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Original research
Parenting app to support socio-emotional and cognitive development in early childhood: iterative codesign learnings from nine low-income and middle-income countries
  1. Mafruha Alam1,
  2. Ian B Hickie1,
  3. Adam Poulsen1,
  4. Mahalakshmi Ekambareshwar1,
  5. Victoria Loblay1,
  6. Jacob Crouse1,
  7. Gabrielle Hindmarsh1,
  8. Yun J C Song1,
  9. Adam Yoon1,
  10. Grace Cha1,
  11. Chloe Wilson1,
  12. Madelaine Sweeney-Nash1,
  13. Jakelin Troy2,
  14. Haley M LaMonica1
  1. 1Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Faculty of Arts and Social Sciences, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Mafruha Alam; mafruha.alam{at}


Objective Many children in low-income and middle-income countries are disadvantaged in achieving early developmental potential in childhood as they lack the necessary support from their surroundings, including from parents and caregivers. Digital technologies, such as smartphone apps, coupled with iterative codesign to engage end-users in the technology-delivered content development stages, can help overcome gaps in early child development (ECD). We describe the iterative codesign and quality improvement process that informs the development of content for the Thrive by Five International Program, localised for nine countries in Asia and Africa.

Design Between 2021 and 2022, an average of six codesign workshops in each country were conducted in Afghanistan, Indonesia, Kyrgyzstan, Uzbekistan, Cameroon, the Democratic Republic of the Congo, Ethiopia, Kenya and Namibia.


A total of 174 parents and caregivers and 58 in-country subject matter experts participated and provided feedback to refine and inform the cultural appropriateness of the Thrive by Five app and its content. Detailed notes from the workshops and written feedback were coded and analysed using established thematic techniques.

Results Four themes emerged from the codesign workshops: local realities, barriers to positive parenting, child development and lessons learnt about the cultural context. These themes, as well as various subthemes, informed content development and refinement. For example, childrearing activities were requested and developed to promote inclusion of families from diverse backgrounds, encourage best parenting practices, increase engagement of fathers in ECD, address parents’ mental well-being, educate children about cultural values and help bereaved children with grief and loss. Also, content that did not align with the laws or culture of any country were removed.

Conclusions The iterative codesign process informed the development of a culturally relevant app for parents and caregivers of children in the early years. Further evaluation is required to assess user experience and impact in real world settings.

  • Community child health
  • Health informatics

Data availability statement

No data are available. Not Applicable.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

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  • Contributors The University of Sydney’s Brain and Mind Centre is conducting the research pursuant to a 3-year agreement between the University and Minderoo. Minderoo’s Thrive by Five International Program aims to promote an increased understanding of and focus on the importance of early child development, with the Thrive by Five app serving as the flagship product of this program of work. This research was commissioned as a Quality Improvement activity to support a quality and engaging user experience and to inform the development of culturally appropriate and relevant content for parents and caregivers in each country in which the app is implemented. Prior to embarking on work in each country, Minderoo Foundation has governed the selection and collaboration of in-country partners to provide support for this project, including providing information about the local context, resourcing beta testers to test and review the app features, functions, and content, and setting up workshops. Importantly, the partners are a mix of governmental and non-governmental organisations; they are not research organisations nor are they formally affiliated academic institutions. All data for this study were collected through quality improvement and codesign workshops facilitated by the University of Sydney research team. These workshops were an important source of local cultural knowledge and were used to inform cultural aspects of the research for each country. As the in-country partners are not research organisations and as this is an ongoing global study involving numerous countries over more than 3 years, the overarching protocol design did not intend for local organisations to contribute to study conceptualisation and design, data collection, analysis, and interpretation, and manuscript preparation. However, the in-country partners are acknowledged for their support and partnership in the research activities. MA, HML, AP, ME, VL contributed to the design, conception, data collection, coding, analysis, interpretation and knowledge translation of data with subsequent contribution from JC, GH, YJCS, AY, GC, CW, MS-N. MA was the major contributor in writing the manuscript. AY, AP, GC, CW and MS-N contributed to notetaking and transcription of the workshops. Scientific oversight and guidance were provided by IBH and JT to ensure that all activities were conducted responsibly and in a culturally appropriate manner. All authors contributed to and approved the final manuscript. All authors are guarantors for this work.

  • Funding This study is supported by Minderoo Foundation’s Thrive by Five International Program (grant number: NA).

  • Competing interests IBH is the codirector, Health and Policy at the Brain and Mind Centre at the University of Sydney. The Brain and Mind Centre operates an early intervention youth service at Camperdown under contract with headspace. He is the Chief Scientific Advisor to, and a 3.2% equity shareholder in, Innowell Pty Ltd. Innowell was formed by the University of Sydney (45% equity) and PwC (Australia; 45% equity) to deliver the A$30 million (US$21.63 million) Australian Government-funded Project Synergy (2017–2020; a 3-year programme for the transformation of mental health services) and to lead the transformation of mental health services internationally through the use of innovative technologies. Importantly, Innowell has no role in the development, production or distribution of the Thrive by Five app. VL is a board member for Matana Foundation, a philanthropic organisation that provides funding to programmes for disadvantaged young people in Australia. She does not receive any financial benefit for this role.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.