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Delivering Home Visiting Programs via Mobile Phones - Evidence from Brazil

Fri, March 24, 3:30 to 5:00pm, Salt Palace Convention Center, Floor: 1, Meeting Room 151 A-C

Abstract

Introduction: Remote messages and other e-health platforms have been widely used in many countries. Due to the social distance measures imposed by the COVID-19 pandemic, programs had to develop remote strategies to continue providing services, including the early childhood stimulation program offered by the municipality of Boa Vista. An alternative WhatsApp version of an intervention based on “Reach Up and Learn” curriculum was developed in early 2020. The objective of this study was to assess the feasibility and acceptability of the remote delivery of this intervention in Brazil.

Hypotheses: The remote WhatsApp-based delivery strategy developed during the pandemic can be used as an alternative to the labor and cost-intensive home visits to promote early stimulation and child development among the Brazilian population.

Study population: The study comprised caregivers and children from 24-36 months who were "Bolsa Família" (national cash transfer program) recipients and received the WhatsApp delivery strategy exclusively for 6 months. All participants lived in the municipality of Boa Vista, Roraima in the northern region of Brazil.

Methods: A randomized control trial to assess the impact of the intervention was conducted in Boa Vista, Brazil. During the pandemic when in-person meetings were suspended, a remote version of the intervention was implemented using WhatsApp. To evaluate this delivery strategy, a subgroup of children allocated in the control arm of the main study were included in the remote meeting sub-study. After enrollment, they were randomly assigned to remote-intervention or control group. The remote intervention group children and their caregivers were invited to receive bi-weekly WhatsApp calls from a previously trained agent for 6-8 months. The control group did not receive any contact or any other delivery strategy. Focus groups with the three agents and interviews with six caregivers were conducted to evaluate the acceptability and feasibility of the delivery strategy. All interviews were recorded and transcribed in Portuguese. Codebooks defining themes and sub-themes were developed and transcripts coded by interviewers and uploaded into NVivo® for electronic coding.

Results: One focus group with the three agents and six interviews with beneficiaries were conducted in 2021. Qualitative results showed that both providers and beneficiaries appreciated the program and related improving their interaction with their children. Barriers included limited mobile phone access, lack of time from parents to receive the call during working hours and overload of beneficiaries per agent. In conclusion, remote delivery methods are feasible and acceptable in Brazil and can be used as an alternative delivery strategy to scale up parenting programs.

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