A Mobile App, KhunLook, to Support Thai Parents and Caregivers With Child Health Supervision: Development, Validation, and Acceptability Study

Content and features of Mobile health (mHealth) for mother and child nutrition in the first 1000 days of life (family based intervention): A systematic review

Background: Improving mother and child nutrition during the first 1000 days of life (DoL) is one of the major areas where mHealth has demonstrated great promise. A lot of mHealth is already used in society. However, no study examines the content and features of mobile health. Aim: This study aims to examine the difference in content and features of mHealth intervention for maternal and child nutrition throughout the first 1000 days of life. Thus, new apps can be enhanced. Methods: The online journal databases that offer free papers from Scopus-indexed journals published in 2017-2022 served as the primary sources for the literature included in this study. Several keywords were used in the literature search, which used the databases Google Scholar, Science Direct, and PubMed. A total of 8 articles were included in the literature review. Results: Existing mHealth provides content and features to support and improve the health status of pregnant women, breastfeeding mothers, and children aged 0-24 months. mHealth interventions have the potential to improve maternal and child nutrition health in the first 1000 days of life by providing education, communication, support, data collection and analysis, cultural appropriateness, accessibility, and capacity building for health workers. However, it is crucial to address challenges such as evidence-based design, privacy and security, sustainability, and data management, and to ensure cultural appropriateness and accessibility for all populations. Conclusions: The more complete the content, features, and uses of mHealth, the greater the users' acceptance.

Mobile applications as a strategy to support parents in the care of newborns: a scoping review

OBJECTIVE

To map and describe studies available in the literature about mobile applications to support parents in newborn care and data from applications accessible in online stores.

METHOD

This is a scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The searches were carried out in theses and dissertations databases and portals, in September 2021, and articles, theses, and dissertations were included. An independent search was performed in online stores of applications for operating systems Android and iOS, in October and December 2021, and applications with content to support parents of newborns were selected.

RESULTS

A total of 5,238 studies and 757 applications were found, and of these, 16 and 150, respectively, composed the sample. The topics discussed in the studies were: care, breastfeeding, fever, identification of neonatal diseases, child growth and development. In the applications, the themes found were care, breastfeeding, growth, immunization, development, sleep, tips, and guidelines.

CONCLUSION

Applications are important support tools for parents, as they are an innovative means and accessible to a large part of the population.

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.

Effectiveness of a mobile app, KhunLook versus the maternal and child health handbook on Thai parent’s health literacy, accuracy of health assessments and convenience of use: A randomized controlled trial (Preprint)

BACKGROUND

Children of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents' HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child's health in complement to the standard Maternal and Child Health Handbook (MCHH).

OBJECTIVE

This trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents' HL. Data on accuracy of parents' assessment of their child's health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2).

METHODS

Parents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child's handbook to assess their child's growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire.

RESULTS

A total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; Δ 8.2%; P=.04), specifically in the health management (30/182; Δ 16.4%; P<.001) and child health management (18/182; Δ 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child's head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit.

CONCLUSIONS

Our results suggest the potential of a smartphone app (KhunLook) to improve parents' HL as well as to promote superior accuracy of parents' assessment of their child's head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood.

TRIAL REGISTRATION

Thai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR20200312003.

Can a Multi-Component Intervention Improve Pediatric Service Delivery in Guangzhou?

Background: Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou. Methods: Based on the World Health Organization (WHO) "six building blocks" model and Donabedian's "Structure-Process-Outcomes" framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011-2014 and 2016-2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality. Results: We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR. Conclusions: Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.