Effectiveness of a mobile app, KhunLook versus the maternal and child health handbook on Thai parent’s health literacy, accuracy of health assessments and convenience of use: A randomized controlled trial (Preprint)

Abstract

Children of parents who have higher health literacy benefit more from preventative child health care. Digital interventions have been used to improve parent health literacy with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve health literacy. It was developed to assist parents in assessing and keeping track of their child’s health in complimentary to the standard Maternal and Child Health Handbook.

This trial focuses on effectiveness of using KhunLook app with the Maternal and Child Health Handbook and standard care (intervention) compared to the conventional MCHH and standard care (control) on parent’s health literacy. Accuracy of parent’s assessment of their child’s health in addition to growth, and convenience of use in the well-child clinic were collected at 2 visits (immediate = visit 1, and intermediate = visit 2).

Parents of children < 3 years old, who had a smartphone or tablet and a MCHH, who could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand were enrolled in this 2-arm parallel randomized controlled trial during April 2020-May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, demographics and baseline health literacy (Thailand Health Literacy Scales) were collected. Parents in the app group used KhunLook app and the control group used their child’s handbook to assess their child’s growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the health literacy questionnaire.

A total of 358 parents completed the study (87.7%). After the intervention, the proportion of parents with high total health literacy significantly increased from 51.6% to 59.9% ( 8.3%, P=.038), specifically in the health management ( 16.4%, P<.001), and child health management ( 9.9%, P=.013) domains in the app group, not the control group. Parents in the app group could correctly assess their child’s head circumference (93.5% vs 70.5%, P<.001) and development (95.1% vs 79.0%, P<.001) better than the control group at both visits. A higher proportion of parents in the app group rated their tool as easy-very or easy to use (96.2-99.5% vs 80.1-94.3%, P<.001) on every item since the first visit.

Our results demonstrate the potential of a smartphone app (KhunLook) to improve parent’s health literacy as well as to promote superior accuracy of parent assessment of their child’s head circumference and development, and with a similar effect on weight, height, nutrition and feeding and immunization as in traditional interventions. Using KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood.

Thai Clinical Trials Registry (TCTR20200312003)