Secondary Benefits to Attentional Processing Through Intervention with an Interactive Maths App

Previous research has shown that a specific interactive app, designed to support the development of early mathematical skills and delivered on hand-held tablets, is effective at raising mathematical attainment in young children in low-and high-income countries. In the countries where this app has been deployed, teachers have consistently reported improved concentration skills in children who have received intervention with this app. To investigate the legitimacy of these claims, we conducted secondary data analyses of children’s performance on core cognitive tasks to examine if additional benefits are observed in children who received intervention with the interactive maths app compared to those that did not. We drew on data from a three-arm randomised control trial conducted in a primary school in Malawi (Pitchford, 2015). In addition to assessing mathematical skills, children’s visual attention, short-term memory, and manual processing speed were examined at baseline, before the introduction of the maths app intervention, and at endline, after the intervention had been implemented for 8 weeks. A group of 318 children (73-161 months) attending Standards 1-3 of a Malawian primary school were randomised to receive either the new maths app (treatment group), a non-maths app that required similar interactions to engage with the software as with the maths app (placebo group), or standard teacher-led mathematical practice (control group). Before and after the 8-week intervention period children were assessed on mathematics and core cognitive skills. Results showed the maths app intervention supported significant and independent gains in mathematics and visual attention. Increases in visual attention were attributable only to interactions with the maths app. No significant benefits to attention were found from using the tablet device with non-maths software or standard class-based mathematical practice. These results suggest that high-quality interactive, educational apps can significantly improve attentional processing in addition to the scholastic skills targeted by the intervention

Mastery Motivation and Executive Functions as School Readiness Factors: Enhancement of School Readiness in Kenya

The overall goal of this study is to enhance school readiness assessment in Kenya by developing an easy-to-use tablet-based android app that can support teachers and learners during the assessment of Pre-academic skills, Mastery Motivation (MM) and Executive Functions (EF) in the Kenyan context. We operationalised MM and EF as components of Approaches to Learning (ATL): one of the poorly assessed domains of school readiness. This research was based on the theory of ATL and followed a non-experimental longitudinal research design. One study was a Scoping Review that identified the gap in the literature in the assessment of School Readiness domains using game-like apps. This study formed the basis for developing Finding Out Children's Unique Strengths (FOCUS) app for Kenya following Education Design Research Approach. Two studies tested and evaluated the psychometric properties of the FOCUS app in the Kenyan context. Another two empirical studies focused on adapting the Preschool Dimension of Mastery Questionnaire 18 (DMQ 18) and the Childhood Executive Functioning (CHEXI) to complement the assessment of MM and EF, respectively. In addition, one study addressed the role played by MM and EF on school academic performance. A total of 40 teachers, 497 preschool and 535 grade 1 children were involved in this study. Both parametric and non-parametric statistical analyses were used to analyse the generated data. The FOCUS app, CHEXI and DMQ 18 fit well with the data and exhibited strong psychometric properties, thus being suitable for the Kenyan context. Furthermore, both MM and EF were directly and indirectly, involved in grade one children's academic performance. FOCUS app tasks, pre-academic skills, and number and letter search tasks at preprimary II strongly predicted preschool and grade one academic performance. MM assessed using the FOCUS app as a better predictor of academic performance than the DMQ 18. Interventions to improve MM and EF promise to enhance School Readiness in the Kenyan context. The FOCUS app can greatly complement Kenya School Readiness Test to give teachers and parents a broader spectrum to make correct decisions concerning the child

Development and Application of FOCUS App for Assessment of Approaches to Learning in 3–8-Year-Old Children in Kenya: A Design-Based Research Approach

Performance-based tools to assess school readiness domains such as Approaches to Learning are lacking in Low and Middle-Income Countries such as Kenya. This study aims to develop the Kenyan version of the FOCUS app (Finding Out Children's Unique Strengths), a game-like computer tablet assessment of two Approaches to Learning domains: mastery motivation and executive functions. We used a design-based research approach to develop and validate the FOCUS app, initially designed for the US and Hungarian Cultures, to suit the Kenyan context. We later followed children longitudinally from preschool to grade 1, to assess the applicability of the FOCUS app to the two grade levels. Results showed that the FOCUS app is valid and reliable. There was no significant difference in mastery motivation between the two waves. The FOCUS App can complement other school readiness tools to assess Approaches to Learning as one of the strategies to enhance school and life success

Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review

Aim: Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. Methods: An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. Results: Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. Conclusions: Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs. Keywords: Gender-based violence, Intimate partner violence, Sexual and reproductive health, Low-and-middle - income countries, mHealth, Digital health, Adolescents Development, Revie

Executive functioning skills and their environmental predictors among pre-school aged children in South Africa and The Gambia

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3–5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. Research Highlights: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3–5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance

Feasibility of a smartphone application to identify young children at risk for Autism Spectrum Disorder in a low-income community setting in South Africa

Introduction and aims More than 90% of children with Autism Spectrum Disorder (ASD) live in low- and middle-income countries (LMIC) where there is a great need for culturally appropriate, scalable and effective early identification and intervention tools. Smartphone technology and application (‘apps’) may potentially play an important role in this regard. The Autism&Beyond iPhone App was designed as a potential screening tool for ASD risk in children aged 12-72 months. Here we investigated the technical feasibility and cultural acceptability of a smartphone app to determine risk for ASD in children aged 12-72 months in a naturalistic, low-income South African community setting. Methodology 37 typically-developing African children and their parents/carers were recruited from community centres in Khayelitsha Township, Cape Town, South Africa. We implemented a mixed-methods design, collecting both quantitative and qualitative data from participants in 2 stages. In stage 1, we collected quantitative data. With appropriate ethics and consent, parents completed a short technology questionnaire about their familiarity with and access to smartphones, internet and apps, followed by electronic iPhone-based demographic and ASD-related questionnaires. Next, children were shown 3 short videos of 30s each and a mirror stimulus on a study smartphone. The smartphone front facing (“selfie”) camera recorded video of the child’s facial expressions and head movement. Automated computer algorithms quantified positive emotions and time attending to stimuli. We validated the automatic coding by a) comparing the computer-generated analysis to human coding of facial expressions in a random sample (N=9), and b) comparing automated analysis of the South African data (N=33) with a matched American sample (N=33). In stage 2, a subset of families were invited to participate in focus group discussions to provide qualitative data on accessibility, acceptability, and cultural appropriateness of the app in their local community. Results Most parents (64%) owned a smartphone of which all (100%) were Android based, and many used Apps (45%). Human-automated coding showed excellent correlation for positive emotion (ICC= 0.95, 95% CI 0.81-0.99) and no statistically significant differences were observed between the South African and American sample in % time attending to the video stimuli. South African children, however, smiled less at the Toys&Rhymes (SA mean (SD) = 14% (24); USA mean (SD) = 31% (34); p=0.05) and Bunny video (SA mean (SD) = 12% (17); USA mean (SD) = 30% (0.27); p=0.006). Analysis of focus group data indicated that parents/carers found the App relatively easy to use, and would recommend it to others in their community provided the App and data transfer were free. Conclusion The results from this pilot study suggested the App to be technically accurate, accessible and culturally acceptable to families from a low-resource environment in South Africa. Given the differences in positive emotional response between the groups, careful consideration should be given to identify suitable stimuli if % time smiling is to be used as a global marker for autism risk across cultures and environments