Helping Families Help Themselves? Heterogeneous Effects of a Digital Parenting Program

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Public Disclosure Authorized

Policy Research Working Paper

9850

Helping Families Help Themselves?

Heterogeneous Effects of a Digital Parenting Program

Sofia Amaral

Lelys Dinarte

Patricio Dominguez

Santiago M. Perez-Vincent

Development Economics

Development Research Group

November 2021

Policy Research Working Paper 9850

Abstract

Parenting practices are crucial for the development of chil- dren's brains and social skills. However, parenting styles may be far from ideal, particularly those of caregivers with high stress levels. Using an individual-level experiment with male and female caregivers of young children in El Salvador, this paper evaluates the impact of a free digital stress management and positive parenting intervention. The results indicate that, for males, the intervention increased

stress and anxiety and lowered caregiver-child interactions. The effect on males was concentrated among the poorer and those residing with a partner. In contrast, women's mental health was not impacted. Yet, their use of physical violence toward children decreased by 18 percent. These results align with theories linking economic deprivation and family structure to caregivers' cognitive overload and mental health.

This paper is a product of the Development Research Group, Development Economics. It is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world. Policy Research Working Papers are also posted on the Web at http://www.worldbank.org/prwp. The authors may be contacted at [e-mail].

The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

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Helping Families Help Themselves?

Heterogeneous Effects of a Digital Parenting Program∗

Sofia Amaral†	Lelys Dinarte Diaz‡
Patricio Dominguez§	Santiago M. Perez-Vincent¶

Keywords: Mental health, positive parenting, parental stress, child maltreatment

JEL Codes: J13, J22, I24, I12, J12, J16

∗We appreciate the valuable feedback from Kathleen Beegle, Sven Resnjanskij, Victoria Endl-Geyer, Andrew Friedson, Selim Gulesci, Florencia Lopez Boo, Barbara Petrongolo, and participants at the NBER Winter Development Conference, ifo Institute, IZA, and Nordic Development Economics Conference. We also thank Miguel Paniagua for his invaluable fieldwork coordination and Stef- fanny Romero for her superb work as research assistant. We thank Glasswing International, our implementation partner, for their support in the development and implementation of this program, as well as their trust and commitment to generate rigorous evidence. This work was supported by the IDB-COVID-19 Call for Research Projects, the World Bank Research Support Budget, and theCOVID-19 Emergency Call Window from the World Bank Early Learning Partnership. This research project's protocol was reviewedand approved by the Institutional Review Board (IRB) at the Universidad Francisco Gavidia in El Salvador in April 2020 with approvalID No. 003-2020. A preanalysis plan was registered at the American Economic Association RCT registry - AEARCTR- 0007096. The authors have no conflicts of interest to report. The findings, interpretations, and conclusions expressed in this report are entirely thoseof the authors. They do not necessarily represent the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent; nor those of the World Bank and its affiliated organizations, its Executive Directors, or the governments they represent.

† ifo Institute at the Ludwig Maximilian University of Munich and CESifo. Email: [e-mail]

‡Development Research Group. The World Bank. Email: [e-mail]

§Pontificia Universidad Catolica, Chile. Email: [e-mail]

¶Inter-American Development Bank. Email: [e-mail]

1 Introduction

Parenting styles and decisions are crucial in driving human capital accumulation (Olivetti and Petrongolo, 2017; Doepke et al., 2019; Attanasio et al., 2020b). Parental inputs during early life stages influence the development

of children's cognitive and socioemotional skills, which subsequently influence their health, school

performance, and labor market outcomes in adulthood (Carneiro et al., 2019; Attanasio et al., 2020b,a; Baranov

et al., 2020).1 Despite the importance of parenting to the development of children's brains and social skills,

parenting styles and practices are far from ideal. UNICEF estimates that nearly three in four children regularly suffer physical or psychological violence by their caregivers (UNICEF, 2017). This early exposureto violence can have long-lasting effects. For instance, children raised in a violent or stern environment are more likely to participate in criminal activities (Doyle Jr and Aizer, 2018; Sviatschi, 2018) and exhibitrisky behaviors as teenagers (Hamby et al., 2011). Overall, the high prevalence of child maltreatment and its potential long- term impact on children's well-being call for innovative and effective strategies. We exploitthe association between caregivers' mental health and quality of interactions between parents and children (Cluver et al., 2020; Renzetti, 2009; UNICEF, 2020, 2017) as a potential avenue to address the prevalence of child maltreatment in the context of a highly violent country.

In this paper, we evaluate the impact of a digital parenting skills intervention that provided caregivers with stress-management and positive parenting techniques, using a large-scale,individual-level, randomized controlled trial (RCT) with 3,103 caregivers2 of children aged 0 to 8 years old in El Salvador3 duringthe second half of 2020-that is, in the context of the COVID-19 pandemic and stay-at-home orders. We randomly assigned caregivers to a treatment or control group with equal probability. Caregivers in the treatment group received up to four SMS/WhatsApp messages per week over eight consecutive weeks.4 Before the

intervention, we collected data on caregivers' mental health, impulsiveness, caregiver-child interactions,

attitudes towards violent parenting, violence perpetration, and other sociodemographic characteristics. We combined direct questions and vignettes to reduce potential social desirability bias in responses to sensitive questions, such as those on attitudes toward violent parenting practices. We resurveyed caregivers one month after the completion of the intervention to measure the short-run impact of the program.

1Growing evidence in medicine and psychology shows that the emotional development of children is shaped early in life through interactions with caregivers. Emotional development impacts the architecture of the developing brain and lays the foundations for sound mental health and life experiences (Thompson and Lagattuta, 2006).

2In our setting, a caregiver can be a parent or a non-parent adult. Throughout the paper we use caregivers to mean individuals such as mothers, fathers, grandmothers, and others who provide a child's primary care.

3Violence against children is a major socioeconomic problem in El Salvador. A recent nationally representative survey shows that 55% of boys and 50% of girls (1-14 years old) experienced violent discipline in the past month (WHO, 2020).

4Overall, the intervention consisted of 27 messages containing information, videos, infographics and exercises on parental stress-management and positive parenting techniques. Section 2 provides a detailed description of the intervention. Figure A2 in the Appendix shows examples of the materials received.

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We document three main results. First, we show that the large majority of caregivers opened the SMS/ WhatsApp messages. Importantly, by using knowledge incorporation surveys, we document that caregivers in the treatment group were more likely to know about stress and parenting techniques than those in the control group. Second, we find the intervention had an overall negative impact on caregiver mental health. Contrary to what we had hypothesized in our pre-analysis plan (PAP), our estimations indicate that the mental health of treated caregivers worsened by 0.057 standard deviation (sd) relative to that of caregivers in the control group. This effect was driven by a negative impact on stress (0.072 sd). Third, despite the impact on mental health, we find no evidence that the intervention changed caregiver impulsiveness, the quantity of caregiver-child interactions, caregiver attitudes towards violent parenting, or children's behaviorsor socio- emotional development.

Moreover, we find heterogeneous impacts of the intervention depending on caregiver sex. The overall unintended effects of the intervention were concentrated among men: treated male caregivers' stress and anxiety levels increased relative to those in the control group by 0.108 sd and 0.095 sd, respectively. We observe no significant impact on women's mental health. We also observe that the intervention led to fewer interactions with children among male caregivers (0.137 sd) and had no impact among women. Finally, we find that the intervention reduced the reported use of physical violence among female caregivers (0.098 sd) and had no effect among men. This reduction in the use of physical violence amounts to a decrease of 18 percent. The often observed differential roles and involvement in parenting activities (Hupkau and Petron- golo, 2020; Olivetti and Petrongolo, 2017) and mental health status (Offer and Schneider, 2011) betweenmale and female caregivers presaged a heterogeneous impact of the intervention between these groups.5 Overall, our results verify the empirical importance of caregiver sex in moderating the impact of a parenting intervention. We also show that the intervention improved the quality of parenting for female caregivers by reducing the use of physical violence against children.6 In contrast, for males, the intervention led to more mental distress and a retraction from parenthood.

To further understand the differential impacts by gender, we show that living in more economically deprived households and cohabiting with a partner were associated with a greater negative impact of the intervention on mental health, especially among male caregivers. For example, among male caregivers in the most economically deprived households, the intervention had a 0.36 sd impact in mental distress (vs. a non-significant-0.032 sd impact among those in other less-deprived households). These results align with the literature linking economic deprivation with increased cognitive load (Mullainathan and Shafir, 2013; Mani et al., 2013; Asadullah et al., 2021; Schilbach et al., 2016; Ridley et al., 2020) and suggest that, for caregivers burdened by economic deprivation, the intervention may have added to the cognitive overload

5Our PAP contemplated the estimation of the intervention's impact by caregiver sex.

6In the U.S., females are generally the main perpetrators of child maltreatment (Lindo et al., 2018). This is also the case in our setting - with women having a higher rate of perpetration of violence when comparedto men. This outcome may be more easily impacted with the intervention for females.

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