Economic evaluation of interventions delivered by primary care providers to improve neurodevelopment in children aged under 5 years: protocol for a scoping review

Interventions delivered in early childhood have been shown to have substantial and sustained impacts on long-term cognitive and neurodevelopmental outcomes. Frequently cited benefit-cost ratios from the USA suggest that for every dollar invested in services for preschool age children, there will be a $2 to $2.60 return to society [7, 8]. The economic return has been estimated at between 15 and 17% for every dollar taking into account crime, education and welfare savings and increased taxes due to higher earnings [7, 8].

Primary care providers are health professionals who work at the first level of the health service and are trained in clinical care. They include community health workers, Indigenous health workers, generalist nurses, health visitors, midwives, child health nurses, general practitioners and other primary care doctors. Primary care providers routinely provide face to face ‘non-medicinal’ interventions such as advice, counselling and the promotion of behaviour change for their clients. Pregnant women, families and care givers of young children receive anticipatory guidance, health promotion, health education, promotional interviewing and motivational interviewing. They also receive screening, surveillance and ‘brief interventions’ (time-limited interventions implemented by primary care providers that focus on praising and reinforcing or changing caregiver behaviour). Delivery channels may include home visiting, clinic visits, group programmes, telehealth, antenatal care and child health checks. Examples include screening for postnatal depression and developmental milestones, the World Health Organization (WHO)/Unicef Care for Child Development package [20], the WHO Thinking Healthy programme [22] and the nurse family partnership model for high-risk families [15, 17]. Many of these programmes have been highly effective in improving children’s long-term neurodevelopmental outcomes when implemented in highly controlled research settings. However, there are many challenges when implementing these programmes at scale, and it is unclear how many research studies or programmes have examined cost-effectiveness and which methods were used.

There are also increasing numbers of alternate channels available for delivery of interventions to reinforce and change the behaviour of children’s care givers including electronic and social media (e.g. biofeedback, chat rooms, mass media, plain packaging, social marketing, websites, web boards and webinars). Face to face access to primary care providers can be limited especially in remote areas; their services can be expensive to maintain and their quality of care is variable. Reinforcing and changing behaviour is also difficult and requires a specific skill set, high quality training and a population who are ‘ready to change’. Indeed, it has been suggested that face to face encounters with mainstream primary care providers should be restricted to acute care and targeted screening and that behaviour change interventions should be provided by other channels [17].

Systematic reviews have assessed the effect of medicinal approaches to improving child neurodevelopment such as vaccinations [4] and nutritional supplementation including vitamin A [6] and iron [21]. ‘Non-medicinal’ systematic reviews have focused on interventions to promote access [14], combined impact of ‘packages’ of interventions [12], maternal mental health interventions [9, 16] and child weight management programmes [1]. However, no scoping reviews, inventories or narrative assessments of cost and cost-effectiveness appear to have been published. This information is important for health professionals to make policy decisions and implement programmes on a large scale.