JMIR Publications

ABSTRACT

Background:

Early childhood is a critical period for shaping cognitive and socioemotional foundations, with maternal sensitivity recognized as a central predictor of positive developmental outcomes. In low- and middle-income countries (LMICs) such as Indonesia, anticipatory guidance for early parenting is limited and often emphasizes physical growth while neglecting socioemotional domains. Digital innovations provide a promising avenue to bridge this gap by delivering scalable, context-specific parenting support. However, evidence on culturally adapted, mobile-based anticipatory guidance in LMIC settings remains scarce.

Objective:

This study evaluated the effectiveness of a mobile phone–based anticipatory guidance program (the Stimulus App) in improving maternal sensitivity and promoting socioemotional development in infants aged 0–3 months.

Methods:

We conducted a quasi-experimental study with an equivalent control group design in Bandung, Indonesia. A total of 135 mother–infant dyads were screened, with 120 eligible mothers recruited consecutively from community health centers and maternal–child clinics. Participants were allocated at the facility level to either the intervention group (n=60) or control group (n=60). The intervention consisted of an 8-week mobile program designed through iterative development and expert review, aligned with the WHO Nurturing Care Framework and attachment theory. The Stimulus App included 16 culturally adapted modules on feeding, sleep, communication, motor stimulation, and socioemotional interaction, delivered through short videos, interactive storylines, pop-up reminders, and gamified features. Mothers received training on app use, weekly monitoring, and automated reminders, while engagement was tracked via backend analytics. Control participants received no intervention during the study but were offered access afterward. Observed maternal sensitivity was assessed using the culturally adapted Nursing Child Assessment Teaching Scale (NCATS), and infant socioemotional development was measured using the Indonesian version of the Ages & Stages Questionnaire: Social-Emotional, Second Edition (ASQ:SE-2). Assessments were conducted at baseline (T0), one month post-intervention (T1), and one month post-follow-up (T2).

Results:

Mothers in the intervention group demonstrated significant improvements in sensitivity scores (T0 mean = 29.54; T2 mean = 34.28; P<.001; η²=0.31) and reductions in infant socioemotional difficulty scores (T0 mean = 91.03; T2 mean = 77.86; P<.001; η²=0.29). No significant changes were observed in the control group. Generalized estimating equations confirmed significant group-by-time interaction effects for both outcomes. Attrition was 0%, and all 120 participants were included in the final analysis.

Conclusions:

The Stimulus App significantly enhanced maternal sensitivity and early socioemotional development in infants within an LMIC urban context. By embedding anticipatory guidance into a culturally adapted mobile platform, the program demonstrates potential as a scalable, cost-effective tool to strengthen parenting interventions in resource-constrained settings.