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Field
Abstract
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Before
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.
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After
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.
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