Principal Findings
’s head circumference, HL
SECONDARY
This is the first randomized controlled trial to assess parents’ HL after using an app for child health assessments as part of routine child health supervision. We found that after using the KhunLook app, the proportion of parents who had high total HL significantly increased, whereas the proportion of parents with fair to poor HL decreased (15/182; Δ 8.2%). When looking at domains, the increase was significantly pronounced in the health management (30/182; Δ 16.5%) and child health management (18/182; Δ 9.9%) domains. Our findings are encouraging because the KhunLook app was designed to assist parents by providing high-quality information and making health assessments easier with the intention that parents would be able to detect abnormal growth and development in their children early on. Further, better HL in health management and child health management domains has implications for having good and enough health information to be able to manage health and prevent sickness, finding time to plan activities and choosing a better environment for better health, and participating in health activities with health care providers for themselves and their children [We did not find similar changes in HL category shifts in parents who used the MCHH. By contrast, we found that using the MCHH significantly increased the proportion of parents with high HL in the communication and social support domain (15/176; Δ 8.5%; We analyzed mean scores to allow for understanding of more subtle changes in HL, and found that parents’ scores significantly improved after the intervention in both groups for total HL and 4 subscales.Our secondary outcomes show that parents in the intervention group could correctly assess their child’s head circumference and development better than those in the control group both immediately (visit 1) and intermediately (visit 2). More parents in the intervention group rated the app easier to use than those in the control group instantly at the first visit, with statistical significance in all domains. Upon follow-up, there were no significant changes in the proportion of parents who rated the app to be easy to use, suggesting sustained intermediate effects. Parents in the control group rated the content in the MCHH to become increasingly more understandable with statistical significance at visit 2. We propose that this may be because our study required parents to use the MCHH, and thus, they had a chance to engage with the MCHH more, while this was not required in routine care. In addition, participants in the intervention group were slightly younger than those in the control group and may have preferred a novel intervention over the conventional standard.Looking into subgroups, we had 42 males in our study, 44 single parents, and 131 parents who had more than 1 child. The number of participants in each subgroup may not be enough to yield statistical power to make conclusions. However, the primary and secondary outcomes showed comparable trends to those from analysis of all parents. Our results tended to be more pronounced in parents of the first child. Parents who had more than 1 child could be previously exposed to the app, the MCHH (which may have different formats between versions), and child supervision from health care providers. This could lead to a possibility of a less accentuated effect of the outcomes. We found that parents who had more than 1 child and who were allocated to the MCHH group had a significant increase in the proportion of those with high HL in the “access to health information and services” domain. This could be because the MCHH, which is larger than a smartphone, could have created a perception of more information for this subgroup.