The Impact of Training and Technological Innovation on Early Childhood Development under a National Home-Visiting Programme in Ecuador: study protocol for a cluster-randomised trial

Abstract

Abstract Background This study aims to document the effect of teacher training, technology-enabled monitoring, information and motivational nudges in a national home-visiting programme on early childhood development in Ecuador. Methods The study is a 2-arm, cluster randomized controlled trial with parallel assignment and an active control group. The clusters are 48 catchment areas (districts) in the Sierra (Highlands) region of Ecuador, and all home-visiting teachers, district analysts, and children in the selected districts are included in the study. In addition, a random sample of 34 children and their biological mothers or caregivers per district will be selected for evaluation of outcomes. The primary outcome measures are: (1) pre-literacy and pre-numeracy skills as measured by the IDELA (2) executive functioning as measured by the IDELA and the Delay Choice Task (3) language development as measured by the TVIP and (4) Child Development (caregiver report) as measured by ECDI. Discussion Several small-scale home-visiting trials, targeting undernourished children in developing countries, have shown impacts on early childhood development in the short run. But the important question remains as to whether such results can be achieved at scale. If the intervention under this study is found to be effective at improving child development, it would have important implications for low and middle-income countries where 250 million children under the age of five are at risk of not reaching their full development potential. The intervention is integrated into an existing nation-wide home-visiting programme in Ecuador and involves training existing staff alongside upgrading the digital infrastructure, thus representing a feasible strategy for large-scale implementation. Trial Registration Number: ISRCTN16602033. Registered on 14 January 2023, https://www.isrctn.com/ISRCTN16602033.