The Effectiveness Of A Community-based Video-facilitated Parenting Intervention For Child Development Integrated Into Routine Maternal And Child Care Services In India: Study Protocol
Conditions: Child Development, Child Nutrition and Early Child Development
Sponsor: Sangath

Document Title: Study Protocol and Sta4s4cal Analysis Plan 
Date: 14 May 2025 
 
 

“Aalana Palana”, a community-based video-facilitated paren:ng interven:on for child 
development in Telangana, India: Study protocol 
Children thrive developmentally when they are surrounded by systems and rela5onships 
that consistently provide nurturing care. This care must operate across both proximal 
environments—such as the family and community-based workers (CBWs)—and distal 
inﬂuences such as suppor5ve social policies, ins5tu5onal services, and cultural norms (1). A 
nurturing home environment includes a constella5on of factors: sensi5vity and 
responsiveness to a child's health and nutri5onal needs, regular and developmentally 
appropriate opportuni5es for learning, emo5onally enriching caregiver interac5ons, and 
protec5on from both environmental and psychosocial adversity (2). These elements are 
especially vital during the ﬁrst 1,000 days of life, a cri5cal window when the brain undergoes 
rapid development and lays the founda5on for future cogni5ve, social, and emo5onal 
func5oning. 
While global progress has been made in reducing developmental risk, evidenced by a decline 
in the number of children under ﬁve at risk of not reaching their developmental poten5al 
from 279.1 million to 249.4 million between 2004 and 2010, the burden remains high, 
par5cularly in regions such as South Asia. Many of these risks stem from social and 
structural inequi5es that limit caregivers’ access to knowledge, s5mula5on resources, and 
health-promo5ng environments (1). 
Interven5on research from LMICs has consistently demonstrated that programs integra5ng 
nutri5on with responsive caregiving and play ac5vi5es, par5cularly those delivered in the 
early years, yield signiﬁcantly beUer developmental and nutri5onal outcomes than stand-
alone nutri5onal approaches (3). Paren5ng programs that emphasize emo5onally aUuned 
and developmentally suppor5ve interac5ons between caregivers and children are especially 
eﬀec5ve in improving child cogni5on, caregiver knowledge, paren5ng behaviors, and the 
quality of parent-child engagement (4). These ﬁndings have led to a global consensus around 
the need to scale up paren5ng interven5ons as a key strategy to support child development. 
However, the prac5cal implementa5on of such programs at scale faces several systemic 
barriers. In many LMICs, child development and health systems are o[en underfunded, 
fragmented, and overburdened (5). CBWs—who serve as the primary bridge between health 
systems and communi5es—are frequently tasked with delivering a wide range of services 
without suﬃcient training, resources, or ins5tu5onal support (6). This can not only 
compromise their eﬀec5veness but also increase burnout and aUri5on, ul5mately 
weakening the sustainability of interven5on eﬀorts. 
To overcome these limita5ons, experts have advocated for contextually appropriate, scalable 
delivery mechanisms that leverage and strengthen exis5ng systems rather than bypass 
them. This includes equipping CBWs with tailored training, structured supervision, 
technological tools, and incen5ves that match the complexity of their work (7). As key 

intermediaries, CBWs are uniquely posi5oned to foster behavior change within households 
and communi5es, provided they are adequately supported (8). 
One promising avenue for such scalable innova5on is the use of mobile health (mHealth) 
technologies, including video-based interven5ons. These plaaorms can reduce the cogni5ve 
and logis5cal burden on CBWs by standardizing messaging, providing engaging and 
repeatable content, and suppor5ng ﬁdelity in delivery (9). Videos are par5cularly eﬀec5ve at 
capturing caregiver aUen5on, illustra5ng prac5cal skills, and enhancing learning through 
modeling and storytelling—factors that make them well-suited for low-literacy or resource-
constrained environments (10,11). 
Evidence from various LMICs demonstrates the poten5al of video-based paren5ng programs 
to enhance early s5mula5on, improve ECD knowledge among caregivers, increase 
household safety prac5ces, and promote father engagement (12). Furthermore, recent 
innova5ons such as video-viewing combined with facilitated discussion have been shown to 
be both feasible and impacaul in resource-limited sefngs, enabling large-scale access to 
high-quality paren5ng support even in the absence of extensive professional infrastructure 
(13). 
Building on global evidence and contextual relevance, this protocol outlines a study to 
implement and evaluate Aalana Palana, a culturally adapted, video-facilitated paren5ng 
interven5on for caregivers of young children in Telangana, India. The interven5on is 
designed to promote responsive caregiving prac5ces and op5mal nutri5on in the early years 
of life. Aalana Palana will be integrated within the exis5ng framework of the Integrated Child 
Development Services (ICDS) and delivered by frontline community-based workers, 
speciﬁcally trained Anganwadi Workers (AWWs). By embedding the interven5on within 
rou5ne maternal and child care services and u5lizing pre-loaded video content as the 
primary delivery modality, the program aims to enhance ﬁdelity, reduce provider burden, 
and improve caregiver engagement. This study will assess the eﬀec5veness of the 
interven5on in improving child developmental outcomes and the home caregiving 
environment, and will examine its feasibility as a scalable, low-cost solu5on for low-resource 
sefngs. 
Methods 
Study Setting 
The proposed study will be situated in Telangana, the youngest state in India, established in 
2014. Telangana presents a unique context for the implementation of early childhood 
development (ECD) interventions due to both its demographic characteristics and service 
delivery infrastructure. According to the National Family Health Survey-5 (2019–21) (14), 
while maternal and child healthcare indicators in the state have shown progress and are 
generally better than national averages—such as 70.4% of mothers receiving four or more 
antenatal check-ups, 97% institutional deliveries, and 84.7% full immunization coverage for 
children aged 12–23 months—there remain significant gaps in child nutrition and early 
feeding practices. Only 37.1% of children under three months were breastfed within the 

first hour of birth, and just 9.2% of children aged 6–23 months received an adequate diet. 
Alarmingly, the state has seen a deterioration in under-5 anthropometric indicators over 
recent years, with increased rates of stunting, underweight, and wasting. 
Given these challenges, the study will build on existing collaborations between Sangath, 
UNICEF, and the Department of Women Development and Child Welfare (DWDCW), 
Government of Telangana. The intervention, Aalana Palana, is proposed to be implemented 
within the Integrated Child Development Services (ICDS) framework (15). This initiative 
would be delivered across 30 Anganwadi Centres (AWCs) spanning three ICDS projects: 
Maheshwaram, Khairtabad, and Alwal. AWCs serve as key community-level service delivery 
points, catering to approximately 5,000 people in urban and 1,000 in rural areas, and are 
managed by Anganwadi Workers (AWWs), a cadre of community-based frontline workers. 
A key enabling factor for intervention delivery in this context is the widespread mobile 
phone access in Telangana, with 96% of urban and 91% of rural households owning a mobile 
phone. Furthermore, 60% of women in the state have access to a mobile phone that they 
use personally, which enhances the feasibility of integrating digital or hybrid models of ECD 
delivery (14). 
This context provides a strong foundation to evaluate and scale integrated, community-
based, and technology-supported ECD interventions within public systems like the ICDS in 
Telangana. 
The Aalana Palana Intervention 
Aalana Palana is a facilitated video-viewing intervention combining responsive parenting 
and nutrition messaging. Aalana Palana which, in the local language Telugu, translates to 
‘caring and nurturing’, represents a transition from largely paper-based counselling sessions 
to a facilitated video viewing, discussion and demonstration model. It aims to ensure fidelity 
of the intervention delivery by standardising the content delivered during sessions. AWWs 
would use these videos to conduct both individual and group counselling sessions with 
caregivers at AWCs and family homes. Aalana Palana was developed using the following 
steps: 
Development of video content 
Information synthesis: A desk review of published global research on parenting 
interventions specifically in LMICs, the Nurturing Care Framework (16), the WHO Care for 
Development Package (17), and the early years learning framework. Resources in the Indian 
context, such as the Mother and Child Protection card (18), Home-Based Care for Young 
Child (HBYC) program guidelines, Poshan Abhiyan (19), and Intintiki Anganwadi (20), were 
also reviewed for content and implementation guidelines. 
Blueprint: A blueprint was developed based on this review, findings from our formative 
research (21), multiple consultations with system-level stakeholders and available resources 
for content development. Eleven videos were prioritized for development which included 
one video for pregnancy, eight videos for caregivers of children up to two years of age (each 
video specifically targeting 3-month periods viz., 0-3 months, 4-6 months, 7-9 months, up to 
22-24 months), one video for caregivers of children aged 2-5 years and one specifically 
addressing fathers’ involvement in parenting. ECD messages and parent-child interaction 
activities to be included in each video were listed to build a cohesive narrative for a specific 

age group keeping in mind counselling sessions that would be conducted by AWWs and also 
to prevent information overload. 
Scripting: This blueprint guided the iterative development of the scripts which were first 
drafted in English followed by Telugu and Hindi. Each English script was reviewed by the 
senior investigators of Aalana Palana and representatives of DWDCW and UNICEF. Once 
English scripts were finalised, they were translated in the two regional languages, ensuring 
the use of simple, colloquial, daily-use language, culturally relevant and relatable terms. The 
scripts incorporated learning objectives, visuals, narration, and discussion points. 
Video content development: A creative team from Telangana (22) was engaged for the pre-
production, shoot and post-production of the videos. All content for Aalana Palana videos 
were shot in local communities where AWCs facilitated identification and selection of 
pregnant women and caregivers of children in their catchment areas based on briefings 
provided by the Aalana Palana team. All families were consented before initiating shoots. 
Shoot habituation was done to make family members accustomed to the creative team and 
equipment (lights and cameras) inside their households. This was done such that the final 
visuals were as close to real life interactions as possible. Additionally, the usual routine of 
families especially ones with young children was discussed to identify mutually convenient 
times during the day when shoots could be organized to capture specific interactions. For 
play activities, existing reference videos and suitable coaching was also given to caregivers. 
Specific planning was done to include families and caregivers of both male and female 
children, belonging to varied social and religious groups to ensure equitable representation. 
Content and structure of Aalana Palana videos: The videos promote responsive and 
sensitive parenting, early learning opportunities and desired nutritional practices for young 
children and pregnant women. The content not only describes ‘WHAT’ behaviours caregiver 
should adopt, ‘HOW’ they could include these behaviours in their routines but also ‘WHY’ a 
particular behaviour is important for their child’s development. 
Each 5–6-minute video is divided into three segments which focus on a specific set of 
parenting practices. At the end of each segment instructions are displayed to pause and 
discuss key issues on the viewed content. These pauses are aimed at facilitating a two-way 
communication between AWWs and their audience, while providing listeners an 
opportunity to share their opinions and concerns regarding the topics being discussed. At 
the end of each video, a sutradhaar (narrator), who is a well-known media personality from 
Telangana (23), summarizes key takeaways and actionable practices. To address specific 
behaviours, shorter 1–2-minute variants of these videos were developed and shared with 
caregivers which were derived from the 5–6-minute videos. 
Feedback on video content: During the production and post-production phases of the video 
content development, stakeholders from DWDCW, UNICEF and the Sangath team iteratively 
provided feedback to the creative team. These recommendations on organization of visuals 
in each video, language used in scripts, voice modulation, and cultural diversity of content 
were used to refine the videos.  
Implementation of Aalana Palana  
Training plan: Consultations with DWDCW and UNICEF were conducted to develop a 
capacity building plan which would be integrated within the existing training schedules of 
AWWs. A three-day training of four hours was implemented that focused on experiential 

learning and role plays. Training content included session plans, learning objectives for each 
session, and expected competencies required for the delivery of Aalana Palana. The topics 
covered - importance of the early years of life and responsive caregiving, objectives of 
Aalana Palana , intervention content, values of two-way communication, intervention 
delivery processes, and supportive supervision. Aalana Palana videos were also uploaded on 
the phones of the AWWs using external solid-state drives and they were trained to select 
age-specific videos for session delivery. 
In December 2021, 30 AWWs from three ICDS projects, along with their supervisors and 
Child Development Project Officers (CDPOs), underwent in-person training. Pre and post-
tests were done at the beginning and end of each training day to understand any changes in 
knowledge and obtain feedback about sessions from AWWs. 
Session delivery: Qualitative research conducted during the formative stage of Aalana 
Palana highlighted challenges on time use and workload of AWWs (21). One of the 
mitigation strategies that emerged during further consultations with AWWs which could 
facilitate effective implementation of Aalana Palana was the prioritisation of group over 
individual counselling sessions. Evidence also indicated benefits of parenting interventions 
involving group-based sessions on child outcomes, particularly in LMICs (24). Based on this, 
AWWs were encouraged to use the Aalana Palana videos primarily during group-based 
counselling sessions. AWWs started delivering Aalana Palana sessions from January, 2022. 
Supportive supervision: The Aalana Palana team conducted at least one in-person 
supervision visit per month for all 30 AWWs and used a semi-structured questionnaire to 
observe the sessions. To record session delivery, stickers were placed next to the names of 
caregivers in existing registers maintained by AWWs. 
The process of Aalana Palana video development and implementation can be seen in Figure 
1. 
 
Figure 1: Process of Aalana Palana video development and implementation 
Study Design and Participants 

To assess the impact of the Aalana Palana interven5on, we propose a quasi-experimental, 
non-randomized post-test only design incorpora5ng a convenience-based comparison group. 
The study will be conducted in the catchment areas of 30 Anganwadi Centres (AWCs), 
previously iden5ﬁed as implementa5on sites through partnerships with government and 
community stakeholders. 
Household mapping within these catchment areas will be undertaken to iden5fy eligible 
par5cipants, speciﬁcally caregivers of children under three years of age. All eligible 
par5cipants who provide informed consent will be included in the study. The interven5on 
(or “exposed”) group will comprise caregivers who report having viewed an Aalana Palana 
video within the three months preceding data collec5on. 
A comparison (unexposed) group will be formed using a convenience sampling approach, 
including par5cipants from the same catchment areas who have not been exposed to the 
interven5on. Importantly, par5cipa5on in the study will not be restricted to households 
registered at an AWC, allowing for the inclusion of a broader range of community members 
and enhancing the generalizability of ﬁndings within the selected geographies. 
This design enables the assessment of real-world exposure and its poten5al eﬀects under 
naturalis5c condi5ons while acknowledging limita5ons related to non-random alloca5on. 
Data Collection Tools 
For all par5cipants who consent to par5cipate in the proposed study, basic demographic and 
iden5fying informa5on will be collected, including GPS coordinates of households; child’s 
name, sex, and date of birth; names and dates of birth of parents; contact details; address; 
and maternal educa5on level. Maternal educa5on will be categorized using classiﬁca5ons 
from the modiﬁed Kuppuswamy scale (25), which has been adapted for Indian socio-
economic contexts. 
Assessment of Exposure to Aalana Palana 
Exposure to the Aalana Palana interven5on will be determined through a structured set of 
ques5ons developed by the interven5on team. These will include: 
(i) Whether the par5cipant has heard of Aalana Palana (with follow-up on the source of 
informa5on); 
(ii) Whether the par5cipant has watched any Aalana Palana video in the three months prior 
to data collec5on; 
(iii) Whether anyone in the household has any Aalana Palana video stored on their mobile 
device (with follow-up on the source). 
For the purposes of this study, exposure will be deﬁned as having watched any Aalana 
Palana video within the three-month period preceding data collec5on. 
Outcome Measures 
Child development outcomes will be measured using three validated tools appropriate for 
low- and middle-income country (LMIC) sefngs: 
1. Family Care Indicators (FCI) (26)– Developed by UNICEF and adapted from the HOME 
inventory, this caregiver-report tool assesses the quality of the home environment, 
focusing on caregiving prac5ces that support early child development in children 
aged 0–5 years. The FCI includes yes/no items covering the availability of and variety 
in play materials and play-related ac5vi5es. 

2. Infant and Young Child Feeding (IYCF) Framework (27)– This tool captures data on 
key nutri5on indicators, par5cularly breasaeeding and complementary feeding 
prac5ces for children under two years of age. It follows WHO and UNICEF 
recommenda5ons and includes 17 opera5onally deﬁned indicators to assess 
adequacy in early feeding prac5ces. 
3. Caregiver Reported Early Development Instruments (CREDI) (28)– Designed to 
measure developmental progress in children aged 0–36 months, this popula5on-
level, caregiver-reported tool assesses four domains: motor, language, cogni5ve, and 
socio-emo5onal development. The long-form, which includes 108 items, will be 
used. With necessary permissions, the CREDI tool has been translated into Telugu by 
the Sangath team to ensure cultural and linguis5c relevance for the study popula5on. 
These tools have been selected for their strong psychometric proper5es, appropriateness for 
use in community sefngs, and feasibility for administra5on by trained data collectors. 
Data collection 
Two diﬀerent teams were deployed to collect data between July 2023 and January 2024. 
This was done to minimize assessor bias by ensuring that exposure and outcome data was 
collected by two separate teams. The ﬁrst team comprised of two ﬁeld workers who mapped 
the study geography, consented eligible par5cipants, and collected data on geoloca5ons, 
demographic, socio-economic, and exposure to Aalana Palana. The list of consented 
par5cipants iden5ﬁed by the ﬁrst team was shared with a second team who visited the 
households three-to-four weeks post consen5ng. The second team of non-specialist child 
development assessors collected all outcome data on FCI, CREDI, and IYCF prac5ces. Data on 
IYCF prac5ces was collected from a subset of children aged >6 months and <2 years at the 
5me of data collec5on. 
Data Analysis 
All data will be analyzed using Stata 15 and SPSS 27. 
• 
Descrip5ve Analysis: Frequencies, means, and standard devia5ons will be used to 
summarize par5cipant characteris5cs, exposure levels, and outcomes. Group 
diﬀerences will be tested using chi-square tests for categorical variables and t-tests 
for con5nuous variables. 
• 
Primary Analysis: Linear regression will be used to es5mate the associa5on between 
interven5on exposure and CREDI z-scores, adjus5ng for child age, child sex, maternal 
educa5on, FCI score, and AWC registra5on status. 
• 
Secondary Analyses: 
o Logis5c regression will assess the associa5on between exposure and binary 
outcomes for FCI and MAD. 
o Modera5on analysis will examine interac5on eﬀects of child age, sex, and 
maternal educa5on on the primary outcome. 

o Media5on analysis will be conducted using structural equa5on modeling 
(SEM) to assess whether the eﬀect of the interven5on on child development 
is mediated by the quality of the home environment (FCI score). 
Sensi5vity Analysis: Subgroup analyses will be performed for caregivers registered at AWCs 
to account for poten5al confounding due to engagement with AWC services. 
Data Management and ConﬁdenEality 
Data will be collected digitally on secure tablets using encrypted plaaorms (e.g., REDCap). 
Data will be uploaded to a password-protected server accessible only to designated research 
personnel. Iden5ﬁers will be stored separately from de-iden5ﬁed datasets. Regular backups 
and integrity checks will ensure data security and accuracy. 
Ethics Approval and Consent 
Ethical approval has been granted by the Sangath Ins5tu5onal Review Board (Ref: 
RR_2019_58). WriUen informed consent will be obtained in the local language (Telugu) from 
all par5cipants. Illiterate par5cipants will consent via witnessed thumbprint. All ﬁeld staﬀ 
will be trained in ethical research prac5ces, conﬁden5ality, and par5cipant rights. 
LimitaEons 
This quasi-experimental study may be aﬀected by confounding and selec5on bias due to the 
absence of randomiza5on. We will address this through mul5variable regression, and 
subgroup analyses. Lack of baseline data and reliance on caregiver recall are addi5onal 
limita5ons. However, use of standardized tools and blinded outcome assessors mi5gate 
poten5al bias. 
 
 

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