Evaluation of Digital Decision-support Tool for Child Nutritional Monitoring: a Protocol for Cluster Randomized Controlled Trial in Urban and Semi-Urban Areas in Indonesia (KSI-RCT)

This research is a collaborative study between Indonesia's Strategic Development Initiatives (CISDI), Knowledge Partnership Platform Australia - Indonesia (KONEKSI), Center on Child Protection and Wellbeing (PUSKAPA), and Center for Development Economics and Sustainability at Monash University. This study is a part of the PN PRIMA research universe, which is a program lead by CISDI with a focus of strengthening the primary healthcare facilities of Indonesia, known as Integrated Health Posts (Posyandu). This project supports the Ministry of Health's (MoH) flagship program: the Integrated Primary Health Care Services (ILP).

This study aims to evaluate the impact of implementing a digital mHealth app, called the PN PRIMA app, in enhancing the work quality of Community Health Workers working in Posyandu, known as Kader. This study specifically improve the PN PRIMA app from a web-based platform to a mobile application. We aim to improve data quality, streamline service delivery workflows, and enhance decision-making support for community health workers. The enhanced version incorporates new features and Gender Equality, Disability, and Social Inclusion (GEDSI) framework to strengthen primary health care delivery.

Impact evaluation of the study will be conducted through a three-arm parallel cluster randomized controlled trial. Posyandu will be the unit in which randomization will occur. The primary outcomes focuses on the improvements of Kader Posyandu performance in delivering follow-up home visits and how the app effectively support Kader in delivering nutrition interventions for children under five years of age.

The study will be conducted in the Puskesmas PN PRIMA catchment area, located in Kabupaten Bekasi and Kota Depok, focusing the intervention at the Posyandu level. In total, 38 Posyandu out of 12 health centers (Puskesmas) across the two areas will be recruited to take part in this study.

Study Overview

• Status: Active, not recruiting
• Conditions: Nutritional Status; Primary Health Care for Children
• Intervention / Treatment: Device: Web-Based Apps PRIMA; Device: Apps PRIMA Mobile; Behavioral: Advance GEDSI Training

• Study Type: Interventional
• Enrollment (Estimated): 1030
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Indonesia
  • Depok, Indonesia
    • Puskesmas Abadijaya
  • Depok, Indonesia
    • Puskesmas Baktijaya
  • Depok, Indonesia
    • Puskesmas Cinangka
  • Depok, Indonesia
    • Puskesmas Limo
  • Depok, Indonesia
    • Puskesmas Sukatani
  • West Java
    • Depok, West Java, Indonesia, 16411
      • Puskesmas Sukmajaya

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Community Health Workers (CHWs) assigned to work in one of the eligible Posyandu PN PRIMA
• Consent to participate in the program and the study

Exclusion Criteria:

- Community Health Workers working outside of Posyandu PN PRIMA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Web-Based App; The first group of Posyandu will use the standard web-based version of the PN PRIMA app in addition to the routine nutritional services. This web-based version is accessible only through browsers and includes the basic functions such as reporting key health indicators and in-app warning alerts. This group will serve as the control group, using the baseline functionality of the app currently available to Kader	Device: Web-Based Apps PRIMA; Apps PRIMA (posyandu monitoring tools) is delivered using a web-based app accessible through web browsers with basic core functionalities
Experimental: Mobile-Based App; This group will receive access to the mobile version of PN PRIMA app. The mobile-based version has additional features unavailable in the web-based version. The mobile-based version has access to the PN PRIMA app using a standalone mobile app. In addition to the standard reporting of patients' key health indicators and in-app warning message alerts which are available in the web-based version, the mobile app includes active notifications for Kader, which serve as reminders to encourage Kader in making on-time assistance for healthcare beneficiaries, especially those considered requiring special attention (kunjungan khusus) and for those facing access barriers who need regular checkups (kunjungan rutin).	Device: Apps PRIMA Mobile; Enhancement of Apps PRIMA delivered using a standalone mobile app. Enhanced core functionalities include the looping system of children measurements, automatic charts, and GEDSI-sensitive features
Experimental: Mobile + GEDSI Training; In addition to using the new mobile-app as arm 2, this arm will include training module that focuses on identifying and addressing caregiver and community vulnerabilities. This training is designed to strengthen Kader's capacity in recognizing risk factors that may contribute to malnutrition, such as social, economic, and environmental barriers to care. The training emphasizes empathetic and responsive service delivery, equipping Kader not only with technological tools but also with improved understanding and skills for working in complex community settings. This integrated intervention enables the study to assess the combined effect of digital tools and conventional capacity-building efforts on service delivery outcomes.	Device: Apps PRIMA Mobile; Enhancement of Apps PRIMA delivered using a standalone mobile app. Enhanced core functionalities include the looping system of children measurements, automatic charts, and GEDSI-sensitive features; Behavioral: Advance GEDSI Training; Additional training to address vulnerabilities in communities and empathetic service from CHWs to caregivers. The training is a follow-up training from a basic GEDSI materials already delivered to CHWs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
At least one visitation completed	The proportion of U5 children's visitation cycles in which CHWs completed at least the one required home visitation according to the app-generated schedule. For each cycle, a score of 1 is coded if the assigned CHW completes at least one visitation session within the scheduled time window, and 0 if none of the scheduled visitation was delivered. The final proportion is calculated as the number of cycles coded 1 in proportion to the total number of visitation cycles assigned to the CHW.	From intervention roll-out to the end of intervention period in 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge and Attitude of CHWs	Kader's knowledge on children's nutritional needs and status, and attitudes toward vulnerable population	Measured in baseline (pre-intervention; maximum 1 months before training intervention) and endline (post-intervention; minimum 6 months intervention implementation)
Caregiver's knowledge and attitude	Parents/caregivers knowledge on children's nutrition and primary care services, and attitudes towards primary healthcare services	Measured in baseline (pre-intervention; maximum 1 months before training intervention) and endline (post-intervention; minimum 6 months intervention implementation)
Caregiver's satisfaction on healthcare	Parents/caregivers satisfaction towards primary healthcare services	Measured in baseline (pre-intervention; maximum 1 months before training intervention) and endline (post-intervention; minimum 6 months intervention implementation)
Proportion of on-time and completed visitation	The measure captures the proportion of required visits that were completed on time for each child's visitation cycle. Within each cycle, visits conducted within the recommended time window were assigned a score of 1. The total number of on-time visits for each child was calculated by summing the score. The final proportion was calculated by dividing the score of actual on-time visits by the total number of required visits.	Every visitation conducted by CHW during the intervention period, marked by 6-month after the first use of app after training

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility on mHealth decision-support	Perception of feasibility and usability of apps PRIMA from Kader	Measured in endline (post-intervention) after 6 months
Satisfaction on digital app	Satisfaction of digital app (apps PRIMA) by Kader	Measured in endline (post-intervention) after 6 months

Collaborators and Investigators

• Sponsor: Center for Indonesia's Strategic Development Initiatives

Study record dates

Study Major Dates

• Study Start (Actual): July 8, 2025
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: June 9, 2025
• First Submitted That Met QC Criteria: June 16, 2025
• First Posted (Actual): June 18, 2025

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: mHealth; primary health care; community health workers; decision-support tools; posyandu
• Other Study ID Numbers: koneksiRCT; 1447/CRG/2024/46-CISDI (Other Grant/Funding Number: KONEKSI)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No