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Journal Description

JMIR Pediatrics and Parenting (JPP) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2017: 4.671), with a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education in pediatrics, training/counselling and behavioral interventions, preventative interventions and clinical care for children and adolescent populations or child-parent dyads. JPP recognizing that pediatrics in the 21st century should be a participatory process, involving parents and informal caregivers, and using information and communication technologies.

As an open access journal, we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

During a limited period of time, there are no fees to publish in this journal. Articles are carfully copyedited and XML-tagged, ready for submission in PubMed Central.

Be a founding author of this new journal and submit your paper today!


Recent Articles:

  • Source: iStock by Getty Images; Copyright:; URL:; License: Licensed by the authors.

    Exploring Social Media Group Use Among Breastfeeding Mothers: Qualitative Analysis


    Background: Breastfeeding is well known as the optimal source of nutrition for the first year of life. However, suboptimal exclusively breastfeeding rates in the United States are still prevalent. Given the extent of social media use and the accessibility of this type of peer-to-peer support, the role of social networking sites in enabling and supporting breastfeeding mothers needs to be further explored. Objective: This study aimed to leverage mothers’ attitudes and behaviors of social media usage to understand effects on breastfeeding outcomes. Methods: Participants were recruited from 1 probreastfeeding social media group with over 6300 members throughout the United States. Online focus group discussions were conducted with 21 women; interviews were conducted with 12 mothers. Qualitative data were aggregated for thematic analysis. Results: Participants indicated that the social media group formed a community of support for breastfeeding, with normalizing breastfeeding, empowerment for breastfeeding, resource for breastfeeding, and shared experiences in breastfeeding as additional themes. Conclusions: According to participants, social media groups can positively influence breastfeeding-related attitudes, knowledge, and behaviors as well as lead to longer duration of breastfeeding. The results of this study should be taken into account when designing interventions for breastfeeding mothers.

  • The POWERbreathe Plus device used by patients with cystic fibrosis. Source: Wikimedia Commons; Copyright: Entryjapan; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Assessing the Perceptions of Inspiratory Muscle Training in Children With Cystic Fibrosis and Their Multidisciplinary Team: Mixed-Methods Study


    Background: Little is known about the opinions or perceived benefits of an inspiratory muscle training intervention in patients with cystic fibrosis and their multidisciplinary team. Objective: The aim of this qualitative study was to examine patients' and multidisciplinary teams' views on inspiratory muscle training to inform and tailor future interventions. Methods: Individual, semistructured interviews were conducted to evaluate participants’ perspectives of a 4-week inspiratory muscle training intervention. In this study, 8 of 13 individuals involved in the inspiratory muscle training program (5 children aged 11-14 years; 2 physiotherapists; and 1 respiratory physician) participated. Interviews were transcribed verbatim, analyzed using thematic analyses, and then coded into relevant themes. Results: Four key themes emerged: acceptability, facilitators, barriers, and recommendations. While fun, enjoyment, and improved perceived physical ability were reported by children and their multidisciplinary team following the inspiratory muscle training program, the multidisciplinary team identified factors such as time and cost as key barriers. Conclusions: A short inspiratory muscle training program was perceived to have positive effects on the physical ability and psychosocial health of children with cystic fibrosis. These findings highlight the importance of obtaining participants’ and multidisciplinary teams' perceptions and recommendations to ensure the efficacy and optimal design of future inspiratory muscle training protocols.

  • Source: Flickr; Copyright: The Parents Union; URL:; License: Creative Commons Attribution (CC-BY).

    Electronic Mentoring Programs and Interventions for Children and Youth With Disabilities: Systematic Review


    Background: Children and youth with disabilities experience many challenges in their development, including higher risk of poor self-esteem, fewer friendships, and social isolation. Electronic mentoring is a potentially viable approach for youth with disabilities to access social and peer support within a format that reduces physical barriers to accessing mentors. Objective: Our objective was to synthesize and review the literature on the impact of electronic mentoring for children and youth with disabilities. Methods: We conducted a systematic review, completing comprehensive searches of 7 databases from 1993 to May 2018. We selected articles for inclusion that were peer-reviewed publications, had a sample of children or youth with disabilities (≤25 years of age), and had empirical findings with at least one outcome focusing on the impact of electronic mentoring. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality before discussing the findings. Results: In the 25 studies meeting our inclusion criteria, 897 participants (aged 12-26, mean 17.4 years) were represented across 6 countries. Although the outcomes varied across the studies, of 11 studies testing significance, 9 (81%) reported a significant improvement in at least one of the following: career decision making, self-determination, self-advocacy, self-confidence, self-management, social skills, attitude toward disability, and coping with daily life. The electronic mentoring interventions varied in their delivery format and involved 1 or more of the following: interactive websites, virtual environment, email, mobile apps, Skype video calls, and phone calls. A total of 13 studies involved one-to-one mentoring, 6 had group-based mentoring, and 6 had a combination of both. Conclusions: The evidence in this review suggests it is possible that electronic mentoring is effective for children and youth with disabilities. More rigorously designed studies are needed to understand the impact and effective components of electronic mentoring interventions.

  • Source: Binyam Tilahun; Copyright: The Authors; URL:; License: Fair use/fair dealings.

    Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia:...


    Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)–based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message–based mHealth intervention. Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718). Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message–based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message–based mHealth interventions.

  • Source: Flickr; Copyright: Tadmit MFA; URL:; License: Creative Commons Attribution (CC-BY).

    Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High-Risk Youth with Asthma: Pilot Study


    Background: Youth with asthma who have poor medication adherence, have limited access to care, and are frequently seen in the acute care setting are often termed “high risk.” Objective: This study aimed to design and test the feasibility of using smartphone technology to assess contextual factors that may impact changes in daily medication adherence and to identify new symptom episodes among high-risk youth with asthma in their home environment. Methods: Youth aged 8-17 years with high-risk asthma from 2 children’s hospitals were eligible for the 2-month study. An app was downloaded on participants’ phones at enrollment. Daily text message (short message service) reminders were sent to complete ecological momentary assessment of asthma symptoms and other contextual factors such as emotional state using the app. Bluetooth inhaler devices were used to record timestamps of inhaler use with the ability to review and manually enter data. The acceptability was assessed with surveys, key informant interviews (KII), and frequency of days with asthma data. KII data were used in an iterative design approach to identify challenges, strengths, and suggestions for maximizing use. Generalized linear mixed modeling was used to preliminarily explore contextual factors associated with changes in daily adherence. Results: We enrolled 14 children aged 8-16 years (13/14, 93% were African Americans). Over the 2-month study period, participants reported coughing (42/110, 38%), wheezing (8/111, 7%), chest tightness (9/109, 8%), boredom (57/109, 52%), and 10 new asthma symptom episodes. The controller medication adherence was 30%, which increased significantly on days with asthma symptoms or boredom. Data were received on 89% (606/681) of study days. Surveys and KIIs suggest acceptability among youth and their caregivers. Challenges reported during the study included lost or damaged phones and available memory. Conclusions: Youth and their caregivers reported the acceptability of using smartphones for real-time asthma monitoring. Overall, the controller medication adherence was low but increased significantly on days with reported asthma symptoms or boredom, suggesting that daily contextual factors may be associated with a change in the adherence behavior.

  • Source: Image created by the Authors; Copyright: Lisa Militello; URL:; License: Creative Commons Attribution (CC-BY).

    Pokémon GO Within the Context of Family Health: Retrospective Study


    Background: Pokémon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families. Objective: The aims of this study were (1) to explore the Pokémon GO user experience from a family perspective and (2) to investigate Pokémon GO within the context of family health. Methods: Between January and February 2017, congruent with one of the largest anticipated Pokémon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pokémon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pokémon GO. Results: Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. “Spending time together” was the most cited reason for gameplay by both parents (122/160, 76.3%) and children (24/31, 77%), followed by “it helped me go outdoors” for parents (113/160, 70.1%) and “I am a Pokémon fan” by children (21/31, 68%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t97=3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t130=4.70, P<.001) PA per week after playing Pokémon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (rs=.514, P=.003) and after (rs=.536, P=.003) Pokémon GO uptake. Conclusions: Pokémon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach.

  • Source: Pexels; Copyright: Cytonn Photography; URL:; License: Creative Commons Attribution (CC-BY).

    Exploring the Needs of Adolescents With Sickle Cell Disease to Inform a Digital Self-Management and Transitional Care Program: Qualitative Study


    Background: Accessible self-management interventions are critical for adolescents with sickle cell disease to better cope with their disease, improve health outcomes and health-related quality of life, and promote successful transition to adult health care services. However, very few comprehensive self-management and transitional care programs have been developed and tested in this population. Internet and mobile phone technologies can improve accessibility and acceptability of interventions to promote disease self-management in adolescents with sickle cell disease. Objective: The aim of this study was to qualitatively explore the following from the perspectives of adolescents, parents, and their health care providers: (1) the impact of sickle cell disease on adolescents to identify challenges to their self-management and transitional care and (2) determine the essential components of a digital self-management and transitional care program as the first phase to inform its development. Methods: A qualitative descriptive design utilizing audio-recorded, semistructured interviews was used. Adolescents (n=19, aged 12-19 years) and parents (n=2) participated in individual interviews, and health care providers (n=17) participated in focus group discussions and were recruited from an urban tertiary care pediatric hospital. Audio-recorded data were transcribed verbatim and organized into categories inductively, reflecting emerging themes using simple content analysis. Results: Data were categorized into 4 major themes: (1) impact of sickle cell disease, (2) experiences and challenges of self-management, (3) recommendations for self-management and transitional care, and (4) perceptions about a digital self-management program. Themes included subcategories and the perspectives of adolescents, parents, and health care providers. Adolescents discussed more issues related to self-management, whereas health care providers and parents discussed issues related to transition to adult health services. Conclusions: Adolescents, parents, and health care providers described the continued challenges youth with sickle cell disease face in terms of psychosocial impacts and stigmatization. Participants perceived a benefit to alleviating some of these challenges through a digital self-management tool. They recommended that an effective digital self-management program should provide appropriate sickle cell disease–related education; guidance on developing self-advocacy and communication skills; empower adolescents with information for planning for their future; provide options for social support; and be designed to be engaging for both adolescents and parents to use. A digital platform to deliver these elements is an accessible and acceptable way to address the self-management and transitional care needs of adolescents.

  • Source: Image created by the Authors; Copyright: Kelly Pretorius; URL:; License: Licensed by JMIR.

    Sudden Infant Death Syndrome and Safe Sleep on Twitter: Analysis of Influences and Themes to Guide Health Promotion Efforts


    Background: In the United States, sudden infant death syndrome (SIDS) is the leading cause of death in infants aged 1 month to 1 year. Approximately 3500 infants die from SIDS and sleep-related reasons on a yearly basis. Unintentional sleep-related deaths and bed sharing, a known risk factor for SIDS, are on the rise. Furthermore, ethnic disparities exist among those most affected by SIDS. Despite public health campaigns, infant mortality persists. Given the popularity of social media, understanding social media conversations around SIDS and safe sleep may assist the medical and public health communities with information needed to spread, reinforce, or counteract false information regarding SIDS and safe sleep. Objective: The objective of our study was to investigate the social media conversation around SIDS and safe sleep to understand the possible influences and guide health promotion efforts and public health research as well as enable health professionals to engage in directed communication regarding this topic. Methods: We used textual analytics to identify topics and extract meanings contained in unstructured textual data. Twitter messages were captured during September, October, and November in 2017. Tweets and retweets were collected using NUVI software in conjunction with Twitter’s search API using the keywords: “sids,” “infant death syndrome,” “sudden infant death syndrome,” and “safe sleep.” This returned a total of 41,358 messages, which were analyzed using text mining and social media monitoring software. Results: Multiple themes were identified, including recommendations for safe sleep to prevent SIDS, safe sleep devices, the potential causes of SIDS, and how breastfeeding reduces SIDS. Compared with September and November, more personal and specific stories of infant loss were demonstrated in October (Pregnancy and Infant Loss Awareness Month). The top influencers were news organizations, universities, and health-related organizations. Conclusions: We identified valuable topics discussed and shared on Twitter regarding SIDS and safe sleep. The study results highlight the contradicting information a subset of the population is exposed to regarding SIDS and the continued controversy over vaccines. In addition, this analysis emphasizes the lack of public health organizations’ presence on Twitter compared with the influence of universities and news media organizations. The results also demonstrate the prevalence of safe sleep products that are embedded in safe sleep messaging. These findings can assist providers in speaking about relevant topics when engaging in conversations about the prevention of SIDS and the promotion of safe sleep. Furthermore, public health agencies and advocates should utilize social media and Twitter to better communicate accurate health information as well as continue to combat the spread of false information.

  • Men's pregnancy playbook (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Engaging Men in Prenatal Health via eHealth: Findings From a National Survey


    Background: Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors. Objective: The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers. Methods: A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey. Results: Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger. Conclusions: We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early “teachable moment”—where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States.

  • Source: Flickr; Copyright: moodboard; URL:; License: Creative Commons Attribution (CC-BY).

    Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment


    Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia.

  • Source: Freepik; Copyright: Freepik; URL:; License: Licensed by JMIR.

    Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children:...


    Background: Functional abdominal pain disorders are chronic abdominal pain conditions, which affect up to 20% of children worldwide. Of the various functional abdominal pain disorder treatment modalities, psychological therapies such as guided imagery therapy appear most effective. However, there are significant barriers to receiving psychological therapies, including access to trained therapists. Alternatively, remotely delivered psychological therapies for functional abdominal pain disorders have been efficacious. Objective: The objective of our study was to assess acceptability of a proposed guided imagery therapy app designed to treat functional abdominal pain disorders through remote delivery of prerecorded audio sessions and to evaluate user preferences for using such an app. Methods: Using a mixed-methods approach, we conducted a predevelopment formative study among children aged 7 to 12 years with a functional abdominal pain disorder and their parents. The parents completed our modified Technology Acceptance Model (TAM) questionnaire, which quantified behavioral intention and related factors for using a guided imagery therapy app. Dyads participated in separate in-person semistructured interviews to assess their attitudes toward and preferences for a guided imagery therapy app. Questionnaire and interview findings were collected concurrently, analyzed separately, and then integrated through methods triangulation. Results: Among the 15 participating parent-child dyads, 5 (33%) children were Hispanic and 11 (73%) had irritable bowel syndrome. They had diverse socioeconomic status. All parent participants were mothers. The TAM questionnaire indicated that mothers scored favorably on behavioral intention to use a guided imagery therapy app (mean score 12.0, SD 2.6, possible range 3-15). Scores for the TAM factors perceived usefulness, perceived ease of use, hedonic motivation, compatibility, and habit also were favorable. Maternal interviews confirmed positive attitudes toward the proposed app. They advocated a visual component to hold their child’s attention during the guided imagery therapy sessions; recommended incorporating background sounds into the sessions; favored session reminder notifications from the app; and thought the best time for their child to listen to the sessions would be in the evening or before bed. The child interviews also confirmed positive attitudes toward the proposed app. They suggested guided imagery therapy session topics such as sports and adventures; listening to sessions in their bedroom; and the need for parental supervision to install the app on their mobile device. Integration of the quantitative and qualitative methods findings complimented one another on acceptability. The favorable behavioral intention TAM score aligned well with expressed positive maternal and child attitudes toward the app and can be explained by the desire to avoid medications. The questionnaire and interviews also confirmed therapeutic benefit as an intrinsic motivator to promote routine use. Conclusions: A guided imagery therapy app designed to treat pediatric patients with functional abdominal pain disorders appears to be acceptable to both mothers and children. Incorporating parent and child preferences into a guided imagery therapy app could promote therapeutic compliance and increase access to optimal care.

  • Source: Freepik; Copyright: Yanalya; URL:; License: Licensed by JMIR.

    eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review


    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as cognitive behavioral therapy, in the treatment of psychological disorders in adults, such as depression, anxiety, obsessive-compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone, self-help) and computer-assisted (in combination with face-to-face therapy, or therapist guided) programs for youth. Objective: Our objective was to summarize and critically review the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim was to improve the understanding of what would be critical for future development of effective technology-based interventions. Methods: We conducted an exploratory review of the literature through searches in 3 scientific electronic databases (PsycINFO, ScienceDirect, and PubMed). We used keywords in various combinations: child or children, adolescent, preschool children, anxiety, intervention or treatment or program, smartphone applications or apps, online or Web-based tool, computer-based tool, internet-based tool, serious games, cognitive behavioral therapy or CBT, biofeedback, and mindfulness. For inclusion, articles had to (1) employ a technological therapeutic tool with or without the guidance of a therapist; (2) be specific for treatment or prevention of anxiety disorders in children or adolescents; (3) be published between 2000 and 2018; and (4) be published in English and in scientific peer-reviewed journals. Results: We identified and examined 197 articles deemed to be relevant. Of these, we excluded 164 because they did not satisfy 1 or more of the requirements. The final review comprised 19 programs. Published studies demonstrated promising results in reducing anxiety, especially relative to the application of cognitive behavioral therapy with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional interventions. Other approaches have been applied to technology-based interventions with inconclusive results. Most programs were developed to be used concurrently with traditional treatments and lacked long-term evaluation. Very little has been done in terms of prevention interventions. Conclusions: Future development of eHealth programs for anxiety management in children will have to address several unmet needs and overcome key challenges. Although developmental stages may limit the applicability to preschool children, prevention should start in early ages. Self-help formats and personalization are highly relevant for large-scale dissemination. Automated data collection should be built in for program evaluation and effectiveness assessment. And finally, a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.

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  • The quality of online information about periviable birth

    Date Submitted: Nov 7, 2018

    Open Peer Review Period: Nov 9, 2018 - Jan 4, 2019

    Background: Over 20,000 parents in the United States face the extraordinary challenge of participating in decisions about whether to use life support for their infant(s) born on the cusp of viability....

    Background: Over 20,000 parents in the United States face the extraordinary challenge of participating in decisions about whether to use life support for their infant(s) born on the cusp of viability. Clinicians must help these families grasp complex medical information about their baby’s immediate prognosis as well as the risk for significant long-term morbidity. Patients faced with this decision desire supplemental information and frequently seek medical information on the internet. Empiric evidence about the quality of websites, however, is lacking. Objective: We sought to evaluate the quality of online information available about periviable birth and treatment options for infants born at the cusp of viability. Methods: We read a counseling script that included information typically provided by obstetrical and neonatal providers when periviable birth is imminent to twenty pregnant women. The women were then asked to list terms they would use to search the internet if they wanted additional information. Using these search terms, two reviewers evaluated the content of websites obtained via a GoogleTM search. We used two metrics to assess the quality of websites. The first was the DISCERN instrument, a validated questionnaire designed to assess the quality of patient-targeted health information for treatment choices. The second metric was the Essential Content Tool (ECT), a tool designed to address all the key components of counseling around periviable birth as outlined by professional organizations. Scores ≥6 using ECT and ≥4 using DISCERN were considered "high quality”. Inter-reviewer agreement was assessed by calculated kappa statistic. Results: A total of 97 websites were reviewed. Over half (58%) were for-profit sites, new stories or personal blogs, 28% were government or medical sites, and 13% were non-profit or advocacy sites. The majority of sites scored poorly in DISCERN questions designed to assess the reliability of information presented. For example only 27% (n=26) presented a range of treatment options for infants born during periviable period and over half (n=62) did not cite the sources that informed their website. Only 10% of websites were “high quality” as defined by the DISCERN tool. The majority of sites did not address the essential content defined by the ECT. Importantly, only 18% of websites (n=17) indicated that there are often a number of reasonable approaches to newborn care when faced with periviable birth. Agreement was strong with ᴋ ranging from 0.72-0.91. Conclusions: Most information about periviable birth found on the internet using common search strategies is of low quality. News stories highlighting positive outcomes are disproportionately represented. Few websites discuss comfort-care or how treatment decisions impact quality of life.  

  • A pilot randomized control trial of a 4-week electronic mentoring employment intervention for youth with physical disabilities

    Date Submitted: Oct 30, 2018

    Open Peer Review Period: Nov 3, 2018 - Dec 29, 2018

    Background: Youth with disabilities are more likely to live in poverty and to be unemployed compared to youth without a disability. Such trends are often a result of a lack of supports, inaccessible j...

    Background: Youth with disabilities are more likely to live in poverty and to be unemployed compared to youth without a disability. Such trends are often a result of a lack of supports, inaccessible jobs, environmental barriers, and discriminatory attitudes towards people with disabilities. Youth with disabilities also face barriers in accessing vocational preparation programs. One encouraging way that could help to address challenges that youth encounter is by providing support through electronic mentoring. Objective: The objective of this study was to assess the feasibility of a 4-week online peer electronic mentoring employment intervention for youth with physical disabilities. Methods: We conducted a pilot randomized control trial (RCT) to evaluate our intervention, Empowering youth towards employment. Participants included youth aged 15-25 who were randomly assigned to an experimental (mentored) or control (non-mentored group). Our employment preparation intervention involved having trained youth mentors (i.e., near peers who also had a disability) lead online discussion forums while offering peer support and resources. The intervention involved 12 modules (3 topics a week for 4 weeks). Primary outcomes focused on implementation (i.e., feasibility and acceptability) while secondary outcomes focused on effectiveness (i.e., measures of self-determination, career maturity and social support). Results: Twenty-eight youth (mean age 19.62  3.53 (SD), 50% female) completed the RCT, in three intervention groups and two control groups (intervention n= 17, control n=9). Participants reported satisfaction with the program and that it was feasible and acceptable. Youth’s mean engagement level with the program was 6.44/10 (SD 2.33) for the experimental group and 5.56  3.53 for controls. Participants in the intervention did not demonstrate any significant improvements in social support, career maturity or self-determination compared to the control group. No adverse events were reported. Conclusions: The ‘Empowering youth towards employment’ electronic mentoring intervention needs further testing with a larger sample and different length of formats to understand how it may have an impact on employment outcomes youth with disabilities. Clinical Trial: NCT02522507;

  • Feasibility and Acceptability of a Culturally Tailored Website featuring Cartoons to Increase Fruit and Vegetable Intake and Physical Activity Levels in African-American Mother-Child Dyads

    Date Submitted: Oct 13, 2018

    Open Peer Review Period: Oct 14, 2018 - Dec 9, 2018

    Background: African-American youth (8 to 14 years old) do not adhere to national dietary and physical activity guidelines. Non-adherence to these recommendations contributes to disproportionate rates...

    Background: African-American youth (8 to 14 years old) do not adhere to national dietary and physical activity guidelines. Non-adherence to these recommendations contributes to disproportionate rates of obesity compared to their White counterparts. Culturally tailored e-health solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. Objective: This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African-American mother-child dyads. Methods: Statistical analysis included paired sample t-tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska’s Stages of Change towards the four behaviors: 1.fruit and vegetable selection on my plate; 2.meal preparation; 3. fruit and vegetable selection outside of home, and 4.physical activity were assessed with pre and post-test surveys. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. Results: A final sample size of ninety-three mother-child dyads completed the study. Mothers reported significant improvement from pre-contemplation or contemplation stages to preparation or action stages for: 1) fruit and vegetable selection on her plate (p=.034); 2) meal preparation for her family (p=.010); 3) fruit and vegetable selection outside the home (p=.000); and, 4), and physical activity (p=.000). Significant improvements were found in knowledge, stage of change and self-efficacy for the four target behaviors of interest (p=.000). Children’s open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. Conclusions: Culturally adapted cartoons that incorporate tailored preferences by African-American families, such as race or demography, may help increase adherence to target health behaviors when developing e-health behavior solutions.

  • A systematic review of eHealth interventions for preventing and treating negative psychological sequelae resulting from pediatric medical conditions

    Date Submitted: Oct 5, 2018

    Open Peer Review Period: Oct 9, 2018 - Dec 4, 2018

    Background: Pediatric medical conditions have the potential to result in challenging psychological symptoms (e.g., anxiety, depression, posttraumatic stress-PTSS) and impaired health-related quality o...

    Background: Pediatric medical conditions have the potential to result in challenging psychological symptoms (e.g., anxiety, depression, posttraumatic stress-PTSS) and impaired health-related quality of life in youth. Thus, effective, accessible interventions are needed to prevent and / or treat psychological sequelae associated with pediatric medical conditions. eHealth interventions may help to meet this need, with the capacity to reach more children and families than in-person interventions. Many of these interventions are in their infancy, and we do not yet know what key components contribute to successful eHealth interventions. Objective: The primary aim of this study is to conduct a systematic review to summarize current evidence on the efficacy of eHealth (web- and mobile-based) interventions designed to prevent or treat psychological sequelae in youth with medical conditions. Methods: MEDLINE (PubMed) and PsycINFO databases were searched for studies published between February 2, 1998 and February 1, 2018 using pre-defined search terms. Two authors independently reviewed titles and abstracts of search results to determine which studies were eligible for full-text review. Reference lists of studies meeting eligibility criteria were reviewed. If the title of a reference suggested that it might be relevant for the current review, the full manuscript was retrieved and reviewed. Inclusion criteria required that eligible studies had 1) conducted empirical research on the efficacy of a web or mobile-based intervention for youth with a medical condition, 2) assessed outcomes of psychological sequelae (i.e., symptoms of posttraumatic stress, anxiety, depression, internalizing symptoms or quality of life) in youth (0-18 years) and / or their caregivers, 3) included assessments at two or more time points, and 5) was available in the English language. Results: 67 studies were reviewed for inclusion based on their title and abstracts; 23 articles qualified for full-text review. 15 studies met inclusion criteria for the systematic review. Of the 15 included studies, 9 reported results indicating that eHealth interventions significantly improved psychological sequelae in participants. Common characteristics among interventions which showed an effect included content on problem-solving, education, communication, and behavior management. Studies most commonly reported on child and caregiver depression, followed by child PTSS and caregiver anxiety. Conclusions: Early research is mixed but suggests that eHealth interventions may be helpful in alleviating and /or preventing problematic psychological sequelae in youth with medical conditions and their caregivers. Additional research is needed to advance understanding of the most powerful intervention components and to determine when and how to best disseminate eHealth interventions, with the goal of extending the current reach of psychological interventions

  • Can breastfeeding smartphone apps help mothers with low milk production?: Development and validation of a novel scale grounded in Social Cognitive Theory

    Date Submitted: Sep 30, 2018

    Open Peer Review Period: Oct 6, 2018 - Dec 1, 2018

    Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with tracking milk production and learning how to...

    Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with tracking milk production and learning how to establish and maintain milk production. It is not known if app developers take into account health behavior or education theory when developing content and features in breastfeeding apps. Objective: The primary objective was to develop and validate a scale grounded in Social Cognitive Theory to evaluate the educational content and tracking features related to milk production within breastfeeding smartphone apps. The secondary objective was to determine whether apps developed by for-profit companies or large businesses were more likely to be free and contain evidence-based educational content with diverse representations of the breastfeeding experience. Methods: Breastfeeding apps were identified in the App Store (iOS). If the app fit the inclusion criteria, then all features that assist mothers with tracking or interpreting milk production in the first zero to six months postpartum were noted. Every screen containing educational information about milk production was identified and saved review. A two-part scale grounded in Social Cognitive Theory was created to evaluate all features that assist mothers with tracking milk production and the quality of the educational content about milk production, as measured by scope, references, multimedia, and diverse representations of the breastfeeding dyad. Results: Forty-one breastfeeding apps were reviewed. Only seven contained both tracking features and educational content related to milk production. Breast pump companies created many of the the top scoring apps in tracking, education, and hybrid categories. There were no differences in scores between apps that were free and not free. Very few apps contained evidence-based content or images of non-White breastfeeding dyads. Conclusions: Breastfeeding smartphone apps were evaluated using a novel two-part scale grounded in Social Cognitive Theory to determine which apps could comprehensively assist mothers with tracking milk production and interpreting their results through evidence-based educational content. Very few apps contained both tracking features and high-quality, engaging educational content with images of diverse caretakers. Thus, it is clear that parents, especially those from minority or low-income groups, have limited options to choose from when selecting an app to reach their breastfeeding goals.