Closing the Gap: Dialogic Book-Sharing as a Tool for Developmental Equity in Low-Middle Income Countries
Leonardo De Pascalis1,2, Hallam Cooper3, Nicolas Dowdall4, Lynne Murray5, Mark Tomlinson4
1: University of Bologna, Italy; 2: University of Liverpool, UK; 3: University of Oxford, UK; 4: Stellenbosch University South Africa; 5: University of Reading, UK
Training parents of young children in the use of dialogic book-sharing (DBS) has been shown to be an effective, well-accepted, and cost-effective method to support improvements in child development, related to numerous key outcomes, such as language, attention, mental health, and socio-emotional understanding and functioning (Dowdall et al., 2019; Adrian, Clemente, & Villanueva, 2007).
DBS parent training has been shown to be particularly effective in contexts of socio-economic disadvantage, with notable benefits evidenced in trials conducted in Low-Middle Income Countries (LMICs) (Cooper et al., 2014). Given that these countries are where the majority of the world’s millions of children at cognitive and socio-emotional developmental risk reside (Grantham-McGregor et al., 2007; McCoy et al., 2016), the effectiveness of DBS in disadvantaged contexts highlights its potential in contrasting the cycle of deprivation, through the early uplifting of key developmental trajectories.
Beyond contextual factors, an open question remains regarding individual influences: how does a child's developmental status interact with DBS training? The effectiveness of DBS training may for example be proportional to initial developmental conditions (i.e., children who are more advanced at baseline remain comparably more advanced post-training); alternatively, the training may magnify developmental potential, and thus developmental trajectory inequalities (i.e., children who are more advanced at baseline get even further ahead post-training); more desirably, DBS training may promote more equitable outcomes by being especially beneficial for children whose developmental is least evident (i.e., children who are less advanced at baseline close the gap post-training).
The present study addressed this question by leveraging data from two randomised controlled trials conducted in South Africa: one on 14-16 month olds (Vally et al., 2015; N DBS: 49; N Control: 42), the other on 21-28 month olds (Dowdall et al., 2021; N DBS: 70; N Control: 70). In both studies, parents received an 8-week-long DBS training, and children were assessed, before and after the training, on receptive and expressive language, and attention.
Results showed that in both trials, the children who most benefited from the DBS parent training were those with the lowest language and attention scores at baseline. Children who performed poorly at baseline were found to close or reduce the post-training gap from other children, in all the outcomes examined. This pattern of findings was found to be especially pronounced in the younger aged cohort.
The findings from the present study strengthen the case for dialogic book-sharing: beyond being effective, well-received by parents and children, and efficient from an economic perspective, DBS actively promotes developmental equity by exerting a compensatory effect for those most at risk across key developmental areas. Crucially, this seems to be especially true the younger the child is, perfectly aligning with the WHO, UNICEF, and World Bank’s Nurturing Care Framework directive to intervene early to transform developmental trajectories and maximize human potential.
|
