Home-Based Learning Opportunities, Responsive Caregiving and the Development of Preschool-Aged Children in Low- and Middle-Income Countries of the East Asia and Pacific Region: A Systematic Review.

Abstract

Background Optimal early childhood development predicts lifelong health and well-being. A child's immediate environment, especially the home, shapes cognitive, physical, language, motor, social and emotional development. Contextually relevant data on the proximal settings that support preschool-aged children are lacking in low- and middle-income countries (LMICs) across the East Asia and Pacific region. This systematic review synthesises evidence on associations between home-based learning opportunities and caregiving experiences and the cognitive and overall development of children aged 2-5 years in LMICs of the East Asia and Pacific region. Methods We searched Medline, Embase, PsycINFO, Emcare and Global Health for studies published between January 1990 and January 2025. The search strategy used subject headings and free text terms using the condition, context and population (CoCoPop) framework to capture studies on cognitive or overall development (condition), home-based learning opportunities and responsive caregiving (context) and children aged 24-59 months in LMICs in the East Asia and Pacific region (population). Data were independently extracted and appraised using the Joanna Briggs Institute Critical Appraisal Tools risk of bias and quality assessment checklists. The findings were summarised using narrative syntheses. Results Studies were from lower and upper middle-income countries in East Asia, and the study quality ranged from medium to high. Eighteen of the 19 included studies reported significant positive associations between home-based learning opportunities and caregiving and higher child development. The strongest effects were linked with psychosocial stimulation, academic-focused caregiving and enriched home learning environments. Measures of learning opportunities and caregiving varied widely. Conclusions The review findings suggest that home-based learning opportunities and responsive caregiving experiences may be associated with improved developmental outcomes among 2- to 5-year-old children. Although these patterns are consistent with broader evidence, the heterogeneity of measures and limited representation mean that conclusions should be interpreted with caution. Future research could prioritise underrepresented settings, including low-income countries and Pacific Island nations, to ensure policy reflects regional diversity. The heterogeneity in measures highlights the need for standardised tools to better capture associations between child development and the home environment.