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

Interactive Malaysian Childhood Healthy Lifestyle (i-MaCHeL) programme: a single-arm pilot study

BACKGROUND

The growing obesity epidemic in Malaysia presents a public health challenge that requires innovative intervention strategies. In an effort to address this problem, an Interactive Malaysian Childhood Healthy Lifestyle (i-MaCHeL) programme, which is a web-based initiative designed for preschool child-parent dyads offers a novel approach. Nevertheless, the success of such a web-based intervention depends on several interrelated factors. This research aims to examine the feasibility of i-MaCHeL in the Malaysian context, its usability for preschool child-parent dyads, and the acceptability of the programme among these user groups.

METHODS

This was a single-arm pilot study involving 46 child-parent dyads recruited from six government preschools in Terengganu, Malaysia. The preschools were selected using a cluster random sampling technique at the preschool level. The intervention feasibility was determined based on the retention rate of participants in the pilot study. The System Usability Scale (SUS) and intervention process evaluation were used to assess the usability and acceptability of the web-based i-MaCHeL programme.

RESULTS

The retention data demonstrated that 42 out of 46 participants completed the 13-week intervention programme, which showed that the overall retention rate was 91.3%. A mean (SD) SUS score of 84.70 (13.82) was obtained from parents, indicating that the web-based i-MaCHeL had an acceptable usability level. The mean scores of the process evaluation items ranged from 4.52 (0.63) to 4.83 (0.38), demonstrating that the web-based i-MaCHeL was highly accepted by the parents. The acceptability data also indicated that at least 92.9% (39/42) of the parents agreed/strongly agreed that the web content, programme duration, intervention dose, WhatsApp group, and delivery mode were appropriate.

CONCLUSIONS

According to these findings, the i-MaCHeL intervention using a web-based approach was feasible, usable, and acceptable as part of a weight-related behaviour change intervention for preschool child-parent dyads. This pilot study demonstrated that the web-based i-MaCHeL was feasible and promising for delivering weight-related behavioural intervention to child-parent dyads.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04711525 . Registered on January 15, 2021.

A realist review of digitally delivered child development assessment and screening tools: Psychometrics and considerations for future use

BACKGROUND

Developmental screening improves the detection of developmental concerns, yet numerous children are not screened/assessed. Remote child developmental tool administration has been utilized to increase screening and assessment accessibility.

METHOD

We conducted a realist review to: (1) identify existing multi-domain child development assessment and screening tools for children 0-5 years; (2) review psychometric data on their digital (i.e., only administered remotely) administration; and (3) explore contextual factors relevant to their digital administration. We searched APA PsycInfo, MEDLINE, CINAHL, and ERIC to identify tools and papers on their psychometrics. We reference-searched included articles and searched Google for relevant grey literature.

RESULTS

Of 33 multi-domain child development tools identified in objective one, five tools (in five studies) were delivered digitally and compared to traditional (e.g., paper) delivery (i.e., objective two). Studies evaluated within-group equivalence reliability (k = 2) and between-group equivalence (k = 3). Within-group equivalence reliability was established for the Vineland Adaptive Behavior Scales, and domains (e.g., gross motor) of the Ages and Stages Questionnaires 2nd edition (ASQ-2) and Revised Prescreening Denver Questionnaire (R-PDQ). Between group equivalence was demonstrated for Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-II) subtests and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3) items. In another between group evaluation, web-based and paper versions of the ASQ-2 were deemed generally equivalent. Digital Bayley-3 inter-observer reliability ranged from 0.82 to 1.0. Examiner support, time, tool modifications, family resources, and comfort promotion supported digital administration.

CONCLUSION

Digitally delivered ASQ-2, R-PDQ, Vineland, and Bayley-3 and NEPSY-II components show promise for equivalence with traditional administration.

A novel wide scale well-baby clinic mobile application: an Egyptian pilot study

BACKGROUND

Utilization of under 5-year-old child healthcare services in Egypt is considered low, the highest proportion of well-baby visits is mainly for immunization in the first 2 years of age. Mobile health (mHealth) interventions have the potential to be a useful and low-cost way to disseminate information about proper nutrition, can be used to monitor children's growth using the official charts of World Health Organization, can also help in accessing vaccine-related information and schedules.

OBJECTIVES

To assess needs and requirements for a new comprehensive well-baby clinic mobile application (app) covering well-baby clinic service components. Thereafter, to develop the app prototype and validate it.

METHODS

This study was conducted in four phases: User requirements, development, validation and usage. In user requirement phase, the need for the new app was assessed by performing literature review, market app research and an online survey. In development phase, we developed the novel well-baby clinic app that constituted all well-baby clinic services for children's health monitoring relying on evidence-based information and honoring data safety. In validation phase, after a series of testing, the app was validated using Mobile app rating scale (MARS) by public health and pediatrics consultants to assess its quality. Finally, the app was launched and made available to the public on Android platform.

RESULTS

Sehhat Tefly app was developed based on the demands and requirements of mothers of under 5-year-old children. The app constituted caregiver, child information and seven service elements: physical growth, developmental milestones, immunizations, nutrition, teething, safety & emergency measures and report. The app quality mean was rated 3.7 out of 5 by the panel of experts. The app was downloaded 1445 times in a 4 month period.

CONCLUSIONS

Sehhat Tefly app can meet the need for a free, easy and accessible tool for caregivers to track the progress of children's development and wellbeing. It can also provide advice for referral to physician consultation in case of deviation from normal measures.

Early childhood tracking application: Correspondence between crowd-based developmental percentiles and clinical tools

Barriers to child developmental screening lead to delayed diagnosis and intervention. babyTRACKS, a mobile application for tracking developmental milestones, presents parents their child's percentiles computed relative to crowd-based data. This study evaluated correspondence between crowd-based percentiles and traditional development measures. Research analyzed babyTRACKS diaries of 1951 children. Parents recorded attainment age for milestones across Gross Motor, Fine Motor, Language, Cognitive, and Social domains. Fifty-seven parents completed the Ages and Stages Questionnaire (ASQ-3), and 13 families participated in the Mullen Scales of Early Learning (MSEL) expert assessment. Crowd-based percentiles were compared with: Centers for Disease Control (CDC) norms for comparable milestones, ASQ-3 and MSEL scores. babyTRACKS percentiles correlated with the percentage of unmet CDC milestones, and with higher ASQ-3 and MSEL scores across several domains. Children who did not meet CDC age thresholds had lower babyTRACKS percentiles by about 20 points and those at ASQ-3 risk had lower babyTRACKS Fine Motor and Language scores. Repeated measures tests showed significantly higher MSEL versus babyTRACKS percentiles in the Language domain. Although ages and milestones in diary varied, the app percentiles corresponded with traditional measures, particularly in fine motor and language domains. Future research is needed for determining referral thresholds while minimizing false alarms.

mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review

BACKGROUND

Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations.

OBJECTIVE

In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity.

METHODS

We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions.

RESULTS

Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields.

CONCLUSIONS

To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations.

TRIAL REGISTRATION

PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2.

The feasibility of a crowd-based early developmental milestone tracking application

Objective

Parents’ tracking of developmental milestones can assist healthcare providers with early detection of developmental delays and appropriate referrals to early intervention. Crowdsourcing is one way to update the content and age data distribution of developmental checklists for parents and providers. This feasibility study examined which developmental milestones parents chose to track and what they added beyond traditional milestones, using the babyTRACKS crowd-based mobile app.

Method

We analyzed the developmental diaries of 3,832 children, registered in the babyTRACKS app at an average age of 9.3 months. Their parents recorded a median of 5 milestones per diary, selecting from the accumulating lists of age-appropriate milestones or authoring new milestones. The final database included 645 types of milestones; 89.15% were developmental, of which 43.6% were comparable to the Centers for Disease Control (CDC) milestones while the rest were crowd-authored. Milestones were categorized into developmental domains: Gross Motor, Fine Motor, Oral Motor, Self-Care, Cognitive, Language Comprehension, Speech, Non-Verbal Communication, Social, Emotional, and Regulation.

Results

On average, the milestone domains of Gross Motor, Fine Motor, Cognitive and Social were the most added to diaries (20%-30% of a diary). Within the Cognitive, Speech and Language Comprehension domains there were significantly more CDC comparable versus crowd-authored milestones (29% versus 21%, 22% versus 10%, 8% versus 4%). In contrast, within the Regulation and Oral Motor domains there were more crowd versus CDC milestones (17% versus 3%, 9% versus 3%). Crowd-authored Speech milestones were significantly older by 7 months than CDC milestones.

Conclusion

Tracking daily observations of child development provides a window into personally relevant milestones for the child and parent. The crowd of parents can independently track and add new milestones across main developmental domains. Regulation and Oral Motor development especially interest parents. Parents may be less aware of early progress in Language Comprehension and Speech; thus, these domains require more structured screening. Designing mobile early screening which is crowd-based engages parents as proactive partners in developmental tracking.

mHealth developmental screening for preschool children in low-income communities

Children are often only identified with a developmental delay when they enter primary school due to developmental delays hindering academic progress. Detection of at-risk children in low-income communities is typically unavailable due to several challenges. This study validated an mHealth-based developmental screening tool as a potential time- and cost-effective way of delivering services for preschool children. This cross-sectional within-subject study screened 276 preschool children from low-income communities using the mHealth Parents' Evaluation of Developmental Status (PEDS) tools. The mHealth PEDS tools' performance was then evaluated by comparing caregiver concerns according to the PEDS tools with results obtained using a reference standard assessment tool, the Vineland-3. The mHealth PEDS tools identified 237 (85.9%) of children at risk of developmental delay compared to 80.1% (n = 221) of children identified with a developmental delay using the Vineland-3. Sensitivity of the PEDS tools was high (92.6%) with low specificity (22.5%) using US standardised criteria. Literacy skills were found to be most delayed, according to the PEDS: DM (89.3%; n = 142) and Vineland-3 (87.1%; n = 134). Low specificity of the prescribed criteria may require the implementation of adapted referral criteria within low socio-economic status (SES) settings. The mHealth PEDS tools may still be valuable for preschool developmental surveillance of children within low SES settings. It is recommended, however, that children who are identified with a developmental concern undergo a second screen to reduce false positives.