Impact case study database

Cooper and Murray’s studies have informed international policies advocating for action to improve ECD by helping to close a significant knowledge gap on the benefits and effectiveness of early parenting interventions in an LMIC setting. This was corroborated by a 2015 report from the Inter-American Development Bank on childhood wellbeing and the role of public policy, which cited Vally et al. [5] as ‘an exception’ to the paucity of research in developing countries [E1]. Indeed, book sharing is being implemented by organisations that support families in poor communities around the world as a direct result of training programmes established by Cooper and Murray.

Evidence for policy change and action to improve ECD in developing countries

In 2016, the World Health Organisation (WHO) set out how it would prioritise early childhood development as part of the report ‘INSPIRE: seven strategies for ending violence in children ’. One of the seven strategies, on parent and caregiver support, cited Cooper et al. [2] as one of only two rigorous studies performed in LMIC countries that suggested parenting interventions may be feasible and effective in improving parent-child interaction and parental knowledge in relation to child development [E2]. The INSPIRE report also highlighted the collaborative Parenting for Lifelong Health (PLH) initiative, a suite of four prototype parenting programmes endorsed by the WHO. Two of the four age-specific PLH programmes – the infant programme (for children aged up to six months) and the toddler programme (for children aged one to five years) – were developed by Cooper and Murray based on their research from the University of Reading [E3]. Furthermore, the INSPIRE report cited two University of Reading-led RCTs [2,5], as ‘preliminary evidence of effectiveness of these prototype programmes’ in South Africa.

The 2018 WHO publication ‘Nurturing Care for Early Childhood Development: a Framework for Helping Children Survive and Thrive to Transform Health and Human Potential’ provides a roadmap for action for governments and organisations who work with families, built on ‘state-of-the-art evidence about how child development outcomes are influenced and how they can be improved by policies and interventions’. The framework cites six publications from Murray and Cooper, as evidence that caregiver-child interactions are highly beneficial for ECD and have long-lasting effects, as well as evidence that quality time in the first few months after birth, through sharing and reading books, promotes brain development. Book sharing is also specifically mentioned in the framework as an intervention appropriate to early education [E4].

Building global capacity to deliver DBS programmes

The Mikhulu Trust UK – a charity established by Cooper and Murray in 2014 – is recognised by the WHO as the implementation partner for both the PLH infant and toddler programmes. The Mikhulu Trust UK has provided training to seven non-government organisations in the UK, Brazil, Italy, Cameroon, Lesotho, and South Africa to implement age-specific DBS in a variety of contexts (e.g. with families whose children have neuro-developmental problems, in poor rural communities, and with refugee populations). Three of these organisations have been endorsed by the Mikhulu Trust UK to deliver DBS training on the Trust’s behalf, including the programme lead of the Parents and Children Together (PACT) project, part of the charity Citizens UK. Since May 2018, PACT has run book sharing courses with local community groups in Camberwell, an area of London known to have poor ECD outcomes. By training additional facilitators working across the project, PACT now offers book sharing courses to local community groups in Tyneside and Leeds [E5].

The Mikhulu Trust UK has also supported seven other research groups around the world to instigate trials of DBS as part of their own research programmes. For example, the 2018 PIÁ Trial in Brazil (involving 369 families and led by the University of Pelotas), is examining whether improvements in socioemotional and cognitive development due to DBS are associated with reduced later child aggression. As an adjunct to this trial, between April 2018 and February 2020 over 200 teachers in the cities of Pelotas and Lajeado have been trained to deliver DBS in classrooms or with families. Furthermore, four international research groups are adapting Cooper and Murray’s DBS programmes for specific populations: families with children with language delay in the USA; families of deaf children with cochlear implants in the UK and Netherlands; families with children with learning delay, including those with cleft palate due to chromosome deletion, in the USA; and families who have adopted young children in Italy [E5].

Since the Mikhulu Trust UK was established, by far the biggest demand has been for training in the DBS programme. In October 2017, in response to this growing demand, an independent public benefit organisation was registered in South Africa to implement DBS with parents and primary caregivers of children aged one to six. The Mikhulu Trust South Africa (SA) is managed by seven executive staff members, with Cooper and Murray acting as external consultants. Between October 2017 and December 2020, the Mikhulu Trust SA has trained staff from 22 non-government organisations that work with families to deliver DBS in South Africa. Fourteen of these organisations are actively implementing DBS in 19 communities across the country, from Cape Town in the Western Cape to Durban on the East coast, supporting families in villages, townships, and city suburbs [E6]. For example, Save the Children SA has included book sharing as one of four priorities within its positive parenting programme. Following training of its staff by the Mikhulu Trust SA, the charity is now implementing the programme with vulnerable communities, as confirmed on its website: “ In order to promote and maintain early life stage brain development, through our book sharing project, we focus on providing early learning opportunities for communities in need, like Setswetla, a temporary informal settlement in Alexandra, where approximately 2,000 children and their families benefit from the services of the Hlayisanani ECD Centre” [E7].

Developing tailored DBS resources

In 2016, driven by a shortage of locally relevant picture books in South Africa, Cooper and Murray wrote the storylines for two books, ‘Little Helpers’ and ‘All's well that ends well’ , and commissioned an established South African children’s book illustrator, Lyn Gilbert, to produce the artwork . In 2018, with support from the Mila Foundation, the Mikhulu Trust SA recruited four local interns to be mentored by Gilbert to produce a further six books. These were launched at an event in November 2018 with celebrated UK illustrator Korky Paul (of the ‘Winnie the Witch’ series). Following a successful crowd-funding initiative, they printed 15,000 books. As a result, the Mikhulu Trust SA now provides two free books to every parent and ECD teacher in South Africa who graduates from one of its DBS training programmes [page 14, E8]. Furthermore, between April and May 2020, the Mikhulu Trust SA made four of these books available online as part of its #LockDownBookShare campaign, which reached approximately 80,000 people [E9].

Supporting ECD policy implementation across Western Cape province

Since 2017, the Mikhulu Trust SA has been working with the ‘First 1,000 Days’ Division of the Western Cape Department of Health (WCDoH) to expand the services that the Department provides to caregivers of children under three years old, beyond advice and support on nutrition and physical health. Between January 2019 and November 2020, 55 community health workers (CHWs) have been trained by the Mikhulu Trust SA to deliver key messages from the DBS programme on relationship building and how to use the picture books. In total, 90 CHWs who support families across three districts in the Western Cape (Saldanha Bay, Drakenstein and Eden Karoo, total estimated population 920,000 according to 2011 census data) will be trained by the Trust over the next two years as part of a contract with WCDoH. In addition, the WCDoH has printed 50,000 copies of one of the Trust’s picture books to give to families to take home and keep. Additionally, the Mikhulu Trust SA and WCDoH have expanded their partnership to fully integrate support for DBS in the community, by connecting every local clinic to a local library [page 8, E8]. Once a mother has been introduced to the basic principles of book sharing at the clinic, they are signposted to the library, where key messages are reinforced. Following ‘introduction to book-sharing’ training by Mikhulu Trust SA, all 100 libraries across the city of Cape Town included DBS as part of their summer programmes in 2019. In June 2020, 10 of the city’s librarians took part in full book-sharing training, which was provided online by the Trust due to COVID-19. The training enabled those enrolled to think about the wider influence of their role. As one recalled: “As librarians we always read books with the children and do story telling – that was nothing new. But I’ve never really looked at my part as a trainer for parents before. The connection between the parent and child is what we need to strive for as librarians: not just reading to the child but preparing the parent for how they can do it when they get home” [E10].

Measuring the value of DBS to caregivers

The Mikhulu Trust SA monitors and evaluates the impact of the training they offer, and the response from trainee facilitators has been universally excellent. Recently they have also made direct assessment of subsamples of children whose parent has received book sharing coaching from recently trained facilitators. The findings have been highly positive. Thus, with one recent training course 19 parent child dyads were observed book sharing before and after receiving instruction; and a marked increase was apparent in both the number of words spoken by the child and the number of conversational turns. However, these hard measurements do not reflect the holistic value of DBS observed by families: “While book-sharing has incredible proven impacts on child development, parents are drawn to the tangible benefits they feel when they start feeling closer to their children and start learning about their children through book sharing,” CEO of the Mikhulu Trust SA [E6]. Examples of typical feedback from parents are provided below.

Parent based in Western Cape: “ When my daughter was little, she would ask me to assist her with her reading homework. Most of the time her reading would be in Afrikaans and I cannot read in Afrikaans, so I would avoid her. After being trained in the book sharing programme, now with my younger son, I understand that he and I have the freedom to create our own story, in our own words. I am able to learn more about my son and he is able to know me better as his mother.” [E6]

Parent based in Lesotho: “ I used to have the most stubborn child. I would tell him what to do, and it would be like he never even heard me. I would shout at him – nothing. I would threaten to hit him – nothing. I would hit him – still nothing. But now [since we have been doing book sharing], when I want him to do something, we sit down and talk about it, and then he does it. Now, I realise that I have been the stubborn one.” [E6]

Summary: Evidence from Cooper and Murray’s studies – showing that simple, cost effective interventions to support parent-child interactions can improve ECD outcomes – has informed policy development by the WHO as well as influencing international, national and local organisations who are responsible for ECD policy implementation. Through the charity they established, and affiliated organisations, their dialogic book sharing programmes have been used to train NGOs across the world and in a variety of contexts, building global capacity to improve the lives of deprived children and their families and steer them on a course towards happier, more successful lives.