1. Measurement of Home Environment: The Family Care Indicators
Patrice Engle
California Polytechnic State University
Yuko Nonoyama-Tarumi
UNICEF

2. Why Indicators for Family Care?
Caregiving Practices and Resources
Quality of Interactions with the Child
Child Development Outcomes
It is widely recognized that caregiving practices during the early years of life have a powerful influence on children’s developmental trajectories, due to (1) rapid gain in all domains, and (2) the importance of stimulation from environment—family is the immediate environment of the child and is the major source of stimulation.
There are many programs or polices that are based on this theory both in the industrialized and developing countries: Increased caregiving practices and resources would lead to higher quality of interactions between the caregiver and the child, and hence, result in positive child developmental outcomes.
However, in developing countries, there is dearth of data on caregiving practices and resources, because there are no standard measures.
Data that exist in developing countries tend to be single country studies with small sample size.
In this context, UNICEF, with its partners, took the initiative to develop family care indicators, and have included them in a cross-national household survey.
This presentation will consist of three parts.
Process of development of family care indicators (Yuko)
Preliminary cross-national analyses (Yuko)
Validation of the measures from more in-depth analyses focusing on one country (three countries?) (Pat)

3. Multiple Indicator Cluster Survey (MICS)
Household Survey
Nationally representative sample
MICS 3 (2005)
56 countries
Household module
household characteristics, education, water and sanitation, nutrition, child labor, support HIV/AIDS orphans, etc.
Women module
women’s characteristics, child mortality, maternal and newborn health, marriage/union, HIV/AIDS knowledge, female genital mutilation, sexual behavior, etc.
Children under five module
children’s characteristics, birth registration, early learning, breast feeding, immunization, anthropometry, malaria, etc.

4. Development of Items Phase I: Item identification
Literature review
Meeting of global experts (Nov, 2002)
Phase II: Item evaluation
Field tests in 7 countries (Spring, 2003)
Qualitative analyses: Focus groups (Content validity)
Quantitative analyses: Frequency analyses (Discrimination)
Phase III: Item selection
Meeting of global experts (Nov, 2003)

5. Domains selected Caregiving Practices Caregiving resources
Quality of verbal interaction
Learning/stimulating activities
Limit setting and discipline techniques
Responsiveness and acceptance
Responsive feeding
Caregiving resources
Caregiver stress
Caregiver physical health
Caregiver knowledge
Alternate caregiver
Father’s involvement
Family cohesion
Social networks
Learning/stimulating materials

6. Family Care Items in MICS3 (Core Early Learning Module: 52 countries)
Learning/stimulating activities
Engage in any of the activities with the child (in the past 3 days) [multiple responses]
(Asked to caretakers of children under 5 years old for each child) (
Mother
Father
Other
No one
Read books or look at picture books
Tell stories
Sing songs
Take outside the home, compound yard or enclosure
Play
Spend time naming, counting and/or drawing things

7. Family Care Items in MICS3 (Optional Child Development Module: 33 countries)
Learning/stimulating materials
(Asked to caretakers of children under 5 years old once)
Number of books
Number of children’s books
Play materials that child play with at home
Household objects; Objects and materials found outside the living quarters; Homemade toys; Toys that come from a store; None
Alternate caregiver (in the last week)
Number of times the child was left in the care of another child (younger than 10 years old)
Number of times the child was left alone

8. Child Discipline Items in MICS3 (Child Discipline Optional Module)
Setting Limits (Methods used in the past month)
(Asked to caretakers of children 2-14 years old for a randomly selected child)
Non-violent
Forbade something he/she liked
Explained why something was wrong
Gave him/her something else to do
Psychological aggression
Shouted, yelled at or screamed at him/her
Called him/her dumb, lazy, etc
Minor physical assault
Shook him/her
Spanked, hit or slapped him/her on the bottom with bare hand
Severe physical assault
Hit him/her on the body with something a belt, stick, etc
Hit or slapped him/her on the face, head or ears
Hit or slapped him/her on the hand, arm, or leg
Beat him/her with an implement
Do you believe that in order to bring up properly, you need to physically punish him/her
Discipline styles (focusing on physical violence in response to bad behavior) (linked to child dev)
Questions asked to the mother or caretaker of the children aged 2-14 years of age
One child was randomly selected per family
“All adults use certain ways to teach children the right behavior or to address a behavior problem. Have you or anyone else in your household used this method with the child in the past month.”

9. ECD Indicators in MICS3 Indicator Definition Support for learning
% of children aged 0-59 months living in households in which an adult has engaged in four or more activities to promote learning and school readiness in the past 3 day
Father’s support for learning
% of children aged 0-59 months whose father has engaged in one or more activities to promote learning and school readiness in the past 3 days
Support for learning: non-children’s books
% of households with three or more non-children’s books
Support for learning: children’s books
% of households with three or more children’s books
Support for learning: materials for play
% of households with three or more materials intended for play
Non-adult care
% of children aged 0-59 months left alone or in the care of another child younger than 10 years of age in the past week
Pre-school attendance
% of children aged months that attend some form of early childhood education programme
School readiness
%of children in first grade that attended some form of pre-school the previous year

10. Preliminary cross-national analyses
To what extent do countries differ in their level of family care?
To what extent is positive family care equally distributed within the country?

11. Learning/stimulating activities (four or more) by wealth

12. Non-children's books (three or more) by wealth

13. Children's books (three or more) by wealth

14. Inadequate care (left in the care of another child or left alone) by wealth

15. How well do these scales work?
Item comparison across countries
Validation on the HOME and Bayley Scales
Validation within country data
Recommendations for next steps

16. Descriptive data on activities by country
Selected three countries with publicly available data from different parts of the world
Kyrgyzstan (n=2987) Bangladesh (n=34710) and Sierra Leone (n=5904)
Examined activities separately to see which have reasonable variability and if they vary as expected

17. Activities anyone did: Percent of households

18. Sources of toys: percent of households

19. Conclusions based on descriptive data
Differences by country are reasonable
All families do something
Some questions have little variability (e.g., taking child outside, play with child).

20. Validity study: Bangladesh
800 children at 18 months
HOME
Bayley MDI and PDI
Language Comprehension and Expression
129 of them also measured at 12 months on same measures
40 given 7-14 week test-retest on Activities and Toys
Grantham-McGregor, Hamadani, and Engle, 2008

21. Measures 6 activity items Sources of toys Variety of toys Books
Play – “play with toys” rather than “play”
Sources of toys
Variety of toys
Books
Childcare situation

22. Reliability Measure 1 week (18 months) 12 to 18 months
Family Activity Score
.64**
.57**
Number of sources of toys
.91**
.09 N 40
129

23. Associations of Activity Index with Outcome Measures (n=798)
FCI
FCI regr+
Source of toys
Source regr
HOME
.72** **
.39** ns
MDI
.29** *
PDI
.19**
.09*
Language
.44**
.23**
+Controlling for maternal education, wealth, family size, birthweight, gestational age, paternal education, income, age, gender, other family care measures

24. Means of MDI by Number of Family Activities controlling for age (N=800; 18 months)
ANOVA significant at p<.001

25. Conclusion Family Activity Index appears to be reliable and valid
Increases with MDI in a linear fashion – no clear cut-off
Sources of toys is not so strong
Variety of toys much stronger (not reported here)

26. Validity assessment with MICS data: Bangladesh (N=34,710)
Internal consistency
Association of items with age
Associations with maternal education, household wealth, gender
Associations with two parent report measures: Do you do anything to prepare your child for school (3 and 4 only); and do you do things to develop your child’s intelligence
Value of individual activity questions

27. Which items are related to age? Bangladesh, N= about 34,000
Total activities
.34**
Read books
.47**
Tell stories
.24**
Sing Songs
.01
Take outside
.08*
Play
.02
Naming, counting, drawing
.40**
Do something to develop intelligence
.17**
Prepare for school
.15**

28. Internal consistency of Index: Alpha = .734
Measure
Item-total correlation
Read books
.54
Tell stories
.60
Sing Songs
.48
Take Outside
.29
Play
.38
Names, counts, draw
.52

29. Correlations of items with SES measures controlling for age
M Ed
Wealth
Develop IQ
Prepare school
Total
.34
.25
.31
.29
Read Books
.35
.23
.24
Tell stories
.19
.16
Sing songs
.21
.17
.12
Outside
.07
.05
.06
Play
.15
.13
.09
Name, count.
.02

30. Conclusions Family Activities Scale works quite well
Sources of toys functions less well
Need more work to define a cut-off point – four or more activities may not be the best

31. Recommendations Analyze role of fathers separately
Make a separate code for some activities such as “read books”
May revise wording on some questions
Could replace “take outside”
Might use “play with toys” rather than “play”
Complete analyses with the rest of the countries
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