Mobile Health Intervention to Promote Positive Infant Health Outcomes in Guatemala

婴儿与照顾者互动的数量和质量影响他们获得最佳发展的机会， 为终身健康成果奠定基础。然而，在世界各地，约有2.5亿年轻人 儿童面临着无法实现其发展潜力的风险。改善这些处于风险中的人的发展 对于儿童，循证方法包括支持照料者提供养育护理。但是，扩展 在许多低资源交付环境中，为照顾者提供这些服务和支持是具有挑战性的 对一线医护人员的过重负担是一个限制性限制。对于婴儿发育，mHealth技术 有可能通过直接向照顾者提供量身定制的内容来解决此问题，涉及和 增强他们促进婴儿发育的能力，促进和促进与卫生工作者的互动 当确定了令人关注的领域，并因此扩大了医疗保健系统的覆盖范围。这个 该项目的目标是开发可用于初级参与的mHealth智能手机技术 照顾者直接参与积极监测婴儿的发育，并提供量身定制的反馈和 支持提供养育护理。此外，我们还将对实施情况进行前瞻性评估 该技术的特点--可用性、可接受性和可持续性--供护理人员和卫生工作者使用。 目标1是使用敏捷设计方法开发和受众测试智能手机应用程序 照顾者监测其婴儿的发育，并为养育提供量身定制的前瞻性指导 关心。目标2是通过纵向评估智能手机应用程序的实现特征， 为期六个月的可用性试验，以确定随时间推移的护理者敬业度并评估感知的有用性 应用程序的。目标3是确定基于智能手机的实时照顾者反馈的有效性 采取干预措施，促进积极的婴儿发育结果和改善照看行为。 该探索性/发展性研究应用响应了PAR 19-376号S的号召：“研究开发， 创新的移动健康(MHealth)干预措施或工具的有效性、可行性和有效性 适用于低收入和中等收入国家(LMIC)“，在这种情况下，以文化为基础，以家庭为重点的方法 让照顾者参与对高危婴儿的养育护理。这是一项多学科的提案，涉及 儿科学、发展和社区心理学、物理疗法和生物医学工程。我们的结果 将有助于使用移动技术的证据基础(以客户为中心的应用程序提供真正的 时间交互反馈)，让目标人群围绕重要的公共卫生优先事项直接参与，同时 在危地马拉的LMIC建设移动健康的研究能力。此应用程序是 洛杉矶儿童医院(一家美国机构)、埃默里大学(一家美国机构)和玛雅健康 联盟(LMIC机构)。拟议的计划将加强LMIC的移动健康研究能力 通过发展研究和方案编制人员和资源，在危地马拉建立了一个机构。

The amount and quality of infants’ interaction with caregivers impact their opportunities for optimal development, providing the foundation for lifelong health outcomes. Nevertheless, around the world, some 250 million young children are at risk of not achieving their developmental potential. To improve development for these at-risk children, evidence-based approaches include supporting caregivers to provide nurturing care. However, scaling these services and support for caregivers is challenging in many low-resource delivery environments, where over-taxing of frontline healthcare workers is a limiting constraint. For infant development, mHealth technologies have the potential to solve this problem by providing tailored content directly to caregivers, involving and empowering them to promote infant development, promoting and facilitating interactions with health workers when areas of concern are identified and, therefore, and expanding the reach of healthcare systems. The objectives of this project are to develop mHealth smartphone technology which can be used to engage primary caregivers directly in the active monitoring of their infants’ development, and to provide tailored feedback and support for the provision of nurturing care. In addition, we will also prospectively assess the implementation characteristics of the technology—usability, acceptability, and sustainability—for caregivers and health workers. Aim 1 is to use an agile design approach to develop and audience test a smartphone application to engage caregivers in monitoring their infants’ development and to provide tailored anticipatory guidance for nurturing care. Aim 2 is to assess the implementation characteristics of the smartphone application through a longitudinal, six-month usability trial, to determine caregiver engagement over time and to assess the perceived usefulness of the application. Aim 3 is to determine the effectiveness of a smartphone-based, real-time caregiver feedback intervention to promote positive infant developmental outcomes and improved caregiving behaviors. This exploratory/developmental research application responds to PAR 19-376’s call to “study the development, validation, feasibility, and effectiveness of innovative mobile health (mHealth) interventions or tools specifically suited for low- and middle-income countries (LMICs)”, in this case a culturally-based, family-focused approached to engaging caregivers in nurturing care for infants at-risk. This is a multidisciplinary proposal, involving pediatrics, developmental and community psychology, physical therapy, and biomedical engineering. Our results will contribute to the evidence base for the use of mobile technology (client-focused applications providing real- time interactive feedback) to directly engage target populations around important public health priorities while building research capacity for mHealth in an LMIC, Guatemala. This application is a partnership between the Children’s Hospital Los Angeles (a U.S. institution), Emory University (a U.S. institution), and Maya Health Alliance (an LMIC institution). The proposed plan will strengthen the mHealth research capabilities at the LMIC institution and in Guatemala through the development of research and programming personnel and resources.