A qualitative study of stakeholder perspectives on adopting a digital tool to measure child development at the 2–2½ year review in England

Aim The 2–2½-year review is the final universal mandated contact in England’s Healthy Child Programme, with a child development assessment using the Ages and Stages Questionnaire-3 (AQ®-3). Amid a wider digitisation agenda, the UK government is exploring digital alternatives to the paper-based ASQ®-3 tool. Understanding stakeholder perspectives is critical for informing implementation. Subject and methods 15 focus groups (63 participants), including parents, health visiting professionals, local authority colleagues, and policy officials, analysed using Framework Analysis. Results Stakeholders reported potential benefits of a digital tool: user experience, service efficiency, and alignment with national digital priorities. However, where services were trying to meet the mandate to review every child aged 2–2½-years with limited resources and workforce, our participants saw a risk that a digital tool might replace a full in-person assessment. Parents and professionals agreed that any digital tool must not compromise the holistic, relational nature of the 2–2½-year review or undermine the universal coverage of in-person contacts with families. Participants highlighted the complexities of digital exclusion, incompatibility with local data systems, and staff training. Conclusions Digitisation must be implemented carefully to avoid undermining service equity and the core components of the service (universal in-person assessments), must include system interoperability, professional training.