Reading aloud and child development in low-income families in Northern Brazil. A parent education program improved vocabulary, working memory and IQ scores in children aged 2 to 4 years-old, collaborating to the SDG 4 and targets 4.1., 4.2. and 4.6.
Description
Evidence suggests that early child development lays the foundation for lifelong health, education, and economic productivity, yet an estimated 250 million children worldwide are not meeting their developmental potential because of conditions associated with poverty. Having that in mind the mayor of Boa Vista in collaboration with Instituto Alfa e Beto, a nonprofit organization, launched a parent education program called Universidade do Bebê focused on the promotion of reading aloud. The program was delivered in free educational child care centers (Casas-Mãe) serving low-income children ages 2 to 4 years. The program was implemented and evaluated between March and December 2015
Objective of the practice. Distinguishing feature(s) making it an effective response to the SDGs/2030 Agenda (e.g. integration of environmental, social, economic indicators; design for acceleration of progress or for reaching the furthest behind; interlinkages among the SDGs and targets; institutional changes; other innovative change in line with the transformative spirit of the 2030 Agenda.,etc.) Describe how challenges were met, and difficulties overcome.<br />
The objective of the program was the promotion of parent-child reading aloud practice benefitting parent-child interactions and child language and cognitive development. This was proven to be an innovative and effective response to collaborate with SDG 4 - Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all - as working with parents presented greater results than those provided by educational child care alone. Added to that, few early childhood development programs in low- and medium-income countries have focused on reading aloud strategies, in part because of concerns about the cost of books, low parental literacy levels, and cultural acceptability. Those challenges were overcome by 1) creating a book loan scheme, reducing necessity of acquiring a high quantity of books; 2) using books that had only images or texts of limited difficulty so that illiterate parents could still interact with the children; 3) training families using innovative interaction techniques adapted from the Reach out and Read program and Video Interaction Techniques developed by MDª Alan Mendelsohn from the University of New York. Training was delivered monthly over the duration of the project. <br />
The results showed that a program focused on reading aloud and delivered as an add-on to educational child care has meaningful impacts on parent-child interactions and on child language and cognitive development among low-income families in Brazil. The extent of the benefit to children’s language and cognitive outcomes was comparable to that of other early-childhood development programs with similar intensity and approximately half that of a more intensive intervention that was previously evaluated with a similar population in northeastern Brazil. Notably, IQ scores of children in the intervention group at follow-up were comparable to the population mean of 100, whereas those of children in the control group were ∼0.5 standard deviations below the population mean; this suggests that the intervention substantially reduced poverty-related disparities in IQ. This is especially important considering research revealing that early cognitive development is a strong predictor of school outcomes for children in low- and medium-income countries.
The parent education program was developed as an add-on to the standard educational curriculum provided in the Casas-Mãe. This program included the following: (1) a book-lending library, allowing families to borrow children’s books to take home and exchange them for new ones on a weekly basis and (2) monthly parent workshops with a facilitator who guided discussion about reading aloud and other opportunities for interacting with children, such as play and talking during everyday routines.
The parent workshops were collaboratively developed by Instituto Alfa e Beto and investigators at the New York University School of Medicine. They incorporated strategies from Reach Out and Read and the Video Interaction Project and used a group model similar to that of various US programs (eg, Legacy for Children, Literacy Inc). Session plans were developed to structure each workshop, which included tips related to reading aloud and discussion prompts provided by the facilitator (an example session plan is included in the Supplemental Information). During each workshop, parents (1) learned strategies for reading aloud with their child; (2) shared their experiences of reading aloud at home; (3) discussed perceived barriers and solutions to reading aloud, including challenges related to child behavior during reading; (4) engaged in reading aloud with their child by using children’s books provided by the program; and (5) reflected on what they liked about reading aloud with their child and received feedback on their reading interactions from the facilitator and/or other parents. The bulk of each session consisted of back-and-forth discussion between the parents and facilitator. Therefore, although each session followed a standardized plan and structure, the content varied on the basis of parents’ goals and concerns.
Book lending took place from March to December 2015. Parent workshops took place at the Casas-Mãe (maximum of 30 parents per workshop) approximately every 4 weeks for 1 hour between May and December 2015. Initially, workshops were led by the head teacher of each child care center. However, variability in delivery of the intervention was noted; thus, after the first 2 months of the program, a decision was made for the workshops to be led by Família que Acolhe or Instituto Alfa e Beto staff (individuals with a bachelor of arts degree in psychology or education), to standardize delivery of the workshops across centers for assessing program efficacy. Facilitators were trained and supervised by Instituto Alfa e Beto leadership, with periodic review of sessions by NYU investigators.
A cluster-randomized study was conducted to evaluate the impact of the program. Assessments were conducted at enrollment (March–June 2015) and at the end of the school year (December 2015). All assessments took place in the Casas-Mãe and were conducted by research assistants (RAs; undergraduate psychology students) blind to all elements of the study design (including site assignment) and study hypotheses. Assessments included 3 components: parent interviews, observation of parent-child interactions, and direct assessments of child outcomes. Each of the 3 components was conducted by a separate assessor unaware of performance in the other components
Of 660 families enrolled in the 22 Casas- Mãe at the beginning of the school year, 566 parent-child dyads were assessed at baseline (279 intervention; 287 control). Of these, 484 (86%) dyads (232 intervention; 252 control) had follow-up assessments and composed the analytic sample.
Among families in the analytic sample, parents in the intervention group attended a median of 5 (out of 9) workshops, with 97% attending at least 1 workshop; children borrowed a median of 20 books, with 84% borrowing at least 1 book.
The main parenting outcomes were seen for cognitive stimulation (mean difference StimQ Total = 2.77, 95% confidence interval [CI], 0.21 to 5.34, P = .03), especially in the context of reading activities (mean difference StimQ READ = 1.84, 95% CI: 0.76 to 2.92, P < .001), and observed interactive reading (mean difference ACIRI = 2.80, 95% CI: 1.40 to 4.19, P < .001). The intervention group also had lower physical punishment scores than the control group (mean difference = −0.33, 95% CI: −0.01 to −0.04, P = .04).
From the other hand, children in the intervention group had higher receptive vocabulary scores (mean difference = 2.54, 95% CI: 1.10 to 3.97, P = .001), working memory scores (mean difference = 2.20, 95% CI: 1.0 to 3.41, P < .001), and IQ scores (mean difference = 5.58, 95% CI: 2.98 to 8.17, P < .001) than children in the control group. Children in the intervention group also had higher interactive reading scores than children in the control group (mean difference = 2.98, 95% CI: 1.91 to 4.10 points, P < .001).
There were no significant group differences in expressive vocabulary (P = .24) or phonological short-term memory (P = .29). There were also no significant differences in children’s social-emotional competence (P = .56) or externalizing behaviors (P = .24).
A very important second set of outcomes was presented on a paper (submitted for publication: RCT of a reading aloud intervention in Brazil: Do impacts differ depending on parent literacy? Alan L. Mendelsohn; Adriana Weisleder, Denise S.R. Mazzuchelli, Aline Sá Lopez, Walfrido Duarte Neto, João Batista Oliveira) shows comparable impacts on parent- child interaction, the cognitive home environment and nonverbal IQ regardless of parent literacy level. These findings suggest that preventive interventions in low- and medium-income countries should consider promotion of shared reading even for low literacy families.
The costs have not been analyzed and could not be generalized to other circumstances given the fact that in Boa Vista there was a pre-existing structure that allowed a relatively easy access to the families. However, similar circumstances are very common in Brazil and possibly in other developing countries.
The direct costs for running the project are low in absolute and relative terms – an instructor to organize the meetings with groups of parents every 3 weeks (for nine months) and a set of books that were lent to parents on a rotating basis.
To the extent that well-trained parents can provide children with adequate socio-emotional and cognitive/linguistic skills constitutes a cost-effective and more feasible alternative to generally over-crowded and under-staffed public day-care centers typically offered in Brazil (and possibly in other developing countries).
The project’s impact included increased parent-child interactions through an increase in reading frequency and improved reading quality; and developmental progress of the children, with a positive impact in language, cognition and socio-emotional abilities. Added to that, there was a general increase in cognitive stimulation in homes, reduction of physical punishment and an increase in phonological processing (phonological memory). <br />
This project relies on decades of experience with books and interactive parenting practices and projects throughout the world. It does contribute to the existing literature and existing practices in two important ways. First, it was the first project of its kind to provide video-interactions to help parents observe, analyze and reflect on their interactions, and this seems to have contributed to increase the impact of the intervention (vis-à-vis previous projects without this component). The other important piece of evidence relates to documenting that almost illiterate parents can benefit from this kind of training practices and based on the training they can practice these skills and promote important development skills on their children. <br />
Universidade do Bebê caused large and consistent increases in both parent-child interactions and child development. These are significant effects considering that the program consists only of lending books and parent training sessions. In conclusion, there is a huge opportunity for scaling the project and significant opportunity for adaptation in other places in Brazil and abroad.
Results documented at Instituto Alfa e Beto website: http://iab10anos.alfaebeto.org.br/resultados-iab.pdf (portuguese)
Presentation of main findings by MD. Alan Mendelsohn http://www2.camara.leg.br/atividade-legislativa/comissoes/comissoes-per… (portuguese)
Published News stories: (portuguese)
http://estudio.folha.uol.com.br/foco-nas-cidades-boa-vista/2017/05/1887…
https://revistacrescer.globo.com/Voce-precisa-saber/noticia/2016/07/lei…
A second set of new outcomes was submitted for publication: RCT of a reading aloud intervention in Brazil: Do impacts differ depending on parent literacy? Alan L. Mendelsohn; Adriana Weisleder, Denise S.R. Mazzuchelli, Aline Sá Lopez, Walfrido Duarte Neto, João Batista Oliveira.
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Jalusa Lopes, Consultant