Digital Health Interventions for Child Health Monitoring

The trial compares three versions of support for community health workers who deliver child nutrition services in Posyandu participating in the PN PRIMA program.

In all arms, Kader continue to receive the standard PN PRIMA package, including routine training, supervision and performance-based incentives. In the control arm, Kader use the existing web-based PNP application accessed via computer at the health centre to record anthropometric measurements, and identify nutritional problems.

In Treatment 1, Kader receive a mobile version of the PNP application installed on their smartphones. The mobile app contains all functions of the web version and adds real-time notifications about newly confirmed cases of malnourished children, reminders for scheduled follow-up home visits, and an interface to record vulnerability factors faced by the child's household.

In Treatment 2, Kader receive the same mobile PNP application as in Treatment 1 plus an additional in-person training package. This training focuses on recognising and responding to vulnerability (for example poverty, disability, single parenthood, or unstable housing), communicating respectfully with caregivers, and problem-solving common barriers to conducting timely home visits.

2025-11-18

2026-02-27

The primary outcome is the proportion of scheduled follow-up home visits for children aged 0–4 years with identified nutritional problems (wasting, stunting, underweight, weight faltering or obesity) that are completed within the recommended time window over the trial period. The recommended schedule follows PN PRIMA clinical pathways (e.g. weekly visits with a minimum number of required visits depending on the nutritional condition). This outcome will be constructed from PNP digital logs as the number of home visits conducted on time divided by the total number of visits that should have occurred, aggregated at the child and Kader levels and evaluated at endline.

Key secondary outcomes cover three domains: service-delivery indicators, Kader knowledge and attitudes, and caregiver-level outcomes.

- Service-delivery outcomes include indicators such as the proportion of first follow-up visits conducted within one week of case confirmation, the proportion of children who complete the minimum recommended number of home visits, and measures of continuity and completeness of care for children with nutritional problems, all derived from PNP app logs.

- Kader outcomes include knowledge about child nutrition and growth monitoring protocols, knowledge and attitudes related to vulnerability and GEDSI, perceived self-efficacy in managing complex households, and reported feasibility, usability and satisfaction with the PNP app.

- Caregiver outcomes include knowledge about child nutrition and Posyandu services, attitudes towards growth monitoring and home visits, perceived responsiveness of Kader to their needs, and satisfaction and trust in Posyandu-delivered services. These are measured through structured baseline and endline surveys with caregivers of children enrolled in the monitoring pathway.

Service-delivery indicators are intended to capture both timeliness and completeness of home-visit implementation beyond the primary outcome. For example, we will construct measures of whether the first follow-up visit occurs within a one-week window after confirmation from health workers, the share of scheduled weekly visits that are conducted over the recommended monitoring period for each nutritional condition, and drop-off in visits over time. Because the app encodes recommended care pathways by nutritional status, we can benchmark realised visits against the ideal schedule for each child. Kader knowledge and attitudes will be measured using survey modules administered at baseline and endline. Items will cover factual knowledge about child nutrition and home-visit protocols, understanding of vulnerability factors (e.g. disability, household composition, income constraints), perceived empathy and responsibility toward vulnerable families, and comfort with using digital tools. We will also collect Likert-scale measures of usability, perceived usefulness and satisfaction with different versions of the PNP app. Caregiver-level outcomes are collected through household surveys with parents or caregivers of children enrolled in the nutritional monitoring pathway. Questionnaires will measure knowledge of child feeding and illness signs, awareness of Posyandu services and PN PRIMA interventions, perceived quality of interaction with Kader (respect, clarity of explanations, responsiveness), and overall satisfaction with child nutrition services. These indicators allow us to assess whether changes in Kader behaviour translate into improved experience and empowerment for service users. All secondary outcomes will be analysed as pre-specified indices within each domain, alongside selected individual measures, with appropriate adjustments for multiple hypothesis testing.

We implement three-arm cluster randomized controlled trial in 38 Posyandu that have been selected into the PN PRIMA program in Depok City and Bekasi Regency. Posyandus are the unit of randomization. Each Posyandu's Kader team and their enrolled children receive the same treatment assignment.

Posyandus are randomly assigned in approximately equal numbers to: (i) continue using the standard web-based PN Prima application (control); (ii) receive the mobile PNP application; or (iii) receive the mobile PNP application plus additional training. We follow Kader and caregivers over the PN PRIMA implementation period, collecting baseline information where relevant and constructing endline outcomes mainly from app usage data and a follow-up survey.

Not available

Randomization was conducted using a computer-generated random number sequence.

The unit of randomization is the Posyandu (integrated community health post). All Kader and enrolled children within a Posyandu receive the same treatment status.

Yes

We include 38 Posyandu clusters participating in PN PRIMA across Depok City and Bekasi Regency.

At the provider level, we expect to enrol approximately 190 community health workers (Kader Posyandu) across the 38 Posyandu. At the caregiver level, we expect to survey around 836 caregivers of children aged 0–4 years who are enrolled in the nutritional monitoring pathway and identified as needing follow-up home visits.

Clusters will be assigned in approximately equal numbers to each arm, with an expected distribution of about 13 Posyandu in the control (web) arm, 13 Posyandu in the mobile-app-only arm, and 12 Posyandu in the mobile-app-plus-training arm. This implies roughly 60–70 Kader and around 270–290 caregivers per arm, assuming similar cluster sizes across arms. Exact numbers may vary slightly depending on final recruitment and eligibility at the time of implementation.