Improved responsive caregiving and home learning environment through a relational home visitation program: Delayed control group comparison

Abstract

Early child development (ECD) is one of the best long-term investments for sustainable community development. Yet, more research is needed on the impact and implementation of ECD interventions, especially in marginalized communities that need them most. This study investigates the effectiveness of a home visitation program in a Zulu community in South Africa in improving the home learning environment, responsive caregiving, social support, and virtuous hope, compared to a delayed control group. Participants included 290 female caregivers in the intervention and 79 demographically similar families in the delayed control group recruited from a nearby neighborhood of the same peri-urban area. Assessments occurred at baseline and approximately 6 months later. Using propensity score matching, analyses indicated significant improvements in posttest home learning environment and responsive care in the intervention group relative to the control group, controlling for pretest values. No significant increases were noted in social support or virtuous hope. Implications for community ECD implementation and future research directions are discussed.

Keywords

Maternal sensitivity mother–child interaction parental involvement parent–child relations parenting

Get full access to this article

View all access options for this article.

References

Adelson

J. L.

McCoach

D. B.

Rogers

H. J.

Adelson

J. A.

Sauer

T. M.

(2017). Developing and applying the propensity score to make causal inferences: Variable selection and stratification. Frontiers in Psychology, 8, Article 1413. https://doi.org/10.3389/fpsyg.2017.01413

Ahun

M. N.

Ali

N. B.

Hentschel

Jeong

Franchett

Yousafzai

A. K.

(2024). A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development. Annals of the New York Academy of Sciences, 1533(1), 99–144. https://doi.org/10.1111/nyas.15110

Al Sager

Goodman

S. H.

Jeong

Bain

P. A.

Ahun

M. N

. (2024). Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: A systematic review and meta-analysis. The Lancet. Child & Adolescent Health, 8(9), 656–669. https://doi.org/10.1016/s2352-4642(24)00134-2

Austin

P. C.

(2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. https://doi.org/10.1080/00273171.2011.568786

Barnhart

D. A.

Farrar

Murray

S. M.

Brennan

R. T.

Antonaccio

C. M.

Sezibera

Ingabire

Godfroid

Bazubagira

Uwimana

Kamurase

Wilson

Rawlings

L. B.

Yousafzai

Betancourt

T. S.

(2020). Lay-worker delivered home visiting promotes early childhood development and reduces violence in Rwanda: A randomized pilot. Journal of Child Family Studies, 29, 1804–1817. https://doi.org/10.1007/s10826-020-01709-1

Bergelson

Soderstrom

Schwarz

I. -C.

Rowland

C. F.

Ramírez-Esparza

Rague Hamrick

Marklund

Kalashnikova

Guez

Casillas

Benetti

Van Alphen

P. M.

Cristia

(2023). Everyday language input and production in 1,001 children from six continents. Proceedings of the National Academy of Sciences, 120(52), e2300671120. https://doi.org/10.1073/pnas.2300671120

Bond

Cheonga

Byansi

Puffer

Betancourt

T. S.

(2025). Exploring nonspecialist preparedness to deliver an evidence-based, family strengthening intervention in Rwanda: A qualitative study. Journal of Behavioral Health Services and Research, 52, 139–154. https://doi.org/10.1007/s11414-024-09913-3

Bornstein

M. H.

Rothenberg

W. A.

Lansford

J. E.

Bradley

R. H.

Deater-Deckard

Bizzego

Esposito

(2021). Child development in low- and middle-income countries. Pediatrics, 148(5), Article e2021053180. https://doi.org/10.1542/peds.2021-053180

Bradley

R. H.

Caldwell

B. M.

Corwyn

R. F.

(2003). The Child Care HOME Inventories: Assessing the quality of family child care homes. Early Childhood Research Quarterly, 18(3), 294–309. https://doi.org/10.1016/S0885-2006(03)00041-3

10.

Britto

P. R.

Lye

S. J.

Proulx

Yousafzai

A. K.

Matthews

S. G.

Vaivada

T. P.

Perez-Escamilla

Rao

Fernald

L. C. H.

MacMillan

Hanson

Wachs

T. D.

Yao

Yoshikawa

Cerezo

Leckman

J. F.

Bhutta

Z. A.

(2017). Nurturing care: Promoting early childhood development. The Lancet, 389(10064), 91–102.

11.

Carmiol

A. M.

Castro

Castro-Rojas

M. D.

Weisleder

Robalino

(2024). Links between booksharing and early vocabulary development in Costa Rica. Infant Behavior and Development, 76, 101958.

12.

Carstensen

Ørnbøl

Fink

Jørgensen

Dantoft

T. M.

Madsen

A. L.

Buhmann

Eplov

L. F.

Frostholm

(2020). Adverse life events in the general population—A validation of the cumulative lifetime adversity measure. European Journal of Psychotraumatology, 11(1), 1717824. https://doi.org/10.1080/20008198.2020.1717824Returntoref2020inarticle

13.

Chang

Y. E.

(2017). Pathways from mothers’ early social support to children’s language development at age 3. Infant and Child Development, 26(6), Article e2025. http://dx.doi.org/10.1002/icd.2025

14.

Cottone

(2012). Preschoolers’ emergent literacy skills: The mediating role of maternal reading beliefs. Early Education and Development, 23, 351–372.

15.

Dawson

Lachman

Voges

Berg

(2024). Developing culturally sound infant mental health practice for the South African Context. In Osofsky

J. D.

Fitzgerald

H. E.

Keren

Puura

(Eds.), WAIMH handbook of infant and early childhood mental health: Cultural context, prevention, intervention, and treatment, volume two (pp. 39-55). Springer International Publishing.

16.

Dowdall

Melendez-Torres

G. J.

Murray

Gardner

Hartford

Cooper

P. J.

(2020). Shared picture book reading interventions for child language development: A systematic review and meta-analysis. Child Development, 91(2), e383–e399. https://doi.org/10.1111/cdev.13225

17.

Dowdall

Murray

Skeen

Marlow

De Pascalis

Gardner

Tomlinson

Cooper

P. J.

(2021). Book-sharing for parenting and child development in South Africa: A randomized controlled trial. Child Development, 92(6), 2252–2267. https://doi.org/10.1111/cdev.13619

18.

Edler

Behrens

Jacques

Valentino

(2023). Preventing child welfare reinvolvement: The efficacy of the reminiscing and emotion training intervention. Development and Psychopathology, 36(4), 1558–1569. https://doi.org/10.1017/S0954579423000809

19.

Erkel

M. K.

Abregu del Pino

V. F.

Bayer

A. M.

(2019). Exploring the literacy habits of caregivers with young children ages 11–25 months old in Lima, Peru: A pilot study for the LIBRE project. Early Childhood Education Journal, 47(6), 731–741.

20.

Fang

Luo

Boele

Windhorst

van Grieken

Raat

(2024). Parent, child, and situational factors associated with parenting stress: A systematic review. European Child Adolescent Psychiatry, 33, 1687–1705. https://doi.org/10.1007/s00787-022-02027-1

21.

Giese

Dawes

Tredoux

Mattes

Bridgman

van der Berg

Schenk

Kotzé

(2022). Thrive by five index report revised August 2022. Innovation Edge. https://thrivebyfive.co.za/

22.

Heckman

J. J.

Moon

S. H.

Pinto

Savelyev

P. A.

Yavitz

(2010). The rate of return to the HighScope Perry Preschool Program. Journal of Public Economics, 94(1–2), 114–128.

23.

Hentschel

Yousafzai

A. K.

Aboud

F. E.

(2021). The nurturing care framework: Indicators for measuring responsive care and early learning activities. World Health Organization. https://nurturing-care.org/assessing-responsive-caregiving-and-early-learning-activities/

24.

Imai

King

Stuart

E. A.

(2011). MatchIt: Nonparametric preprocessing for parametric causal inference. Journal of Statistical Software, 42(8), 1–28. https://doi.org/10.18637/jss.v042.i08

25.

Hoang

N. T.

Yakes

Moran

E. G.

Musherure

Turahirwa

Bartels

Reagan

Vandezande

Thomas

K. J.

(2024). Hopeful parenting: A systematic literature review on hope among parents. International Journal of Applied Positive Psychology, 9, 1563–1587. https://doi.org/10.1007/s41042-024-00181-2

26.

Hoff

Trecca

Højen

Laursen

Bleses

(2024). Context and education affect the quality of parents’ speech to children. Journal of Applied Developmental Psychology, 91, 101632. https://doi.org/10.1016/j.appdev.2024.101632

27.

Hopper

Cosco

T. D.

(2023). What can we learn about resilience from large-scale longitudinal studies? In Goldstein

Brooks

R. B.

(Eds.), Handbook of resilience in children (pp. 85–102). Springer International Publishing.

28.

Ihmeideh

(2017). Getting parents involved in children’s play: Qatari parents’ perceptions of and engagement with their children’s play. Education 3-13, 47(1), 47–63. https://doi.org/10.1080/03004279.2017.1399152

29.

Jacovidis

J. N.

Foelber

K. J.

Horst

S. J.

(2017). The effect of propensity score matching method on the quantity and quality of matches. The Journal of Experimental Education, 85(4), 535–558. https://doi.org/10.1080/00220973.2016.1250209

30.

Jensen

S. K.

Murray

S. M.

Placencio-Castro

Kajani

Amponsah

Sezibera

Betancourt

T. S.

(2023). Family violence reduction within a parenting intervention in Rwanda: A mixed-methods study. Pediatrics, 151(Suppl. 2), Article e2023060221L. https://doi.org/10.1542/peds.2023-060221L

31.

Jeong

Franchett

E. E.

Ramos

Oliveira

C. V.

Rehmani

Yousafzai

A. K.

(2021). Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLOS Medicine, 18(5), Article e1003602. https://doi.org/10.1371/journal.pmed.1003602

32.

Knowledge, Information & Data Solutions. (2019). South African early childhood review. https://ilifalabantwana.co.za/research-and-data

33.

Luthar

S. S.

Eisenberg

(2017). Resilient adaptation among at-risk children: Harnessing science toward maximizing salutary environments. Child Development, 88(2), 337–349. https://doi.org/10.1111/cdev.12737

34.

Mograbi

R. Z.

Bain

Pretorius

(2024). Changing motherhood in the South African middle-class context. Journal of Family Issues, 45(11), 2679–2710. https://doi.org/10.1177/0192513X231211455

35.

Monahan

K. C.

Lee

J. M.

Steinberg

(2011). Revisiting the impact of part-time work on adolescent adjustment: Distinguishing between selection and socialization using propensity score matching. Child Development, 82(1), 96–112. https://doi.org/10.1111/j.1467-8624.2010.01543.x

36.

Nag

Vagh

S. B.

Dulay

K. M.

Snowling

Donolato

Melby-Lervåg

(2024). Home learning environments and children’s language and literacy skills: A meta-analytic review of studies conducted in low-and middle-income countries. Psychological Bulletin, 150(2), 132. https://doi.org/10.1037/bul0000417

37.

Neugebauer

van der Laan

(2005). Why prefer double robust estimators in causal inference? Journal of Statistical Planning and Inference, 129(1–2), 405–426. https://doi.org/10.1016/j.jspi.2004.06.060

38.

Nguyen

T. L.

Collins

G. S.

Spence

Daurès

J. P.

Devereaux

P. J.

Landais

Le Manach

(2017). Double-adjustment in propensity score matching analysis: Choosing a threshold for considering residual imbalance. BMC Medical Research Methodology, 17(78), 1–8. https://doi.org/10.1186/s12874-017-0338-0

39.

Osher

Cantor

Berg

Steyer

Rose

(2020). Drivers of human development: How relationships and context shape learning and development. Applied Developmental Science, 24(1), 6–36. https://doi.org/10.1080/10888691.2017.1398650

40.

Osofsky

J. D.

Gurwitch

Dozier

Isosävi

(2024). Trauma-informed mental health interventions for young children. In Osofsky

J. D.

Fitzgerald

H. E.

Keren

Puura

(Eds.), WAIMH handbook of infant and early childhood mental health: Cultural context, prevention, intervention, and treatment, volume two (pp. 321–337). Springer. https://doi.org/10.1007/978-3-031-48631-9_21

41.

Pierce

(2021). Nurturing care for early childhood development: Path to improving child outcomes in Africa. Population Research and Policy Review, 40, 285–307. https://doi.org/10.1007/s11113-020-09581-z

42.

Rosenbaum

P. R.

Rubin

D. B.

(1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.

43.

Rubin

D. B.

(2007). The design versus the analysis of observational studies for causal effects: Parallels with the design of randomized trials. Statistics in Medicine, 26(1), 20–36. https://doi.org/10.1002/sim.2739

44.

Stuart

E. A.

(2010). Matching methods for causal inference: A review and a look forward. Statistical Science: A Review Journal of the Institute of Mathematical Statistics, 25(1), 1.

45.

Thomas

K. J.

Mangino

Walker

(2022). Translational research on caregiver reading and playing behaviors: Evidence from an in vivo community-based intervention throughout the Covid-19 pandemic. Journal of Child and Family Studies, 31(8), 2187–2201. https://doi.org/10.1007/s10826-022-02334-w

46.

Thomas

K. J.

Namtu

Ebert

(2023). Virtuous hope: Moral exemplars, Hope theory, and the centrality of adversity and support. International Journal of Applied Positive Psychology, 8, 169–194. https://link.springer.com/article/10.1007/s41042-022-00083-1

47.

Thomas

K. J.

Rand

Rogers

S. K.

Henry

Witvliet

C. V. O.

(2025). Hope as a virtue: Toward a theoretically grounded measure in English, isiZulu, and Portuguese. Applied Developmental Science, 1–20. https://doi.org/10.1080/10888691.2025.2486062

48.

Thomas

K. J.

Valentino

Matabaro

(2024). Hoping and caregiving in adversity: Ithemba Hope for Parents Study. International Journal of Applied Positive Psychology, 9, 1635–1653. https://doi.org/10.1007/s41042-024-00185-y

49.

Tomlinson

Darmstadt

G. L.

Yousafzai

A. K.

Daelmans

Britto

Gordon

S. L.

. . .Dua

(2019). Global research priorities to accelerate programming to improve early childhood development in the sustainable development era: A CHNRI exercise. Journal of Global Health, 9(3), 020703. https://doi.org/10.7189/jogh.09.020703

50.

Urban

J. B.

Archibald

Hargraves

Buckley

Hebbard

Linver

M. R.

Trochim

W. M.

(2021). Introduction to relational systems evaluation. New Directions for Evaluation, 2021(169), 11–18. https://doi.org/10.1002/ev.20444

51.

Urban

J. B.

Hargraves

Trochim

W. M.

(2014). Evolutionary evaluation: Implications for evaluators, researchers, practitioners, funders and the evidence-based program mandate. Evaluation and Program Planning, 45, 127–139. https://doi.org/10.1016/j.evalprogplan.2014.03.011

52.

Valentino

Speidel

Fondren

Behrens

Edler

Cote

Cummings

E. M.

(2022). Longitudinal effects of reminiscing and emotion training on child maladjustment in the context of maltreatment and maternal depressive symptoms. Research on Child and Adolescent Psychopathology, 50(1), 13–25. https://doi.org/10.1007/s10802-021-00794-0

53.

Venter

(2022). A systems perspective on early childhood development education in South Africa. International Journal of Child Care and Education Policy, 16(1), 7. https://doi.org/10.1186/s40723-022-00100-5

54.

Wang

Nianogo

R. A.

Arah

O. A.

(2017). G-computation of average treatment effects on the treated and the untreated. BMC Medical Research Methodology, 17, 1–5.

55.

Weber

Fernald

Diop

(2017). When cultural norms discourage talking to babies: Effectiveness of a parenting program in rural Senegal. Child Development, 88(5), 1513–1526. https://doi.org/10.1111/cdev.12882

56.

World Economic Forum. (2020). Global social mobility index. https://www.weforum.org/reports/global-social-mobility-index-2020-why-economies-benefit-from-fixing-inequality

57.

World Health Organization. (2018). Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential. https://apps.who.int/iris/bitstream/handle/10665/272603/9789241514064-eng.pdf

58.

Zhang

Ssewanyana

Martin

M. C.

Lye

Moran

Abubakar

Marfo

Marangu

Proulx

Malti

(2021). Supporting child development through parenting interventions in low-to middle-income countries: An updated systematic review. Frontiers in Public Health, 9, Article 671988. https://doi.org/10.3389/fpubh.2021.671988

59.

Zhang

Kim

H. J.

Lonjon

Zhu

(2019). Balance diagnostics after propensity score matching. Annals of Translational Medicine, 7(1), 16. https://doi.org/10.21037/atm.2018.12.10

60.

Zimet

G. D.

Dahlem

N. W.

Zimet

S. G.

Farley

G. K.

(1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2

61.

Zimmer-Gembeck

M. J.

Rudolph

Kerin

Bohadana-Brown

(2022). Parent emotional regulation: A meta-analytic review of its association with parenting and child adjustment. International Journal of Behavioral Development, 46(1), 63–82. https://doi.org/10.1177/01650254211051086

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.67 MB