Using WhatsApp support groups to promote responsive caregiving, caregiver mental health and child development in the COVID-19 era: A randomised controlled trial of a fully digital parenting intervention

Objective: Digital interventions hold important potential for supporting parents when face-to-face interventions are unavailable. We assessed the feasibility and effectiveness of a digital parenting intervention in Zambia and Tanzania. Methods: Using a randomised controlled trial, we evaluated the Sharing Stories digital parenting intervention for caregivers of children aged 9–32 months with access to a smartphone in their household. Caregivers were stratified based on child age and randomly assigned to the intervention or waitlist control arm. The intervention was delivered via facilitated WhatsApp groups over 6 weeks to promote caregiver wellbeing and responsive caregiving through shared reading activities. Primary outcomes were caregiver-reported responsive caregiving, child language and socio-emotional development. Secondary outcomes were caregiver mental health and parental stress. Masked assessors conducted assessments at baseline and immediate follow-up. Results: Between October 2020 and March 2021, we randomly assigned 494 caregiver–child dyads to the intervention (n = 248) or waitlist control (n = 246) arm. Caregivers in the intervention group reported more responsive caregiving (OR = 2.55, 95% CI: 1.15–5.66, p = 0.02), time reading or looking at books (β = 0.45, p = 0.04) and telling stories (β = 0.72, p = 0.002). Intervention caregivers reported significantly lower symptoms of depression (β = −0.64, p = 0.05) and anxiety (β = −0.65, p = 0.02). Child development and parental stress did not differ significantly between groups. Conclusions: Digital parenting interventions using WhatsApp can effectively promote responsive caregiving and caregiver mental health in low-resource settings, with great potential for scalability. Trial registration: ISRCTN database, ISRCTN77689525.