Before developing the app’s content, we agreed on 5 thematic domains that are relevant to children’s social, emotional, and cognitive development and 5 neurobiological systems that are involved in social, emotional, and cognitive development. These domains and neurobiological systems (Figure 2) guide the development of the app’s content, are used to categorize the content within the app, and provide the scientific rationale for encouraging parents to engage with the practices promoted by the app.

The thematic domains are based broadly on the Bright Tomorrows project (developed by Minderoo Foundation and Telethon Kids Institute), with the Brain and Mind Centre team mapping new domains. The domains and the broad types of content included in each domain are (1) the Cognitive Brain domain, which includes content about broad cognitive processes (eg, attention, learning, memory, visual and auditory processing, motor skills, and imagination); (2) the Social Brain domain, which includes content about social interaction and the sociocognitive processes involved in recognizing, interpreting, and responding to social cues (eg, eye gaze, joint attention, and facial expressions); (3) the Language and Communication domain, which includes content about processing, understanding, and using verbal and nonverbal language and signals (eg, gestures); (4) the Identity and Culture domain, which includes content about the development of a sense of personal, social, and community identity and the roles that culture and place play in identity development (eg, customs, festivals, and folk stories); and (5) the Physical Health domain, which includes content about physical health, growth, and development and physical protection from harm and abuse (eg, harsh discipline).

The neurobiological systems that we focus on and an outline of their relevance to early child development are shown in Figure 2. These five systems and their main functions include (1) the stress response system, which creates a hormonal response to stress (prolonged activation of the stress response system is associated with negative emotional, behavioral, and physical health outcomes); (2) the oxytocin system, which regulates social, behavioral, and emotional processes (eg, smiling, attention to eye gaze, and breastfeeding), of which many are fundamentally important for early child-caregiver bonds and other social bonds; (3) the learning system, which assigns value to objects and behaviors (in childhood, this is fundamental for motivation creation, social behaviors, and associative learning); (4) the fear-arousal-memory system, which encodes and maintains memories of fearful stimuli and the contexts in which they are experienced; and (5) the circadian system, which orchestrates the daily rhythmic timing of almost all physiological processes and behaviors (eg, sleep and wakefulness, appetite, mood, and cognitive function). Other publications provide more details about these systems and their relevance to early child development [25-38].

For each country, a cultural framework is developed collaboratively with the research team and a nominated country-specific expert. This framework is used to guide the first draft of the app’s content for each local context. The cultural framework summarizes information from a variety of published literature (eg, government reports, journal articles, and textbooks) that is relevant to child-rearing; family environments; and broader social, economic, and political factors that may influence family functioning and early child development. For each country, we follow a dedicated pro forma that covers the topics presented in Figure 3.

Concurrently, the research team prepares a literature summary that presents the strengths (eg, transgenerational family networks; the empowerment of women; and the cultural celebration of art, music, and dance) and challenges (eg, high rates of childhood mortality, obesity, and exposure to corporal punishment) of each country, which are considered when developing the app’s content. The content aims to celebrate the cultural strengths and practices of each country by highlighting how they align with the scientific evidence about childhood development while also considering the various challenges that may impede these practices and how these challenges may be mitigated. Once complete, the cultural framework and literature summary are reviewed and approved by an in-country partner organization.

Many available parenting apps adopt a narrow focus in their content, encouraging activities to be completed by 1 parent (typically a mother) with 1 child. Although these activities are well-meaning and are still of potential benefit, their dyadic structure is limiting. Such activities reduce exposure to a variety of social interactions with different people; lack the richness of multigenerational and extended family structures; and narrow the bounds of the complexity and variety of children’s social, emotional, and cognitive experiences. Therefore, we conceptualize the content in the app not as parenting tips but as collective actions.

These collective actions broaden the scope of the child-focused activities to include a significantly larger network of individuals in a child’s life. As well as mothers, fathers, uncles, aunts, siblings, cousins, grandmothers, and grandfathers (Figure 4), we also encourage families to bring in other trusted adults from their communities and social networks to engage in these actions. We believe that this wider circle of interactions with and around a child may drive greater gains in cognitive, social, and emotional development (by increasing the varieties of experiences, stimuli, and interactions), in addition to increasing the opportunities for a child to be exposed to and embedded within the rich tapestries of their extended family’s culture and history (eg, rituals; folk stories; myths; and traditional songs, music, and dance).

In the Thrive by Five app, the primary content (collective actions) comprises 2 components (Figure 5). First, “The Why” provides the scientific background that supports a particular activity (eg, the importance of breastfeeding for a baby’s social, cognitive, emotional, and physical development and health outcomes) [39,40]. Second, the “Activity Pop Up” provides a practical activity in which parents, siblings, grandparents, other extended family members, and trusted community members could participate with the child. “The Why” and the “Activity Pop Up” are available both in text form and in audio form.

Over the course of this 3-year project, the Thrive by Five app will be implemented in 30 countries. A unique feature of this project is that for each country, we are actively considering how we can integrate cultural practices into the collective actions as a way of strengthening connections across families and communities and connections to places, cultural traditions, and values. To ensure that the app’s content is culturally acceptable, usable, relevant, and engaging, we developed a 4-stage process for developing and prototyping the country-specific collective actions (Figure 1) in partnership with local and international experts in ethnography, anthropology, ECD, medicine, psychology, and other disciplines.

The first phase of development is the conceptualization of the initial library of collective actions for a given country. This process is guided by the research team’s expertise and an examination of published research in areas that are relevant to the five domains and the five neurobiological systems that we previously described (Figure 2). The cultural framework (Figure 3) is used concurrently to highlight topics regarding local needs (eg, hygiene and distress management).

In the second phase of development and prototyping, the research team—in cooperation with a nominated in-country partner and representatives from the Minderoo Foundation—holds a series of co-design workshops with local subject matter experts (eg, educators, pediatricians, and psychologists) to examine the acceptability, feasibility, and relevance of the draft content (more details are provided elsewhere [41]). Similarly, in the third phase of development and prototyping, the research team holds a series of workshops with in-country parents, using a beta version or clickable demonstration version of the app to further examine the acceptability, usability, and relevance of the content. Based on the data that emerge from the co-design workshops, the drafted content is iteratively revised.

Finally, the last phase of development and prototyping includes the implementation of the app in the given country, after which an evaluation phase is conducted that examines the impacts of the Thrive by Five app on several factors, including parent-level confidence and self-efficacy (more details are provided elsewhere [41]). Importantly, at any one of the phases that involve communication with in-country partners, experts, and parents, ideas for subsequent collective actions may emerge.