An Early Childhood Internet-based and Family-based Intervention Study (ECII)

A Large Scale Cross-sectional Survey and a Randomized Control Study on the Effectiveness of an Early Childhood Family-Based and Internet-Based Intervention

The poverty rate among children under 18 years old in Hong Kong in 2015 was 18% after social welfare intervention. James Heckman, a Nobel Prize winner in Economics, advocates early childhood investment to enhance social mobility, given its lifelong impact of on child development. However, few randomized control trails have been used to examine the effectiveness of early childhood intervention in promoting social mobility through child development in Hong Kong. To fill these gaps, we propose an interdisciplinary intervention study involving academics from economics, sociology, social work, gerontology, education, and psychology to investigate methods to promote the social mobility of children living in poverty through early intervention.

The overall objective is to enhance the developmental outcomes of children in poverty by utilizing parental resources within a family system, technological resources available in modern metropolis and the human resources enjoyed by the elderly in Hong Kong.

The primary objective is to evaluate an internet- and family-based intervention to promote the development of children in poverty enrolled in the first year of Hong Kong's nurseries, who are mostly aged 24 months to three years. The examined outcomes will be the developmental well-being of participating children and parenting attitudes and behaviors, with the long-term goal of promoting their social mobility to break the cycle of poverty. In the long run, we aim to establish the proposed intervention in policy to promote the development of disadvantaged children.

The secondary objective is to identify intergenerational volunteerism as a means for productive aging through a mentoring program using older adults as mentors to participating parents.

Study Overview

• Status: Completed
• Conditions: Early Childhood Development
• Intervention / Treatment: Other: Online curriculum

Detailed Description

The proposed research consists of three phases. The first phase will be a cross-sectional survey with a sample of 1,000 cases from 60 nurseries cum kindergartens to explore the family demographics and developmental profiles of low-income children in comparison to others. The second phase will be a randomized control trail implementing two waves of a 10-month internet-based intervention with 200 toddler-parents dyads from 20 to 30 of the original 60 nurseries. Interventions will be delivered by older mentors professionally trained by the research team. All children, parents and elderly mentors will be evaluated through a set of outcome measurements to assess the effectiveness of the program. The last phase will involve the dissemination of research information that may become building blocks for policies on internet-based early childhood education, poverty alleviation and social mobility enhancement, as well as productive aging.

• Study Type: Interventional
• Enrollment (Actual): 233
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Hong Kong Christian Service
  • Hong Kong, Hong Kong
    • Hong Kong Lutheran Social Service
  • Hong Kong, Hong Kong
    • Hong Kong Young Women's Christian Association
  • Hong Kong, Hong Kong
    • Po Leung Kuk
  • Hong Kong, Hong Kong
    • The Salvation Army
  • Hong Kong, Hong Kong
    • Tung Wah Group of Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Parents who have children enrolled in the first year of Hong Kong nurseries ("N1"), mostly aged 24 months to 3 years

Exclusion Criteria:

• Parents who do not have children enrolled in the first year of Hong Kong nurseries ("N1")

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment group; Online curriculum has been delivered to this group of participants on an Internet-based platform	Other: Online curriculum; The psychologist and our advisory team had successfully developed a total of 100 hours of parenting curriculum. The adopted curriculum had focused on using play to facilitate parents in promoting their children's development in cognitive, motor, emotional and social aspects. Play-based activities are instrumental in improving children's development. Given that parents in poverty had difficulties spending time and money travelling back-and-forth to the training site and their homes, the research team decided to use e-learning as the medium of learning for our parenting programme. Web-based learning has the advantage of cutting time and travelling costs, which are luxuries to many parents in poverty.
No Intervention: Wait-list control group; Participants in wait-list control group would not have access to the online curriculum until the intervention process for treatment group is finished.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bayley Scales of Infant and Toddler Development- Third Edition	Bayley-III is a comprehensive tool to identify development issues during early childhood through direct assessment of the child. Domains include: Cognitive, Receptive Communication, Expressive Communication, Fine Motor, Gross Motor. The minimum scaled score is 1 and maximum scaled score is 19. A higher score means a better outcome.	Change from baseline assessment at 10 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parenting Sense of Competence Scale- Chinese	Parenting Sense of Competence Scale- Chinese (C-PSOC) was used to measure parenting sense of competence and satisfaction. The minimum score is 17 and the maximum score is 102. A higher score means a better outcome.	Change from baseline assessment at 10 months
Chinese version of the Parental Feeding Style Questionnaire	A Chinese version of the parental feeding style questionnaire (PFSQ; Tam et al., 2014) was used, which covers: (1) instrumental feeding; (2) emotional feeding; (3) promoting and encouraging of feeding; and (4) control over children's eating. The minimum score is 27 and the maximum score is 135. A higher score means a better outcome.	Change from baseline assessment at 10 months
Connor-Davidson Resilience Scale 10-item	Connor-Davidson Resilience Scale 10-item version (CD-RISC-10) was used to assess parents' resilience. The minimum score is 10 and the maximum score is 50. A higher score means a better outcome.	Change from baseline assessment at 10 months
The Multidimensional Scale of Perceived Social Support-Chinese	The Multidimensional Scale of Perceived Social Support-Chinese Version (MSPSS-C) was used which measured the social support network of and support from friends, and perceived social support from family from parents' perspectives. The minimum score is 12 and the maximum score is 84. A higher score means a better outcome.	Change from baseline assessment at 10 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Ages and Stages Questionnaires (ASQ) -3 (Third Edition)	This scale is parent-reported and measures child development. It covers the following aspects: Communication, gross motor skills, fine motor skills, problem-solving, and personal-social skills. The minimum score is 0 and the maximum score is 300. A higher score means a better outcome.	Change from baseline assessment at 10 months
Ages and Stages Questionnaire: Social-Emotional- 2 (Second Edition)	This scale is parent-reported and measures child development. This scale assesses social-emotional competence and challenging behaviors. The minimum score is 0 and the maximum score is 540. A higher score means a worse outcome.	Change from baseline assessment at 10 months
Strengths and Difficulties Questionnaire	This scale is parent-reported and measures child development. It assesses parent's perception of children's behavioral problems, including emotional symptoms, conduct problems, hyperactivity/inattention, peer relationships problem, and prosocial behavior. Each domain's minimum score is 0 and maximum is 10. For all domains except for prosocial behavior, a higher score means a worse outcome. For the prosocial behavior domain, a higher score means a better outcome.	Change from baseline assessment at 10 months
Bayley Scales of Infant and Toddler Development- Third Edition: Social-Emotional	This scale is parent-reported and measures child development. Social-Emotional has 35 items. The minimum score is 0 and maximum score is 140. A higher score means a better outcome.	Change from baseline assessment at 10 months
Bayley Scales of Infant and Toddler Development- Third Edition: Adaptive Behavior	This scale is parent-reported and measures child development. Adaptive Behavior includes 10 domains: Communication (25 items), Community Use (22-items), Functional Pre-Academics (23-items), Home Living (25-items), Health and Safety (24-items), Leisure (22-items), Self-Care (24-items), Self-Direction (25-items), Social (24-items), Motor Skills (27-items). The minimum score for the Adaptive Behavior composite is 0 and the maximum is 723. A higher score means a better outcome.	Change from baseline assessment at 10 months
The General Functioning Subscale of the McMaster Family Assessment Device	The General Functioning Subscale of the McMaster Family Assessment Device (Epstein, Baldwin, and Bishop, 1983) was used to measure the family functioning. The minimum score is 12 and the maximum score is 48. The higher the score, the worse the outcome.	Change from baseline assessment at 10 months
Parenting Stress Index - Short Form	PSI-SF was used to measure stress, which includes sub-scales: parental distress, parent-child dysfunctional interaction, and difficult child. The minimum score is 36 and the maximum score is 180. A higher score means a worse outcome.	Change from baseline assessment at 10 months
The Depression, Anxiety and Stress Scale - 21 Items	DASS-21 was used to measure depression, anxiety and stress. The minimum score is 0 and the maximum score is 63. A higher score means a worse outcome.	Change from baseline assessment at 10 months
Interpersonal Mindfulness in Parenting (IEMP) scale, Chinese version	IEMP was used to measure parental mindfulness, which has subscales: awareness & present-centered attention, non-judgment, and non-reactivity. The minimum score is 31 and the maximum score is 155. A higher score means a better outcome.	Change from baseline assessment at 10 months
Psychological and Behavioral Control	This Chinese scale was originally developed by Dr. Daniel Shek (2006) and was adapted by the research team from adolescent-reported to parent-reported to assess levels of parental psychological control and behavioral control of their children. The minimum score is 23 and the maximum score is 92. The higher the score, the worse the outcome.	Change from baseline assessment at 10 months

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Investigators: Principal Investigator: Pauline Sung-Chan, Ph.D, Hong Kong Institute of Economics and Business Strategy

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2017
• Primary Completion (Actual): May 31, 2020
• Study Completion (Actual): September 30, 2021

Study Registration Dates

• First Submitted: May 15, 2020
• First Submitted That Met QC Criteria: August 10, 2020
• First Posted (Actual): August 13, 2020

Study Record Updates

• Last Update Posted (Actual): June 18, 2025
• Last Update Submitted That Met QC Criteria: June 17, 2025
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: Intergenerational; Social mobility & poverty; Internet & family-based; Early childhood intervetion; Productive aging
• Other Study ID Numbers: early-childhood-2020

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IPD shall be released ten years upon the completion of this project. For research purpose only, interested parties shall write to us to get the data.
• IPD Sharing Time Frame: Ten years upon the completion of this project
• IPD Sharing Access Criteria: For research purpose only
• IPD Sharing Supporting Information Type: ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No