Leveraging technology to improve child-caregiver interactions at scale

Persistent and substantial ability gaps across children from various socioeconomic backgrounds emerge in the early stages of infant development. The challenge is to design cost-effective remedial and preventive interventions that can be scaled up to reach more children. Interventions using technology to support child development are increasingly drawing attention due to their potential of expanding programs’ reach at a low cost.  

Child development is strongly related to the quality of the interactions between parents and children during their first years of life. Despite parents’ good intentions, factors such as the fast rhythm of life, economic insecurities, and social isolation can magnify behavioral barriers that preclude good parental investments, such as engaging in physical games and didactic activities, father’s involvement in childrearing, and good bonding between the caregiver and the child. This, in turn, can hinder child development in areas such as language, health, and emotional attachment.

How can caregivers overcome these barriers to improve their parenting?

Behavioral barriers     

Behavioral studies have identified several barriers that can challenge the development of an adequate parenting environment:

• Present bias or high discount rates. Parents may fail to internalize future benefits from their investment in parenting practices and make shortsighted investment decisions for their children. 
• Complexity of the parental role, lack of attention, and diversion of the cognitive resources necessary to carry out the parental tasks. For instance, the stress associated with financial problems and social isolation can reduce self-control and consume the cognitive resources needed for parenting. 
• Status quo bias. Many parents mirror, by default, the parenting patterns they themselves experienced with their parents.
• Negative identities. When parents have low self-esteem, they feel that they are not capable of positively influencing their children’s development and well-being.

Leveraging technology to support parents

Some parenting interventions—such as home visiting programs where health workers encourage and instruct parents on how to interact with their children—have helped parents improve their parenting practices. However, most typical parenting interventions are too costly and tightly controlled to be implemented at a large scale. The challenge is to design interventions that are inexpensive and feasible to implement without highly trained facilitators.

Based on these challenges and the expansion of mobile technologies even in low-income neighborhoods—and with the financial support of ReachingU Foundation and the Inter-American Development Bank—our team of researchers from the University of Montevideo, the Catholic University of Uruguay, Fe y Alegría, and Fundación América por la Infancia designed Crianza Positiva, a low-cost intervention to support parents of infants and toddlers in their parenting role. One key component of the intervention is a protocolized delivery of text and audio messages to the primary caregiver three times a week for 25 weeks.

We designed the messages to directly address the behavioral barriers mentioned above. 

• The messages aim to address present bias by reminding parents about the benefits of different parental behaviors and by making these benefits more salient.
• They address biases due to parental limited attention by breaking down complex parental tasks into simpler tasks.  
• The messages contribute to strengthen routines and forge new habits through repetition, fighting status quo bias.
• Finally, they aim at transforming negative identities into positive ones by helping parents identify their own resources.

Evaluation of the Crianza Positiva program

Families participating in the randomized evaluation of Crianza Positiva came from a  group of candidates who had attended an eight-week parenting workshop at Uruguay’s Children and Family Care Centers (CAIF) (publicly funded, privately managed early childhood centers), which concluded in December 2017. The results of the evaluation were promising: we found incremental effects of Crianza Positiva, when paired with the workshop, on the frequency of parental involvement and parenting quality. The intervention also successfully improved the quality of parental vocalizations in parent-child interactions, as measured by the parent’s pitch range (a speaking style that alternates low and high pitched voice tones, contributing to maintain the attention of the child and to improve communication).

In 2020, in the context of Covid-19, we replicated the Crianza Positiva text and audio messages, but without the previous workshop component due to sanitary restrictions. We found no effects of the intervention on the outcomes of interest. We have various hypotheses behind the lack of results, which point to key issues to consider when designing similar programs. First, these messaging programs may work as a complement to interventions that involve some human interaction but messages may have a limited impact on isolation. Second, CAIF centers actively used WhatsApp messages to stay in touch with families during the pandemic, competing with the messaging program for the attention of the families. Third, the problems introduced by the pandemic increased families’ stress and potentially reduced families’ receptivity to the messages.

A chatbot for pregnancy and reinforcing teleassistance 

With the continued financial support of the Inter-American Development Bank and in coordination with local authorities, we are working now on two new interventions:

Intervention 1. Reaching out to women with timely information, resources, and support strategies before, during, and after pregnancy can help prevent preterm births, infant morbidity, and mortality, and promote child development in general. We are currently implementing and evaluating the impact of a mobile-based chatbot that will present families with timely information on pregnancy care and newborn developmental stages and needs and will encourage adopting behaviors that enhance health, well-being, and fetal and child development.  

Intervention 2. This program consists of e-messaging modules of different lengths aimed at families with children between the ages of 0 and 3. The program is built on top of a teleassistance intervention being implemented by a government agency in Uruguay (Uruguay Crece Contigo). Families receive calls from a facilitator once a week for eight months. The facilitator discusses pressing issues, as well as the messages that are sent to the family every week. 

The way ahead

Our work contributes to nascent literature utilizing text-based communication and behavioral economic insights to boost early childhood development at scale. Our prior results and anecdotal evidence from our ongoing evaluations suggest the large potential of these very low-cost interventions, based on mobile technology and on the understanding of behavioral biases, to enhance parenting resources and improve parental decision-making, particularly when combined with activities that involve some interaction with human facilitators.