CHV)，这是一个完善的主要社区 肯尼亚孕产妇和儿童身体健康的劳动力，以实施虚拟和内部干预。 将检查人员交付模式，以确定可持续发展的最佳方法。 这项为期 5 年的研究将完成： (1) 使用平行组确定 SCK 的临床有效性 (2) 确定 SCK 实施的可行性和可能的​​效用。 为了开始在肯尼亚扩大和维持 SCK 的努力，我们将招募 312 个家庭与 24 个 CHV 配对。 随机分配以提供 SCK（16 名提供者；208 个家庭）或照常护理（8 名提供者；104 个家庭）。 项目的长期目标是：(1) 在肯尼亚建立可持续研究和实施能力 非洲以及 (2) 传播与文化相关、基于证据的育儿计划，以促进儿童 健康并降低一生中患非传染性疾病的风险。