PDF(Pubmed)
Abstract：
BACKGROUND: Despite the high number of children living with neurodevelopmental disabilities in sub-Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI-whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes.
METHODS: We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2.
RESULTS: Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication-9/10 improved, Foundations of Learning-10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication-9/10 improved, Socialization-6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers.
CONCLUSIONS: This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
METHODS: We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2.
RESULTS: Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication-9/10 improved, Foundations of Learning-10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication-9/10 improved, Socialization-6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers.
CONCLUSIONS: This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
摘要：
背景：尽管撒哈拉以南非洲有大量患有神经发育障碍的儿童，获得早期干预几乎不存在。因此，重要的是开发可行的，可扩展的早期自闭症干预，可以整合到护理系统中。虽然自然主义发展行为干预(NDBI)已经成为一种基于证据的干预方法，全球存在实施差距，任务共享方法可以解决访问差距。在这项南非原则验证试点研究中，我们开始回答关于12个会议级联任务共享NDBI的两个问题-该方法是否可以与保真度一起交付，以及我们是否可以识别儿童和照顾者结果变化的信号。
方法：我们采用了单臂前置后置设计。富达(非专业人士，护理人员)，护理人员结果(压力，能力感)，和儿童成果(发育，自适应）在基线（T1）和随访（T2）进行测量。十名照顾者-儿童二元组和四名非专家参加了会议。前后汇总统计数据与个人轨迹一起显示。配对样本的非参数Wilcoxon符号秩检验用于比较T1和T2之间的组中位数。
结果：护理人员实施保真度在10/10参与者中增加。非专业人员表现出教练保真度的显着增加（增加了7/10）。在两个Griffiths-III分量表（语言/交流-9/10改进，学习基础-10/10改进）和一般发展商（9/10改进）。在两个Vineland自适应行为量表(第三版)子量表上也看到了显著的进步(Communication-9/10改进了，社会化-6/10改善）和适应行为标准分数（9/10改善）。7/10护理人员的照顾者能力感得到改善，6/10护理人员的照顾者压力得到改善。
结论：这项关于撒哈拉以南非洲第一个级联任务共享NDBI的原理验证试点研究提供了保真度和干预结果数据，支持了此类方法在低资源环境中的潜力。需要更大的研究来扩大证据基础，并回答有关干预效果和实施结果的问题。
方法：我们采用了单臂前置后置设计。富达(非专业人士，护理人员)，护理人员结果(压力，能力感)，和儿童成果(发育，自适应）在基线（T1）和随访（T2）进行测量。十名照顾者-儿童二元组和四名非专家参加了会议。前后汇总统计数据与个人轨迹一起显示。配对样本的非参数Wilcoxon符号秩检验用于比较T1和T2之间的组中位数。
结果：护理人员实施保真度在10/10参与者中增加。非专业人员表现出教练保真度的显着增加（增加了7/10）。在两个Griffiths-III分量表（语言/交流-9/10改进，学习基础-10/10改进）和一般发展商（9/10改进）。在两个Vineland自适应行为量表(第三版)子量表上也看到了显著的进步(Communication-9/10改进了，社会化-6/10改善）和适应行为标准分数（9/10改善）。7/10护理人员的照顾者能力感得到改善，6/10护理人员的照顾者压力得到改善。
结论：这项关于撒哈拉以南非洲第一个级联任务共享NDBI的原理验证试点研究提供了保真度和干预结果数据，支持了此类方法在低资源环境中的潜力。需要更大的研究来扩大证据基础，并回答有关干预效果和实施结果的问题。
