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Journal of Applied Developmental Psychology 64 (2019) 101054

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Journal of Applied Developmental Psychology


journal homepage: www.elsevier.com/locate/jappdp

The impact of Galli Galli Sim Sim on Indian preschoolers T


a,⁎ a b a
Dina L.G. Borzekowski , Darius Singpurwalla , Deepti Mehrotra , Donna Howard
a
School of Public Health, University of Maryland, College Park, MD, USA
b
BGM Policy Innovations, Bangalore, India

ABSTRACT

While educational media can affect young children's development, rigorous studies rarely occur in low and middle income countries. Using an experimental design,
researchers investigated the effect of an educational television series (Galli Galli Sim Sim (GGSS), the Indian version of Sesame Street) with 1340 children in 99
preschools in Lucknow, India. Boys and girls, ages three to seven and mostly from low income households, saw 30 min of television five days a week for twelve weeks,
varying how much Galli Galli Sim Sim versus other programming children watched. Assessments occurred at baseline, endline, and six weeks later. Hierarchical
models showed that Galli Galli Sim Sim receptivity, an independent variable that combines exposure and recall, significantly improved literacy, numeracy, socio-
emotional strategies, and nutritional knowledge. Locally-produced educational media should be encouraged as it can positively affect potential school success and
child development.

Introduction healthy learning environment, young children can benefit greatly from
educational media (Anderson & Pempek, 2005). Significant positive
Universally, the preschool child achieves a huge number of devel- effects of educational media have been observed among preschool and
opmental tasks between the ages of three to seven years. In this period, early school aged children in a broad range of content areas (Kirkorian,
language and literacy skills emerge where the child starts out only Wartella, & Anderson, 2008). While some global research is now
having 250 to 500 words to being able to speak intelligibly and story evaluating the impact of different media on youth (Borzekowski, Lando,
tell (Bowen, 1998; Dosman, Andrews, & Goulden, 2012; Gleason, Olsen, & Giffen, 2019), historically, the most researched children's
2000). The cognitive development of a three year old involves naming program is Sesame Street (Fisch, 2014; Kearney & Levine, 2015; Mares &
familiar colors, sorting objects by shape and size, remembering parts of Pan, 2013). Longitudinal research conducted in the United States shows
a narrative, and recognizing and identifying common objects and pic- that children's early viewing of Sesame Street can lead to positive tra-
tures (Dosman et al., 2012). By age six or seven years, children's pho- jectories, lasting well into secondary school and beyond (Anderson,
nological and syntactical awareness leads to being able to read age- Huston, Schmitt, & Linebarger, 2001; Fisch, 2014). Internationally,
appropriate books (Gleason, 2000). She or he understands the concept preschool children exposed to the various Sesame Street co-productions
of numbers and can do simple arithmetic functions (Butterworth, have made significant gains in their knowledge of letters, numbers,
2005). The young preschooler cautiously leaves his or her parent's side, shapes, science, environment, one's culture, and health and safety-re-
and will initiate social interactions with peers (Dosman et al., 2012). lated practices (Borzekowski & Henry, 2011; Borzekowski & Macha,
Peer acceptance and friendships become a priority, and the older pre- 2010; Cole et al., 2003; Mares & Pan, 2013). In a six week intervention
schooler can be expected to problem solve some interpersonal conflicts study conducted with 223 Tanzanian preschool children, significant
(Feldman, 1998). Around the globe, compulsory schooling occurs gains in literacy, numeracy, social development, and emotional devel-
around age six years, when children start primary school (World Bank, opment were associated with children's receptivity of Kilimani Sesame,
2019). as assessed through the accurate naming of the program's characters
While some people express concern, there are strong beliefs and (Borzekowski & Macha, 2010).
evidence that media and technology can facilitate children's school The mechanisms by which educational media exert a positive effect
readiness. Around the world, well-produced television programming on preschool children has been building since the 1960's and are now
and media can engage vulnerable, hard-to-reach audiences by offering a better understood (Fisch, 2000). Psychologist Albert Bandura explored
source of informal education and enrichment (Borzekowski, 2018; media effects, especially among young children and demonstrated
Mares & Pan, 2013). While not a replacement for a resource rich and through the process of observational learning that message components


Corresponding author at: Department of Behavioral and Community Health, School of Public Health, University of Maryland, 1234B SPH Building, College Park,
MD 20742, USA.
E-mail address: dborzeko@umd.edu (D.L.G. Borzekowski).

https://doi.org/10.1016/j.appdev.2019.101054
Received 12 September 2018; Received in revised form 1 July 2019; Accepted 16 July 2019
Available online 09 August 2019
0193-3973/ © 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

could be manipulated to impact attention, retention, (re)production We hypothesized that given the entertaining, educational and cul-
and motivational processes, as well as self-efficacy (Bandura, 2001; turally appropriate nature of Galli Galli Sim Sim, Indian children with
Bandura, 2004; Bandura & Walters, 1963). Successful educational high receptivity would perform better on all of the assessed outcomes
programs appear to be those that weave educational content, such as compared to those with lower levels of receptivity.
facts and lessons, into the program narrative in an entertaining and
accessible storyline (Aladé & Nathanson, 2016; Borzekowski, 2018; Method
Fisch, 2000). There is evidence that bold and bright images and simple,
melodic music improve children's recall and retention of media content School recruitment and arrangements
(Borzekowski, 2018; Borzekowski et al., 2019; Yazejian & Peisner-
Feinberg, 2009). Additionally, Fisch's Capacity Model offers that a This study took place in Summer and Fall of 2016 in Lucknow, India
baseline familiarity with a show's characters, format, and/or educa- and involved extensive implementation and research teams (sub-
tional material is predictive of better narrative and content compre- contracted through BGM Policy Innovations, Ltd., Bangalore, India).
hension (Fisch, 2000). It seems critical that educational programming Lucknow is the capital city of Uttar Pradesh and is a Tier II city with
provide engaging, entertaining material that not only reflects the cul- households mainly from the C, D, and E socioeconomic classes (SECs)
ture and experiences of the audiences it is trying to reach, but also (Singh, Sharma, & Nagesh, 2017). After doing exploratory field work,
presents new material within structures to which children are familiar the implementation team chose to do the study in private preschools
(Borzekowski et al., 2019). over government anganwandi centers. Private preschools are ubiqui-
Galli Galli Sim Sim (GGSS) is the Indian adaptation of the preschool tous and 86% of low-income, urban Indian children attend these
children's program Sesame Street. Galli Galli Sim Sim was first broadcast schools (Irfan, Karamchandani, Kohli, & Jain, 2016). Similar to what
in 2006, is produced in New Delhi, India, and includes live action, parents report (Irfan et al., 2016), our team found that private pre-
puppet, and animated segments, delivered in a half-hour magazine schools had more stable infrastructure (i.e., continuous power source,
format. The program's target audience is four to six years olds but adequate seating arrangement for children, guaranteed safety of
younger children and adult caregivers are frequent viewers. The show, equipment) and better administrative engagement and control (i.e.,
offered in Hindi, presents age-appropriate and entertaining lessons consistent teacher and student attendance and ratio, and records
about letters, numbers, social interactions, foods, and exercise. Around maintenance). We felt the private preschools would be better at
85% of the delivered content is new and produced in India; the re- meeting the study's prescribed protocols (i.e., active cooperation
maining content is drawn from the Sesame Workshop archives. Like the reaching parents, program implementation and assessment, willingness
other Sesame Street productions,Galli Galli Sim Sim features Muppets.™ for researchers to be in the school settings).
Muppets™ are bright and bold puppet characters, who reflect the cul- Recruitment and selection of preschools began with the creation of a
ture of the specific country. In India, the most popular Muppet™ is comprehensive list of low-cost private schools across urban and peri-
Chamki, an inquisitive and outgoing six year old schoolgirl who enjoys urban neighborhoods in the Lucknow district, drawn from government
learning, especially engaging in language and word play. Other Galli documents. School inclusion criteria required classification as a private
Galli Sim Sim characters include Googly, a blue monster who is more school, enrollment of 15 or more children in the school's pre-primary
shy and introverted, Boombah, a large pink, purple lion who loves to class(es), and monthly school fees less than INR 500 (US $7.71). The
dance, and Anchoo, a purple monster who tells stories from her travels, school fee limit was later reduced to INR 200 (US $3.09) to acquire
sings and makes up riddles and rhymes (http://muppet.wikia.com/ children from lower SECs.
wiki/Muppet_Wiki). The implementation team created a master list of schools covering
Most studies examining media's impact are short-term, either done all six zones (including urban and peri-urban areas) of Lucknow. To
as cross-sectional studies or interventions lasting only a few hours or secure geographic representation, the team combined zones one & two
days. The general objectives and research design of the work presented to form five clusters. Each cluster listed approximately 200 schools,
in this paper originated from conversations among the program's fun- which were randomly sorted. The first 20 schools were then selected
ders and producers. The goal of this work was to not only examine the from each cluster list.
impact of Galli Galli Sim Sim but also inform development of new Two implementation team members approached each selected
content. This work employs a quasi-experimental design, conducted in school and explained to the administrators the study's general purpose,
99 preschools, using a 12 week intervention, in Lucknow, India. While and the protocols involved in the assessments and intervention. When
controlling for demographics and developmental change over time, this necessary, the team did multiple visits to ensure that school adminis-
research explores if and how receptivity to the program Galli Galli Sim trators understood what would be expected from the school and the
Sim affects young Indian children in terms of four early childhood do- children. Over 80% of the originally selected schools agreed to parti-
mains of (1) literacy, (2) numeracy, (3) social and emotional skills, and cipate. Five of the schools were ineligible, mainly because their actual
(4) health, as it relates to nutrition. Receptivity captures both exposure school fees were higher than published. Another four schools declined
and recall of media material, serving as a more sensitive and specific participation, as their administrators felt the protocol was too bur-
measure. densome. Two schools placed unreasonable demands (paying for the
Specific research questions examined include: intervention to be done in their school) on the research team. These
eleven schools were replaced with alternative schools that were next in
a. Controlling for demographics and developmental changes, does re- line from the master lists. Recruitment occurred over a three month
ceptivity to Galli Galli Sim Sim have an impact on children's literacy period, and eventually 99 schools were enrolled from the five clusters.
skills? Schools received identical media equipment (Vu televisions and BPE
b. Controlling for demographics and developmental changes, does re- UPS sets) and installation was done by an implementation team
ceptivity to Galli Galli Sim Sim have an impact on children's nu- member. Room selection was determined by various factors (i.e.,
meracy skills? lighting, low external disturbance, size) and equipment was wall-
c. Controlling for demographics and developmental changes, does re- mounted at similar heights. Strict instructions (as per the signed Memo
ceptivity to Galli Galli Sim Sim have an impact on children's social of Understanding between the research team and school administra-
and emotional skills? tion) required that provided equipment not be used for any purposes
d. Controlling for demographics and developmental changes, does re- outside of the intervention, during the study's duration. Remotes and
ceptivity to Galli Galli Sim Sim have an impact on children's health, warranty cards were NOT given to school administrators until the
specifically knowledge of nutrition? completion of data collection.

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D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

The Intervention Measures

Randomization occurred at the school level and the intervention Demographics


had three groups (control, low, and high), where the amount of Galli Only a handful of child demographic measures were assessed, as this
Galli Sim Sim children saw differed. Children watched the same amount study occurred in preschools. Some information was provided by par-
of television, one half-hour episode five days a week for 12 weeks. ents, including the child's sex, child's age, and household's SEC (Socio
Indian media producers and experts provided the names of the five Economic Class). As per India's latest market standard report (Singh
most popular age-appropriate children's programs (Chhota Bheem, Roll et al., 2017), SEC was determined by asking the parents about: (1) the
No. 21, Dora the Explorer, Dinosaur Train, and Tom & Jerry), and these highest level of education achieved by any of the adults in the house-
were used in the control and low groups. The non-Galli Galli Sim Sim hold and (2) household durables.
shows were selected because they represent what Indian children might
typically be watching, based on industry ratings. Two of these shows, Media Receptivity
Dora the Explorer and Dinosaur Train, are educational; however, their We used a design where viewing in school was set; however, chil-
content (problem-solving and paleontology) is distinct from that of Galli dren could easily watch Galli Galli Sim Sim at home or friends' houses
Galli Sim Sim. As noted earlier, Galli Galli Sim Sim offers educational through broadcast. To account for viewing in and out of school, we used
content delivered through different formats. The majority of Galli Galli as our main independent variable media receptivity. At each assess-
Sim Sim's educational material focuses on literacy and numeracy; ment, children were shown a card containing images of 16 media
however, recent seasons have conveyed content on issues around socio- characters. While half of these characters were from Galli Galli Sim Sim,
emotional and health topics. the other half were characters from other popular children's programs.
The intervention team made a six week viewing schedule (from Children were asked to name each character, and they received a score
baseline and midline), which was repeated during the following six for non-Galli Galli Sim Sim character receptivity and Galli Galli Sim Sim
weeks (from midline to endline). Such repetition has been employed in receptivity. Receptivity captures not only basic exposure to materials
other research on children and media, and has been found to enhance but also gauges whether a child has retained content seen and heard
overall and specific comprehension by young audiences (Borzekowski (Borzekowski & Cohen, 2013; Borzekowski & Pires, 2018). It is both
et al., 2019; Kirkorian et al., 2008; Mares, 2006). The control group sensitive and specific. Previous evaluations of children's television
watched one episode each from the five non-Galli Galli Sim Sim pro- productions have shown this measure to be valid, reliable, and highly
grams, each day during the intervention. Those in the low group were predictive of anticipated outcomes (Borzekowski & Henry, 2011;
shown Galli Galli Sim Sim two days a week (on the Tuesday and Friday Borzekowski & Macha, 2010). Statistical models that include both
of the week) and randomly selected episodes from the non-Galli Galli specific program receptivity and general media receptivity isolate the
Sim Sim programs on the other three days. The high group only saw impact of exposure to a specific show (regardless of setting), while
Galli Galli Sim Sim during the intervention. For the high group, thirty controlling for a participant's cognitive ability to remember general
complete episodes were viewed in order by children during the first six media content (Borzekowski & Macha, 2010). Specific show receptivity
weeks and then repeated in the same order during the second half of the picks up not just if a child was in the room while a show was being
intervention. All Galli Galli Sim Sim episodes came from the production's played but also if the child was paying attention to the communicated
seventh and eighth broadcast seasons. content.
Strong oversight was done to ensure the intervention occurred as In the analyses, we created three groups of no, low, and high re-
planned. Daily, implementation team members received flash drives ceptivity. Those in the no receptivity group could name none of the
with only the material that their assigned schools were to see. Time and Galli Galli Sim Sim characters. Children in the low group could name
global position stamped photographs confirmed attendance and that one or two Galli Galli Sim Sim characters and those in the high group
the correct videos played at the specified times. Supervisors also did a could name three or more Galli Galli Sim Sim characters. We set these
minimum of six unannounced visits at every intervention site. cutoffs, especially for the high group, to detect that a child was likely to
be seeing and remembering more than the most popular character of
Data Collection Procedures Chamki. In contrast to the U.S., where practically every toddler can
name the Sesame Street character of Elmo (Lauricella, Gola, & Calvert,
In May 2016, parents were notified by the participating school 2011), Galli Galli Sim Sim characters were less popular at least at the
about the study, both orally and in writing, at beginning of the year time of this study in the city of Lucknow.
meetings. Parents provided passive consent as this was sufficient for the
University of Maryland's Institutional Review Board, which reviewed Dependent Variables
and approved all protocols for this study. The Ministry of Education This study used instruments assessing children's developmental
Early Education, Lucknow Division also considered and approved the skills, many based on established measures (i.e., World Bank India
study's methods. School Readiness Instrument, Learning Metrics Task Force) and in-
This research paper describes three rounds of data collection. At struments used in other evaluations of educational media productions
each round, a team of 40 data collectors, who were experienced at (Borzekowski, 2018; Cole & Lee, 2016). There were overall scores for
doing assessments with young children, were assembled and trained in each domain, but also subscales for specific topics. Most but not all of
the ethical implementation of the instruments. The individuals com- these items were measured at every data wave collection.
prising the data collection/research team differed from the im- As part of the literacy construct, six questions assessed if children
plementation team, and were blind to the study's purpose. With the could recognize letters in Hindi, and another six asked children to
permission of school administrators, one to two days were allotted for identify what letter started a word. As well, children were asked six
data collection at each assessment round. The research team recorded questions about common street signs (i.e., “Open,” “Closed,”
the exact assessment dates for each child. Digital data collection oc- “Pedestrian Crossing”). Six different vocabulary words featured on Galli
curred on smartphones to minimize errors, improve efficiency and Galli Sim Sim were tested (‘Word on the Street’) by having children
transparency in the data collection process. As well, digital data col- point to pictures that best showed the meaning of recited words. Lastly,
lection enabled supervisors and the research team to know the exact children were questioned about six English letters (recognition and
GPS location of data collector and time taken for each survey. word start). An overall literacy score was created from the sum of these
Throughout the study, reviews of the data for inconsistencies and subcategories. With 30 items, the Cronbach's α was the same (0.91) at
completeness were made by the supervising team. baseline, endline, and follow-up.

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D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

Numeracy was measured through six sub-categories. First and for the naturally occurring interdependence of variables (Snijers &
second, children had to identify (four questions) and name (another Bosker, 2012). In this study, children were nested within schools,
four questions) numbers using a card that listed in order the numbers meaning that participants may have shared common characteristics
one through twenty. Third, children were shown four different objects such as being from a particular neighborhood, having relationships
and asked to count how many were on a page. Fourth, children were with certain teachers, and accessing similar resources in a school-set-
given a picture card with nine different shapes and had to identify, by ting. HLM algorithms allowed for researchers to hypothesize different
pointing, four of them, leading to a score for shape recognition. Fifth, levels of nesting and to statistically test whether these levels accounted
children were assessed in their knowledge of spatial words, where re- for a significant portion of the variation in the outcome (Woltman,
searchers presented an image and asked four questions about positions Feldstain, MacKay, & Rocchi, 2012). We decided to use a three level
of the items in the image (“What is in between the tree and the goat?”). HLM. At the highest level of the hierarchy are the schools, which served
The sixth numeracy category involved four pattern predictions, such as the primary sampling unit for the study; the second level of the
that children had to name the shape that would come next in a se- hierarchy consists of the students within these schools, and finally, the
quence (“Here is a circle, a triangle, a triangle, a circle, and a triangle. third level of the hierarchy represents the measurements taken for each
What shape would come next?”). Overall numeracy was the sum of student at the three different time periods of the study. While several
these subcategories and had 24 items. The Cronbach's α was 0.93 at predictors (both at the school and the individual level) and interactions
baseline, 0.91 at endline, and 0.92 at follow-up. were tested when developing the HLM, we settled upon a parsimonious
In the social-emotional assessment, children considered six different model where we accounted for the child's sex and age, SEC level of the
scenarios. Researchers showed and explained to the children a picture child's household, make-up of the class, baseline scale score, passage of
card illustrating a situation such as bullying, peer pressure, conflict time, and a general measure for how well the children pay attention to
resolution, good touch/bad touch, jealousy, and getting lost in the and recall media content (non-Galli Galli Sim Sim receptivity).
market. The naming emotions battery had children indicate how a Two different effect sizes were calculated for this data. The first
depicted character was feeling, by pointing to different faces on a card. effect size is the percent difference in adjusted mean outcome score
Each face showed a different emotion, such as happy, sad, surprised, or between receptivity groups (i.e., high receptivity vs. no or low re-
angry. Identifying strategies required participating children to point to ceptivity vs. no). The second effect size is a modified Cohen's d statistic,
a picture of one of four possible ways to “solve the problem” described offering an effect size that measures the standardized difference be-
in the original scenario. The overall socio-emotional score combined tween two group means (Cohen, 1988). Cohen's d is calculated by
the exercises of naming emotions (six questions) and identifying stra- taking the difference between the model adjusted mean scores, and
tegies (six questions). At baseline, the Cronbach's α was 0.83; at endline dividing by their pooled standard deviation. The term “modified” is
it was 0.76 and at follow-up 0.72. used because these effect sizes are calculated using the group's model
The health outcome was essentially a measure of children's knowl- adjusted means rather than their raw means and the unadjusted pooled
edge of healthy food items versus foods of low nutritional value. standard deviations. Cohen's d statistics are provided as a simple way to
Researchers asked children to classify 16 different food or beverage assess the magnitude of having high or low receptivity to the show
items, using the same terms presented through Galli Galli Sim Sim when compared to having no receptivity. Cohen's d provides a measure
content. So that all children were familiar with the terms of “anytime” of the size of the difference between these two groups and moves be-
and “sometime” foods, the researcher provided a brief explanation and yond simply reporting the existence of an effect.
example (i.e., “ice cream” is a “sometimes” food), children were asked Anticipating questions about intervention group's impact, additional
to sort image cards of foods and beverages into piles of “anytime” or analyses were done exploring models and significant differences across
“sometimes” items. Children were given a point for each correct clas- control, low, and high exposure groups in predicting the various out-
sification. This measure was not assessed at baseline. The Cronbach's α comes. We briefly discuss findings from these analyses at the end of the
was 0.73 at both endline and follow-up. results section.

Statistical Analyses Results

Data was collected from 1990 children at baseline, 2613 children at Table 1 displays demographic and baseline information on the
endline, and 2290 children at the follow-up. While there are several sample of 1304 children. This table also presents endline and follow-up
ways one could approach this data, we chose to analyze data from the information by receptivity groups. At endline, 655 children were in the
1340 children who we completed interviews at all assessments. To no receptivity group, while 385 and 264 children were in the low and
create three receptivity levels, children who were unable to name any high receptivity groups, respectively. At follow-up, 843 children had no
Galli Galli Sim Sim characters were placed in the “No” receptivity group. receptivity, while 350 children had low and 111 children had high
Those who could name one or two characters were put in the “Low receptivity. As expected, Galli Galli Sim Sim receptivity increased from
Receptivity” group and three or more characters in the “High baseline to endline, but then there was a drop-off at the six week follow-
Receptivity” group. Again, we used receptivity to capture Galli Galli Sim up.
Sim exposure as it not only accounted for school viewing but also We did look at groupings based on what children viewed through
captured home and other natural exposure to Galli Galli Sim Sim. school groups. The greatest Galli Galli Sim Sim receptivity was among
Our first step in the analyses involved an examination of the uni- the children who only saw Galli Galli Sim Sim during the school inter-
variate statistics and bivariate relationships, noting patterns for the vention (M = 2.55; SD = 1.96) followed by those who saw a mix of
variables and determining if there were any significant differences be- programming (M = 1.10; SD = 1.31), and those who saw no Galli Galli
tween the receptivity groups. We explored patterns of receptivity to Sim Sim at school (M = 0.15; SD = 0.55). Children were assigned into
Galli Galli Sim Sim over time, considering validity and manipulation the no, low, and high receptivity groups and the association with school
checks with other variables viewing groups was significant (endline Χ2(4, N = 1304) = 586.6,
To investigate whether receptivity to Galli Galli Sim Sim predicted p < .001; follow-up Χ2(4, N = 1304) = 273.3, p < .001). We should
endline and follow-up scores for the four (and 18 subcategory) out- note that there were children who saw no Galli Galli Sim Sim at school
comes, the analyses used the hierarchical linear modeling (HLM) ap- who were in either the low or high receptivity groups, suggesting home
proach. HLM is a modeling technique that is often used when ob- viewing of Galli Galli Sim Sim. At endline, among those in the control
servations are nested within different levels. It is preferred over other viewing group of 464 children who saw no Galli Galli Sim Sim at school,
regression techniques when analyzing nested data because it accounts 89%, 10%, and 1% were in the no, low, and high receptivity groups,

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D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

Table 1
Key demographic and media exposure variables (n = 1304).
Baseline Endline Follow-up

a b c
Total N (%) No N (%) Low N (%) High N (%) Sig Diff? Noa N (%) Lowb N (%) Highc N (%) Sig Diff?

Sex
Female 613 (47) 315 (48) 186 (48) 112 (42) 402 (47) 164 (47) 47 (42)
Male 691 (53) 340 (52) 199 (52) 152 (57) Χ2 = 2.8, NS 441 (52) 186 (53) 64 (58) Χ2 = 1.2, NS

Age
4 years and younger 414 (32) 206 (31) 140 (36) 68 (25) 79 (9) 39 (11) 9 (8)
5 years 489 (38) 252 (38) 137 (36) 100 (38) 273 (32) 106 (30) 37 (33)
2
6 years and older 401 (31) 197 (30) 108 (28) 96 (36) Χ = 9.5* 491 (58) 205 (59) 65 (59) Χ2 = 1.5, NS

SEC Category
A and B 470 (36) 240 (37) 134 (35) 97 (37) 320 (38) 119 (34) 32 (29)
C 348 (27) 193 (29) 90 (23) 65 (25) 224 (27) 96 (27) 28 (25)
D and E 387 (30) 173 (26) 133 (35) 84 (32) 239 (28) 109 (31) 42 (38)
Missing 98 (8) 49 (7) 28 (7) 18 (7) Χ2 = 10.0, NS 60 (7) 26 (7) 9 (8) Χ2 = 6.3, NS

How often do you watch TV?


Less than once a day 184 (14) 61 (9) 43 (11) 32 (12) 103 (22) 68 (19) 37 (33)
Once a day 466 (36) 264 (40) 140 (36) 125 (47) 335 (40) 139 (40) 34 (31)
Several times a day 654 (50) 330 (50) 202 (52) 107 (41) Χ2 = 11.5* 405 (48) 143 (41) 40 (36) Χ2 = 38.2***

Can name Doraemon?


No 431 (33) 182 (28) 104 (27) 48 (18) 181 (21) 69 (20) 8 (7)
Yes 873 (67) 473 (72) 281 (73) 216 (82) Χ2 = 9.7** 662 (79) 281 (80) 103 (93) Χ2 = 12.6*

Have you ever seen GGSS?


No 1035 (79) 325 (50) 86 (22) 30 (11) 372 (44) 89 (25) 6 (5)
Yes 269 (21) 330 (50) 299 (68) 234 (87) Χ2 = 155.2*** 471 (56) 261 (75) 105 (95) Χ2 = 86.4*

Can name Chamki?


No 1285 (99) 355 (100) 140 (36) 32 (12) 843 (100) 173 (49) 11 (10)
Yes 19 (1) 0 (0) 245 (63) 232 (88) Χ2 = 799.8*** 0 (0) 177 (51) 100 (90) Χ2 = 799.8***
M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)
Non-GGSS characters named 3.36 (1.80) 2.62 (1.46) 2.84 (1.70) 3.67 (1.80) F = 40.9*** 3.07 (1.51) 3.66 (1.71) 5.33 (1.72) F = 104.5***
GGSS characters named 0.01 (0.35) 0 (0) 1.38 (0.48) 4.18 (1.31) F = 3929.7*** 0 (0) 1.29 (0.45) 3.81 (1.08) F = 808.7***

NS, non-significant, ~p < .10, *p < .05, **p < .01, ***p < .001.
a
No refers to a child being unable to name any GGSS characters, blow receptivity refers to a child being able name one or two GGSS characters, and chigh receptivity
refers to a child naming 3 or more GGSS characters.

respectively. In the Galli Galli Sim Sim-only viewing group at endline, scores increased over time except for the socio emotional variable. All
17%, 36%, and 46% were in the no, low, and high receptivity groups, baseline scores were significantly (moderate and positive) associated
respectively. with endline and follow-up scores. Baseline literacy scores were cor-
Table 2 provides the overall raw means and standard deviations for related with endline (r(1,302) = 0.61, p < .001) and follow-up (r
the various outcomes at baseline, and by receptivity group at endline (1,302) = 0.51, p < .001) literacy scores. Baseline numeracy scores
and follow-up. At baseline, there were no significant differences across were correlated with endline (r(1,302) = 0.58, p < .001) and follow-
receptivity groups for overall literacy. There were slight differences for up (r(1,302) = 0.52, p < .001) numeracy scores. Baseline socio-emo-
overall numeracy baseline scores (F(2, 1301) = 8.2, p = .003), with the tional scores were correlated with endline (r(1,302) = 0.23, p < .001)
no (M = 13.3; SD = 5.8) and high (M = 13.4; SD = 6.3) receptivity and follow-up (r(1,302) = 0.18, p < .001) socio-emotional scores.
groups being slightly greater than the low (M = 12.0; SD = 6.7) group. Table 3 offers the results of the HLM models predicting the overall
The socio-emotional baseline scores also differed significantly (F(2, outcomes at endline and Table 4 shows similar models at follow-up.
1301) = 3.3, p = .034), with the no (M = 3.9; SD = 1.6) group being These tables offer standardized coefficients for each variable. All
greater than the low (M = 3.6; SD = 1.6) and high (M = 3.7; SD = 1.7) models used identical approaches and included passage of time, sex,
receptivity groups. (The health score data was not available at base- age, SEC level, class type, baseline score for the construct, non-Galli
line). For the overall scores and most of the subscores, the raw mean Galli Sim Sim receptivity, and Galli Galli Sim Sim receptivity. Models

Table 2
Outcomes by receptivity category (n = 1304).
Scores Baseline Endline Follow-up

Overall Noa Lowb Highc Noa Lowb Highc

Mean (SD) Mean (SD) Mean (SD) Mean (SD) Fstat Mean (SD) Mean (SD) Mean (SD) Fstat

Literacy 12.7 (6.2) 15.3 (5.8) 15.7 (5.8) 18.1 (4.7) 24.9*** 16.1 (5.9) 17.5 (5.4) 20.1 (4.8) 25.7***
Numeracy 13.0 (6.2) 15.1 (4.8) 16.4 (4.7) 18.1 (3.7) 16.9*** 16.9 (5.2) 18.0 (4.3) 18.3 (3.6) 8.6***
Socio-Emotional 3.74 (1.6) 3.47 (1.9) 3.71 (1.9) 4.2 (1.9) 15.7*** 3.5 (1.9) 3.8 (2.1) 4.4 (2.1) 12.7***
Health NA 8.9 (3.3) 9.6 (3.1) 10.3 (3.1) 18.5*** 10.0 (3.3) 10.4 (3.3) 11.3 (3.1) 8.5***

NS, non-significant, ~p < .10, *p < .05, **p < .01, ***p < .001.
a
No refers to a child being unable to name any GGSS characters, blow receptivity refers to a child being able name one or two GGSS characters, and chigh receptivity
refers to a child naming 3 or more GGSS characters.

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D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

Table 3
Predicting endline literacy, numeracy, socio-emotional, and health scores (N = 1304).
Predictors Literacy Numeracy Socio-Emotional Health

Std. β Std. β Std. β Std. β

Intercept −0.25 *** −0.24 *** −0.36 *** −0.12 ~


Time 0.20 *** 0.25 *** −0.01 NS 0.13 ***
Sex (Males vs. Females) −0.05 ** −0.04 * −0.04 NS −0.01 NS
Age 0.02 * 0.03 *** 0.07 *** 0.00 NS
SEC Level
SEC Level C vs. A & B 0.01 NS 0.02 NS −0.03 NS 0.01 NS
SEC Level D & E vs. A & B 0.01 NS −0.04 NS 0.00 NS 0.02 NS
Class
Kindergarten vs. Nursery 0.14 *** 0.12 *** 0.01 NS 0.04 NS
Mixed vs. Nursery 0.13 ** 0.04 NS 0.02 NS 0.03 NS
Baseline Score 0.67 *** 0.64 *** 0.40 *** 0.61 ***
Non GGSS Receptivity 0.12 *** 0.13 *** 0.10 *** 0.09 ***
Receptivity Groups
Lowb vs. Noa 0.13 *** 0.11 *** 0.08 ** 0.12 **
Highc vs. Noa 0.20 *** 0.14 *** 0.13 ** 0.17 ***

NS, non-significant, ~p < .10, *p < .05, **p < .01, ***p < .001.
a
No refers to a child being unable to name any GGSS characters, blow receptivity refers to a child being able name one or two GGSS characters, and chigh receptivity
refers to a child naming 3 or more GGSS characters.

predicting the sub-categorical outcomes at endline and follow-up are receptivity, when comparing to no receptivity. Table 5 offers the Co-
available from the corresponding author. hen's d and percent increase effect sizes, not only for the overall con-
Several trends emerged in the models. Except for the overall socio- struct but also for the subcategories at endline and follow-up. Here, the
emotional outcome, time was significant in each of the models in- Cohen's d and effect sizes are generally small, with the largest effect
dicating that children performed better (as they got older) on the dif- being with overall literacy at the endline assessment. When controlling
ferent assessments. Sex was a significant predictor with females out- for all other factors, a child having high receptivity to Galli Galli Sim Sim
performing males in literacy, numeracy, and socio-emotional (but not will score, on average, 13% higher on the overall literacy outcome
health). In all but the health model, age was a significant predictor, compared to a child having no receptivity. Under literacy, the sub-
with older children tending to do better than younger children. Across categories of English and Hindi letter start had the greatest gains. For
all the models, SEC level was not a significant predictor. One's school the numeracy subcategories, receptivity was associated with improved
class type (i.e., kindergarten, mixed classes, or nursery) was a sig- performance on the shape recognition assessments. Identifying strate-
nificant predictor in several models with kindergarten and mixed class gies drove the improvements for the socio-emotional variable, as
types doing better than nursery level classes in literacy. Being in a naming emotions was either negative or non-significant.
kindergarten class versus a nursery class predicted numeracy, while As mentioned, additional analyses were run upon the request of the
controlling for the other variables. Not surprisingly, a child's score at funders and the producers of Galli Galli Sim Sim. We estimated models
baseline was a significant predictor in each of the models. Lastly, non- using the group intervention assignment (control, low, and high) as a
Galli Galli Sim Sim receptivity was significantly associated with higher dummy variable, controlling for time, sex, SEC level, class, and baseline
scores on all the outcomes. score. When it was significant, this variable was only a weak predictor
Receptivity to Galli Galli Sim Sim was a significant predictor for all of the outcome scores. At endline and follow-up, low exposure versus
the measured outcomes, controlling for the aforementioned variable control intervention groups approached significance for predicting
set. In every model, high receptivity had a larger coefficient than low overall literacy scores but not for high versus control for either. For

Table 4
Predicting follow-up literacy, numeracy, socio-emotional, and health scores (N = 1304).
Predictors Literacy Numeracy Socio-Emotional Health

Std. β Std. β Std. β Std. β

Intercept −0.27 *** −0.26 *** −0.35 *** −0.22 **


Time 0.23 *** 0.26 *** −0.01 NS 0.19 ***
Sex (males vs. females) −0.07 ** −0.05 * −0.07 NS −0.01 NS
Age 0.02 * 0.02 *** 0.06 *** 0.01 NS
SEC level
SEC Level C vs. A & B −0.01 NS 0.00 NS −0.03 NS 0.00 NS
SEC Level D & E vs. A & B 0.01 NS −0.03 NS −0.00 NS 0.03 NS
Class
Kindergarten vs. nursery 0.18 *** 0.18 *** 0.07 NS 0.15 NS
Mixed vs. nursery 0.19 ** 0.11 NS 0.07 NS 0.11 NS
Baseline score 0.60 *** 0.59 *** 0.32 *** 0.46 ***
Non GGSS receptivity 0.14 *** 0.12 *** 0.14 *** 0.11 ***
Receptivity groups
Lowb vs. noa 0.13 *** 0.15 *** 0.08 ** 0.10 **
Highc vs. noa 0.25 *** 0.19 *** 0.15 ** 0.18 ***

NS, non-significant, ~p < .10, *p < .05, **p < .01, ***p < .001.
a
No refers to a child being unable to name any GGSS characters, blow receptivity refers to a child being able name one or two GGSS characters, and chigh receptivity
refers to a child naming 3 or more GGSS characters.

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D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

Table 5
Cohen's d and effect sizes (% increase) associated with GGSS Receptivity, for the full sample at endline and follow-up.
Modified Cohen's d Effect Sizes % Increase

Endline Follow-Up Endline Follow-Up

Lowa Highb Lowa Highb Lowa Highb Lowa Highb

Literacy
Overall literacy score 0.24 0.37 0.14 0.28 10% 13% 6% 11%
Hindi letter recognition NS NS 0.06 0.10 NS NS 4% 6%
Hindi letter word start 0.12 0.12 0.09 0.14 12% 16% 8% 13%
Sign recognition 0.08 0.09 0.07 0.20 11% 14% 13% 24%
Word on the street 0.11 0.27 0.14 0.27 3% 6% 4% 7%
English letter recognition NS 0.12 0.07 0.19 NS 6% 3% 8%
English letter word start 0.22 0.23 0.17 0.33 14% 22% 10% 18%

Numeracy
Overall numeracy score 0.15 0.20 0.18 0.24 5% 6% 6% 7%
Identifying numbers 0.07 NS 0.16 0.17 2% NS 7% 8%
Number recognition NS NS 0.12 0.10 NS NS 6% 5%
Enumeration 0.11 0.18 0.15 0.23 3% 5% 5% 8%
Shape recognition 0.22 0.39 0.09 0.21 12% 23% 4% 10%
Spatial understanding 0.16 0.18 0.20 0.21 7% 8% 6% 8%
Patterns NS NS 0.09 0.13 NS NS 6% 9%

Socio-emotional
Overall socio-emotional score 0.06 008 0.01 0.03 5% 7% 4% 8%
Naming emotions NS NS NS −0.07 NS NS NS −5%
Identifying strategies 0.11 0.17 0.21 0.22 7% 11% 7% 14%

Health
Sorting food 0.13 0.18 0.10 0.19 5% 6% 4% 7%

NS, non-significant.
a
Low receptivity refers to a child being able name one or two GGSS characters, and bhigh receptivity refers to a child naming 3 or more GGSS characters.

overall numeracy, high exposure versus control approached sig- Tanzania, when researchers used a similar analytic model, also con-
nificance at only the endline assessment. The high exposure versus the trolling for the baseline construct score and general media receptivity,
control was a significant predictor of the socio-emotional score at receptivity to Kilimani Sesame significantly predicted higher scores for
endline, but only approached significance at follow up. Lastly, high literacy, numeracy, social and emotional development, and health
exposure versus control approached significance at endline and follow (Borzekowski & Macha, 2010). Observed effect sizes reported in this
up for the health/food sorting outcome. When we created models using study of Galli Galli Sim Sim resemble those recently found in work
both intervention group and reception levels, the intervention groups evaluating another preschool program Akili and Me (produced in Dar es
were never significant, while the reception levels were always sig- Salaam, Tanzania) (Borzekowski, 2018).
nificant predictors. These different analyses are available upon request Exposure to educational programs has a significant and positive
from the corresponding author. impact; however, drastic changes are hardly ever observed. Television
programs can influence children but media does not appear to be cure-
all. Children at this age are at a stage of rapid development and growth.
Discussion Observed gains may reflect a child's readiness to learn and maturity,
and have little to do with seeing and remembering a television show.
This quasi-experimental study, conducted in 99 private preschools Likewise, some children may fail to thrive and media neither harms nor
in Lucknow, India, shows that receptivity to the children's television helps.
program Galli Galli Sim Sim can have a significant, albeit small positive A limitation of this study is that used 30 episodes from one program.
effect on several important early childhood developmental domains, These episodes may not be generalizable to all Galli Galli Sim Sim
including literacy, numeracy, socio-emotional, and health. The most content, but mainly Galli Galli Sim Sim episodes are quite similar across
consistent finding was for the literacy outcome, with children in the episodes and seasons. Consistently, Galli Galli Sim Sim employs many
high receptivity group having a 13% effect size gain at endline and an critical and theoretically-based factors that would predict gains. We
11% gain at follow-up. Weak, although positive and significant, effects believe that Galli Galli Sim Sim's most distinctive feature is its delivery of
were found for overall numeracy, with the greatest gains in the sub- content in Hindi and the inclusion of many culturally relevant elements.
category of shape recognition. Overall socio-emotional scores were Live action pieces are filmed in locations around the country and
impacted by high receptivity to Galli Galli Sim Sim, although driving this puppet skits use Muppet™ characters who look, dress, and act in an
finding was the subcategory component of identifying strategies and Indian style. Local details, such as fabric styles and foods eaten, are
not naming emotions. Only one aspect of health was tested and that embedded in the program. Children's media research shows that if
involved a food sorting exercise. Children who had high receptivity to children are more familiar with a program's features, then they are
Galli Galli Sim Sim did significantly better in identifying sometimes and better able to devote more energy to processing the novel content
anytime foods compared to those with no or low receptivity. (Fisch, 2000), such as new words, numbers, and letters. This is not a
Researchers have done a handful of similar but much smaller stu- surprising finding. Forty years ago, researchers found that children
dies. Many of our findings are comparable. One study found that, in learned more from a televised narrative when their ethnic and social
contrast to those in the control group, Indonesian preschool children class background matched that of the program's characters and situa-
with high exposure to Jalan Sesama had significantly higher scores on tion (Newcomb & Collins, 1979).
literacy, numeracy, safety, and cultural awareness outcomes, but not Another limitation of this study is that it occurred within schools.
the social development outcomes (Borzekowski & Henry, 2011). In

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D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

This is not the typical way children watch television, and it would be Sim Sim affects the assessed outcomes. While we would believe children
interesting to investigate naturalistic home viewing. The school setting, may be directly learning lessons from the content, one finding suggests
however, permitted our research team to control not only what children that other mechanisms may be related to exposure to Galli Galli Sim Sim.
were exposed to but also allowed data collection at several time points Children with high Galli Galli Sim Sim receptivity did 22% better than
from a large sample. children without receptivity on the outcome of English letter recogni-
A critique raised by some is that this research does not use experi- tion. This is curious, as Galli Galli Sim Sim infrequently presents content
mental group as a proxy for exposure. We performed a variety of ana- delivered in English. One possible explanation is that watching Galli
lyses, and found that receptivity more so than intervention exposure Galli Sim Sim may encourage its audience to be more curious and learn
group consistently predicted increases among the outcomes. We are content presented in many educational settings (such as their pre-
advancing that receptivity better isolates who was paying attention to schools or homes.) Exposure to educational media may possibly sti-
the content, not just who was in the room when the material was being mulate learning in different contexts.
presented. As has been done elsewhere, this strict measure of re-
ceptivity requires a child to provide the exact name of a character Conclusion
(Borzekowski, 2018; Borzekowski et al., 2019). We believe receptivity
is more sensitive and specific than other measures. We could have used This study is unlike any other that has ever been conducted to ex-
the question “Have you ever watched the television show Galli Galli Sim amine the impact of children's educational television. The work oc-
Sim?” Participants could say “yes” to such a question, but when one curred in Lucknow, India in almost one hundred preschools. Great care
gives this answer, there is no verification. In contrast, providing a was taken in the conduct of this work, assuring that the design was not
character's name requires not only exposure but also memory of that compromised by threats to its internal validity. Data collection occurred
character. There is no way to respond “Chamki” or “Googly” without at over time, and our team considered immediate as well as slightly
familiarity to those characters. Finally, receptivity also captures delayed impact of a specific program. Great efforts have been made to
viewing outside of the intervention as well as other potential con- collect age- and culturally-appropriate data, which is both valid and
tamination (i.e., seeing promotional materials in the community, reliable. A trained and diligent team successfully re-contacted this di-
sharing songs learned through the programming), where intervention verse sample of vulnerable children, to study television's impact using a
group assignment might not account for such influences. quasi-experimental design. The analysis approach was strict and iso-
Children in the low and high receptivity groups at endline could lated exposure to Galli Galli Sim Sim. While modest, it is clear through
only name on average 1.4 and 4.2 characters, respectively; however, this research that Galli Galli Sim Sim is having a positive effect on the
this is similar to what has been found in other research. Surprisingly, development of young Indian children.
even when there is verifiable exposure, children have difficulty naming Accessible and high quality childhood education is a key component
a show's characters. With a six week intervention study in Tanzania, of global development efforts and a moral imperative (Heckman, 2011;
preschool children who saw 2 or 6 h a week of Kilimani Sesame could Rees, Chai, & Anthony, 2012). That is, investing in children is not only
correctly name only 2.2 or 2.8 characters, respectively (Borzekowski & the right thing to do for their survival and well-being but vital for
Macha, 2010). In a 14-week study of Jalan Sesama in Indonesia, those in creating and sustaining economic development and societal improve-
the low exposure group could name 2.8 characters while those in the ments (Boyden & Dercon, 2012; Heckman, 2011; NAM, 2016; Rees
high exposure group could name 6.1 characters (Borzekowski & Henry, et al., 2012). Early childhood is a critical developmental period, and
2011). Research exploring the TV show Akili and Me found that pre- enriched environments and quality stimulation are of utmost im-
school children in a treatment group (exposure to 5 episodes, each portance (WHO, 2007). Educational media is one platform that can be
shown 4 times over 4 weeks) could only name an average of 1.8 out of 5 used to convey and model information (Kirkorian et al., 2008) parti-
characters (Borzekowski, 2018). cularly when attending school imposes an opportunity cost that can be
A child can know a character without having watched the actual burdensome to the poor families. Through this work, we see that a well-
television show, possibly seeing characters through books, community designed educational television program impacts child development.
activities, or even promotional materials. In studying the receptivity of Broadcast television in developing countries can serve as a cost effective
Galli Galli Sim Sim, this research does not identify how the child came to way to influence and affect learning, especially through educational
know the characters' name. Rather than assume that exposure to the programming designed to increase school readiness and competence
show only came through the media intervention, receptivity allows us among young viewers (Baydar, Kağitҫibaşi, Küntay, & Gökşen, 2008;
to broadly detect if any exposure, be it through the classroom, play- Borzekowski, 2018; Engle et al., 2011; Huston & Wright, 1996). This
ground, or home interactions, affects developmental outcomes. study of Galli Galli Sim Sim, along with the literature on other inter-
Despite small effects, educational media producers should be en- national productions, offer promising support that media can have
couraged. The design of this study left little room for change, as the positive effects, even among some of the world's most vulnerable chil-
employed instruments, protocols, and analyses in this research were dren (Borzekowski, 2018; Kirkorian et al., 2008; Mares & Pan, 2013).
quite rigorous. Most of the variance in the outcomes can be explained
by the child's performance on the baseline measure. We also controlled Contributor Statement
for the passage of time, in which we would expect that these partici-
pating children would improve on these types of measures over the Dr. Borzekowski developed the research proposal. Drs. Borzekowski
period of the experiment and beyond. Not surprisingly, age was a sig- and Howard, along with the assistance of Ms. Mehrotra prepared the
nificant predictor. With this variable we are recognizing that children research protocol and instruments. Dr. Borzekowski submitted and
who are slightly older (five, six and seven year olds) are more ready to obtained clearance from the institutional review board. Dr.
learn material than their younger (three and four year old) peers. The Borzekowski and Ms. Mehrotra hired and trained the researchers. Ms.
models included an assessment of non-Galli Galli Sim Sim character Mehrotra oversaw data collection and data entry. Dr. Borzekowski and
receptivity. This variable detects a type and level of intelligence where Mr. Singpurwalla conducted the data analyses. All authors helped
children see and are able to remember media characters. We feel con- prepare this manuscript and take responsibility for its findings.
fident that observed effects associated with Galli Galli Sim Sim re-
ceptivity suggest that, indeed, seeing and remembering this specific Funding
show results in improved outcomes among a vulnerable population of
Indian children. Research for this article was funded by The Children's Investment
This research does not explain how or why exposure to Galli Galli Fund Foundation (UK) (“CIFF”). The views, opinions, assumptions or

8
D.L.G. Borzekowski, et al. Journal of Applied Developmental Psychology 64 (2019) 101054

any other information set out in this article are solely those of the au- Lawrence Earlbaum Associates.
thors and should not be attributed to CIFF or any person connected with Cole, C. F., Arafat, C., Tidhar, C., Tafesh, W. Z., Fox, N. A., Killen, M., & Yung, F. (2003).
The educational impact of Rechov Sumsum/Shara'a Simsim: A sesame street televi-
CIFF. sion series to promote respect and understanding among children living in Israel, the
West Bank, and Gaza. International Journal of Behavioral Development, 27, 409–422.
Acknowledgements https://doi.org/10.1080/01650250344000019.
Cole, C. F., & Lee, J. H. (2016). The sesame effect: The global impact of the longest street in the
world. New York: Routledge.
The authors are grateful for the assistance provided by BGM Policy Dosman, C. F., Andrews, D., & Goulden, K. J. (2012). Evidence-based milestone ages as a
Innovations implementation and data collection research teams framework for developmental surveillance. Paediatric Child Health, 17(10), 561–568.
https://doi.org/10.1093/pch/17.10.561.
(Bangalore, India). As well, we appreciate materials provided by Engle, P. L., Fernald, L. C., Alderman, H., Behrman, J., O'Gara, C., Yousafzai, A., ... Iltus,
Sesame Workshop India (Delhi, India). S. (2011). Strategies for reducing inequalities and improving developmental out-
comes for young children in low-income and middle-income countries. The Lancet,
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