Using Mobile Health to Promote Early Language Development: A Narrative Review

Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial

BACKGROUND

Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies.

OBJECTIVE

The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot.

METHODS

This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools.

RESULTS

Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024.

CONCLUSIONS

This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50371.

A Randomized Controlled Trial Assessing the Effectiveness of the Háblame Bebé Mobile Application With Spanish-Speaking Mothers Experiencing Economic Hardship

PURPOSE

This study examined the effectiveness of a standalone mobile application (app), Háblame Bebé, for use in real-world settings without supplemental human interaction to promote Spanish-speaking mothers' language interactions with their young children and associated child bilingual (Spanish-English) language development.

METHOD

Thirty-seven Spanish-speaking Latina mothers with lower incomes and their children were randomly assigned to experimental and wait-list control groups for 12 weeks. The experimental group was introduced to the app to learn how to provide language-promoting strategies in the home language and encouraged to use the app to track child vocabulary growth and overall development. Mother and child outcomes were measured before and after intervention via standardized assessments, direct observations, and parent report. Engagement and social validity data were also gathered.

RESULTS

No statistically significant differences were identified between experimental and control groups. However, looking at the magnitude of the difference between groups, child outcomes consistently favored the experimental group (d = 0.2-0.4). Mothers reported high levels of acceptance of the intervention.

CONCLUSIONS

Culturally and linguistically responsive app-based interventions have the potential to serve as a unique delivery model for speech-language pathologists and other professionals to share critical information on bilingual language development with parents of young children who are learning in a bilingual context. Clinical and research implications are discussed, including the consideration that low-intensity interventions may need to be paired with ongoing parent coaching.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18461585.

Household food insecurity and early childhood development in Brazil: an analysis of children under 2 years of age

OBJECTIVE

To determine if household food insecurity (HFI) is associated with the risk of developmental delays.

DESIGN

Cross-sectional study of a representative sample of children under 2 years old. Risk of developmental delays was assessed with the Denver Developmental Screening Test II. HFI was measured with the Brazilian Food Insecurity Measurement Scale. Multivariable logistic regression was used to test the association between HFI (food secure/insecure) and risk of developmental delays, adjusting for household, maternal and child variables.

SETTING

Community Health Centers in the Federal District, Brazil.

PARTICIPANTS

1004 children under 2 years old.

RESULTS

Among participants, 15 % were at risk of developmental delays and about 40 % of children lived in food-insecure households. HFI was associated with the risk of developmental delays (adjusted OR 2·61; 95 % CI 1·42, 4·80) compared with food-secure households after adjusting for key confounders.

CONCLUSIONS

HFI was strongly associated with the risk of developmental delays in children under 2 years. Investments that prevent or mitigate HFI are likely to be key for improved human and national development.

An evaluation of the Hear Glue Ear mobile application for children aged 2-8 years old with otitis media with effusion

Objectives

To evaluate the acceptability and usability of the Hear Glue Ear mobile application to guide families and support speech and language development in children with otitis media with effusion (OME). To assess the validity of the app’s game-based hearing test to estimate changes in hearing levels between audiology appointments.

Method

This evaluation examined 60 children aged 2–8 with and without OME, attending Cambridge Community Audiology clinics. Children’s performance in the app’s hearing test was compared to their pure tone average (PTA) obtained in clinic. Children and caregivers completed questionnaires after their first interaction with the app, and after one week of using it at home. 18 clinicians completed anonymous questionnaires after trialling the app.

Results

Results from the app’s hearing test show a significant correlation with clinic PTA values (r22=−0.656,p=0.000251). 73.1% of caregivers supported their child using the app regularly and 85% thought it enabled them to give more accurate reports to clinicians. After one week, 87.0% of families downloaded and used the app at home, and 85.7% of these felt it provided strategies to help their child. 100% of children liked the app and 93.3% found it easy to use. 77.8% of clinicians supported patients using the app regularly.

Conclusions

Hear Glue Ear is acceptable to children, caregivers and clinicians as part of OME management. The app’s hearing test provides a valid estimate of fluctuating hearing levels. Hear Glue Ear is a free, accessible and family-centred intervention to provide trusted information and support development, as NICE guidance recommends.

Enhancement of Neurocognitive Assessments Using Smartphone Capabilities: Systematic Review

BACKGROUND

Comprehensive exams such as the Dean-Woodcock Neuropsychological Assessment System, the Global Deterioration Scale, and the Boston Diagnostic Aphasia Examination are the gold standard for doctors and clinicians in the preliminary assessment and monitoring of neurocognitive function in conditions such as neurodegenerative diseases and acquired brain injuries (ABIs). In recent years, there has been an increased focus on implementing these exams on mobile devices to benefit from their configurable built-in sensors, in addition to scoring, interpretation, and storage capabilities. As smartphones become more accepted in health care among both users and clinicians, the ability to use device information (eg, device position, screen interactions, and app usage) for subject monitoring also increases. Sensor-based assessments (eg, functional gait using a mobile device's accelerometer and/or gyroscope or collection of speech samples using recordings from the device's microphone) include the potential for enhanced information for diagnoses of neurological conditions; mapping the development of these conditions over time; and monitoring efficient, evidence-based rehabilitation programs.

OBJECTIVE

This paper provides an overview of neurocognitive conditions and relevant functions of interest, analysis of recent results using smartphone and/or tablet built-in sensor information for the assessment of these different neurocognitive conditions, and how human-device interactions and the assessment and monitoring of these neurocognitive functions can be enhanced for both the patient and health care provider.

METHODS

This survey presents a review of current mobile technological capabilities to enhance the assessment of various neurocognitive conditions, including both neurodegenerative diseases and ABIs. It explores how device features can be configured for assessments as well as the enhanced capability and data monitoring that will arise due to the addition of these features. It also recognizes the challenges that will be apparent with the transfer of these current assessments to mobile devices.

RESULTS

Built-in sensor information on mobile devices is found to provide information that can enhance neurocognitive assessment and monitoring across all functional categories. Configurations of positional sensors (eg, accelerometer, gyroscope, and GPS), media sensors (eg, microphone and camera), inherent sensors (eg, device timer), and participatory user-device interactions (eg, screen interactions, metadata input, app usage, and device lock and unlock) are all helpful for assessing these functions for the purposes of training, monitoring, diagnosis, or rehabilitation.

CONCLUSIONS

This survey discusses some of the many opportunities and challenges of implementing configured built-in sensors on mobile devices to enhance assessments and monitoring of neurocognitive functions as well as disease progression across neurodegenerative and acquired neurological conditions.

Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study

Background

Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone–aided interventions have a great potential to improve early childhood development.

Objective

This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China.

Methods

We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge.

Results

The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health.

Conclusions

The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability.

Household food insecurity and early childhood development: Systematic review and meta-analysis

Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta-analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer-reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta-analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta-analysis. Of the studies, 15 were from high income countries (HICs) and four from low-middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta-analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs.

Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study

BACKGROUND

Only 30% of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents.

OBJECTIVE

This study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers.

METHODS

Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George's County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents' Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County's Infants and Toddlers Program met with or called participants whose results indicated that their infants "may be behind."

RESULTS

Eighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was "doing well" in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was "doing well" and one or more domains where their baby "may be behind" (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as "very good" or "good."

CONCLUSIONS

A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants "may be behind." Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby.