JMIR Publications

Background:

Early infancy is a critical period for brain and socioemotional development, with maternal sensitivity serving as a key predictor of secure attachment and long-term developmental outcomes. In low- and middle-income countries such as Indonesia, anticipatory guidance programs predominantly focus on physical growth, with limited emphasis on socioemotional domains. Mobile health interventions offer a scalable approach to delivering culturally tailored parenting support; however, evidence from rigorously evaluated digital programs in LMIC settings remains limited.

Objective:

This study evaluated the effectiveness of a mobile phone–based anticipatory guidance program (Stimulus App) in improving maternal sensitivity and promoting infant socioemotional development.

Methods:

A quasi-experimental study with an equivalent control group design was conducted in Bandung, Indonesia. A total of 120 mother–infant dyads (intervention n=60; control n=60) were recruited consecutively from community health facilities. The intervention group received an 8-week mobile program consisting of 16 culturally adapted modules aligned with the WHO Nurturing Care Framework and attachment theory. Maternal sensitivity was assessed using the Nursing Child Assessment Teaching Scale, and infant socioemotional development was measured using the Indonesian version of the Ages & Stages Questionnaire: Social-Emotional, Second Edition. Outcomes were assessed at baseline (T0), post-intervention (T1), and follow-up (T2). Repeated measures ANOVA and generalized estimating equations were used for analysis.

Results:

: The intervention group demonstrated significant improvements in maternal sensitivity (T0 mean 29.54 vs T2 mean 34.28; P<.001; η²=0.31) and reductions in socioemotional difficulty scores (T0 mean 91.03 vs T2 mean 77.86; P<.001; η²=0.29). No significant changes were observed in the control group. Generalized estimating equations revealed significant group-by-time interaction effects for maternal sensitivity (β=2.11, 95% CI 1.41–2.81; P=.003) and socioemotional development (β=–5.04, 95% CI –6.87 to –3.21; P<.001). Attrition was 0%.

Conclusions:

The Stimulus App significantly enhanced maternal sensitivity and improved early infant socioemotional outcomes in an urban LMIC context. Culturally adapted mobile-based anticipatory guidance may represent a scalable strategy to strengthen early parenting support in resource-constrained settings.

Clinicaltrial: