Funcionalidade e impacto de fatores contextuais em lactentes com e sem risco biológico nos dois primeiros anos de vida: evidência com metodologia remota

Abstract

Telehealth, or digital health practice, gained relevance during the COVID-19 pandemic, expanding the use of remote strategies for the care of vulnerable populations. In this context, this thesis verified the functioning and contextual factors associated with the activities and participation at home of infants and children born with biological risk in the first two years of life, through remote assessment and monitoring. Thus, five studies were conducted that produced evidence with remote methodologies developed during and after the COVID-19 pandemic. Study I aimed to compare gross motor skills and the presence of opportunities in the home environment, as well as to verify the impact of these opportunities at home on the motor skills of infants with biological risk before and after 6 months of age. It was found that the group over 6 months had more toys compared to the younger group, and a greater variety of stimulation and having more gross motor toys were associated with better gross motor skills outcomes. Study II identified facilitators and barriers to home participation for infants with and without biological risk during the first year of life. Environmental factors, such as greater caregiver willingness to change, younger mothers with higher levels of education, and a facilitating home environment, contributed to greater participation in the group of infants with biological risk. In relation to the group without risk, factors such as younger mothers with higher levels of education and less willingness to change, a facilitating home environment, and higher family income promoted greater home participation. Based on these results, and with the aim of expanding knowledge about participation and its intervening factors in the home setting beyond the first year of life, Study III was conceived and developed. Its objective was to describe the e-Followkids protocol for the remote monitoring of functioning and contextual predictive factors in children at 12, 18, and 24 months who were born with biological risk. Study IV evaluated the feasibility of this protocol (e-FollowKids) in Brazil and its association with sociodemographic factors (family income, education, maternal age, and number of siblings). A recruitment rate of 56.86%, adherence of 79.31%, and sample loss of 20.68% were achieved. Mothers reported high satisfaction, good understanding, and acceptability of the protocol, with a low percentage of identified barriers (19.5%) to follow-up. There was no association between feasibility according to mothers' perception and sociodemographic factors. Finally, Study V compared the home participation of infants and children with and without biological risk at 12, 18, and 24 months, verifying the trajectory of participation and associations with environmental 12 factors and functional abilities in the group with biological risk. Children with risk showed higher frequency at 12 months, while those without risk showed greater involvement at 18 months; at 24 months there was no difference between the groups. In the at-risk group, engagement increased at 24 months, and in the non-at-risk group, frequency and engagement were higher at 18 and 24 months compared to 12 months. Greater mobility and environmental support were associated with greater engagement at 12 months. At 24 months, higher scores in functional skills such as daily living and social/cognitive activities, as well as environmental support, were associated with greater participation, while lower scores for the general home environment and less mobility were associated with a greater desire for change on the part of the caregiver. Home environmental factors at 12 months did not predict participation at 24 months. The results obtained in this thesis can begin to support evidence-based practice, through remote methodologies, in the area of child development. Furthermore, it fosters the relationship between health components and contextual factors, based on the principles of dynamic and multidirectional interactions in infants and children in the first 2 years of life. Thus, it favors the promotion of actions and/or programs in public policies in child health, for monitoring functioning in this crucial developmental phase, considering the caregiver as a modulating agent of the environment and remote methodologies as a means of intervention.