Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach

Last registered on July 13, 2023


Trial Information

General Information

Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach
Initial registration date
June 09, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
June 10, 2020, 10:45 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
July 13, 2023, 7:39 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.



Primary Investigator

University of Missouri

Other Primary Investigator(s)

PI Affiliation
The World Bank

Additional Trial Information

Start date
End date
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
How children develop in the early years affects how well they do for the rest of their lives (Campbell et al., 2014; Gertler et al., 2014; Heckman, 2011; Black et al., 2017). There is considerable evidence on the effectiveness on the well-known home-visitation program “Reach-Up” in Kingston, Jamaica that has been replicated in about 20 countries (Grantham-McGregor 1991; Gardner et al. 1996; Chang et al. 2002; Walker et al. 2005; Gertler et al. 2014). Over the past decade, there have been several attempts to reduce the costs of delivering early childhood stimulation training to mothers—including through a conditional cash transfer program in Colombia (Andrew et al. 2018; Attanasio et al. 2014, 2020), a government-run health-worker program in Sindh, Pakistan (Yousafzai et al. 2014), an existing program for improving pre- and post-natal services for vulnerable women in Colombia (Attanasio et al. 2018), a home-visitation program in urban slums in Odisha, India (Andrew et al. 2020), and group sessions for mothers in Odisha (Grantham-McGregor et al. 2020). What nobody has tested yet is the use of voice messages as a way to train parents in early childhood stimulation. Voice messages are inexpensive and do not require literate parents, although they allow for limited feedback and parent educators cannot demonstrate routines. The Covid-19 pandemic rushed governments and NGOs in the developing world to implement voice messages programs, although not using a well-validated curriculum like Reach-Up and as of now, there is no evidence of their effects based on impact evaluations. Thus, understanding the effects of voice messages is key because they can be used beyond the context of the Covid-19 pandemic especially in areas of difficult access and with illiterate parents.

This study will randomly assign families with children 6-33 months of age in rural Guatemala to treatment (n=700) or control (n=700) groups. The treatment group will receive tailored 2-minutes voice messages on stimulating children based on the child’s age and mother’s tongue, while the control group did not receive any intervention.

The intervention uses an adaptation of the Reach-Up curriculum. Reach-Up is an early childhood home visitation program that teaches parents early stimulation by promoting child-parent interaction through reading, singing, talking, and playing with homemade toys (Grantham-McGregor, Powell, Walker & Himes, 1991). Grantham-McGregor and her team selected a list of activities that could be sent through phone messages in light of the Covid-19 pandemic. Using this information, our team designed messages with the following structure: a welcoming message, a fact statement, instructions about taking notes and how to make a toy, instructions on how and when the caregiver should play with the child, and a closing message with a jingle.

We culturally and linguistically adapted the instruments to be used to measure caregiver-child interaction (FCI-play overall subscale; Hamadani et al., 2010), maternal anxiety (GAD-7; Löwe et al., 2008), child vocabulary (MacArthur-Bates; adaptation by Jackson-Maldonado, Marchman & Fenald, 2013) and overall child development (CREDI, short-form; McCoy et al., 2017). We will also assessed the internal consistency of our instruments because some of them were not previously administered via phone surveys.

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

Arteaga, Irma and Julieta Trias. 2023. "Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach." AEA RCT Registry. July 13.
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Experimental Details


The intervention consists of early stimulation program messages using an adaptation of the Reach Up curriculum. Specifically, we will have two treatment arms:
(T1 ) recorded voice messages on early childhood stimulation.
(T2) control group
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
1. Self-reported parental behavior on parent -child interactions (Play activities sub scale of the Family Care Indicators
2. Maternal anxiety (General Anxiety Disorder (GAD-7))
3.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

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 voice messages an early stimulation program (20 messages during 2 months)

(T1) recorded voice message on early childhood stimulation
(T2) control group

Randomization of intervention arms (T1, T2) will ensure balance between groups in terms of observable and unobserved characteristics.

Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Unit of randomization is family
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
1,400 families
Sample size: planned number of observations
700 observations in treatment group 700 observations in control group
Sample size (or number of clusters) by treatment arms
1,4000 families
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. 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)

Institutional Review Boards (IRBs)

IRB Name
University of Missouri-Columbia
IRB Approval Date
IRB Approval Number


Post Trial Information

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Is the intervention completed?
Data Collection Complete
Data Publication

Data Publication

Is public data available?

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials