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，大约2.5亿年轻人 儿童有可能无法实现其发展潜力。为了改善这些高危人群的发展， 对于儿童，循证方法包括支持照顾者提供养育护理。然而，Scaling 在许多资源匮乏的环境中，为护理人员提供这些服务和支持是一项挑战， 前线医护人员的负担过重是一个限制因素。对于婴儿发展，移动健康技术 有可能通过直接向护理人员提供量身定制的内容来解决这一问题， 增强他们促进婴儿发育的能力，促进和便利与卫生工作者的互动 当确定了关注的领域时，因此，扩大了医疗保健系统的覆盖范围。的 该项目的目标是开发移动健康智能手机技术，可用于吸引小学 护理人员直接积极监测婴儿的发育，并提供量身定制的反馈， 支持提供养育护理。此外，我们亦会前瞻性地评估 该技术的特点-可用性，可接受性和可持续性-为护理人员和卫生工作者。 目标1是使用敏捷设计方法来开发和受众测试智能手机应用程序， 照顾者在监测他们的婴儿的发展，并提供量身定制的预期指导， 在乎目标2是通过纵向评估智能手机应用程序的实现特征， 六个月的可用性试验，以确定随着时间的推移护理人员的参与度，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护理人员反馈的有效性 干预，以促进积极的婴儿发育成果和改善的行为。 这种探索性/发展性研究应用响应PAR 19-376的号召，“研究发展， 创新的移动的医疗干预措施或工具的验证、可行性和有效性， 适合低收入和中等收入国家"，在这种情况下，这是一种基于文化、以家庭为重点的方法 to engage从事carefulers护理in nutritional培育care护理for infants婴儿at the risk风险.这是一个多学科的建议，涉及 儿科、发展和社区心理学、物理治疗和生物医学工程。我们的结果 将为使用移动的技术（以客户为中心的应用程序提供真实的- 时间互动反馈），直接让目标人群参与重要的公共卫生优先事项， 在危地马拉的一个低收入中等收入国家建设移动医疗的研究能力。这个应用程序是一个合作伙伴关系， 儿童医院洛杉矶（美国机构）、埃默里大学（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，在机构和危地马拉开展了一系列活动。

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.