Intervention design and development
We conducted formative research and collected data on the household, community, and environmental factors related to caregiving practices that influence the growth and development of children under 3 years through three group discussions at village levels and six interviews of Anganwadi workers, caregivers and other stakeholders. The formative research also explored the underlying beliefs and attitudes around childcare practices, nutrition practices, breastfeeding and complementary feeding practices, household decision-making, income levels, cultural traditions, and social norms around childcare. Additionally, the study team conducted three community meetings to understand the sociocultural and childcare practices and specific challenges to access health and childcare services. In these meetings, the study team informed the community about the proposed Project and sought their consent for intervention. We engaged the community at all levels including intervention design, implementation, and program monitoring. During these community meetings, through a collaborative approach, community members collectively selected Balsakhi- a community volunteer from the village to implement the intervention. The team also collected data on nutrition practices, including breastfeeding and complementary feeding practices, household decision-making, income levels, and cultural traditions and social norms around childcare.The development of a responsive parenting package drew its theoretical framework from Vygotsky’s Zone of Proximal Development (ZPD). The ZPD is a theoretical framework that focuses on the difference between a learner’s actual developmental level and their potential developmental level when provided with appropriate guidance and support. This concept involves nurturing independent actions, skills, and knowledge by offering the necessary scaffolding (The study team co-created a curriculum comprising locally/culturally appropriate play-based activities covering these six groups’ identified parental competencies. Community members, Anganwadi workers and supervisors, schoolteachers/early childhood educators, and other stakeholders participated in the curriculum development process. The enhanced nutrition program included a nutrition demonstration center and locally and culturally relevant recipes for pregnant women and infant and young child complementary feeding. The program linked the study participants with local Anganwadi centers to provide them with supplementary nutrition support. The program also integrated monitoring, evaluation, and learning (MEL) processes to track progress, direct adaptation for improved efficiency, and evaluate impact. Thus, the intervention package comprised age-appropriate content, curriculum, and necessary tools and materials. We designed tools to enable parents to use them with their children to promote their children’s cognitive, language, socioemotional, and physical development at 2 years of age.