Evaluation of the Early Years South Australia mobile application

Abstract

Background

See More

Released in July 2023 by the Office for Early Child Development in South Australia (SA), the Early Years SA mobile app supports parents of children aged 0–5 years with features including health check reminders, developmental milestone information, and a broad range of parenting resources. This study evaluated user awareness, engagement, and overall experience to identify areas for improvement and enhance the app’s impact on child health outcomes in SA.

Methods

The app was promoted through state-wide campaigns, including social media, parenting expos, and healthcare professional referrals, with an estimated eligible population of ~ 52,000 families with children aged 0–5 years in SA. Participants were app users and parents/caregivers of children aged 0–5 years in SA. A mixed-methods approach included four sub-studies: (1) Analysis of app usage statistics; (2) Usability evaluation via the System Usability Scale survey; (3) Assessment of app awareness and behaviour change through a population-level survey; and (4) Qualitative feedback from semi-structured interviews and an in-person focus group.

Results

In its first year, the app attracted 16,411 downloads and 12,289 users, with 4,272 active users in July 2024. The most accessed pages related to newborn sleep, immunisations, and early feeding. The System Usability Scale (n = 415) scored 82.5/100, indicating “excellent” usability. Population survey data (n = 324) showed 17% of South Australian parents of 0–5-year-olds were aware of the app, and among users, 17% reported it influenced their decision to access child health checks and immunisations. Qualitative feedback (n = 17) highlighted appreciation for the app’s user-friendly layout, credible Australian-focused information, and convenient, age-based resources as a digital companion to the My Health and Development Record (Blue Book). Suggested improvements included clarifying age-specific content organisation, adding comprehensive feeding and sleep tracking, and incorporating content for diverse family structures, cultural backgrounds, and neurodivergence.

Conclusion

The Early Years SA app shows strong usability and early evidence of positively influencing health service use. Future improvements should aim to expand reach and enrich content while preserving its user-friendly design. This evaluation offers baseline data for continued monitoring of awareness, usage, and impact on child health outcomes.

Background

Mobile applications (apps) have become integral to modern life, facilitating various daily activities from communication, education, and entertainment to government services. Health and wellness apps show particular promise for improving public health outcomes, though they face significant challenges in the competitive app marketplace. As of 2023, the Google Play Store and Apple App Store contained 2.4 million [1] and 3.8 million [2] apps respectively, with the lifestyle, health and fitness categories representing 5–8% of apps [3]. Despite their potential benefits, health apps struggle with user retention—industry statistics show they are typically used only four times before abandonment, with 25% of users never engaging after download [4].

Parenting apps have emerged as important tools for providing guidance and support across various aspects of child-rearing [5, 6], providing information on child development, health, nutrition, and evidence-based parenting practices. Common features include developmental milestone tracking, appointment reminders, and curated educational resources [6, 7]. The overarching objective is to address parenting challenges by providing readily accessible, evidence-based information and practical tools for daily parenting duties [7].

Research suggests these digital interventions can positively influence parenting practices and child outcomes, though findings are mixed. Studies have shown varied results: while some apps increase perceived social support for perinatal parents [8], others show limited impact on parenting self-efficacy [9]. However, evidence indicates high user satisfaction, with most caregivers willing to recommend parenting apps to others. Smartphone-delivered parenting support has demonstrated improvements in parenting behaviour [10], and digital interventions have achieved strong engagement while enhancing parental self-efficacy [11]. Parental education plays a critical role in promoting child development, improving parenting confidence, and fostering positive parent-child interactions, especially during the foundational early years [12]. However, traditional forms of parenting education—such as face-to-face classes or printed resources—often face barriers related to time, accessibility, and cost. Technology offers a scalable, low-cost solution to overcome these barriers by delivering evidence-based guidance directly to parents’ smartphones, allowing for flexible, on-demand access tailored to their needs. Monitoring child health—particularly developmental milestones, immunisations, and routine health checks—is essential for early detection of delays or health concerns, yet many families face barriers to accessing timely information and services. Parenting apps, when well-designed, can bridge this gap by integrating evidence-based health guidance with tools that encourage proactive engagement in children’s early health and development.

Additionally, these apps can serve as effective platforms for disseminating timely reminders regarding vaccinations and health check-ups, thereby enhancing adherence to recommended paediatric health schedules. The convenience and accessibility of mobile apps makes them an appealing option for parents seeking support and information pertaining to child-rearing. Despite their benefits, parenting apps may unintentionally contribute to increased anxiety, particularly if users perceive conflicting advice or feel pressure to meet developmental milestones [13]. There is also concern that frequent reliance on mobile apps for parenting support may reinforce digital dependency and reduce parents’ confidence in their own judgment [14]. Moreover, excessive mobile phone use prompted by app engagement can compete with in-person parent-child interactions, raising concerns about screen distraction during key bonding moments [15]. A key challenge for parenting apps is maintaining user engagement over time. Success factors include app usability, content personalisation, and resonance with parents’ specific needs and challenges [16, 17]. These elements are crucial for developing digital tools that can sustain engagement and positively impact child health outcomes.

The Office for Early Child Development (OECD) [18], a government department in South Australia, developed the Early Years SA app to support parents of children aged 0–5 years and improve child health and development outcomes. Launched in July 2023, this free app provides evidence-based information and reminders for child health and development checks and immunisations, milestone information, and connections to relevant services. The app has been promoted through various channels, including a launch event with the State Premier, promotional materials in new parent “Bounty Bags” provided by Child and Family Health Services (CaFHS), local news sites, shopping centres, and healthcare settings throughout SA.

This study aims to evaluate the Early Years SA app’s user awareness, engagement, and overall experience through four objectives: (1) assess app awareness and user demographics, (2) analyse engagement metrics, (3) examine relationships between app usage and health-seeking behaviours, and (4) explore user experience and identify improvements through qualitative feedback. These insights will inform ongoing development and serve as a baseline for future evaluations.

Methods

Study design

The Early Years SA app (Fig. 1) was developed by the Office for Early Child Development (OECD) through an iterative, evidence-informed process. Content was prioritised based on current Australian parenting guidelines and expert input from child health professionals, early childhood educators, and public health researchers. During development, community consultation included surveys and focus groups with South Australian parents and caregivers to ensure content relevance, cultural appropriateness, and alignment with user needs.

Fig. 1

Screenshots from the Early Years South Australia mobile app

Researchers from the University of South Australia collaborated with the OECD to evaluate the Early Years SA app between July 2023 and July 2024. This mixed-methods evaluation followed the COREQ guidelines (Consolidated Criteria for Reporting Qualitative Research) [19] for qualitative components and STROBE guidelines (Strengthening the Reporting of Observational studies in Epidemiology) [20] for quantitative aspects. The University of South Australia Human Research Ethics Committee approved the study (#205823). Participants provided informed consent for sub-studies 2–4, while sub-study 1 used anonymous data.

Evaluation components

The evaluation consisted of four sub-studies:

Sub-study 1: engagement evaluation

For the engagement evaluation, data collection occurred automatically through the app’s backend database without requiring active participant recruitment. The OECD provided summary-level, de-identified data to the research team, encompassing metrics such as downloads, days of use, and page views. The automated data collection captured comprehensive user interaction patterns, including frequency of app opens, feature utilisation, navigation sequences, and time spent on different pages.

Sub-study 2: evaluation of usability

For the usability evaluation, users received 2 push notifications inviting them to participate in the study. Through REDCap, participants accessed study information, provided consent, and completed the System Usability Scale [20], a validated 10-item questionnaire that produces a score from 0 to 100 [21, 22]. The scale contains alternating positive and negative statements rated on a 5-point Likert scale from “strongly disagree” to “strongly agree.” The OECD administered this survey alongside demographic questions capturing basic sociodemographic details (age, gender, socioeconomic status, education, and postcode). Additional data were collected on app feature engagement patterns and user satisfaction through a supplementary online survey combining closed ended (multiple choice, Likert scale) and open-ended questions. All survey responses were collected for continuous quality improvement purposes, enabling analysis of usability patterns across different user demographics and engagement levels.

Sub-study 3: evaluation of awareness and behaviour change

The awareness and behaviour change evaluation leveraged the 2024 SA Population Health Survey Module System (PHSMS), a bi-annual government survey that enables organisations to incorporate custom items for population-level data collection. Five custom items about the Early Years SA app were added to the May 2024 iteration, administered by Preventive Health SA. Using Computer-Assisted Telephone Interviews (CATI), the survey randomly sampled South Australian adults to ensure population representativeness. Parents or carers of children aged 0–5 years who participated in the survey were asked about their awareness of the Early Years SA app, how they learned about it, and whether the app influenced their attendance at child health and development checks. Data were collected anonymously via structured telephone interviews and provided to the research team in summary form by Preventive Health SA.

Sub-study 4: qualitative sub-study to assess in-depth user feedback

The qualitative evaluation was initially planned as in-person focus groups in settings frequented by parents of children aged 0–5 years. Due to delays associated with getting permission to conduct the focus groups in relevant settings, the protocol was expanded to include telephone interviews, which had the added benefit of reaching rural and regional participants. Interview participants were recruited via app push notifications directing them to a Qualtrics eligibility survey and offered a $50 gift voucher for participation. For focus groups, recruitment occurred through OECD-provided playgroup contacts, with a research assistant (KD) presenting at playgroup sessions and directing interested parents to the same eligibility survey.

Eligibility criteria for both components required participants to be over 18 years, parent/caregiver of a child aged 0–5 years, and to have used the app within the past month. Non-English speakers and those not meeting these criteria were excluded. Purposive sampling ensured diverse representation across socio-economic backgrounds (using Socio-Economic Indexes for Areas [SEIFA] decile ranks 1–10 [23] and geographic locations (using Australian Standard Geographical Classification [ASGC]) classifications from Major City to Very Remote [24]. The classifications range from Major City, Inner Regional, Outer Regional, Remote, to Very Remote [24]. Informed consent was obtained verbally for phone interviews and in writing for focus group participation.

Data collection comprised 20-30-minute semi-structured phone interviews and one 60-minute focus group at an early learning centre in southern metropolitan Adelaide. Interview and focus group questions, developed through team consultation and pilot testing, explored user perceptions, usage barriers, and improvement suggestions. A female PhD candidate (KD) with qualitative research experience conducted all sessions, which were audio-recorded and transcribed. To ensure methodological rigor, a senior researcher (CM) reviewed recordings and provided feedback on interview technique, incorporating reflexivity discussions about potential biases [25]. Data collection continued until saturation was reached [26]. To minimise bias, the interviewer maintained minimal pre-interview contact with participants and had no prior experience with the app. Due to practical constraints, field notes were not taken and participants did not review transcripts. All sessions focused on understanding user experiences and identifying opportunities for app enhancement.

Analysis

Data analysis approaches were tailored to each sub-study. For sub-study 1 (engagement), descriptive statistics summarised app usage patterns, including frequency distributions of downloads, page views, and interaction metrics. Sub-study 2 (usability) analysis involved calculating mean System Usability Scale scores (range 0-100) and standard deviations, with scores interpreted according to Bangor et al.’s [27] established benchmarks: scores 91–100 “best imaginable”, 81–90 “excellent”, 68–80 “good”, and < 68 indicating usability concerns requiring attention. For sub-study 3 (awareness), descriptive statistics were calculated for survey responses, including proportions of app awareness and reported behaviour change. For the qualitative component (sub-study 4), inductive thematic analysis was conducted using NVivo software (Version 14; QSR International Pty Ltd., Melbourne, Australia). Transcript data were systematically coded, and themes developed as they emerged. The qualitative sub-study was guided by a constructivist paradigm, acknowledging that meaning is co-constructed through participants’ lived experiences and the researchers’ interpretation. An inductive thematic analysis approach, as described by Braun and Clarke [28], was used to identify patterns across the data without imposing pre-existing frameworks. This approach aligns with exploratory health research, where the goal is to generate rich, participant-informed insights about user experiences and perspectives. Thematic development was iterative and reflexive, involving constant comparison and critical discussion among research team members. Multiple rigour strategies were employed: investigation triangulation involved two researchers (KD and RC) independently contributing to coding, interpretation, and feedback; dependability was established through rich coding and representative participant quotes; transferability was supported through detailed documentation of analytical decisions; and confirmability was enhanced through peer feedback during theme development. The research team regularly met to review transcripts and resolve any discrepancies in theme generation through discussion.

Results

Sub-study 1: evaluation of engagement

Between June 2023 and July 2024, the Early Years SA mobile app attracted 16,411 downloads and 12,289 unique users (Table 1). Of these, 8,256 users returned after initial use. As of July 2024, there were 4,272 active users (defined as logging on more than once within the preceding 6-week period) and 8,017 inactive users. Users registered 8,286 children in the app (average 1.5 children per user). The average age of registered children in July 2024 was 26.7 months, with average onboarding age of 17.0 months. Notifications were enabled by 4,655 users, while 3,145 had them turned off. The app recorded 95,279 unique user sessions.

Table 1 App engagement and user characteristics

App content engagement data is detailed in Supplementary content 1–5. Users viewed informational articles 46,601 times, with “Immunisations” (2,585 views) and “Early Feeding” (2,465 views) being most accessed. “Newborn and Baby Sleep” received the most likes. External links garnered 15,098 views, with the Privacy Statement (1,406 views), Terms and Conditions (1,208 views), and Parenting SA Toilet Training Guide (561 views) most frequently accessed.

Other popular services (Supplementary content 3) accumulated 1,860 visits. The Child and Family Health Service was most accessed (651 visits), followed by their Parent Helpline (476 visits) and the Australian Breastfeeding Association (207 visits). For app navigation, the “Home” page received 80,036 visits, “Home - Discover” 67,550 visits, and “Home - Growth Chart” 41,201 visits. Users created 295 bookmarks total, with “Toilet Training” (29 bookmarks), “About Babies” (11 bookmarks), and “Important Milestones: Your Baby by Two Months” (8 bookmarks) being most visited.

Sub-study 2: evaluation of usability

A total of 415 participants completed the System Usability Scale (SUS) survey. The average age of these participants was 34.0 years (SD = 7.7 years). Most respondents were female (66.5%), with a majority reporting no disability (71.8%) and identifying as not Aboriginal or Torres Strait Islander (73.3%; Table 2).

Table 2 Demographic characteristics of users that completed the system usability scale (n = 415)

The mean System Usability Scale score was 82.5 (SD = 15.6) out of 100, indicating “excellent” usability according to established benchmarks [27]. Individual item responses for the System Usability Scale are shown in Table 3. The survey results revealed a generally positive attitude towards the app, with 60.9% of users expressing that they liked it either “mostly” or “a lot.” Additionally, 73.9% found the app “easy” or “mostly easy” to use. Only 10.1% of users reported that the app was hard to understand, and 2.2% needed assistance to use it. Confidence in using the app was relatively high, with 71.6% of users feeling confident. Trust in the information provided by the app was high, with 78.8% of users expressing trust, including 45.5% who trusted it “a lot” and 33.3% who trusted it “mostly.”

Table 3 Individual item responses for the system usability scale (n = 415)

Sub-study 3: evaluation of awareness and behaviour change

Of 3,002 respondents to the 2024 SA Population Health Survey Module System, 324 (10.8%) were parents or carers of children aged 0–5 years (Table 4). Awareness of the Early Years SA mobile app was relatively low, with 17.0% of these parents having heard of the app and 7.7% (n = 25) having downloaded it. Regarding health services, 69.1% (n = 224) of parents were aware of available child health and development checks, and 56.8% (n = 184) reported their child had attended such a check in the past 12 months. Among the subset of parents who had both downloaded the app and attended a health check (n = 23), 17.4% indicated that the Early Years SA app influenced their decision to pursue both a health check and immunisation for their child.

Table 4 Awareness of the app and self-reported behaviour change concerning attendance at child development checks, obtained from the 2024 SA population health survey module system

Sub-study 4: qualitative sub-study to assess in-depth user feedback

A total of 17 participants provided feedback through telephone interviews (n = 11) and a focus group (n = 6). Phone interview participants were recruited from 180 expressions of interest, with final numbers determined by purposive sampling to ensure diverse representation. Most participants were female (76.4%), first-time parents (82.3%) and had children aged 0–2 years (88.2%, Table 5). The majority resided in metropolitan Adelaide (76.4%), with 23.3% from regional or remote areas. Participants represented diverse socioeconomic backgrounds, with 46.9% from more disadvantaged areas (SEIFA deciles 1–3), 35.1% from middle ranges (deciles 4–7), and 17.5% from higher ranges (deciles 8–10).

Table 5 Interview and focus group participant characteristics (n = 17)

Thematic analysis identified three main themes: (1) positive experiences, (2) future expansion and (3) promoting the app, each with several sub-themes.

Main theme 1: positive experiences

Participants consistently described positive experiences using the Early Years SA app. Participants highlighted that they liked the easy to navigate layout to find resources, the credibility of the information, the focus on the Australian context, the resources cover a range of topics that can be personalised to your child’s age group, and the reminders and notifications serve as a great way to prompt parents for upcoming checks.

“Really positive. I’ve really liked the layout and the ease of use, the range of resources and the quality of the resources as well, I found it really useful.” (Participant 2, phone interview).

“I actually found it really helpful, especially for immunisations, because it actually notifies me of certain milestones and immunisations.” (Participant 8, phone interview).

Sub-theme 1: convenient companion

Participants frequently compared the Early Years SA app to the “My Health and Development Record” which is provided to all parents of newborn babies in South Australia called the “Blue Book”. They described the app as an excellent companion to the Blue Book, eliminating the need to always refer to a physical book making it easier to find important information, input growth data, be reminded for appointments and health and developmental checks, helpful to interpret data and handy to refer to on the go.

“When you’ve got a baby and you’re trying to do five things at once, it’s a bit easier to scroll quickly on your phone versus trying to like, flick through this Blue Book.” (Participant 1, focus group).

Sub-theme 2: helpful to navigate challenging situations

Participants explained that they used the Early Years SA app to find information that helped them navigate their expectations and concerns. It also prompted some participants to seek further support from medical professionals. Participants described how they rely on the app’s resources for guidance, especially when they were unsure how best to support their child.

“Cause my bubba [baby or infant], she’s a little bit delayed, so knowing what she should be up to, I can then address that quicker.” (Participant 6, phone interview).

“If he’s not meeting milestones, it’s a good prompt to go and investigate and find resources on how to navigate those challenges, if those milestones or expected outcomes aren’t being made.” (Participant 12, phone interview).

Main theme 2: future expansion

Participants described additional features and information that they would like to see added or incorporated into the app. Participants recommended that the app organise resources by the child’s age to improve navigation and help users find specific information more easily. However, resources on a child’s profile are already age-specific and filtered by age range, and the ‘All Resources’ tab, which was introduced during the evaluation, also provides the option to filter by age range. The confusion may have arisen due to this recent addition. Participants also suggested providing clear instructions for measuring growth, including assistance in interpreting the growth data.

“It would be really useful if the resources matched with the age of the child, so if you have a four-month-old, the resources should be in that section, rather than we have 200 different articles and resources in one section.” (Participant 10, phone interview).

Sub-theme 1: one stop shop

Most participants indicated that, besides the Early Years SA app, they relied on other child development related health apps to find resources and keep track of their child’s sleep and developmental milestones.

“We use Huckleberry all the time because there is a feature in Huckleberry called Sweet Spot. And basically, what it does is predict or give you time frame for naps and those sort of things. So, if we add those features, obviously into this app it would be more helpful.” (Participant 10, phone interview).

Participants described how it would be beneficial if they could have all the credible information they need within one app, such as the Early Years SA app, rather than having to access multiple apps.

“If you could incorporate that into the same app, that would be awesome. Because like I said, just opening one app instead of having five on your phone.” (Participant 2, focus group).

Despite participants often using Google to find information, they acknowledged that they disliked this method. They found that information on Google can be contradictory, causing confusion and anxiety among parents.

“I Google and everything for their milestones, but it varies too. Like she’s killing it on one site and then you read another site which sends you into a spiral.” (Participant 6, focus group).

Sub-theme 2: additional resources and features

Participants suggested that the app should offer resources for tracking breastfeeding, bottle feeding, and meal counts, as well as provide information on techniques like latching and tube feeding. Participants also described the need for guidance on government assistance programs to support challenges faced by parents of premature babies, such as frequent hospital visits and parking fees. Additionally, they highlighted the importance of tracking nappies [diapers] for health monitoring and suggested reminders for milestones like school enrolment and preschool planning.

“Different techniques on how to hold bubs [baby or infant] and how to latch, having all of that really accessible would promote breastfeeding, obviously, they talk about breast is best and having that information there that people don’t have to go look know that they need to look for.” (Participant 12, phone interview).

“I had a premmie baby and they wouldn’t let me stay, so I was literally going home, pumping, driving back. Feeding her and just doing that constantly and you can only imagine the parking fees.” (Participant 6, focus group).

Sub-theme 3: support from the beginning

Participants described the need for more support and guidance from the very beginning of pregnancy through to childbirth. Participants highlighted the potential benefits of starting to use the app during pregnancy to track vital information, which can be readily available to health professionals once the baby is born.

“I think it would be helpful to start using the app during pregnancy. That’s when you start wanting to track everything, and if you already have it set up, once the baby is born, you have all the information ready. For example, if the app knows the baby was born at 37 weeks, it can immediately recognise that they were born a bit early.” (Participant 1, focus group).

Participants also expressed a desire for early and clear guidance on navigating pregnancy, including understanding various pregnancy options, necessary medications, and prenatal care.

“I’m pregnant, what do I do? I’m just like, okay, help with this. Or can a GP appointment do this? Start taking the medication, here’s all different ones, look for folic acid, or whatever it is.” (Participant 1, focus group).

They pointed out that health professionals often assume they have prior knowledge, leaving expectant parents confused.

“But sometimes health professionals especially at the start, they’re like have you done this yet? Have I done what? If you haven’t told me, how I’m supposed to do it.” (Participant 3, focus group).

Additionally, participants stressed the importance of being provided with the information needed to make informed decisions about prenatal tests and other critical aspects of pregnancy.

“You don’t get given the opportunity to get the information behind the decision for prenatal tests, it’s just like on the spot, I need an answer, yes or no, are you having the test, and it’s oh, if I had the test, what does that mean, and what does it entail, and all of that. You’re like, what? What does it do? Yeah, you need to know. You need to make an informed decision.” (Participant 5, focus group).

Sub-theme 4: well-being for parents

This sub-theme emphasised the need for more mental health support resources aimed at the parents’ well-being, including the relationship between mum and dad.

“More like mental health support. And it’s not just between mum and baby and dad and baby. I think it’s got to do between mum and dad as well.” (Participant 8, phone interview).

Participants highlighted the importance of addressing the well-being of mothers, recognising that while the app is designed for children’s health, the mothers’ health is equally crucial.

“I know that it’s an app designed about the well-being and health of the kids, but what about the mum?” (Participant 1, focus group).

There was also the suggestion for more services and resources for parents dealing with infant loss from one participant:

“Even if there’s more services or resources for infant loss because one of my friends, she had twins and one of them didn’t make it past 48 hours.” (Participant 4, phone interview).

Overall, participants stressed that mothers often feel like they are thought of last, despite being essential caregivers.

“I reckon you could do more for the mums. For sure. We’re the ones keeping the kids alive, right? Yeah, we’re always the person we think about last, aren’t we?” (Participant 9, phone interview).

Sub-theme 5: cultural diversity and inclusive support

This sub-theme reflects the insights from participants, highlighting the importance of acknowledging and celebrating the cultural connection of Aboriginal and Torres Strait Islander people with their local communities by providing resources and activities they can participate in with their child addressing specific health challenges they may face.

“A list of local playgroups, including any tailored for Aboriginal and Torres Strait Islander kids and more information about what Aboriginal and Torres Strait Islander kids need to connect to culture.” (Participant 4, phone interview).

“My son is Aboriginal, and I know that they need more vaccinations because they’re more at risk for certain things, so more awareness around that.” (Participant 4, phone interview).

Participants also emphasised the unique needs of various family structures, including single parents and same-sex couples.

“Obviously you got single parents, you got same sex parents. I think that possibly being able to cater those situations might be very good.” (Participant 14, phone interview).

They also discussed how cultural differences impact growth patterns and their representation in percentile data should be included.

“His dad’s Jamaican the head circumference for him is apparently massive, but then if you look at that background, hang on a minute, they’re like, actually fine. But unless you can have that perspective you can really go into a bit of a spiral.” (Participant 3, focus group).

Additionally, participants also underscored the necessity of tailored resources for neuro-diverse children.

“I don’t think there’s much about kids who might be on the spectrum, maybe more resources to identify kids on the spectrum, things like that and local services who might be able to support that.” (Participant 4, phone interview).

Sub-theme 6: data storage and sharing

Participants described the usefulness of an additional feature that allows you to share the data on the app with others such as between partners, GPs, and other medical professionals.

“If you and your partner both have the app on your phones, there’s no way to sync the data.” (Participant 12, phone interview).

Participants highlighted that this feature could be in the form of a medical history section within the app allowing parents to write notes and enter in data.

“For instance, if he had an allergy or something like that. Or just like a little notes page. Gave him peanuts, he had a rash. So then, if we went to the doctor, I could refer to my notes. And be like, hey, actually, he had a rash on this day when we gave him peanuts.” (Participant 14, phone interview).

Some participants also suggested expanding this feature to connect to the child’s government health record to ensure all the medical information is up to date and available to health professions especially in emergencies.

“If you could almost link the app to a system that they can log in each baby, they have the immunisation system linked to hospitals, so you fill that stuff in online and then they can open it anywhere. If they could do that it would be awesome. Obviously not have all this paperwork and things everywhere. How often does that go missed if you have a different person.” (Participant 6, focus group).

Main theme 3: promoting the app

Most participants found out about the app through their obstetrician, midwife, nurse or through media such as Instagram, Facebook and radio advertisements. However, participants highlighted the need for better promotion and awareness of the app to ensure that it reaches a wider audience.

“If I mention this app not a lot of people have heard about it. So, I try and get all my mum friends that I know that have got like young bubbies [baby or infant] to try and get onto the app because I do know that it can be helpful.” (Participant 6, phone interview).

Participants suggested that the app could be promoted through GPs, in the form of pamphlets and through social media or integrated within government platforms to increase visibility.

“Even just on a pamphlet would have been something. You get that many pieces of paper that maybe it wouldn’t have worked for everybody, but I think a lot of mums do read all the papers.” (Participant 13, phone interview).

Many participants noted that despite the app’s potential benefits, it may not be well-known amongst some parents, especially those who may live regionally. Participants described that improving these outreach strategies could help more parents access the app’s resources, especially if they cannot access support locally.

“I’ve worked in government many years and, we looked after Ceduna [a remote regional town in South Australia] and areas like that where there’s not a heap of health services out there. If this app is not promoted in GPs, then are they getting told at all about this? Because that’s a really good way for them to connect to a health service because everyone, nearly everyone has a phone.” (Participant 2, focus group).

Discussion

We set out to evaluate the Early Years SA mobile app’s implementation and impact in its first 12 months after release. The app achieved substantial reach (12,289 users), with strong engagement (95,279 sessions) and excellent usability (SUS score 82.5/100). Popular content areas included newborn sleep, immunisation and early feeding. Population-level awareness of the app was modest (17% of eligible parents), though among those who downloaded the app and attended health and development checks, 17.4% reported it influenced their health service utilisation. Qualitative findings highlighted the app’s value as a trusted information source and digital companion to traditional health records, while also identifying opportunities for expanded features and improved promotion to reach a broader audience, particularly for culturally diverse and regional families.

User engagement

The Early Years SA app demonstrated substantial initial uptake, attracting 16,411 downloads and 12,289 users in its first year. This appears substantial, given that approximately 19,000 babies are born in South Australia per year [29]. By July 2024, there were 4,272 active users, a pattern that warrants consideration. On one hand, this could be interpreted as indicating engagement challenges. Conversely, it may also reflect successful knowledge acquisition, with parents becoming more confident and requiring less app support over time. Of note, the 67% return rate (8,256 users) after initial use considerably exceeds typical health app engagement patterns [30], suggesting the app meets an important need during key parenting transitions. This is further supported by usage patterns: the average registration of 1.5 children per user suggests perceived value across child development stages, while the mean age at onboarding (17.0 months) identifies a key window for parent engagement. While the Early Years SA app attracted strong uptake during its first year, active user numbers declined to 4,272 by July 2024. This pattern is consistent with broader trends in digital health, where many apps see steep drop-offs after initial download [30,31,32]. However, the Early Years SA app is designed primarily as an on-demand resource, offering educational content that parents may access episodically - for example, when a specific question or need arises. In this context, high sustained daily or weekly use is not necessarily expected or required for the app to be effective. Encouragingly, the app demonstrated a 67% return rate after initial use, which is well above industry norms and suggests that parents were willing to return when the need arose.

Content engagement metrics (95,279 sessions, 46,601 article views) indicate strong user interest in specific topics, particularly newborn sleep, immunisations, and early feeding. This aligns with previous research identifying these as primary concerns for new parents [33, 34]. The substantial external link views (15,098) position the app as a valued gateway to credible resources, though this highlights the importance of careful curation to maintain the app’s role as a trusted information source in the complex landscape of online parenting advice. The relatively high number of views for the Privacy Statement and Terms and Conditions may reflect users’ interest in understanding how their data are used and stored—an important consideration in digital health tools. This could signal a broader concern among parents about privacy, particularly when inputting sensitive questions related to their children. Ensuring that privacy policies are clear and accessible may help build user trust and encourage continued app engagement.

Usability

The Early Years SA app achieved an excellent System Usability Scale score of 82.5, placing it in the top 10% of digital systems [27], and substantially exceeding both the benchmark for general apps (68.0) [35] and the average for digital health apps [36]. This high usability is reflected in user experiences, with only 10% reporting difficulty understanding the app and 2% requiring assistance. Particularly noteworthy was users’ trust in the app’s information (78.8%), a crucial factor for health promotion tools. While some usability challenges emerged, such as the need for more specific age-based content organisation, this aligns with common challenges in health app design [37, 38] and existing research on personalized health information delivery [39].

Awareness and behaviour change

Population-level awareness of the Early Years SA app was modest, with 17% of target parents aware of the app and 7.7% (n = 25) downloading it, indicating significant scope for enhanced dissemination strategies. This awareness-to-download conversion rate aligns with broader health app adoption research [31, 32], and suggests potential barriers between awareness and uptake that warrant investigation. Among those who did engage with the app, there were promising signs of impact on health behaviours: 17.4% of app users who attended health and development checks reported that the app influenced their decision to pursue both health checks and immunisations. This behavioural influence, while preliminary, is consistent with previous research on digital health interventions [40, 41], and suggests potential for greater population-level impact as app awareness and adoption grow. Traditional parental education programs, such as antenatal classes and printed health booklets, often struggle with limited reach, inconsistent delivery, and lack of personalisation, particularly among parents from diverse or disadvantaged backgrounds [42, 43]. In contrast, digital health interventions like mobile apps offer a scalable, accessible, and low-cost way to deliver evidence-based parenting support [44, 45]. Mobile technologies are particularly promising for engaging parents in real time, providing just-in-time guidance and nudges that align with parenting transitions and decisions [46]. However, previous research has also highlighted that sustained engagement remains a major challenge, underscoring the importance of designing digital tools that are easy to use, trusted, and responsive to user feedback [47].

In-depth user feedback

Our qualitative findings revealed important insights about how parents use and value the app. Parents consistently described the app as a “convenient companion” to their traditional Blue Book health records, highlighting how digital tools work best when they complement rather than replace existing healthcare systems. Many parents expressed interest in having support available from pregnancy onwards, similar to what other researchers have found when studying parenting apps [41]. This suggests there could be real value in expanding the app to support parents through their entire journey from pregnancy through early childhood.

Two particularly striking themes emerged from the interviews and focus groups. Parents emphasised the need for culturally inclusive content, especially for Aboriginal and Torres Strait Islander families. This fits with growing evidence about the importance of culturally responsive digital health tools [48]. Parents also frequently mentioned wanting to share app data with their partners and healthcare providers, reflecting a broader move toward more connected, patient-centred care [49]. While such features could significantly enhance the app’s value, implementing them will require careful attention to data privacy and security measures, along with consideration of development costs. Further, while participants expressed interest in the ability to sync or share app data with others, such as co-parents or healthcare providers, this functionality is not currently available. The app does not support account-based storage or data syncing due to technical constraints and data sovereignty considerations, although a manual export option is provided.

Strengths and limitations

A major strength of this study was the collaborative partnership between university researchers and government app developers, bringing rigorous evaluation methods to a significant public health initiative. Our comprehensive evaluation approach combined multiple complementary elements: automated usage analytics, standardised usability assessment, population-level awareness measurement, and in-depth qualitative feedback. It establishes baseline measures of reach, engagement and impact from which future progress can be tracked. The use of validated tools like the System Usability Scale enabled benchmarking against other digital health tools, while incorporating items into the SA Population Health Survey Module provided rare population-level insights about app awareness. Our purposive sampling strategy for qualitative interviews ensured we captured diverse perspectives across socioeconomic and geographic contexts, providing rich insights into how different communities engage with the app.

However, limitations must also be acknowledged. Users who completed the usability survey and qualitative interviews may have been more engaged with the app, potentially introducing selection bias. The small number of app users identified through the population survey (particularly those who had attended health and development checks) limits our ability to draw firm conclusions about the app’s behavioural impact. As a cross-sectional evaluation conducted one-year post-launch, we cannot yet speak to long-term outcomes. Finally, while users suggested numerous avenues for improvements, some of these fall outside the app’s intended scope or raise substantial privacy and integration challenges that would need careful consideration before implementation. A further limitation is that qualitative feedback was only obtained from active users, meaning the perspectives of those who downloaded but did not engage with the app remain unknown. This limits insight into potential barriers to sustained use and highlights an important area for future targeted research. Additionally, non-English speakers were excluded from the qualitative evaluation because the Early Years SA app is currently only available in English, which may limit accessibility for families with limited English proficiency.

Future research and recommendations

This evaluation provides valuable insights into the Early Years SA app’s first year of implementation, suggesting several priority areas for ongoing development and research. Ten months after launch, the app had achieved 17% awareness among parents of children aged 0–5 years, providing a foundation for future growth. Continuing efforts to raise awareness will help extend the app’s reach to more South Australian families.

The excellent usability scores and positive user feedback indicate that the app’s core architecture and functions are working well, providing a strong foundation for future enhancements. Rather than needing to address fundamental usability concerns, development efforts can focus on strategic expansion of existing strengths. User feedback suggested several potential directions for enhancement, each with different levels of feasibility and alignment with the app’s core mission.

A clear priority is expanding cultural inclusiveness, particularly for Aboriginal and Torres Strait Islander families and culturally and linguistically diverse communities. This could involve co-designing culturally appropriate content and features with these communities while maintaining the app’s current streamlined, user-friendly interface. Future development could explore opportunities to further involve end users and stakeholders, such as parents, healthcare professionals, and community representatives (including Aboriginal and Torres Strait Islander communities) in the expansion and refinement of the app. Approaches such as advisory groups or participatory methods may offer additional insights into enhancing usability, cultural relevance, and promotional strategies. Suggestions from participants to expand the app’s features (e.g., including co-parenting information) and to explore integration with existing health system touchpoints (e.g., GP visits, child health checks) may help improve reach and user engagement.

Other user suggestions, while valuable, require careful consideration. Requests for expansion into prenatal care, while understandable, fall outside the app’s intended focus on supporting families with children aged 0–5 years. Similarly, suggestions for extensive personalisation and health service integration, though theoretically appealing, present substantial technical and privacy challenges. Such features would require complex data handling protocols, more intensive user onboarding, and careful consideration of security measures that could potentially impact the app’s current simplicity and ease of use.

Future longitudinal research, building on these baseline findings, could examine patterns of app usage over time to better understand whether declining engagement reflects successful knowledge acquisition or the need for enhanced retention strategies. This could involve more in-depth qualitative research with non-users and those who downloaded but did not engage with the app. Studies linking app usage data with health service utilisation could provide stronger evidence about behavioural impacts, building on our preliminary findings about health check attendance.

Conclusion

The Early Years SA app shows considerable promise as a digital tool to support parents of young children in South Australia. The comprehensive evaluation revealed excellent usability and high user trust, alongside opportunities to enhance reach and impact. The combination of strong core functionality with clear pathways for future development suggests the app has potential to become an increasingly valuable resource for SA families. Key priorities moving forward include expanding culturally inclusive content and maintaining the app’s user-friendly approach while carefully considering which new features to implement. Importantly, this evaluation provides baseline data about awareness, usage patterns and user experiences that will inform ongoing app development and evaluation. By continuing to monitor these aspects while incorporating user feedback, the Early Years SA app can evolve to better support the healthy development of young South Australian children.