Parental engagement and implementation fidelity in a mHealth motor skills intervention for young children

Mobile apps (i.e., mHealth) provide unprecedented opportunity for widespread dissemination of health behavior programs. However, for programs directed towards young children, parental engagement may explain differing results of mHealth programs. Within the context of an app-based fundamental motor skill (FMS) intervention that improved children's motor skills (PLAY), this paper examines parents' fidelity to the intervention and the extent to which fidelity was related to children's motor skill improvements.

In the PLAY trial, 72 children aged 3-5 years were randomized for their parents to access a Motor Skills app or Free Play app for a 12-week intervention. The Motor Skills app contained lessons, videos, and activity breaks totaling 1 hour/week of directed FMS instruction by the parent to the child over a 12-week period. The Free Play app was similar in appearance and format but focused on unstructured physical activity. Children's FMS were evaluated with the Test of Gross Motor Development (TGMD-3) at baseline, 12-weeks, and 24-week follow-up. Implementation fidelity data included dosage completed (activity breaks completed), parental engagement (duration of video views), and quality of intervention delivery (feasibility and acceptability). Dosage and engagement were dichotomized within the Motor Skills condition into high vs. low. Linear mixed effects models were used to examine the association of dosage completed and parental engagement with changes in children's FMS both within and between conditions. The level of significance was set at 0.05 for all analyses.

Children completed 70% (8.4 of 12 hours) of the prescribed activity breaks based on parental report in the Motor Skills condition and 87% (10.4 of 12 hours) in the Free Play condition (not significantly different). Parental engagement based on video viewing duration for the Motor Skills condition was on average 8.0 ± 8.6 of the 9.8 available minutes and for the Free Play condition was 5.0 ± 5.5 of the available 18 minutes, with no significant difference between conditions. Parents rated high acceptability and usability for both apps. Children in the Motor Skills condition improved their FMS more than children in the Free Play condition regardless of whether they were classified as receiving high or low dosage or high or low parental engagement.

Parents and children consistently engaged with a 12-week Motor Skills app intervention, and the salience of FMS improvements did not differ by the level of parent fidelity or engagement with the mHealth app. The intervention potency, parental engagement, and dosage completed were sufficient to produce the desired child motor skills improvements.