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Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach
Last registered on June 10, 2020

Pre-Trial

Trial Information
General Information
Title
Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach
RCT ID
AEARCTR-0005980
Initial registration date
June 09, 2020
Last updated
June 10, 2020 10:45 AM EDT
Location(s)

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Primary Investigator
Affiliation
University of Missouri
Other Primary Investigator(s)
PI Affiliation
The World Bank
Additional Trial Information
Status
In development
Start date
2020-06-15
End date
2021-03-30
Secondary IDs
Abstract
The early years are the foundation for human capital: how children develop in these early years affects how well they do for the rest of their lives. Children in rural Guatemala are at risk for not fulfilling their potential for physical, cognitive, and social-emotional development due to high-levels of poverty, malnutrition, low-level of maternal education and lack of early learning opportunities. A parenting program was planning to train parents on child stimulation in rural Guatemala based on a previous World Bank successful pilot in rural Guatemala that found positive impact on child development (Trias, J. & Arteaga, I. 2020). This new parenting program was planned to be delivered through group meeting, where critical cases would receive in addition home visits. Due to COVID-19 stay-at-home government restrictions, the program -that was expected to start its implementation by late March- has been suspended. Instead, a remote learning intervention will start by mid-June. It is unclear when the program will be allowed to resume its implementation as planned given the COVID-19 lockdown and phasing approach to reopen the country.
The remote learning intervention consists of radio-theater that will be transmitted in community radio stations and the main commercial radio stations in six departments in Spanish and local languages. The script’s goal is to reduce mothers/caregivers’ anxiety due to the uncertainties about Covid-19, and to teach them how to stimulate their children’s motor, language, cognitive and socio-emotional skills. This program targets low-income mothers with children aged 0-3. Specifically, we will have three treatment arms: (T1) radio theater skit alone, (T2) T1 + recorded voice message to build awareness about the radio intervention and incentivize take-up , (T3) T2 + phone message about how mother/caregiver could interact with her child. A non-randomized comparison group will be included using communities that are excluded from the interventions (radio, CT). We have phone numbers of children under 3 years.
This research will help to answer to what extent technology can be used to train parents in early stimulation. Our anecdotal experience with this population suggests that it was very time consuming for lead mothers to visit parents that lived in remote areas. Similarly, in the absence of a pandemic, if parents live in remote areas and are not able to travel 2-3 hours to attend a group meeting, then the most disadvantaged parents will be denied access to leaning how to stimulate/shape their children’s development.

External Link(s)
Registration Citation
Citation
Arteaga, Irma and Julieta Trias. 2020. "Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach." AEA RCT Registry. June 10. https://doi.org/10.1257/rct.5980-1.0.
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Experimental Details
Interventions
Intervention(s)
The intervention consists of an early stimulation program through the radio. Voice messages will be used to incentivize the take up of the intervention and reinforce parental-child interactions. Specifically, we will have three treatment arms:
(T1 ) radio theater skit alone + digital cash (or in-kind) transfers ($40 value only once),
(T2) T1 + recorded voice message to build awareness about the radio intervention and incentivize take-up
(T3) T2 + phone message about how mother/caregiver could interact with her child.
Intervention Start Date
2020-06-30
Intervention End Date
2020-09-30
Primary Outcomes
Primary Outcomes (end points)
1. Take up of radio messages
2. Self-reported parental behavior on parent -child interactions (Play activities sub scale of the Family Care Indicators
3. Maternal anxiety (General Anxiety Disorder (GAD-7))
4.Child development using two instruments: (1) Caregiver Reported Early Childhood Development Instrument-Short Form (CREDI-SF) to measure child overall development status, and (2) MacArthur-Bates Communicative Development Inventories Short Form (MA-CDI-SF) to measure language skills
Primary Outcomes (explanation)
FAMILY CARE INDICATORS (FCI; from Hamadani et al 2010)

Play Activities Subscale
In the past week, on how many days did you or any other adult family member do the following
with (CHILD)? (read list; indicate ‘yes’ or ‘no’ for each)

Read books or look at picture-books with child
Tell stories to child
Sing songs with child
Take child outside home place
Play with the child with toys
Spend time with child in naming things, counting, drawing


ANXIETY: GAD-7
Instruction: Over the last 2 weeks, how often have you been bothered by the following problems?
Variable Items
gad1 1. Feeling nervous, anxious or on edge.
gad2 2. Not being able to stop or control worrying.
gad3 3. Worrying too much about different things.
gad4 4. Trouble relaxing.
gad5 5. Being so restless that it is hard to sit still.
gad6 6. Becoming easily annoyed or irritable.
gad7 7. Feeling afraid as if something awful might happen.

response options: 0 = Not at all
1 = Several days
2 = More than half the days
3 = Nearly every day

Caregiver Reported Early Childhood Development Index (CREDI) - Consists of 20 questions by age group (0-5 months, 6-11 months, 12-17 months, 18-23 months, 24 to 29 months, 30-35 months). Examples of questions for the first age group are:

CREDI_A1 Does the child smile when others smile at him/her?
CREDI_A2 Does the child grasp onto a small object (e.g., your finger, a spoon) when put in his/her hand?
CREDI_A3 Does the child recognize you or other family members (e.g., smile when they enter a room or move toward them)?
CREDI_A4 Does the child show interest in new objects by trying to put them in his/her mouth?
CREDI_A5 When lying on his/her stomach, can the child hold his/her head and chest off the ground using only his/her hands and arms for support?
CREDI_A6 Can the child pick up a small object (e.g., a small toy or small stone) using just one hand?
CREDI_A7 When lying on his/her back, does the child grab his/her feet?
CREDI_A8 Does the child look at an object when someone says "look!" and points to it?
CREDI_A9 Does the child look for an object of interest when it is removed from sight or hidden from him/her (e.g., put under a cover, behind another object)?
CREDI_A10 Does the child intentionally move or change his/her position to get objects that are out of reach?
CREDI_A11 Does the child play by tapping an object on the ground or a table?
CREDI_A12 Can the child hold him/herself in a sitting position without help or support for longer than a few seconds?
CREDI_A13 Can the child pick up and eat small pieces of food with his/her fingers?
CREDI_A14 Can the child transfer a small object (e.g., a small toy or small stone) from one hand to the other?
CREDI_A15 Can the child use gestures to indicate what he/she wants (e.g., put arms up to indicate that he/she wants to be held, or point to water)?
CREDI_A16 Can the child crawl, roll, or scoot forward on his/her own?
CREDI_A17 Can the child throw a small ball or small stone in a forward direction using his/her hand?
CREDI_A18 Can the child pick up and drop a small object (e.g., a small toy or small stone) into a bucket or bowl while sitting?
CREDI_A19 Can the child say one or more words (e.g., names like "Mama" or "ba" for "ball")?
CREDI_A20 Can the child walk several steps while holding on to a person or object (e.g., wall or furniture)?

Response options are: Yes, No, I don't know.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The intervention consists of an early stimulation program through the radio. Voice messages will be used to incentivize the take up of the intervention and reinforce parental-child interactions. Specifically, we will have three treatment arms:

(T1)radio theater skit alone + digital cash transfers (CT) ($40 only once),
(T2) T1 + recorded voice message to build awareness about the radio intervention and incentivize take-up
(T3) T2 + phone message about how mother/caregiver could interact with her child.

Randomization of intervention arms (T1, T2, T3) will ensure balance between groups in terms of observable and unobservables characteristics. The evaluation will measure the value added of including awareness campaigns to the radio intervention and the value of combining awareness campaign with child development messages on top of radio. [T1 is our experimental control]


Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
Unit of randomization is community, but we are collecting data at the individual level. Thus, individuals are clustered in a community.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
35 clusters (communities)
Sample size: planned number of observations
29 observations per cluster 35 clusters x 29 families per cluster x 3 treatment arms=1,015 x 3= 3,045 families
Sample size (or number of clusters) by treatment arms
35 communities in treatment 1, 35 communities in treatent 2, 35 clusters in treatment 3
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The calculation of MDE were done with response rates instead of total sample. I expect 20% attrition and 90% take up. Thus, I expect to collect data for 20 families per cluster MDE outcome Family care indicator - play activity scale=0.32 (mean=2.53, SD=1.27, power=.80) MDE outcome General anxiety disorder =0.12 (mean=30%, power=.80). MDE outcome MacArthur-Bates Communicative Development Inventory = 7.54 (mean=54.01, SD=29.88, power=.80) MDE outcome Caregiver-Reported Early Development Instrument= 0.06 (mean=0.2 [normalized], SD=0.25, power=0.80)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
University of Missouri-Columbia
IRB Approval Date
2020-06-09
IRB Approval Number
2023882