Can Smartphone Applications Help Caregivers Improve Early Childhood Development in Peru?

Clusters will be randomized by the research team into three equal-sized groups: control and two treatments. This intervention is designed to complement the existing government intervention (standard day care) by integrating three components: (1) smartphone-based app; (2) text/audio messages; and (3) parent learning groups. The control group will consist of those enrolled only in standard day care.

The three randomized groups thus include:
• Control: Standard day care.
• Treatment 1: Standard day care + “Volar” app/messages
• Treatment 2: Standard day care + “Volar” app/messages + learning groups.

The app-based intervention will include content presented through videos, activities, audio, images, and text. The information covers quality interactions, routines, play, development of socio-emotional skills, nutrition, and hygiene. Activities proposed for children 6 to 36 months old follow the curriculum for the Cuna Más home visiting program. APORTA will help the households download and install the App through remote workshops and face-to-face meetings in specific zones.

The intervention will also build off pilot experience and other behavioral insights from messaging interventions to integrate text/audio messages into the app-based intervention. Messages may include: (1) Concepts or evidence related to Early Childhood Development (ECD); (2) Practical advice on parenting practices; and (3) Motivational messages to continue carrying out the activities proposed.

The learning group component is a social intervention leveraging the Cuna Más daycare infrastructure. It consists of holding group sessions to drive information sharing and foster parent-to-parent interaction. For the intervention, the groups would be led by staff or a program volunteer. This person will be a member of the community who can facilitate the creation of trust and increase the likelihood of adopting and using the app-based platform. APORTA will train the staff or volunteer a month before the start of implementation. The parent learning groups will be carried out in six workshops over the course of the 18-month intervention. These workshops will be attended at daycare centers.

2023-11-15

2025-05-15

Our primary outcomes of interest are childhood development, this will be assessed using two instruments.

We will use the Global Scales for Early Development (GSED) new tool developed from WHO. The GSED (Short Form) captures child development holistically through a common unit, the Developmental score (D-score). GSED dimensions include a) language, b) motor, c) cognition, d) socio-emotional and e) adaptive. For the enplane, we will use the GSED long-form.

Second, we will use the Caregiver Reported Early Development Instruments (CREDI) (Long Form) designed to measure the developmental functioning of infants in five dimensions. Dimensions include a) communication, b) gross motor, c) fine motor, d) problem solving, e) personal-social.

Secondary outcomes include the primary caregiver's intermediate outcomes and interactions in the home:

Parenting Attitudes: We will assess parenting attitudes with Parenting Attitudes Questionnaire Scoring (EAPQ). The EPAQ is a short instrument for assessing attitudes about parenting and child development. The EPAQ measures three sub-scales: rules and respect, affection and attachment, and early learning.

Parenting Skills: We will assess parenting skills with Parenting Sense of Competence Scale (PSOC), a 17-item scale developed to assess parenting self-esteem. The scale includes two rationally derived scales, Skill knowledge and Value-comforting, referred to as Efficacy and Satisfaction. The PSOC can be used to measure intermediate outcomes, and, in other contexts, to measure a parent's level of perceived competence. It can also be used to measure satisfaction in parenting, and confidence in parenting efficacy individually, or as a combined total measure.

Parental investment and quality of the home environment: We will assess parental investment and quality of the home environment with Home Observation for Measurement of the Environment (HOME), is an Indicators of Family Care for Development. The HOME instrument is based on information provided by the primary caregiver. This indicator includes parental investment in time and materials, and the child has a quality space for his needs at home.

The target population consists of primary caregivers of children ages 6-36 months old who are part of Cuna Mas National Program (PNCM) day-care program. We will conduct a cluster randomized controlled trial (RCT) in 240 urban and peri-urban daycare centers. To identify the sample, we will first select 240 daycare centers assuming an average distance of 2km between the clusters. Clusters will be randomized by the research team in equal numbers of treatments and control groups.

The intervention will involve urban and peri-urban areas in seven regions in Peru: Lima, Cusco, Arequipa, Cusco, Huancavelica, Junín, Lambayeque, Lima, and Piura. Activities will take place between 2023 and 2025. As part of the Cuna Más National Program, the participants come from households living in poverty or extreme poverty.

Clusters will be randomized by the research team into three equal-sized groups: (T1) regular day care and usage of the Volar app, (T2) day care, the Volar app, and parent learning groups, or (Control) regular day care.

Randomization will be conducted following baseline data collection. The research team will perform the randomization using a random number generator in Stata 17 with a reproducible seed. While it is not possible to blind the participants to their respective treatments, the cluster assignment data will not be shared with testers or surveyors so they will not know the assignment of respondents.

Day-care centers will be randomized within geography/distance blocks.

Yes

240 day cares

2400 children/caregivers/households

Control: Standard day care - (80 day cares, 800 children/households)
Treatment 1: Standard day care + “Volar” app/messages - (80 day cares, 800 children/households)
Treatment 2: Standard day care + “Volar” app/messages + learning groups (80 day cares, 800 children/households)

For this intervention, we chose a detectable effect size of 0.175 sd for individual child/parent/household outcomes.

Pre-analysis Plan - Volar & Cuna Más - 10.02.23