Design and evaluation of the StartingTogether App for home visits in preventive child health care.

Background: The StartingTogether program (in Dutch SamenStarten) is a family-centred method for early identification of social-emotional and behavioural problems in young children. Nurses in preventive child health care find it challenging to: determine family issues and need for care; provide education; refer to social services; increase parent empowerment. To mitigate these challenges, we developed and evaluated the StartingTogether App, offering nurses and parents conversational support, tailored education and information on social services.

Methods: A mixed method design, consisting of a qualitative evaluation of the StartingTogether App, with group discussions with nurses ( N  = 14) and a pilot test ( N  = 5), and a randomized controlled trial, evaluating the effectiveness of the app. Nurses ( N  = 33) made home visits to parents ( N  = 194), in teams with or without the app. Nurses were surveyed on the challenges experienced during visits. Parents ( N  = 166) were surveyed on their satisfaction with health care and app. Nurses were interviewed on the benefits and barriers to use the app.

Results: Parents with the StartingTogether App were more satisfied with the visits than parents without ( p  = .002). Parents with a high educational level were more satisfied with the visits than the parents with a low educational level. With the app, their satisfaction level was similar ( p  < .001). Nurses using the app felt more equipped to communicate with parents ( p  = .012) and experienced that parents were more knowledgeable and skilled ( p  = .001). Parents felt that with the app the nurse was more polite ( p  = .02), listened more carefully ( p  = .03), and had more time ( p  = .02). Nurses with the app gave parents more opportunity to ask questions ( p  = .001) and gave clearer answers ( p  < .001). The qualitative evaluation indicated that some nurses needed extra time to develop the habit of using the app.

Conclusions: The StartingTogether App contributes to parents' satisfaction with home visits. An interaction effect between parents' educational level and rating of home visits indicated that the app has an additional value for parents with a lower educational level. Applying mobile applications, such as the StartingTogether App, potentially has a positive effect on communication between nurses and parents about the family situation in relation to parent empowerment and the child's development.

Trial registration: The study is registered with ISRCTN under the number ISRCTN12491485, on August 23, 2018. Retrospectively registered.