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Yuyin Xiao

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Journal Articles

Implementation Fidelity and Mechanisms of Change in a Nonspecialist-Led Mental Health Intervention for Female Caregivers of Young Children in Rural China: A Qualitative Process Evaluation

SSM - Mental Health, 2026

Background
The Thinking Healthy Extended Program (THEP) is a nonspecialist-delivered mental health intervention targeting female caregivers (mothers and grandmothers) of children aged 6-36 months in rural China. It consists of 24 fortnightly group sessions, supplemented by individual home visits for caregivers who miss group sessions, and integrates cognitive reframing techniques, behavioral engagement, childrearing skills, and peer support. Embedded within a large-scale randomized controlled trial, this study aims to evaluate implementation fidelity of THEP, examine hypothesized mechanisms of change, and identify contextual factors, including enablers and barriers, that influenced intervention implementation.

Methods
In-depth interviews were conducted at 3 months and 10 months into the intervention implementation with 50 caregivers and 10 facilitators. The interview guides were developed based on the UK Medical Research Council’s process evaluation framework, with the facilitator interview guide focused on implementation fidelity, the caregiver interview guide focused on mechanisms of change, and contextual factors explored in both guides. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results
THEP facilitators demonstrated competence in coordinating schedules, delivering sessions, and engaging caregivers. Caregivers reported improvements in peer support and childrearing skills, along with some uptake of behavioral engagement. However, both facilitators and caregivers demonstrated limited understanding of cognitive reframing techniques. Grandmothers (who accounted for 43% of the sample in the current study) experienced greater challenges than mothers with respect to applying the four program mechanisms of change. Several contextual factors, including a child-focused orientation, distractions related to the presence of children at sessions, and intergenerational differences between mother and grandmothers, influenced THEP implementation.

Conclusions
THEP was feasible to deliver through nonspecialist facilitators, but implementation quality was constrained by limited understanding of cognitive reframing strategies and variation in caregiver engagement. Future adaptation and scale-up should prioritize facilitator capacity and intervention approaches that are more feasible for nonspecialist providers and more accessible to diverse caregivers.

Rethinking Support for Early Motherhood: A Multi-level Ecological Analysis of Mothers’ Experiences in Urban China

International Journal for Equity in Health, 2026

Journal Articles

The Acceptability and Appropriateness of Delivering Postnatal Mental Health Support at Community Health Centers

Annals of the New York Academy of Sciences, 2026

Journal Articles

Screen Exposure and Early Childhood Development in Resource-Limited Regions: Findings From a Population-Based Survey Study

Journal of Medical Internet Research, 2025

Background: The content of children’s screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children’s development is crucial for promoting healthy screen use among children.

Objective: This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction.

Methods: The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver’s presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted.

Results: In total, 28.23% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills.

Conclusions: The type of content viewed and how caregivers engaged in children’s screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas.