Measuring Nurturing Care Across Cultures: Psychometric and Qualitative Approaches to Understanding Early Child Development

Abstract

New estimates find that nearly 250 million children under the age of 5 years in low- and middle-income countries (LMICs) are at risk of not reaching their developmental potential (Black et al., 2017). Children’s exposure to nurturing and responsive relationships are necessary to develop social and emotional competencies, as well as core cognitive skills needed to communicate with others, problem solve, and maintain attention. Comprehensive frameworks, such as the Multigenerational Life-course of Development, Health, and Wellbeing, the Extended Model of Care, and the Nurturing Care Framework, provide countries with a roadmap for how to invest in programs and policies that promote nurturing care and child development. Despite the existence of these frameworks, the global community lacks high-quality indicators for monitoring and evaluating interventions guided by these frameworks. At present, there is some debate as to how to effectively measure the nurturing care input of responsive caregiving, as well as factors in the enabling environment of care such as caregiver mental health and work-related stress. Among existing tools that measure these constructs, most have been created and validated in high-income countries (HICs), with minimal adaptation and psychometric evidence available in LMICs.

This dissertation contributes to addressing these measurement gaps by proposing psychometric evidence for tools that measure key features of care that influence children’s early development. In three papers, I provide psychometric evidence for two key components of the Multigenerational Life-Course of Development: responsive caregiving and early childhood providers’ work-related stress and job satisfaction. These studies are conducted using primary data collection in two distinct global settings with resource scarce communities: industrialized zones in urban Vietnam and rural Pakistan. Paper one uses data from a quasi-experimental evaluation of a childcare training program in Vietnam and finds that a short-form scale is reliable and valid, and effectively measures childcare provider work-related stress and job satisfaction in the informal childcare setting. Paper two uses data from a phenomenological qualitative study of mothers with young children in Naushahro Feroze, Pakistan, and provides evidence that many mothers regularly engage in responsive caregiving behaviors, and that there is substantial variety in expression and approach to responsive caregiving. Paper three builds upon the findings of Paper two and finds that a theoretically driven, evidence-informed measure of responsive caregiving is reliable and valid in rural Pakistan. The culmination of these three papers provides evidence that high-quality, theoretically driven indicators of the nurturing care environment are psychometrically sound in two low-resource environments. These findings support the use of mixed methods in conducting measurement analyses, and provide program implementers with two freely available, high-quality sets of indicators to quantify key aspects of the nurturing care environment.