Co-design is key: A new scientific report details Thrive by Five International’s unique localisation approach

Digital technologies have the potential to improve health outcomes in culturally diverse lower and middle income countries and overcome barriers such as accessibility and affordability; however, their impact relies upon a deep understanding of the target audience’s context and culture.

Mobile technologies are the primary means of internet connection in many countries and a powerful tool for disseminating important health messages. However, many digital health projects claim to be “universal”, when in reality, they adopt a Western or individualist lens and fail to incorporate non-Western or Indigenous perspectives on health and wellbeing. Unsurprisingly, a meta-analysis showed that culturally adapted interventions were more effective than unadapted versions of the same intervention.

The Thrive by Five International Program disrupts this generalist approach with an app that offers evidence-based parenting information, individually tailored to each country. The aim? To celebrate the valued traditions of each country’s culture, while helping parents and caregivers support their child’s socioemotional and cognitive development in the first five years of life.

With the stretch target of an international rollout in 30 countries and counting, an iterative co-design process is at the centre of the Thrive by Five International Program’s app and content development process. As the program’s global research partner, the University of Sydney’s Brain and Mind Centre details this co-design methodology in Developing a Parenting App to Support Young Children’s Socioemotional and Cognitive Development in Culturally Diverse Low- and Middle-Income Countries: Protocol for a Co-design Study, published in JMIR Research Protocols. The Brain and Mind Centre team brings to this project extensive expertise in the use of co-design methodologies to develop effective and clinically meaningful digital health solutions for a range of end users.

The critical learnings from the co-design process inform the content development process led by the Brain and Mind Centre’s research team. The app consists of over 100 activities for parents and caregivers to engage in with their children to support their healthy development, while simultaneously building positive connections between families and communities. Each activity is coupled with ‘The Why’, a simple explanation of the scientific principles that underpin socioemotional and cognitive development in early childhood.

The content is designed and iteratively refined through a series of meetings, workshops and tests with local parents, caregivers and early childhood development experts, who are encouraged to provide feedback for improvements to the app’s content, features and functions. The result is an app that is adapted to each country, from the language to the illustrations to the local examples referenced in the activities.

While the app is the flagship of the Thrive by Five International Program, limited access to the internet, electricity and smartphones will prevent some parents and caregivers from accessing the app. To make the content as accessible as possible, a broader multichannel approach is a key part of the program’s dissemination, including channels such as medical centres and hospitals, print media, radio, television, and WhatsApp. However, this quality improvement research protocol focuses primarily on the co-design, development and refinement of the app and its content.

As highlighted in the linked paper, the co-design research has been completed by Minderoo Foundation and the Brain and Mind Centre in Indonesia, Afghanistan, Namibia, Kenya, Kyrgyzstan, Uzbekistan, the Democratic Republic of the Congo, Cameroon and Ethiopia, with participation from 174 parents and caregivers and 58 in-country experts. The co-design outcomes and their impact on the Thrive by Five app and its content are expected to be published by the University of Sydney’s research team in early 2023.