P0084 - Using a Human-Centered Design Approach to Improve Anticipatory Guidance on Early Cognitive and Language Development During the Well-Child Visit

Background: The early learning environment is an important social determinant of health associated with socioeconomic status (SES) and linked to outcomes including reading proficiency and IQ. Parental knowledge of early cognitive development mediates the relationship between education and caregiving behaviors, and pediatric providers are often considered the primary source of this information for low SES parents. Yet, time constraints, lack of resources, and limited understanding of a parent’s knowledge hinders providers from giving anticipatory guidance in this area.

Human-Centered Design (HCD) is a design methodology that offers a useful framework for developing an intervention that addresses these barriers. HCD involves rapid prototyping, feedback gathering, and responsive iterations, with focus on how context informs design. It encourages widespread participation from stakeholders and engages groups historically left out of design processes. Given that an intervention to assist providers in educating parents about early cognitive development must fit into the paradigm of the well-child visit and meet the needs of diverse users, HCD may be particularly useful.

This study used HCD to develop a tool to assist providers at two Federally Qualified Health Centers in educating parents about early cognitive and language development during well-child visits. We aimed to address barriers by creating a tool shaped by the needs of providers and parents, featuring personalized information about parental knowledge and suggested areas for anticipatory guidance.

Methods: In Phase I, we collaborated with providers to establish the need for intervention and design an initial prototype. Phase II involved an iterative process of implementation of the tool in participating clinics, feedback gathering from parents and providers, assessment of impact on parental knowledge, and responsive revisions.

Results: Phase I yielded Version I of the tool—a one-page, provider-facing guide that synthesized a parent’s results on SPEAK, a validated survey of parental knowledge of early cognitive and language development. It identified one strength and two gaps in the parent’s knowledge and gave evidence-based scripts for guidance. Phase II involved implementation of Version I in well-child visits and feedback collection, leading to the development of Version II—a concise, colorful, and parent-accessible “Brain Building Guide” intended for interactive provider and parent use. Repetition of Phase II with Version II led to the development of Version III, which placed more emphasis on suggested parental behaviors and parent-directed language.

Participating parents showed increased knowledge immediately post-appointment (n=220, p<.0000*) and four-weeks out (n=138, p<.0000*) based on SPEAK scores. Providers (n=6, p<.05*) and parents (n=219, p<.05*). were significantly more satisfied with later versions than the first.

Conclusion: Utilizing an HCD approach, we created a novel tool to assist providers in educating parents on early learning. This tool is both efficacious and satisfactory to stakeholders and should be further evaluated in a randomized control trial.