A non-randomised trial comparing personalised versus non-personalised versions of the Daily Growth parenting app for emotion regulation in parents/carers and their children aged 2-5 years

This research project involves a non-randomised trial comparing two versions of the Daily Growth smartphone parenting app for parents and carers of children aged 2-5 years. The two versions are from two separate trials: data will be compared between a new/current trial (version 2, n=400) and a previous trial (version 1, Group 5, ACTRN12624000937516). The only difference between the two versions is the method for allocating participants to program type. Daily Growth offers three types of parenting support (Emotion Coaching; Active Play; Wayapa Wuurrk). In the previous trial, the type of parenting resource was randomly allocated; in the current trial, the allocation will be determined by a personalisation algorithm developed using machine learning. The Daily Growth app prompts parents twice a day (morning/evening), and if they request support, offers brief 3-minute video 'micro-intervention' resources that provide immediate parenting support that is tailored to a recent parenting situation (e.g., child won't sit for meals; siblings fighting). Daily Growth offers three different types of parenting support: (1) Emotion Coaching; (2) Active Play; and (3) Wayapa Wuurrk (Indigenous led). The previous, randomised controlled trial (RCT) tests a non-personalised version of Daily Growth with 1,200 caregivers of children aged 2-5 years (Group 5, ACTRN12624000937516). In this non-personalised version, participants are sent a brief 1-minute survey twice per day (7am; 7pm) with a question asking whether they want support right now. If participants say they want support, they are randomised in the moment to receive 1 of the 3 types of parenting support in the form of a 3-minute video. The current trial will recruit a further 400 caregivers to receive a personalised version as a comparison to the 1,200 caregivers who received the non-personalised version. The personalised version of Daily Growth will use a machine learning algorithm. Personalisation aims to enhance the benefits of interventions by ensuring they are most relevant and meaningful for each individual. The Daily Growth personalisation algorithm will be developed using data from the 1,200 parents from the previous trial (Group 5, ACTRN12624000937516), including parent demographics and baseline parenting skills; parent app behaviour (e.g., ratings and completion times); contextual factors (e.g., time of day, stage, and type of intervention); and "priors” informed by literature and pilot data. The data collected will enable the algorithm to learn patterns and make personalised recommendations. For the personalised version, the timing and combination of micro-interventions received by each participant over 6 weeks will vary depending on the algorithm, however, some participants may receive a combination of all three programs, while others may receive a combination of just one or two. Once patterns within the data have been learned, predictions from the trained algorithm will be evaluated in a ‘hold-out’ dataset from the previous RCT (Group 5, ACTRN12624000937516). We will then implement the algorithm in the current trial (n=400). METHOD: Procedures for the new trial (n=400) The current trial will use the same procedure as the comparison trial (Group 5, ACTRN12624000937516), which includes offering the same Daily Growth app and the same micro-intervention videos. The procedure is outlined in detail below: After downloading the Daily Growth app, participants will be provided with a Plain Language Statement and asked to consent to participation. Following this, participants will be required to register with Daily Growth and will then be given access to Daily Growth. After completing the baseline survey, participants will begin the 6-week intervention period. Over this 6-week period, participants will have the opportunity to ‘unlock’ an intervention resource twice per day. They will be prompted twice daily (7:00am; 7:00pm) to complete a 1-minute pre-intervention survey on their smartphone and asked whether they want support in that moment. Participants will receive a further reminder notification 2 hours later (9:00am/pm) if the 1-minute survey has not been completed and will have 4 hours to complete the survey before it expires. A single item in the 1-minute survey will be used to determine whether participants are offered a video resource: "Would you like a resource?" The response options are: • Yes - for a parenting challenge right now • Yes - for future parenting challenges • No - not needed • No - too busy Participants will be offered a video resource if they select one of the "Yes" responses. If participants request a resource on this item, they will be invited to select from a list of 30 common parenting situations. The personalisation algorithm will then allocate participants to receive 1 of the 3 types of support (Emotion Coaching; Active Play; Wayapa Wuurrk) in the form of a 3-minute video resource tailored to their selected parenting situation. Participants will be invited to complete a 1-minute post-intervention survey 15 minutes later (allowing time to watch the video resource), which will remain open until the next 1-minute pre-intervention survey. Participants can only unlock intervention content (i.e., 3-minute video resources) via the daily surveys. Once unlocked, video resources are available on demand in the app. The micro-intervention resources have been developed for Daily Growth and consist of 3-minute videos that aim to provide parents with advice about difficult parenting situations. Each video will offer parenting support grounded in one of three parenting programs (Emotion Coaching; Active Play; Wayapa Wuurrk), with each program offering 30 unique videos (i.e., 90 videos in total). The parenting situations, and the themes they sit under, are listed below: • Eating/Food: Eating challenges; sitting for meals; wanting treats • Morning/Evening routine: Going to bed; not staying in bed; bathing/showering; brushing teeth • Siblings/Peers: Conflict between children; sharing difficulties; refusing to play; fighting in the car • Car/Road/Safety: Crossing the road; child out of sight; fighting in the car • Clingy/Resistant: Clingy with you; clingy with others; stopping an activity; sitting for meals • Screen time: Demanding screens; turning off screens • Getting dressed: Resisting dressing; putting shoes on; dressing for the weather; refusing help to dress • General: General meltdowns; general unhappiness/whinging; general resisting; feeling disconnected from my child. The videos will consist of a mix of talking heads, stock footage, and animation, with audio transcriptions also available. Each of the three parenting programs offered to participants employ a unique approach to delivering parenting support, all focused on improving parent and child emotion regulation: Emotion Coaching The Emotion Coaching program in Daily Growth focuses on teaching children the soft skills needed in the modern world to succeed. Emotion Coaching teaches parents how to notice their own emotions; to understand their child’s needs; to notice, accept, and label all of their child’s emotions; and to empathise and connect with their child. It also teaches parents how to reflect on behaviour they regret, take responsibility, make amends, and model these skills to their child. Active Play The Active Play program offers a set of games to help children connect with their body. Active Play draws on scientific evidence showing how physical activity and play can be used to manage stress and difficult emotions, as well as promoting brain development. The games are designed to help children move in ways that support their emotional and physical development, while also having fun and connecting with parents. Wayapa Wuurrk Wayapa Wuurrk helps parents connect to the wisdom of the Earth so that they can create rhythms and rituals for gratitude and balance to pass on to their children. The Wayapa Wuurrk Ways remind parents that we are nature, so when parents connect with and look after the Earth, they can create a deeper connection to themselves, their child, and to their community, creating resilience, harmony, and wellbeing for all. Finally, at the completion of the 6-week intervention period, participants will be invited to complete a 20-minute post survey; and 6 months following the completion of the intervention period, participants will be invited to complete the final 20-minute follow-up survey. Participant engagement will be monitored periodically using data collected from the Daily Growth app, with reminders sent via email and smartphone push notifications to participants who do not engage with the app for an extended period of time.