We present the results with a focus on caregiver knowledge, attitudes and practices. Interviews held after six months and twelve month of the intervention, showed changes in caregiver knowledge, attitude and practices, perspectives that were also observed by CHVs and health workers.
Reported improvements in caregivers’ knowledge of ECD and caregiving
At midline, caregivers, CHVs and health workers mentioned that participating in the intervention was beneficial with regards to enhancing their knowledge and understanding of ECD (developmental milestones) and caregiving and equipping them with new information. This is because information on the developmental progression of their children had been made available to the caregivers through the monthly text messages that they recieved. Further, caregivers mentioned that the suggestions that they had received on how to stimulate their children enhanced how they attended to and cared for their children.
“This project has helped me a lot in the development of my child as there are things my child was not previously able to do. As soon as the question comes in, I look for the child and she practically does as per the question. If it is a question about a spoon, l give her food and observe if she can feed herself using that spoon then l respond to the question. I do not respond to the question out of my imagination on whether the child can or cannot perform the task. I do it practically so that l may respond to the question.” FGD with female caregivers, Korogocho
Further, female caregivers reported that the program had provided them with a greater understanding of how children’s development takes place in stages and that they had become closer to their chidren and more attentive to their developmental changes. They reported that the messages that caregivers received also served as a reminder of the activities they could engage in together with their children as learning opportunities.
“...It has really helped me because l have learnt that as a child grows, things develop one stage after another and she does not have to do all the things at one go. She will develop them one at a time as she continues to grow…” FGD with female caregivers, Korogocho
“…In my view the project has really helped me because those questions act as a reminder. Every time they ask me “…can your child do this?” I go and try out with her. If l observe she can do it…and then they tell me to show her how to do something, l show her and she learns to do it...” FGD with female caregivers, Korogocho
“...I have observed that there is a big change because l sometimes find him playing. He takes the ball and throws it to me; if l throw it back he enjoys the game. When we get to the house maybe he wants his book and starts to draw in it. He even starts telling me this is this and the other…” FGD with male caregivers, Korogocho
There was information and knowledge sharing with other members in the caregivers’ households. Caregivers reported that they were able to inform/teach other members of their families on what they had learnt from the intervention with regards to how to handle or play with the child. Caregivers also reported that they shared this information with other parents in the community. This increased the awareness and potential for improved practices of child stimulation within and beyond the household.
“...I would say, there is a time the father got a question and asked me if a child is supposed to open books and view pictures. I told him yes, that these questions are to assist us to know what to do for the child. The next day he went and bought books and crayons for the child. So in the evenings, he calls the child and they begin to color. So now the child already knows when his father comes in, they take the books and they begin to color…”
FGD with female caregivers, Korogocho
Increased caregiving knowledge among the caregivers receiving the intervention was also observed and noted by the CHVs who supported the intervention and heal. They (CHVs) mentioned that caregivers (mothers and fathers) had become more aware of the importance of ECD monitoring. They further noted that caregivers had acquired knowledge on how to do it well particularly with regards to monitoring their children’s milestones and in supporting the child to achieve the expected milestones through stimulation.
Simillar sentiments were echoed by a health worker and CHVs who supported the interventions. In both instances they indicated that the mobile phone platform was beneficial in providing mothers with information and sensitizing them on the development of their children.
A health worker at the community health facility that through the monthly messaging, caregivers were better placed to follow up on their children’s development and note anormalies early.
“…Before that, you find that the same caregivers will just stay, until maybe a CHV will come later when sometimes it is already too late to be helped to achieve those milestones. But with the phone, they are able to know to follow their children well and see if they are achieving these milestones. So for the children it is easier for these caregivers to help them, to achieve the milestones, so we have less children who are not achieving milestones, less children who are … malnourished, we have less people on the program right now because now the parents know the things they are supposed to look for, for the children...”
KII with health worker, Korogocho
“…when the caregivers started being asked questions they begun to realize that it is important because the child begins to understand things early or to understand things well…so the caregiver begins to appreciate that they should teach the child things like these and the children begin to learn things that they do not know. Even playing ball with a child in that age bracket that we have had in the Saving Brains project, a caregiver does not know that that they can take up a ball and kick it with the child…is important in the growth of a child. There are parents like those and we have them in the community and they are now becoming knowledgeable…”
IDI with CHV, Korogocho
Reported changes in attitudes towards ECD and caregiving
We noted that many caregivers pointed out that they appreciated their children better and felt more capable of responding to their developmental needs more appropriately than they did before they were exposed to the intervention. One caregiver said that the intervention demonstrated that caring for a child was not that difficult, hence the experience in participating in the project had given them confidence in their caregiving as indicated in the quotes below.
“For me, l now have confidence that l can care for my child. As the questions keep coming l keep practicing those things with my child. Before l did not believe that l could play with my child or be like a parent. But now l have confidence…”
FGD with female caregivers, Korogocho
Female caregivers and CHVs reported that the intervention had encouraged more male participation in the care of young children as they (male caregivers) received information on how to care for and relate with their children. In some cases, female caregivers did not own a phone and resulted to sharing a phone with their male spouses. This occurrence gave male spouses an opportunity to engage with the intervention partly or jointly.
“...For me it has really helped because the father of this child never wanted to see the child, even when the child wanted to play with him, he did not want. But now l observe that he will even pick the toys, they sit together and begin to play…” FGD with female caregivers, Korogocho
CHVs also noted that as a result of sharing phones in the case where a household depended one phone to receive and send messages, fathers had become interested and more involved in understanding their children’s development and implementing what was advised for the child to achieve the milestones.
“For me, my child and his father are not usually very close as it is difficult for my husband to be around daily or he returns when the child is already asleep. But when he is around, they play together and he checks on the messages to see what the child can do even though l am the one who responds…”
FGD with female caregivers, Korogocho
“We (CHVs) are really happy because even the men have come to understand about their children because they receive the questions and they too are happy to respond. It is making them happy because they can see the children are progressing step by step getting to know that a child needs to breastfeed, a child needs to play so they are happy.”
FGD with CHVs, Korogocho
Male caregivers reported that participating in the project helped them see that the role of stimulating development and learning in young children was not the preserve of a mother. They now understood that children play as part of learning and play was achievable and not a difficult thing to do with a young child.
“...Every so often we men we take it as though caring for young children is the burden of the women but this project has enlightened us and gotten us to know that we need to do it together to help with caring for the child…”
FGD with male caregivers, Korogocho
“...This project has helped because previously before it brought us this education, we knew that playing with a child is wrong. That if you put a ball to kick and the child also kicks, that is wrong…So now if l give the child a pencil, they may spoil it while wanting to know what is inside that is making it draw on this book and there is nothing wrong with it. You leave the child to explore… many times most people in the slum understood that only the mother can play with the child things like those. So we (now) know that one can play with the child when you want to teach them something…”
FGD with male caregivers, Korogocho
Reported changed in improved caregiving practices
Caregivers reported that as a result of participating in the intervention, they saw the benefit of being close to the child and spending time with the child. They reported that they had learnt the importance of play and were implementing this with their children. They also began seeing and utilizing learning opportunities with their children. This sentiment was expressed by both female and male caregivers who participated in the intervention. A few caregivers reported that their use of harsh discipline (disciplining a child by inflicting some pain) had reduced in that they no longer saw it as the best way to communicate to a child that they had done something wrong.
“…For me, it has helped me to be close to both my children. It has also helped me understand that with a routine, a child gets used to doing things like l can give her a cloth item for her to dress herself. Before, if l would give her a cloth item and she wears it wrong, I would beat her. Now l know l need to teach her so that she can know. I have also learnt that you can give a child a book to read, so now she can count even though not consistently like …1, 2, 5… I have learnt that l can teach her…”
FGD with female caregivers, Korogocho
“…l used to think that playing with a child was bad. When they (assessors) came home and l saw how when they put things there like stones to pile them, the child watched this and then also imitated and when they fall the child would laugh. Thereafter they said l should show the child how to play. After that l also started making the child play. I bought some things, l cut up some wood pieces and when l place three or four or five, when they fall she laughs, then she places more. That is how a child should play. So as she grows, she knows it is a good game…Now she cannot play a bad game when l am close-by…”
FGD with male caregivers, Korogocho
“...It has taught me that the cane does not help. Previously, l was one to cane the child l used to think that the cane is what teaches the child. I have also become friendly with the child. Yes…When she spoils something, l have also learnt that she would have curiosity and I would interpret that as her wanting to spoil something so l would beat her with a cane. But now l have learnt that she is curious and wants to know and l have learnt how to be friendly…” FGD with female caregivers, Korogocho
These changes in caregiving were also observed by the CHVs who mentioned that caregivers had become keen on monitoring their children’s development.
“…What has been most successful as l see it is that the children have improved in the slum. That is why as l had mentioned earlier, someone leaves the child in the child daycare center and is not bothered on how the child is developing as long as they look well and they are breathing and there is no sign of illness anywhere. When they get to the house, tomorrow they go back. However now at least now there is a parent whom you could ask how the child is progressing and that is the improvement you will see in the slum. At least when you ask the mother, even before you ask her she will tell you my child is progressing in this or this way". Therefore, l see it is improving...”
FGD with CHVs, Korogocho
A community health assistant expressed hope, after noting the change in caregiving behavior. She noted the cascading effect that good caregiving would potentially have in future for the caregivers. That this trend would provide for less worried parents who then be able to engage with economic activities and provide better for their children, not held back by children who are not thriving.
“If the children are okay, that means these parents don’t have to take their children to the facilities now and again, that saves time and that saves money. If the babies are well developed, it means the parents don’t have to worry about these kids so they can be able to go out there and…be able to do something to get some income…They will be at least economically stable. They will not use a lot of money on medical care or rather making sure these kids are well. It also gives again the parents peace of mind which is the most important.” KII with CHA, Korogocho
From the data collected we see that caregivers obtained knowledge and were encouraged to know how their children are growing. They appreciated that there is something they could do to contribute towards their childrens development. We see caregivers sharing these learnings out of their own volution with other family and community members. It does go to say that the knowledge acquired through the SMS platform had made a difference in their caregiving. We also see that in some cases, this experience was shared between male and female caregivers in a home.