Table 2.

Examples of feedback on the content and changes made

Themes	Subtheme	Feedback	Implicated countries	Changes made to the content
Local realities	Understanding diversity	Experts requested to include activities that can be done by low-income families who lack resources	DRC, Namibia	Updated content on children’s activities and food to include resources available to them. Activities that could be done during ‘breakfast’ and ‘dinner’ were replaced with ‘morning’ and ‘night’ as some families cannot provide multiple meals per day
	Aligning with local policies	Experts requested to exclude activities that are prohibited according to the law of the country	Afghanistan	Seven CAs were removed that involved music and dancing
Barriers to positive parenting	Conflicting parenting approaches	Parents requested strategies to be reasonable with children when they get frustrated or do not behave appropriately	Ethiopia, Kenya, Namibia	A new CA titled ‘Positive behaviour management’ was developed and included in the library
		Parents noted that consistency among parents is a challenge (ie, one parent may undermine the decisions of another)	Cameroon	A new CA titled ‘Raising children as a team’ was developed addressing the benefits of parents being consistent in their parenting practices
		Parents requested content to address the conflict between traditional strict and contemporary permissive parenting strategies	Kyrgyzstan, Uzbekistan, Ethiopia	A new CA titled ‘Traditional and contemporary parenting’ was included
	Gender	Experts requested typically male-oriented activities (eg, learning to count, playing football, riding a tricycle and climbing a tree) within the first set of CAs to better engage male users with the app	Kenya	No content changes were made. The research team highlighted the importance to consider how this approach to presenting the content might further reinforce gender roles and stereotypes by assigning a gender to specific activities. Wherever possible instructions were changed from ‘you’ to ‘the whole family, parents, fathers, grandparents, older siblings, etc’
	Unmet parental well-being	Parents, especially new mothers expressed their struggles to cope with ‘baby blues’ and requested content	Kenya	A new CA titled ‘Coping after childbirth’ was developed to support young mothers and fathers to cope with their parenthood
	Role of multiple caregivers	Experts requested that the activities further consider supporting caregivers of abandoned or bereaved children	Cameroon, Kenya	A new CA (titled ‘Fostering a child’) supporting families who are fostering or caring for a non-biological child was added
		Parents requested content to involve older siblings for childrearing when parents are at work	DRC	No new CA was developed. It is important to note that the Thrive by Five app considers parents and adult caregivers as the primary target audience for the content and does not promote underage children to be the main user of the app
Child development	Skills and activities	Parents requested content to help children to be cooperative from an early age	Ethiopia	A new CA titled ‘Motivating children to cooperate’ was added to the library
		Experts suggested to include local activities (eg, solving riddles) that would develop children’s problem-solving skills	Ethiopia	A new CA titled ‘Riddles help children learn’ was developed where children are encouraged to solve riddles
		Experts suggested content to encourage parents to participate in children’s imaginative play and foster bonding between parents and children	Ethiopia	An additional activity was added in the CA ‘Imaginative free play’ indicating parents’ active participation
	Managing screen time	Parents and experts expressed concerns about children’s sleep as parents allow children to take gadgets to bed	Afghanistan, Indonesia	New CAs titled ‘Screen time’ and ‘Lights out’ were included informing parents about the negative impacts of excessive screen time on children’s psychosocial well-being and motor and cognitive development with suggestions of alternative activities (eg, reading from books)
	Building resilience	Experts requested information to support children who have lost parent(s) due to HIV/AIDS	Kenya	A new CA titled ‘Dealing with loss’ provides information to caregivers to support children with grief and loss
		Experts requested content to support children who were impacted by abuse, violence and neglect in conflict areas	DRC	A new CA titled ‘Building resilience’ was developed and incorporated into the app
		Parents requested content about helping older children adjust to the arrival of a new sibling	Afghanistan	A new CA titled ‘Welcoming a new sibling’ was included
	Disability	Experts requested for diagnosis of clinical symptoms or disability through the app and customised support to families as per their need	Almost all countries included in the study	The Thrive by Five app is not a diagnostic tool; a disclaimer about the scope of the app is planned. Although it is beyond the scope of Thrive by Five to provide customised content for children with disability, it is likely that parents could still make use of many of the activities in the app, noting that some adjustments or accommodations may be required
	Staying safe	Parents requested information to increase awareness about unsupervised children meeting fatalities (burning, road accidents) at home and outside due to a lack of safety measures	DRC	A new CA titled ‘Safety first’ was developed to help parents and adult family members including older siblings take safety measures at home and outside to prevent children from falling victim to accidents
Lessons learnt	Values and norms	Parents and experts requested content regarding children learning to respect diversity in their community (including disability)	Kenya	A new CA titled ‘Celebrating diversity’ was developed and included
		Parents highlighted the need for children to appreciate what they have and in turn to recognise that others around them may not be as fortunate	Namibia	A new CA titled ‘Showing gratitude’ was developed and included

CA, collective action; DRC, Democratic Republic of the Congo.