Early childhood (ages 0 to 3) is a critical period in human development, shaping cognitive, social, and emotional skills that influence lifelong outcomes. In Peru, the Cuna Más National Program, under the Ministry of Development and Social Inclusion (MIDIS), is dedicated to improving the development of children under 36 months in areas of poverty and extreme poverty.

The success of many development policies or initiatives largely depends on behavior change among citizens. In the context of early childhood, this mainly involves primary caregivers—individuals whose behaviors can significantly benefit children's development in areas such as health, nutrition, and psychosocial development, among others.

By 2020, the program had served over 170,000 families through home visits and child care services. However, the COVID-19 pandemic disrupted face-to-face interactions, requiring a rapid transition to remote delivery via phone calls, text messages, and WhatsApp.

Financed by the World Bank, this study aimed to identify the barriers (and facilitators) that caregivers faced in implementing the program's recommendations in four key areas: interaction, hand washing, playing, and supplementation. These findings served as the main input for designing evidence-based communication strategies that addressed caregivers' barriers and ensured the program’s continuity despite the challenges posed by the pandemic.

Understanding the barriers

The research phase of the project combined a literature review, qualitative and quantitative research to uncover key behavioral insights.

• Building a theoretical foundation: We conducted an extensive review of literature on Early Childhood Development (ECD) as well as documentation provided by the program.

• Gathering direct user insights: 

• Qualitative research: 20 in-depth interviews were conducted with both primary caregivers (from peri-urban and rural areas) and and 6 Cuna Más facilitators. This phase provided a deep understanding of the contextual and emotional factors influencing caregivers' behavior using the COM-B model of behavior.

• Quantitative research: Building on the findings from the qualitative phase, a nationally representative survey of over 600 caregivers was conducted. This allowed the team to validate the qualitative findings, quantify key barriers, and identify communication preferences among the target population.

This comprehensive approach revealed critical insights. Some of the main finding include:

• Interaction: Many caregivers found it difficult to calm their child when they cried.

• Hand washing: Many caregivers felt it was uncommon in their social group to wash their children’s hands frequently.

• Playing: Most caregivers enjoyed playtime, but several indicated they lacked the time to engage in it regularly.

• Supplementation: Many caregivers found it hard to give their children supplements due to the unpleasant taste.

• General difficulties: Daily responsibilities often left caregivers feeling overwhelmed, making it harder to prioritize the recommended activities.

• Communication: Some program recommendations were perceived as vague, which limited their effectiveness.

Results and reflections

This project reinforced how critical it is to align public policy interventions with the realities of those they aim to support. Even a well-designed program can be hindered if personal psychological, contextual, and motivational factors are not accounted for in the user experience.

I particularly enjoy conducting behavioral diagnosis using the COM-B model, as it provides a structured approach that allows for a deep dive into all factors that can hinder or promote the behaviors of interest. It also makes it easier to identify the barriers to target in a subsequent intervention and fosters creativity in designing solutions, drawing on past interventions that have addressed similar issues.

The behavioral diagnosis and communication strategies directly addressed barriers such as time constraints, emotional challenges, and unclear messaging. By focusing on evidence-based approaches, the program successfully adapted to remote delivery while continuing to promote early childhood development.

Notably, the insights and recommendations from this project were officially recognized in the Peruvian Executive Resolution No. 000858-2023-MIDIS/PNCM-D, underscoring their contribution to shaping the national strategy for early childhood development.

Key takeaways:

• Understanding the needs, challenges, and motivations of caregivers is essential for designing effective communication strategies.

• Clear, relatable, and actionable messages have a greater impact on encouraging behavior change.

• The project demonstrated how public programs can adapt and continue to achieve their goals, even during crises, by leveraging evidence-based behavioral strategies.