Smartphone-based support for early childhood development in a rural low-resource setting: an individually randomised pilot feasibility trial from Guatemala

Clinical Snapshot

Key Findings

• P Value: Not applicable for feasibility outcomes

• Effect Size: High engagement with median 11 app opens per month (IQR 6-21)

• Primary Outcome: Feasibility and acceptability of BebeApp implementation using RE-AIM framework

• Nnt Or Sensitivity: 97.6% study completion rate indicating feasibility

• Confidence Interval: Not reported in abstract

Clinical Application

High feasibility demonstrated with good engagement and positive user feedback, though initial training required Relevant for remote Indigenous Australian communities, particularly in Northern Territory and Western Australia. Could complement existing Aboriginal and Torres Strait Islander early childhood programs under Closing the Gap initiatives First-time caregivers in rural, low-resource settings, particularly Indigenous communities with smartphone access

Abstract

OBJECTIVE: To test the feasibility of a smartphone app, BebeApp, that provides evidence-based early childhood development (ECD) guidance in rural Guatemala and pilot procedures for an adequately powered randomised controlled trial. DESIGN: We conducted an individually randomised pilot feasibility trial to compare BebeApp to printed ECD guidance. SETTING: This trial was conducted in Tecpán, Chimaltenango, a semi-rural community that is 95% Kaqchikel Indigenous Maya. PATIENTS: First-time primary caregiver-infant (0-28 days) dyads. INTERVENTIONS: BebeApp provides age-dependent, evidence-based caregiver guidance for breastfeeding and complementary feeding, sleep and developmental support. MAIN OUTCOME MEASURES: A mixed-methods evaluation of BebeApp's implementation and acceptability using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. App usability, usefulness and satisfaction were assessed via questionnaires, semi-structured interviews and app interaction data. RESULTS: 41 infant-caregiver dyads were enrolled with 40 completing the study. Engagement was high with caregivers opening BebeApp a median (IQR) 11 (6-21) times per month. Usability was found to be acceptable but no difference was found between pre-measurements and post-measurements. In interviews, caregivers expressed some initial difficulty using BebeApp but were able to gain confidence with a training session. App usefulness and satisfaction responses were positive. Caregivers often noted that BebeApp was their only source of ECD information outside of their family. CONCLUSIONS: We found that caregivers in rural Guatemala responded positively to a smartphone ECD app and engaged with it throughout the trial. Given the urgent need for ECD programmes in low- and middle-income settings, smartphone apps may be a method to deliver services directly to caregivers.

References

1. 1.Tschida, S., Tuiz, E. L., López, D., Canú, M., Boron, V., Zarazúa, J., Grazioso, M. D. P., Smith, B. A., & Rohloff, P. (2026). Smartphone-based support for early childhood development in a rural low-resource setting: an individually randomised pilot feasibility trial from Guatemala. BMJ Paediatrics Open, 11(1), e003979. https://doi.org/10.1136/bmjpo-2025-003979