Measelle, JeffreyFong, Michelle2020-02-272020-02-27https://hdl.handle.net/1794/25222Approximately half of all children in Laos fail to reach their full developmental potential as a result of exposure to poverty-related risks. Early interventions that encourage sensitive and responsive caregiving in the context of stimulating activities such as reading and playing have shown consistent benefits on children’s developmental trajectories across diverse domains. However, to our knowledge, no such intervention has been implemented in Laos. As such, the overarching goal of this dissertation was to examine the acceptability and efficacy of a culturally adapted early intervention on caregiving practices and children’s cognitive and language outcomes in rural Laos. Our first aim was to culturally adapt an evidence-based responsive stimulation intervention and to assess the acceptability of the resulting intervention, Phadthana Khong Dek (PKD). Cultural adaptation included process adaptations (e.g., identification of local needs and relationship-building with stakeholders) and content adaptations (e.g., adaptations across several domains including language, persons, metaphors, content, concepts, goals, methods, context) following established models of cultural adaptation. Preliminary findings from 93 Lao families receiving the intervention suggested that the cultural adaptions resulted in an intervention that is relevant, useful, and easy to put into practice. A second aim was to examine the efficacy of PKD on caregiving practices and children’s cognitive and language development among 159 caregivers and their under-five children. Trial arms included control, family-, and community-level conditions of PKD. Controlling for sociodemographic risk (e.g., caregiver education level, caregiver depression, ethnicity) and baseline measures, both family- and community-level conditions evidenced medium to large effects on caregiving stimulation practices one-month post-intervention. There was also a positive effect of the family-level condition on the likelihood of child play with different types of stimulating toys. The family-level intervention also had significant short-term benefits with a large effect size on cognitive and language outcomes for children who received the intervention at the earliest ages, before 20 months of age, but not at later ages. Together, these findings point to PKD as one brief, low-cost, and scalable public health strategy for alleviating the enormous burden of children in Laos not reaching their full developmental potential. This dissertation includes unpublished coauthored material.en-USAll Rights Reserved.Electronic Thesis or Dissertation