Article written by Ilse Bigalke, originally published in Stellenbosch University Annual Faculty Publication 2021
Pictured l-r: Marguerite Marlow, Prof Mark Tomlinson & Stefani du Toit
Image credit: Damien Schumann
New WhatsApp programme supports caregivers and children
‘Caregivers reported being more responsive to their children, and spending much more time reading or looking at picture books with their child and telling their child stories. They also reported significantly lower rates of depression and anxiety.’ – FMHS researchers
Since the start of the Covid-19 pandemic, many teachers and teaching institutions world-wide have turned to WhatsApp with its two billion active users to communicate with students, deliver lessons and send and receive assignments.
In 2020/’21 researchers from the Faculty of Medicine and Health Sciences (FMHS) came up with another very useful teaching and support application for this messaging app to help parents and caregivers with the development of young children: the Sharing Stories programme, that is based on the shared reading of digital books.
According to the team of researchers from the Institute for Life Course Health Research (ILCHR), parents and caregivers of young children are facing substantial challenges during the pandemic, with potentially devastating impacts on the development and wellbeing of children, especially in low resource settings.
Supporting caregivers to foster nurturing, playful relationships with their children is an important strategy to mitigate these risks and promote positive outcomes for children. The pandemic has also necessitated the development of new, digital modes to support caregivers.
To address these needs, the researchers embarked upon a very exciting project that tested the feasibility and effectiveness of a WhatsApp-based parenting programme to promote both playful caregiving and caregiver mental health.
The ILCHR team members include Stefani du Toit (project manager), Marguerite Marlow (main developer/intervention designer), Prof Sarah Skeen (co-principal investigator), and Prof Mark Tomlinson (co-principal investigator).
Through the Parent Engagement through Digital Books (PED) Project (funded by the LEGO Foundation and designed to align with the Foundation’s approach to using playful parenting to develop a more creative and resilient society), the Institute created a fully digital parenting programme for caregivers. It is delivered via facilitated WhatsApp groups.
The Sharing Stories programme is a six-week digital intervention and consists of two key components:
Shared reading of digital books delivered to phones to promote playful caregiver engagement with their children; and
Support for caregiver mental health.
The programme makes use of lay health workers to facilitate the WhatsApp groups, host weekly group chat sessions, share digital books, moderate group discussions and support caregivers to implement and practice their new skills.
In 2020/’21, the ILCHR partnered with the Regional Psychosocial Support Initiative (REPSSI), a leading African psychosocial support organisation, and community-based partner organisations in Zambia, Tanzania and Uganda to test Sharing Stories through a pilot randomised controlled trial with caregivers of children aged 9-32 months.
According to the researchers Sharing Stories was developed by integrating an evidence-based in-person shared reading programme with a caregiver mental health support component and redesigning it for digital delivery.
In order to maximise the likelihood of programme success, consultations were conducted with 15 caregivers and 15 programme implementers across the three countries to ensure that their preferences and priorities were incorporated into the programme. Caregivers and programme staff working with families with young children provided valuable input that informed the focus, type and format of the content.
Sharing Stories uses shared reading as its central engagement technique, which creates opportunities for learning through play in a multitude of ways.
According to Marlow, digital books available in the local languages were sent to caregivers each week via WhatsApp. “Books were sourced from Book Dash, a South African social impact publisher with an online repository of free books for young children,” she explains.
“The books depict stories and pictures that are relevant to children in the region, and can be downloaded for free. An additional book, Duma says: Wash your hands, wear a mask by Nathi Ngubane, was included to help caregivers initiate conversations with their children about the Covid pandemic.”
The Sharing Stories content was presented through a variety of formats:
Text messages, to communicate important session information, present questions, and engage caregivers in discussion on the content.
Voice notes, to explain or elaborate messages or demonstrate techniques verbally (such as using a lively voice or praising a child). The voice notes were recorded in the local languages.
Infographics, to visually present key messages alongside helpful, practical tips. All infographics were translated into the local languages.
An animation video to provide an overview of the shared reading approach and key techniques.
Video clips of caregivers engaging in reading with their children to demonstrate key techniques.
According to the researchers, the programme had a meaningful impact on both responsive caregiving behaviours and caregiver mental health.
“Caregivers reported being more responsive to their children, spending much more time reading or looking at picture books with their child and telling their child stories. They also reported significantly lower rates of depression and anxiety.”
Although significant differences in child development outcomes between children in the intervention and control group were not detected, a longer follow-up period may be required to allow for the improvements in caregiving to translate into observed improvements for children.
Benefits of the digital delivery format include ensuring high fidelity to the cost-effective programme, which also offers caregivers more flexibility in terms of using it.
What is next?
According to Marlow future funding opportunities will be explored to further research the implementation, relevance and effectiveness of the Sharing Stories package in different settings for a more diverse group of caregivers.
Future activities will include theory- and evidence-based modifications to improve impact on child development outcomes and developing a full package of materials and tools to provide guidance and support.
“The team is also planning the development of an app for parents, in collaboration with Oxford University. The app will include content from the Sharing Stories intervention, and the team’s implementation experiences will help inform the app's development and testing.”
Other Sharing Stories aims:
To gather information about how to deliver programmes through a commonly used digital platform to reach vulnerable families;
The organisational and operational requirements to successfully implement such programmes; and
The lessons that can be learned to inform future scale-up of such programmes.