Digital health interventions for childhood development depend on interactive learning and community networks for success: Lessons from Indonesia

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Authors
Victoria Loblay, Mahalakshmi Ekambareshwar, Ian Hickie, Aila Naderbagi, Iqthyer Zahed, Haley LaMonica

Parenting apps, like other mHealth interventions, often rely on individual users adopting a new technology via mobile phones or similar devices. In order to understand the impact of these interventions, evaluation approaches typically focus on individual user experiences with impact measures designed to capture individual (or family) behaviour change. Based on an evaluation of a parenting app to promote socioemotional and cognitive development in early childhood in Indonesia, we propose an alternative view of the impact of mHealth interventions. In addition to incorporating behaviour change measures, we explored change processes using a complexity lens that alerted us to dynamic interactions between app users and the broader context of the mHealth intervention. We conducted qualitative interviews and workshops with a variety of users and stakeholders [parents and caregivers (n=47), local experts on early childhood development (n=6) and funders (n=4)]. Two highly engaged participants acted as 'citizen ethnographers,' providing audio-diary recordings of day-to-day interactions relating to the parenting app over a 4-week period. We found significant impact occurring at the community level, where engaged users were initiating informal dissemination channels by harnessing a variety of community networks (e.g. local NGOs working with parents, early childhood centres and social media) to champion and disseminate app content. Understanding creative adaptations of the parenting app content and evolving networks of interaction in local contexts allowed for a broader appreciation of the impact and engagement with the ‘app’ and its ripple effects beyond individual users and their families. This is important not only to better capture engagement and change processes but also to leverage unforeseen opportunities to make mHealth interventions in Lower-middle-income contexts more effective.