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Smartphone-based support for early childhood development in a rural low-resource setting: an individually randomised
Scott Tschida1, Eva Leticia Tuiz2, Duglas López2
1Center for Indigenous Health Research, Maya Health Alliance, Guatemala, Chimaltenango Department, Guatemala scott.tschida@wuqukawoq.org.
Objective:
To test the feasibility of a smartphone app, BebeApp, that provides evidence-based early childhood development (ECD) guidance in rural Guatemala and pilot procedures for an adequately powered randomised controlled trial.
Design:
We conducted an individually randomised pilot feasibility trial to compare BebeApp to printed ECD guidance.
Setting:
This trial was conducted in Tecpán, Chimaltenango, a semi-rural community that is 95% Kaqchikel Indigenous Maya.
Patients:
First-time primary caregiver-infant (0-28 days) dyads.
Interventions:
BebeApp provides age-dependent, evidence-based caregiver guidance for breastfeeding and complementary feeding, sleep and developmental support.
Main Outcome Measures:
A mixed-methods evaluation of BebeApp's implementation and acceptability using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. App usability, usefulness and satisfaction were assessed via questionnaires, semi-structured interviews and app interaction data.
Results:
41 infant-caregiver dyads were enrolled with 40 completing the study. Engagement was high with caregivers opening BebeApp a median (IQR) 11 (6-21) times per month. Usability was found to be acceptable but no difference was found between pre-measurements and post-measurements. In interviews, caregivers expressed some initial difficulty using BebeApp but were able to gain confidence with a training session. App usefulness and satisfaction responses were positive. Caregivers often noted that BebeApp was their only source of ECD information outside of their family.
Conclusions:
We found that caregivers in rural Guatemala responded positively to a smartphone ECD app and engaged with it throughout the trial. Given the urgent need for ECD programmes in low- and middle-income settings, smartphone apps may be a method to deliver services directly to caregivers.
