Through babies' eyes: Practical and theoretical considerations of using wearable technology to measure parent-infant behaviour from the mothers' and infants' view points

Evaluating Users' Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach

BACKGROUND

Wearable devices permit the continuous, unobtrusive collection of data from children in their natural environments and can transform our understanding of child development. Although the use of wearable devices has begun to emerge in research involving children, few studies have considered families' experiences and perspectives of participating in research of this kind.

OBJECTIVE

Through a mixed methods approach, we assessed parents' and children's experiences of using a new wearable device in the home environment. The wearable device was designed specifically for use with infants and young children, and it integrates audio, electrocardiogram, and motion sensors.

METHODS

In study 1, semistructured phone interviews were conducted with 42 parents of children aged 1 month to 9.5 years who completed 2 day-long recordings using the device, which the children wore on a specially designed shirt. In study 2, a total of 110 parents of children aged 2 months to 5.5 years responded to a questionnaire assessing their experience of completing 3 day-long device recordings in the home. Guided by the Digital Health Checklist, we assessed parental responses from both studies in relation to the following three key domains: (1) access and usability, (2) privacy, and (3) risks and benefits.

RESULTS

In study 1, most parents viewed the device as easy to use and safe and remote visits as convenient. Parents' views on privacy related to the audio recordings were more varied. The use of machine learning algorithms (vs human annotators) in the analysis of the audio data, the ability to stop recordings at any time, and the view that the recordings reflected ordinary family life were some reasons cited by parents who expressed minimal, if any, privacy concerns. Varied risks and benefits were also reported, including perceived child comfort or discomfort, the need to adjust routines to accommodate the study, the understanding gained from the study procedures, and the parent's and child's enjoyment of study participation. In study 2, parents' ratings on 5 close-ended items yielded a similar pattern of findings. Compared with a "neutral" rating, parents were significantly more likely to agree that (1) device instructions were helpful and clear (t109=-45.98; P<.001), (2) they felt comfortable putting the device on their child (t109=-22.22; P<.001), and (3) they felt their child was safe while wearing the device (t109=-34.48; P<.001). They were also less likely to worry about the audio recordings gathered by the device (t108=6.14; P<.001), whereas parents' rating of the burden of the study procedures did not differ significantly from a "neutral" rating (t109=-0.16; P=.87).

CONCLUSIONS

On the basis of parents' feedback, several concrete changes can be implemented to improve this new wearable platform and, ultimately, parents' and children's experiences of using child wearable devices in the home setting.

Ecological momentary assessment of parent-child attachment via technological devices: A systematic methodological review

Despite extensive research about parent-child attachment using observational and self-report studies, complementary measures are needed to assess this construct objectively with ecological validity, as well as less obtrusiveness and reactivity than traditional measures. This systematic review describes existing technology-based ecologically momentary assessment (EMA) tools examining attachment-related emotions, cognition, and behaviors between the child and its parents. From the study's inception until March 2021, four databases were searched resulting in 11,910 screened citations. Finally, 18 records were included, characterized by a broad variety of assessment tools, sample characteristics, study designs, and attachment outcomes. Technology-based EMA methods comprised audio, video, diary, and sensory assessment modalities, each occuying its methodological niche. When reported, the psychometric properties of the EMA methods were evaluated as very good; however, the included studies' psychometric data was not completely examined. The main attachment outcomes assessed by EMA were emotional and cognitive reactions and actions of the children, the parents, and the dyad. Cognition was rarely assessed using EMA methods. Future research should focus on the complexity of attachment considering different ethnic backgrounds, multiple caregivers' viewpoints, gender aspects, as well as cognitive and dyadic contents in the naturalistic environment.

Quantifying the efficacy of an automated facial coding software using videos of parents

Introduction

This work explores the use of an automated facial coding software - FaceReader - as an alternative and/or complementary method to manual coding.

Methods

We used videos of parents (fathers, n = 36; mothers, n = 29) taken from the Avon Longitudinal Study of Parents and Children. The videos-obtained during real-life parent-infant interactions in the home-were coded both manually (using an existing coding scheme) and by FaceReader. We established a correspondence between the manual and automated coding categories - namely Positive, Neutral, Negative, and Surprise - before contingency tables were employed to examine the software's detection rate and quantify the agreement between manual and automated coding. By employing binary logistic regression, we examined the predictive potential of FaceReader outputs in determining manually classified facial expressions. An interaction term was used to investigate the impact of gender on our models, seeking to estimate its influence on the predictive accuracy.

Results

We found that the automated facial detection rate was low (25.2% for fathers, 24.6% for mothers) compared to manual coding, and discuss some potential explanations for this (e.g., poor lighting and facial occlusion). Our logistic regression analyses found that Surprise and Positive expressions had strong predictive capabilities, whilst Negative expressions performed poorly. Mothers' faces were more important for predicting Positive and Neutral expressions, whilst fathers' faces were more important in predicting Negative and Surprise expressions.

Discussion

We discuss the implications of our findings in the context of future automated facial coding studies, and we emphasise the need to consider gender-specific influences in automated facial coding research.

A Quantitative Evaluation of Thin Slice Sampling for Parent-Infant Interactions

Behavioural coding is time-intensive and laborious. Thin slice sampling provides an alternative approach, aiming to alleviate the coding burden. However, little is understood about whether different behaviours coded over thin slices are comparable to those same behaviours over entire interactions. To provide quantitative evidence for the value of thin slice sampling for a variety of behaviours. We used data from three populations of parent-infant interactions: mother-infant dyads from the Grown in Wales (GiW) cohort (n = 31), mother-infant dyads from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 14), and father-infant dyads from the ALSPAC cohort (n = 11). Mean infant ages were 13.8, 6.8, and 7.1 months, respectively. Interactions were coded using a comprehensive coding scheme comprised of 11-14 behavioural groups, with each group comprised of 3-13 mutually exclusive behaviours. We calculated frequencies of verbal and non-verbal behaviours, transition matrices (probability of transitioning between behaviours, e.g., from looking at the infant to looking at a distraction) and stationary distributions (long-term proportion of time spent within behavioural states) for 15 thin slices of full, 5-min interactions. Measures drawn from the full sessions were compared to those from 1-, 2-, 3- and 4-min slices. We identified many instances where thin slice sampling (i.e., < 5 min) was an appropriate coding method, although we observed significant variation across different behaviours. We thereby used this information to provide detailed guidance to researchers regarding how long to code for each behaviour depending on their objectives.

Envisioning translational hyperscanning: how applied neuroscience might improve family-centered care

From the very beginning of their life, human beings are immersed in a social and interactive environment that contributes to shaping their social and cognitive development under typical and at-risk conditions. In order to understand human development in its bidirectional relationship with the social environment, we need to develop a 'complexity-sensitive' approach in neuroscience. Recent advances have started to do so with the application of hyperscanning techniques which involve recording adult and child neural activity simultaneously and highlighting the presence of similar patterns of brain activity in the dyad. Numerous studies focused on typically developing children have been published in recent years with the application of this technique to different fields of developmental research. However, hyperscanning techniques could also be extremely beneficial and effective in studying development in atypical and clinical populations. Such application, namely translational hyperscanning, should foster the transition toward a two-brain translational neuroscience. In this paper, we envision how the application of hyperscanning to atypical and clinical child populations can inform family-centered care for children and their parents.

Measuring naturalistic proximity as a window into caregiver-child interaction patterns

The interactions most supportive of positive child development take place in moments of close contact with others. In the earliest years of life, a child's caregivers are the primary partners in these important interactions. Little is known about the patterns of real-life physical interactions between children and their caregivers, in part due to an inability to measure these interactions as they occur in real time. We have developed a wearable, infrastructure-free device (TotTag) used to dynamically and unobtrusively measure physical proximity between children and caregivers in real time. We present a case-study illustration of the TotTag with data collected over two (12-hour) days each from two families: a family of four (30-month-old son, 61-month-old daughter, 37-year-old father, 37-year-old mother), and a family of three (12-month-old daughter, 35-year-old-father, 33-year-old mother). We explored patterns of proximity within each parent-child dyad and whether close proximity would indicate periods in which increased opportunity for developmentally critical interactions occur. Each child also wore a widely used wearable audio recording device (LENA) to collect time-synced linguistic input. Descriptive analyses reveal wide variability in caregiver-child proximity both within and across dyads, and that the amount of time spent in close proximity with a caregiver is associated with the number of adult words and conversational turns to which a child was exposed. This suggests that variations in proximity are linked to-though, critically, not synonymous with-the quantity of a child's exposure to adult language. Potential implications for deepening the understanding of early caregiver-child interactions are discussed.

Validation of an Automated Wearable Camera-Based Image-Assisted Recall Method and the 24-h Recall Method for Assessing Women's Time Allocation in a Nutritionally Vulnerable Population: The Case of Rural Uganda

Accurate data are essential for investigating relationships between maternal time-use patterns and nutritional outcomes. The 24 h recall (24HR) has traditionally been used to collect time-use data, however, automated wearable cameras (AWCs) with an image-assisted recall (IAR) may reduce recall bias. This study aimed to evaluate their concurrent criterion validity for assessing women’s time use in rural Eastern Ugandan. Women’s (n = 211) time allocations estimated via the AWC-IAR and 24HR methods were compared with direct observation (criterion method) using the Bland–Altman limits of agreement (LOA) method of analysis and Cronbach’s coefficient alpha (time allocation) or Cohen’s κ (concurrent activities). Systematic bias varied from 1 min (domestic chores) to 226 min (caregiving) for 24HR and 1 min (own production) to 109 min (socializing) for AWC-IAR. The LOAs were within 2 h for employment, own production, and self-care for 24HR and AWC-IAR but exceeded 11 h (24HR) and 9 h (AWC-IAR) for caregiving and socializing. The LOAs were within four concurrent activities for 24HR (−1.1 to 3.7) and AWC-IAR (−3.2 to 3.2). Cronbach’s alpha for time allocation ranged from 0.1728 (socializing) to 0.8056 (own production) for 24HR and 0.2270 (socializing) to 0.7938 (own production) for AWC-IAR. For assessing women’s time allocations at the population level, the 24HR and AWC-IAR methods are accurate and reliable for employment, own production, and domestic chores but poor for caregiving and socializing. The results of this study suggest the need to revisit previously published research investigating the associations between women’s time allocations and nutrition outcomes.

The headcam mother-infant interaction assessment tool: testing the feasibility and acceptability in Soweto, South Africa, using participatory engagement

BACKGROUND

Many children in low- and middle-income countries lack the stimulation needed to support healthy growth and development. Sensitive interactions between caregivers and infants may promote healthy movement behaviours in infants, which could improve childhood growth and development. However, reliable measures for such interactions require testing in the South African context. The aim of this study was to test the acceptability and feasibility of the headcam caregiver-infant interaction assessment tool in mothers from Soweto, South Africa.

METHODS

Nineteen mother and infant (6-24 months) pairs were asked to wear headcams (first-person observation) while participating in group and individual activities. Detailed instructions on headcam use were provided before and during these activities. Mothers were then asked to use the headcams, as well as photoframe cameras (which provided context of the interactions), in at least three, 5-min mother-infant engagement sessions at home over a 1-week period. Thereafter, focus group discussions (FGDs) were conducted to explore mothers' experiences of using the tool in the home setting. The feasibility of the headcam mother-infant interaction tool was assessed according to a priori criteria which scored (i) technical reliability of the devices and (ii) usability of the recorded footage. Acceptability was assessed according to emerging themes which were coded from the FGDs using a constant comparison method by two researchers.

RESULTS

The headcam mother-infant assessment tool was found to be feasible in Soweto, and sufficient data was available to code. Three main themes emerged from the FGD analysis: use of the headcam, using the headcams in the home environment and using the photoframe vs. the headcam. Mothers remarked on the ease of using the tool across daily activities, the normality of their infant's behaviour during recording and the acceptability by other members of the household. Large amounts of wasted unusable recordings were produced, and challenges related to switching the cameras on and off and to headcam placement were discussed.

CONCLUSIONS

Our study shows that headcams are both an acceptable and feasible method for assessing mother-infant interactions in Soweto. However, improvements to the usability of the tool and the quality of the data collected should be made prior to future work.

Adult responses to infant prelinguistic vocalizations are associated with infant vocabulary: A home observation study

This study used LENA recording devices to capture infants' home language environments and examine how qualitative differences in adult responding to infant vocalizations related to infant vocabulary. Infant-directed speech and infant vocalizations were coded in samples taken from daylong home audio recordings of 13-month-old infants. Infant speech-related vocalizations were identified and coded as either canonical or non-canonical. Infant-directed adult speech was identified and classified into different pragmatic types. Multiple regressions examined the relation between adult responsiveness, imitating, recasting, and expanding and infant canonical and non-canonical vocalizations with caregiver-reported infant receptive and productive vocabulary. An interaction between adult like-sound responding (i.e., the total number of imitations, recasts, and expansions) and infant canonical vocalizations indicated that infants who produced more canonical vocalizations and received more adult like-sound responses had higher productive vocabularies. When sequences were analyzed, infant canonical vocalizations that preceded and followed adult recasts and expansions were positively associated with infant productive vocabulary. These findings provide insights into how infant-adult vocal exchanges are related to early vocabulary development.

Future Directions for Integrative Objective Assessment of Eating Using Wearable Sensing Technology

Established methods for nutritional assessment suffer from a number of important limitations. Diaries are burdensome to complete, food frequency questionnaires only capture average food intake, and both suffer from difficulties in self estimation of portion size and biases resulting from misreporting. Online and app versions of these methods have been developed, but issues with misreporting and portion size estimation remain. New methods utilizing passive data capture are required that address reporting bias, extend timescales for data collection, and transform what is possible for measuring habitual intakes. Digital and sensing technologies are enabling the development of innovative and transformative new methods in this area that will provide a better understanding of eating behavior and associations with health. In this article we describe how wrist-worn wearables, on-body cameras, and body-mounted biosensors can be used to capture data about when, what, and how much people eat and drink. We illustrate how these new techniques can be integrated to provide complete solutions for the passive, objective assessment of a wide range of traditional dietary factors, as well as novel measures of eating architecture, within person variation in intakes, and food/nutrient combinations within meals. We also discuss some of the challenges these new approaches will bring.

Mothers' postpartum sleep disturbance is associated with the ability to sustain sensitivity toward infants

BACKGROUND/OBJECTIVE

Infancy is a period of rapid development when the quality of caregiving behavior may be particularly consequential for children's long-term functioning. During this critical period for caregiving behavior, parents experience changes in their sleep that may affect their ability to provide sensitive care. The current study investigated the association of mothers' sleep disturbance with both levels and trajectories of maternal sensitivity during interactions with their infants.

METHODS

At 18 weeks postpartum, mothers and their infants were observed during a home-based 10-minute "free play" interaction. Mothers' nighttime sleep was objectively measured using actigraphy and subjectively measured using sleep diaries. Maternal sensitivity was coded in two-minute intervals in order to characterize changes in sensitivity across the free play interaction. We used exploratory factor analysis to reduce the dimensionality of the objective and subjective measures of mothers' sleep, identifying a subjective sleep disturbance and an objective sleep continuity factor.

RESULTS

Using multi-level modeling, we found that mothers with poorer objective sleep continuity evidenced decreasing sensitivity toward their infants across the interaction. Mothers' self-reports of sleep disturbance were not associated with maternal sensitivity.

CONCLUSIONS

Although future research is necessary to identify the mechanisms that may explain the observed association between poor sleep continuity and the inability to sustain sensitivity toward infants, mothers' postpartum sleep continuity may be one factor to consider when designing interventions to improve the quality of caregiving.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov, NCT01846585.

The Role of Emotional Valence for the Processing of Facial and Verbal Stimuli-Positivity or Negativity Bias?

Emotional valence is predominately conveyed in social interactions by words and facial expressions. The existence of broad biases which favor more efficient processing of positive or negative emotions is still a controversial matter. While so far this question has been investigated separately for each modality, in this narrative review of the literature we focus on valence effects in processing both words and facial expressions. In order to identify the factors underlying positivity and negativity effects, and to uncover whether these effects depend on modality and age, we present and analyze three representative overviews of the literature concerning valence effects in word processing, face processing, and combinations of word and face processing. Our analysis of word processing studies points to a positivity bias or a balanced processing of positive and negative words, whereas the analysis of face processing studies showed the existence of separate positivity and negativity biases depending on the experimental paradigm. The mixed results seem to be a product of the different methods and types of stimuli being used. Interestingly, we found that children exhibit a clear positivity advantage for both word and face processing, indicating similar processing biases in both modalities. Over the course of development, the initial positivity advantage gradually disappears, and in some face processing studies even reverses into a negativity bias. We therefore conclude that there is a need for future research that systematically analyses the impact of age and modality on the emergence of these valence effects. Finally, we discuss possible explanations for the presence of the early positivity advantage and its subsequent decrease.

Feasibility of wearable cameras to assess screen time and time spent restrained in children aged 3 to 5 years: a study protocol

INTRODUCTION

Wearable cameras may help overcome the limitations of existing tools to measure young children's sedentary behaviour, but their use introduces a range of ethical challenges. The primary aim of this study is to determine the feasibility of using wearable cameras to measure the two aspects of sedentary behaviour currently included in evidence-based guidelines (ie, screen time and time spent restrained). If shown to be feasible, a secondary aim will be to validate subjective measures against the directly measured screen time and time spent restrained.

METHODS AND ANALYSIS

A convenience sample (n=20) will be recruited via flyers at the University of Strathclyde and advertisements on online forums for parents of young children (aged 3 to 5 years). Children will be provided with a wearable camera, attached to the front of their clothing with a clip, to be worn for 3 days (2 non-childcare days and 1 weekend day) in non-public settings. Once switched on, the camera will record continuous video footage. Parents will complete an online survey providing their feedback on their own and their child's experience of the wearable camera. They will also report their own and their child's demographical characteristics and their child's usual daily screen time and time spent restrained in the past week. Data will be downloaded using specialised software and second-by-second coding will be undertaken. Feasibility and acceptability will be assessed using percentages and by analysing qualitative data. If feasibility is shown, intraclass coefficients will be used to determine agreement between video data and parent-reported sedentary behaviours.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the School of Psychological Sciences and Health Ethics Committee at the University of Strathclyde. Results will be used to inform future studies and will be disseminated in peer-reviewed journals and at major international conferences.

The second generation of The Avon Longitudinal Study of Parents and Children (ALSPAC-G2): a cohort profile

Background: The Avon Longitudinal Study of Parents and Children-Generation 2 (ALSPAC-G2) was set up to provide a unique multi-generational cohort. It builds on the existing ALSPAC resource, which recruited 14,541 pregnancies to women resident in the South West of England who were expected to deliver between 01/04/1991 and 31/12/1992. Those women and their partners (Generation 0; ALSPAC-G0) and their offspring (ALSPAC-G1) have been followed for the last 26 years. This profile describes recruitment and data collection on the next generation (ALSPAC-G2)-the grandchildren of ALSPAC-G0 and children of ALSPAC-G1. Recruitment: Recruitment began on the 6 th of June 2012 and we present details of recruitment and participants up to 30 th June 2018 (~6 years). We knew at the start of recruitment that some ALSPAC-G1 participants had already become parents and ALSPAC-G2 is an open cohort; we recruit at any age. We hope to continue recruiting until all ALSPAC-G1 participants have completed their families. Up to 30 th June 2018 we recruited 810 ALSPAC-G2 participants from 548 families. Of these 810, 389 (48%) were recruited during their mother's pregnancy, 287 (35%) before age 3 years, 104 (13%) between 3-6 years and 30 (4%) after 6 years. Over 70% of those invited to early pregnancy, late pregnancy, second week of life, 6-, 12- and 24-month assessments (whether for their recruitment, or a follow-up, visit) have attended, with attendance being over 60% for subsequent visits up to 7 years (to few are eligible for the 9- and 11-year assessments to analyse). Data collection: We collect a wide-range of social, lifestyle, clinical, anthropometric and biological data on all family members repeatedly. Biological samples include blood (including cord-blood), urine, meconium and faeces, and placental tissue. In subgroups detailed data collection, such as continuous glucose monitoring and videos of parent-child interactions, are being collected.

The second generation of The Avon Longitudinal Study of Parents and Children (ALSPAC-G2): a cohort profile

Background: The Avon Longitudinal Study of Parents and Children-Generation 2 (ALSPAC-G2) was set up to provide a unique multi-generational cohort. It builds on the existing ALSPAC resource, which recruited 14,541 pregnancies to women resident in the South West of England who were expected to deliver between 01/04/1991 and 31/12/1992. Those women and their partners (Generation 0; ALSPAC-G0) and their offspring (ALSPAC-G1) have been followed for the last 26 years. This profile describes recruitment and data collection on the next generation (ALSPAC-G2)-the grandchildren of ALSPAC-G0 and children of ALSPAC-G1. Recruitment: Recruitment began on the 6 ^th of June 2012 and we present details of recruitment and participants up to 30 ^th June 2018 (~6 years). We knew at the start of recruitment that some ALSPAC-G1 participants had already become parents and ALSPAC-G2 is an open cohort; we recruit at any age. We hope to continue recruiting until all ALSPAC-G1 participants have completed their families. Up to 30 ^th June 2018 we recruited 810 ALSPAC-G2 participants from 548 families. Of these 810, 389 (48%) were recruited during their mother's pregnancy, 287 (35%) before age 3 years, 104 (13%) between 3-6 years and 30 (4%) after 6 years. Over 70% of those invited to early pregnancy, late pregnancy, second week of life, 6-, 12- and 24-month assessments (whether for their recruitment, or a follow-up, visit) have attended, with attendance being over 60% for subsequent visits up to 7 years (to few are eligible for the 9- and 11-year assessments to analyse). Data collection: We collect a wide-range of social, lifestyle, clinical, anthropometric and biological data on all family members repeatedly. Biological samples include blood (including cord-blood), urine, meconium and faeces, and placental tissue. In subgroups detailed data collection, such as continuous glucose monitoring and videos of parent-child interactions, are being collected.

Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal

BACKGROUND

Populations in low-resource settings with high childhood morbidity and mortality increasingly are being selected as beneficiaries for interventions using passive sensing data collection through digital technologies. However, these populations often have limited familiarity with the processes and implications of passive data collection. Therefore, methods are needed to identify cultural norms and family preferences influencing the uptake of new technologies.

OBJECTIVE

Before introducing a new device or a passive data collection approach, it is important to determine what will be culturally acceptable and feasible. The objective of this study was to develop a systematic approach to determine acceptability and perceived utility of potential passive data collection technologies to inform selection and piloting of a device. To achieve this, we developed the Qualitative Cultural Assessment of Passive Data collection Technology (QualCAPDT). This approach is built upon structured elicitation tasks used in cultural anthropology.

METHODS

We piloted QualCAPDT using focus group discussions (FGDs), video demonstrations of simulated technology use, attribute rating with anchoring vignettes, and card ranking procedures. The procedure was used to select passive sensing technologies to evaluate child development and caregiver mental health in KwaZulu-Natal, South Africa, and Kathmandu, Nepal. Videos were produced in South Africa and Nepal to demonstrate the technologies and their potential local application. Structured elicitation tasks were administered in FGDs after showing the videos. Using QualCAPDT, we evaluated the following 5 technologies: home-based video recording, mobile device capture of audio, a wearable time-lapse camera attached to the child, proximity detection through a wearable passive Bluetooth beacon attached to the child, and an indoor environmental sensor measuring air quality.

RESULTS

In South Africa, 38 community health workers, health organization leaders, and caregivers participated in interviews and FGDs with structured elicitation tasks. We refined the procedure after South Africa to make the process more accessible for low-literacy populations in Nepal. In addition, the refined procedure reduced misconceptions about the tools being evaluated. In Nepal, 69 community health workers and caregivers participated in a refined QualCAPDT. In both countries, the child's wearable time-lapse camera achieved many of the target attributes. Participants in Nepal also highly ranked a home-based environmental sensor and a proximity beacon worn by the child.

CONCLUSIONS

The QualCAPDT procedure can be used to identify community norms and preferences to facilitate the selection of potential passive data collection strategies and devices. QualCAPDT is an important first step before selecting devices and piloting passive data collection in a community. It is especially important for work with caregivers and young children for whom cultural beliefs and shared family environments strongly determine behavior and potential uptake of new technology.