Abstract
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.