Promoting Family Engagement With Early Childhood Developmental Screening via the Baby Steps Text Messaging and Web Portal System: Longitudinal Randomized Controlled Trial.

Background: Approximately 1 in 6 US children has a developmental disability. Early detection is crucial but often delayed, especially in families with limited access to resources. Current paper-based screening methods, such as the Ages and Stages Questionnaire, face challenges such as cultural barriers and timing issues. Digital tools can improve parent engagement and screening accuracy. This research explores new technologies to enhance long-term parent involvement in developmental screening. Objective: The study aims to understand whether features of a digital intervention specifically designed to engage parents in developmental screening are effective over a long-term period. Methods: Parents of children between 7 and 12 months old were recruited through flyers at clinics and libraries, mailing lists, and social media, and then they self-enrolled after eligibility screening. We conducted a randomized controlled trial with 139 families over 20 months, along with follow-up interviews and surveys. The intervention consisted of an interactive web portal that combined developmental and sentimental record-keeping, family-friendly visualizations, and the ability to answer screening questions via multiple modalities (eg, text messaging and web), without involvement of health care providers. The control condition consisted of a web-based portal with no specific engagement features, modeled after standard web-based developmental screening tools. Results: Overall, we enrolled 67 parents in the control group and 72 parents in the experimental group, for a total of 139 enrolled participants. Several parent engagement strategies we deployed in the experimental group were effective in increasing milestone questionnaire completion, with text messaging standing out as the most impactful and efficient, offering the highest return relative to the effort required for its development and implementation. Overall, the experimental group demonstrated a 44% higher average response rate compared to controls (t125=-3.32, P<.01). Participants in the experimental group submitted significantly more timely and valid responses, after text messaging was introduced (phase 2: 95% vs phase 1: 71%; t107=-4.44, P<.01), which is a critical factor for effective and timely tracking of child development. The experimental group participants responded to more questions on average (mean 127.60, SD 49.01) than those in the control group (t70=-7.23, P<.01) in phase 2 as well. In addition, study completion rates were significantly higher in the experimental group (83% vs 30%; t119=-8.40, P<.01), indicating greater long-term engagement. Sentimental record-keeping features showed promise but limited use, suggesting the need for integration with tools parents already use. Conclusions: This study demonstrates that a human-centered design approach for technology-based interventions can significantly enhance parent engagement and completion rates of developmental screening questionnaires. However, further research is needed with a larger sample to determine whether such features effectively prompt parents to seek early intervention services. Future studies should focus on engaging more diverse and underserved populations to validate these findings.