REAP Publications

Journal Articles

Early Childhood Development and Parental Training Interventions in Rural China: A Systematic Review and Meta-Analysis

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BMJ Global Health, 2021

Introduction: Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China. Methods: We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach. Results: We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children’s risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development. Conclusion: There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.

Consultation Length, Process Quality and Diagnosis Quality of Primary Care in Rural China: A Cross-Sectional Standardized Patient Study

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Patient Education and Counseling, 2021

Objective: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. Methods: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. Results: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021). Conclusions: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. Practice Implications: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

Journal Articles

Attention Deficit Hyperactivity Disorder (ADHD) among Elementary Students in Rural China: Prevalence, Correlates, and Consequence

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Journal of Affective Disorders, 2021

Background: Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China. Methods: Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV. Results: The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01). Limitations: The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample. Conclusions: ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

Journal Articles

Complicating China’s Rise: Rural Underemployment

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The Washington Quarterly, 2021

Journal Articles

Special Issue: Agriculture, the Rural Economy and China's Growth in the 21st Century: Celebrating the 10th Anniversary of AAEA China Section

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China Agricultural Economic Review, 2021

Journal Articles

Infant Cognitive Development and Stimulating Parenting Practices in Rural China

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Environmental Research and Public Health, 2021

Journal Articles

Health, Economic, and Social Implications of COVID-19 for China's Rural Population

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Agricultural Economics, 2021

Journal Articles

Comparing the Quality of Primary Care between Public and Private Providers in Urban China: A Standardized Patient Study

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International Journal of Environmental Research and Public Health, 2021

Journal Articles

Trajectories of Child Cognitive Development During Ages 0-3 in Rural Western China: Prevalence, Risk Factors and Links to Preschool-Age Cognition

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BMC Pediatrics, 2021

Background: Cognitive development after age three tends to be stable and can therefore predict cognitive skills in later childhood. However, there is evidence that cognitive development is less stable before age three. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the trajectories of cognitive development between 0 and 3 years of age or how developmental trajectories predict later cognitive skills. This study seeks to describe the trajectories of child cognitive development between the ages of 0–3 years and examine how different trajectories predict cognitive development at preschool age. Methods: We collected three waves of longitudinal panel data from 1245 children in rural Western China. Child cognitive development was measured by the Bayley Scales of Infant Development when the child was 6–12 months and 22–30 months, and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition when the child was 49–65 months. We used the two measures of cognitive development before age three to determine the trajectories of child cognitive development. Results: Of the children, 39% were never cognitively delayed; 13% were persistently delayed; 7% experienced improving cognitive development; and 41% experienced deteriorating development before age 3. Compared to children who had never experienced cognitive delay, children with persistent cognitive delay and those with deteriorating development before age 3 had significantly lower cognitive scores at preschool age. Children with improving development before age 3 showed similar levels of cognition at preschool age as children who had never experienced cognitive delay. Conclusions: Large shares of children under age 3 in rural Western China show deteriorating cognitive development from infancy to toddlerhood, which predict lower levels of cognition at preschool age. Policymakers should invest in improving cognitive development before age 3 to prevent long-term poor cognition among China’s rural children.

Journal Articles

Effects of Vision Health Education and Free Eyeglasses on Knowledge of Vision and Usage of Spectacles Among Primary School Students: Evidence from Gansu and Shaanxi Provinces in China

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Risk Management and Healthcare Policy, 2021

Background

In rural China, children’s vision problems are very common, with many who would benefit from refractive correction not getting the care they need. This study examines whether a health information campaign that involves vision health education and a free trial of health product with free eyeglasses is effective at raising students’ awareness of myopia and promoting students’ eyeglasses usage.

Methods

We conducted an in-the-field randomized controlled experiment of a program providing vision health education and subsidized free eyeglasses to myopic children from 168 primary schools in rural Northwestern China in 2012.

Results

A total of 2189 students, mean age 10.5 years (49.3% male), participated in the baseline survey. At the baseline, the average correct response rate for visual knowledge among the sample students was 30.1%, and only 15% who needed eyeglasses used them. Seven months after intervention, the average correct response rate for vision knowledge were 48.5% and 48.3% in the education group and the education plus free eyeglasses group respectively, significantly higher than that of the control group. The rate of eyeglasses usage was 36% and 43% in the free eyeglasses group and the education plus free eyeglasses group respectively, significantly higher than that of the control group. The rate of eyeglasses compliance in the free eyeglasses group and the education plus free eyeglasses group was 19% and 26%, which also were significantly higher than the control group.

Conclusion

The information campaign combined with subsidized eyeglasses had a better effect both on vision knowledge and eyeglasses usage. The information campaign improved knowledge by providing the right information, and free eyeglasses changed the perceived utility and experience by the students using the product and getting benefits. Information and the free eyeglasses (subsidized) are complements.

Journal Articles

Variations in the Home Language Environment and Early Language Development in Rural China

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International Journal of Environmental Research and Public Health, 2021

Journal Articles

It All Starts at Home: 'Home Reading Environment and Reading Outcomes in Rural China'

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Journal of Research in Reading, 2021

Journal Articles

Skill Levels and Gains in University STEM Education in China, India, Russia, and the United States

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Nature Human Behavior, 2021

Journal Articles

Improving Learning by Improving Vision: Evidence from Two Randomized Controlled Trials of Providing Vision Care in China

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Journal of Development Effectiveness, 2021

Journal Articles

The Impact of Internet Use on Adolescent Learning Outcomes: Evidence from Rural China

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China Agricultural Economic Review, 2021

Purpose: Internet use has become particularly prevalent among adolescents, prompting much thought and concern about both its potential benefits and adverse effects on adolescent learning outcomes. Much of the empirical literature on the impact of Internet use on adolescent learning outcomes is mixed, and few studies examine the causal relationship between the two in rural China. In order to bridge these gaps, we use empirical analysis to investigate the effect of Internet use on the learning outcomes of adolescents in rural China. Design/methodology/approach: We use fixed effect models with samples drawn from a large nationally representative dataset (the China Family Panel Studies—CFPS) to identify the causal impacts of Internet use on the learning outcomes of three cohorts (Cohort A (N = 540), Cohort B (N = 287) and Cohort C (N = 827)) of adolescents in rural China. Findings: The results of the descriptive analysis show a continued increase in the number of adolescents accessing the Internet and the amount of time they spend online. The results of the fixed effect models show that Internet use has positive (in many of the analyses), but mostly insignificant impacts, on the learning outcomes of adolescents. In the sets of results that find significant associations between Internet use and learning outcomes, the measured effects are moderate. Originality/value: This study investigates the causal relationship between Internet use and adolescent learning outcomes in rural China. The findings claim that there is not a great need to worry about adverse effects of Internet use on adolescent learning development. Attention, however, should focus on seeking ways to improve the positive effects of the Internet use on adolescent learning outcomes. The study will provide a reference and experience for the development of education and the Internet in rural areas and promote the integrated development of urban and rural areas in China.

Journal Articles