@Article{info:doi/10.2196/58454, author="Leitner, Kirstin and Cutri-French, Clare and Mandel, Abigail and Christ, Lori and Koelper, Nathaneal and McCabe, Meaghan and Seltzer, Emily and Scalise, Laura and Colbert, A. James and Dokras, Anuja and Rosin, Roy and Levine, Lisa", title="A Conversational Agent Using Natural Language Processing for Postpartum Care for New Mothers: Development and Engagement Analysis", journal="JMIR AI", year="2025", month="Apr", day="22", volume="4", pages="e58454", keywords="conversational agent", keywords="postpartum care", keywords="text messaging", keywords="postpartum", keywords="natural language processing", keywords="pregnancy", keywords="parents", keywords="newborns", keywords="development", keywords="patient engagement", keywords="physical recovery", keywords="infant", keywords="infant care", keywords="survey", keywords="breastfeeding", keywords="support", keywords="patient support", keywords="patient satisfaction", abstract="Background: The ``fourth trimester,'' or postpartum time period, remains a critical phase of pregnancy that significantly impacts parents and newborns. Care poses challenges due to complex individual needs as well as low attendance rates at routine appointments. A comprehensive technological solution could provide a holistic and equitable solution to meet care goals. Objective: This paper describes the development of patient engagement data with a novel postpartum conversational agent that uses natural language processing to support patients post partum. Methods: We report on the development of a postpartum conversational agent from concept to usable product as well as the patient engagement with this technology. Content for the program was developed using patient- and provider-based input and clinical algorithms. Our program offered 2-way communication to patients and details on physical recovery, lactation support, infant care, and warning signs for problems. This was iterated upon by our core clinical team and an external expert clinical panel before being tested on patients. Patients eligible for discharge around 24 hours after delivery who had delivered a singleton full-term infant vaginally were offered use of the program. Patient demographics, accuracy, and patient engagement were collected over the first 6 months of use. Results: A total of 290 patients used our conversational agent over the first 6 months, of which 112 (38.6\%) were first time parents and 162 (56\%) were Black. In total, 286 (98.6\%) patients interacted with the platform at least once, 271 patients (93.4\%) completed at least one survey, and 151 (52\%) patients asked a question. First time parents and those breastfeeding their infants had higher rates of engagement overall. Black patients were more likely to promote the program than White patients (P=.047). The overall accuracy of the conversational agent during the first 6 months was 77\%. Conclusions: It is possible to develop a comprehensive, automated postpartum conversational agent. The use of such a technology to support patients postdischarge appears to be acceptable with very high engagement and patient satisfaction. ", doi="10.2196/58454", url="https://ai.jmir.org/2025/1/e58454" } @Article{info:doi/10.2196/62841, author="Dol, Justine and Campbell-Yeo, Marsha and Aston, Megan and McMillan, Douglas and Grant, K. Amy", title="Impact of a 6-Week Postpartum Text Messaging Program (Essential Coaching for Every Mother) at 6 Months: Follow-Up Study to a Randomized Controlled Trial", journal="JMIR Pediatr Parent", year="2025", month="Apr", day="2", volume="8", pages="e62841", keywords="mHealth", keywords="mobile health", keywords="SMS text message", keywords="text messages", keywords="messaging", keywords="self-efficacy", keywords="postpartum depression", keywords="postpartum anxiety", keywords="social support", keywords="intervention", keywords="postpartum", keywords="postnatal", keywords="mental health", keywords="parenting", keywords="mother", keywords="depression", keywords="anxiety", keywords="RCT", keywords="randomized controlled trial", abstract="Background: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown. Objective: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial. Methods: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis. Results: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6\%) than mothers in the control group (16/68, 23.5\%; P=.007). Conclusions: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum. Trial Registration: ClincialTrials.gov NCT04730570; https://clinicaltrials.gov/study/NCT04730570 International Registered Report Identifier (IRRID): RR2-10.2196/27138 ", doi="10.2196/62841", url="https://pediatrics.jmir.org/2025/1/e62841" } @Article{info:doi/10.2196/65391, author="Mishina, Kaisa and Baumel, Amit and Kinnunen, Malin and Ristkari, Terja and Heinonen, Emmi and Hinkka-Yli-Salom{\"a}ki, Susanna and Sourander, Andre", title="BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study", journal="J Med Internet Res", year="2025", month="Mar", day="13", volume="27", pages="e65391", keywords="parent training", keywords="universal intervention", keywords="online intervention", keywords="irritability", keywords="conduct problems", keywords="hyperactivity", keywords="preschool", keywords="mental health", keywords="strongest families", keywords="positive parenting", keywords="parenting skills", keywords="parent-child relationships", keywords="parent satisfaction", keywords="BePresent", keywords="feasibility study", keywords="single-arm pre-post intervention study", abstract="Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child's behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child's 3-year health check-up were recruited from children's health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36\% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8\%--84.9\%) were satisfied with various aspects of the program, and 89.9\% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents' ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P?.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. ", doi="10.2196/65391", url="https://www.jmir.org/2025/1/e65391" } @Article{info:doi/10.2196/64171, author="Gaynor, Mathew and Hesketh, Kylie and Gebremariam, Kidane and Wynter, Karen and Laws, Rachel", title="Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="21", volume="8", pages="e64171", keywords="fathers", keywords="parenting resources", keywords="health promotion", keywords="My Baby Now", keywords="MBN", keywords="app", keywords="mobile phone", abstract="Background: Evolving societal trends are resulting in fathers having an increasing influence on the health-related behaviors that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child's health. However, parenting resources typically target mothers, with fathers being excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find that mobile health (mHealth) technology does not provide material they can engage with. Objective: This study aimed to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource, the My Baby Now app, as a case study. Methods: A total of 14 purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups and interviews were transcribed verbatim, then coded using a combination of deductive and inductive methods. Reflexive thematic analysis was undertaken to identify patterns and themes. Results: Current parenting apps provide parenting information that can be unappealing for fathers. To improve paternal engagement with mHealth resources, fathers highlighted the need for father specific information, with an increase in positive imagery and positive descriptions of fathers in their parenting role. There should be father-exclusive domains such as forums, and also push notifications to provide positive reinforcement and encouragement for fathers. Conclusions: mHealth has the capacity to deliver information to fathers when needed. This reduces the risk of paternal frustration and disengagement from parenting. Further benefit will be gained by research to understand possible differences in mHealth app usage by fathers of differing socioeconomic position, cultural backgrounds, and family status, such as single fathers and same-sex couples. ", doi="10.2196/64171", url="https://pediatrics.jmir.org/2025/1/e64171", url="http://www.ncbi.nlm.nih.gov/pubmed/39982774" } @Article{info:doi/10.2196/64994, author="Butt, L. Michelle and Willett, Jayne Ysabella and Miller, Vicky and Jacobs, Brenda and Ferron, Mae Era and Wright, L. Amy", title="Indigenous Parents' Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="22", volume="7", pages="e64994", keywords="child", keywords="parenting", keywords="qualitative", keywords="Indigenous health", keywords="support programs", abstract="Background: Parenting support programs enhance parents' health and their child's development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents' experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents' experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. ", doi="10.2196/64994", url="https://pediatrics.jmir.org/2024/1/e64994", url="http://www.ncbi.nlm.nih.gov/pubmed/39576680" } @Article{info:doi/10.2196/56807, author="Rivera Rivera, Nathalie Jessica and AuBuchon, E. Katarina and Smith, Marjanna and Starling, Claire and Ganacias, G. Karen and Danielson, Aimee and Patchen, Loral and Rethy, A. Janine and Blumenthal, Joseph H. and Thomas, D. Angela and Arem, Hannah", title="Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="14", volume="7", pages="e56807", keywords="postpartum care", keywords="newborn care", keywords="health education", keywords="chatbot", keywords="mHealth", keywords="mobile health", keywords="feedback", keywords="health equity", abstract="Background: The 42 days after delivery (``fourth trimester'') are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical ``fourth trimester,'' we developed 2 ruled-based chatbots---one for birthing individuals and one for newborn caregivers---that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63\%) individuals opened the newborn chatbot messaging, and 2244 (64\%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40\% (n=40) identified as Black, 27\% (n=27) identified as Hispanic/Latina, and 18\% (n=18) completed the survey in Spanish. Payer distribution was 55\% (n=55) for individuals with public insurance, 39\% (n=39) for those with commercial insurance, and 2\% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80\%) and found the reminders to schedule the newborn visit (n=59, 59\%) and postpartum visit (n=66, 66\%) useful. Across 23 interviews (n=14, 61\% Black; n=4, 17\% Hispanic/Latina; n=2, 9\% in Spanish; n=11, 48\% public insurance), 78\% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot's impact on health outcomes and reduce disparities. ", doi="10.2196/56807", url="https://pediatrics.jmir.org/2024/1/e56807" } @Article{info:doi/10.2196/55372, author="Mertens, Ellen and Ye, Guoquan and Beuckels, Emma and Hudders, Liselot", title="Parenting Information on Social Media: Systematic Literature Review", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="23", volume="7", pages="e55372", keywords="parenting", keywords="social media", keywords="parenting information", keywords="systematic literature review", keywords="bibliometric literature review", keywords="thematic analysis", abstract="Background: Social media has become extremely popular among parents to seek parenting information. Despite the increasing academic attention to the topic, studies are scattered across various disciplines. Therefore, this study broadens the scope of the existing reviews by transcending narrow academic subdomains and including all relevant research insights related to parents' information seeking on social media and its consequent effects. Objective: The aims of this systematic literature review were to (1) identify influential journals and scholars in the field; (2) examine the thematic evolution of research on parenting and social media; and (3) pinpoint research gaps, providing recommendations for future exploration. Methods: On the basis of a criteria for identifying scholarly publications, we selected 338 studies for this systematic literature review. We adopted a bibliometric analysis combined with a content thematic analysis to obtain data-driven insights with a profound understanding of the predominant themes in the realm of parenting and social media. Results: The analysis revealed a significant increase in research on parenting and social media since 2015, especially in the medical domain. The studies in our review spanned 232 different research fields, and the most prolific journal was JMIR Pediatrics and Parenting. The thematic analysis identified 4 emerging research themes in the studies: parenting motivations to seek information, nature of parenting content on social media, impact of parenting content, and interventions for parents on social media. Conclusions: This study provides critical insights into the current research landscape of parenting and social media. The identified themes, research gaps, and future research recommendations provide a foundation for future studies, guiding researchers toward valuable areas for exploration. ", doi="10.2196/55372", url="https://pediatrics.jmir.org/2024/1/e55372" } @Article{info:doi/10.2196/55280, author="McGrane Minton, Heather and Murray, Linda and Allan, J. Marjorie and Perry, Roslyn and Bettencourt, F. Amie and Gross, Deborah and Strano, Lauri and Breitenstein, M. Susan", title="Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation", journal="JMIR Pediatr Parent", year="2024", month="Jul", day="3", volume="7", pages="e55280", keywords="COVID-19", keywords="implementation", keywords="internet-based intervention", keywords="parenting", keywords="community dissemination", keywords="hybrid delivery", abstract="Background: Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. Objective: This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. Methods: This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. Results: In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child's behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2\%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Conclusions: Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed. ", doi="10.2196/55280", url="https://pediatrics.jmir.org/2024/1/e55280" } @Article{info:doi/10.2196/57849, author="So, Hei Jeffrey Tsz and Nambiar, Smita and Byrne, Rebecca and Gallegos, Danielle and Baxter, A. Kimberley", title="Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops", journal="JMIR Pediatr Parent", year="2024", month="May", day="30", volume="7", pages="e57849", keywords="co-design", keywords="fathers", keywords="child nutrition", keywords="child feeding", keywords="intervention design", keywords="digital delivery", keywords="parenting", keywords="participatory", keywords="videoconference", keywords="communication technology", abstract="Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation--Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. ", doi="10.2196/57849", url="https://pediatrics.jmir.org/2024/1/e57849", url="http://www.ncbi.nlm.nih.gov/pubmed/38815260" } @Article{info:doi/10.2196/43315, author="Glassman, Jill and Humphreys, L. Kathryn and Jauregui, Adam and Milstein, Arnold and Sanders, Lee", title="Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2024", month="May", day="22", volume="7", pages="e43315", keywords="child health", keywords="parent-child relationship", keywords="screen time", keywords="technoference", keywords="health equity", abstract="Background: The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. Objective: We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. Methods: In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. Results: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Conclusions: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based ``screen time rules'' not only for their children but also for themselves. ", doi="10.2196/43315", url="https://pediatrics.jmir.org/2024/1/e43315", url="http://www.ncbi.nlm.nih.gov/pubmed/38446995" } @Article{info:doi/10.2196/54610, author="Pretorius, Kelly and Kang, Sookja and Choi, Eunju", title="Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images", journal="JMIR Pediatr Parent", year="2024", month="Apr", day="23", volume="7", pages="e54610", keywords="SUID", keywords="SIDS", keywords="parenting", keywords="safe sleep", keywords="photo analysis", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="infant", keywords="infants", keywords="infancy", keywords="baby", keywords="babies", keywords="neonate", keywords="neonates", keywords="neonatal", keywords="newborn", keywords="newborns", keywords="sleep", keywords="safety", keywords="death", keywords="mortality", keywords="social media", keywords="picture", keywords="pictures", keywords="photo", keywords="photos", keywords="photographs", keywords="image", keywords="images", keywords="Facebook", keywords="mother", keywords="mothers", keywords="parent", keywords="co-sleeping", keywords="sudden infant death", keywords="sudden unexpected infant death", keywords="adherence", keywords="parent education", keywords="parents' education", keywords="awareness", abstract="Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers' group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers' group in May 2019. After trialing various search terms, searching for the term ``SIDS'' on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86\% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers. ", doi="10.2196/54610", url="https://pediatrics.jmir.org/2024/1/e54610" } @Article{info:doi/10.2196/34166, author="Cunningham, Chentel and Sung, Hyelin and Benoit, James and Conway, Jennifer and Scott, D. Shannon", title="Multimedia Knowledge Translation Tools for Parents About Childhood Heart Failure: Environmental Scan", journal="JMIR Pediatr Parent", year="2022", month="Mar", day="21", volume="5", number="1", pages="e34166", keywords="environmental scan", keywords="pediatrics heart failure", keywords="parent audience", keywords="knowledge translation", keywords="web-based educational tools", abstract="Background: Childhood heart failure is a factor in many hospital admissions each year. It can impose a steep learning curve for parents who need to learn the key information to care for their child at home. In this study, we conducted an environmental scan to identify and assess web-based knowledge translation tools about childhood heart failure for parent audiences developed within North America. Objective: The aim of this study is to inventory tools publicly available to parents about childhood heart failure from popular web-based venues, assess how each tool communicates health information, and explore how they were developed. Methods: Our search strategy included two commonly used multimedia-based platforms: two app stores (Google Play and Apple App Store) and one search engine (Advanced Google Search). Common search terms were used, and results were uploaded to Microsoft Excel for screening between 2 reviewers. The inclusion criteria for the tools were as follows: content focused on educating parents about their child's heart failure, developed in the English language, and originating within Canada and the United States. A total of 2 reviewers screened the app store and internet search results for relevant tools. Each tool was assessed using the Suitability Assessment of Materials (SAM), a validated tool that objectively assesses the suitability of how health information is communicated to a particular audience. Key informants who were involved in tool development were identified and invited for a qualitative interview using a semistructured format to provide data about the development process. Key themes were identified in the semistructured interview process. Results: Frequencies and SAM percent ratings of eligible tools were reported. No apps exist for parents relating to pediatric heart failure. Overall, 17 relevant internet tools were identified, and their suitability was assessed for the parent audience. Most tools scored well in layout and type, but they scored lower in readability and graphics. Qualitative interviews with key informants revealed three key themes: timely and introductory knowledge, credible and trustworthy knowledge, and challenges and evolution in knowledge. Conclusions: This is the first environmental scan looking for parent tools relating to childhood heart failure in Canada and the United States. Findings from this study reveal that there are no apps on this topic and there is a small number of tools for parents on the internet (n=17). Using the SAM, no tools scored in the superior range, and further work in knowledge translation strategies needs to be done in this area to improve more effective education to parents and caregivers who have a child with heart failure. These findings will inform the development of a new resource on children's heart failure that targets parents and caregiver audiences. ", doi="10.2196/34166", url="https://pediatrics.jmir.org/2022/1/e34166", url="http://www.ncbi.nlm.nih.gov/pubmed/35311676" } @Article{info:doi/10.2196/35934, author="Becker, J. Sara and Helseth, A. Sarah and Kelly, M. Lourah and Janssen, Tim and Wolff, C. Jennifer and Spirito, Anthony and Wright, Thomas", title="Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-Assisted Parenting Intervention", journal="JMIR Res Protoc", year="2022", month="Feb", day="28", volume="11", number="2", pages="e35934", keywords="adolescent", keywords="residential", keywords="technology-assisted", keywords="substance use", keywords="parent", keywords="randomized controlled trial", keywords="RCT", keywords="intervention", keywords="eHealth", keywords="problem behaviour", keywords="problem behavior", abstract="Background: Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment)---a technology-assisted parenting intervention informed by extensive formative research---as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. Objective: This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. Methods: Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART+TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multimethod follow-up assessments consisting of self-reported parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6, 12, and 24 weeks postdischarge from residential care. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. Results: The trial was funded in August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021, with recruitment beginning in February 2022. Conclusions: The proposed research has the potential to advance the field by serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. Trial Registration: ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385 International Registered Report Identifier (IRRID): PRR1-10.2196/35934 ", doi="10.2196/35934", url="https://www.researchprotocols.org/2022/2/e35934", url="http://www.ncbi.nlm.nih.gov/pubmed/35225821" } @Article{info:doi/10.2196/21867, author="Macam, Reyes Samantha and Mack, Wendy and Palinkas, Lawrence and Kipke, Michele and Javier, Rivera Joyce", title="Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Feb", day="17", volume="11", number="2", pages="e21867", keywords="Filipino", keywords="mental health", keywords="prevention", keywords="parenting practices", keywords="community health", abstract="Background: Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. Objective: The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. Methods: This study uses a randomized controlled 2-arm individually randomized group treatment pretest--posttest design for 180 parent--child dyads. Individuals are eligible if they are ?18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics' Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. Results: Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. Conclusions: Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. Trial Registration: ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170 International Registered Report Identifier (IRRID): DERR1-10.2196/21867 ", doi="10.2196/21867", url="https://www.researchprotocols.org/2022/2/e21867", url="http://www.ncbi.nlm.nih.gov/pubmed/35175200" } @Article{info:doi/10.2196/28230, author="Swindle, Taren and Poosala, B. Anwesh and Zeng, Nan and B{\o}rsheim, Elisabet and Andres, Aline and Bellows, L. Laura", title="Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review", journal="J Med Internet Res", year="2022", month="Jan", day="11", volume="24", number="1", pages="e28230", keywords="physical activity", keywords="preschool children", keywords="digital", keywords="technology", keywords="intervention", abstract="Background: Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children. Objective: The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions. Methods: This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process \& Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes. Results: In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies. Conclusions: The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children. ", doi="10.2196/28230", url="https://www.jmir.org/2022/1/e28230", url="http://www.ncbi.nlm.nih.gov/pubmed/35014962" } @Article{info:doi/10.2196/26684, author="Gupta, Aarushi and Cafazzo, A. Joseph and IJzerman, J. Maarten and Swart, F. Joost and Vastert, Sebastiaan and Wulffraat, M. Nico and Benseler, Susanne and Marshall, Deborah and Yeung, Rae and Twilt, Marinka", title="Genomic Health Literacy Interventions in Pediatrics: Scoping Review", journal="J Med Internet Res", year="2021", month="Dec", day="24", volume="23", number="12", pages="e26684", keywords="pediatrics", keywords="patient education", keywords="genetics", keywords="genomics", keywords="mHealth", keywords="digital health", keywords="internet", keywords="genetic knowledge", keywords="genomic health literacy", keywords="children", keywords="adolescents", abstract="Background: The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective: The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods: A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results: Of the 4618 studies, 14 studies (n=6, 43\% qualitative, n=6, 43\% mixed methods, and n=2, 14\% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions: This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts. ", doi="10.2196/26684", url="https://www.jmir.org/2021/12/e26684", url="http://www.ncbi.nlm.nih.gov/pubmed/34951592" } @Article{info:doi/10.2196/29731, author="Cooray, Nipuna and Sun, Louise Si and Ho, Catherine and Adams, Susan and Keay, Lisa and Nassar, Natasha and Brown, Julie", title="Toward a Behavior Theory--Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study", journal="JMIR Pediatr Parent", year="2021", month="Dec", day="20", volume="4", number="4", pages="e29731", keywords="child injury", keywords="Behaviour Change Wheel", keywords="mobile app", keywords="mobile phone", abstract="Background: Falls account for approximately 50\% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory--informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory-- and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn's mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory--informed mobile intervention for injury prevention refined using the person-based approach. ", doi="10.2196/29731", url="https://pediatrics.jmir.org/2021/4/e29731", url="http://www.ncbi.nlm.nih.gov/pubmed/34932004" } @Article{info:doi/10.2196/23659, author="Kavanagh, John David and Connolly, Jennifer and Fisher, Jane and Halford, Kim W. and Hamilton, Kyra and Hides, Leanne and Milgrom, Jeannette and Rowe, Heather and Scuffham, A. Paul and White, M. Katherine and Wittkowski, Anja and Appleton, Shelley and Sanders, Davina", title="The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Nov", day="26", volume="23", number="11", pages="e23659", keywords="perinatal", keywords="depression", keywords="prevention", keywords="men", keywords="self-guided", keywords="internet", abstract="Background: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective: This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods: The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks' gestation), using web-based registration. Most (337/388, 86.8\%) were obtained from prenatal hospital classes. Couples' randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50\% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results: Selection criteria were met by 63.9\% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6\%), tertiary educated (324/496, 65.3\%), employed full time (407/496, 82\%), and born in Australia (337/496, 67.9\%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9\% (18/248) of men, and 16.1\% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6\% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92\% ?50). Only 37.3\% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6\%) than fathers (52/248, 20.9\%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions: Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277 ", doi="10.2196/23659", url="https://www.jmir.org/2021/11/e23659", url="http://www.ncbi.nlm.nih.gov/pubmed/34842534" } @Article{info:doi/10.2196/27054, author="Hurst, Rachel and Liljenquist, Kendra and Lowry, J. Sarah and Szilagyi, G. Peter and Fiscella, A. Kevin and Weaver, R. Marcia and Porras-Javier, Lorena and Ortiz, Janette and Sotelo Guerra, J. Laura and Coker, R. Tumaini", title="A Parent Coach--Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="25", volume="10", number="11", pages="e27054", keywords="preventive care", keywords="well-child care", keywords="community health centers", abstract="Background: The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. Objective: This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. Methods: This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ?12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician's attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. Results: Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. Conclusions: This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. Trial Registration: ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898 International Registered Report Identifier (IRRID): DERR1-10.2196/27054 ", doi="10.2196/27054", url="https://www.researchprotocols.org/2021/11/e27054", url="http://www.ncbi.nlm.nih.gov/pubmed/34842563" } @Article{info:doi/10.2196/27297, author="Chin, Samuel and Carlin, Rebecca and Mathews, Anita and Moon, Rachel", title="Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="15", volume="4", number="4", pages="e27297", keywords="sleep position", keywords="bed-sharing", keywords="social norms", keywords="social media", keywords="safe sleep", keywords="bedding", abstract="Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of ``likes'' for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of ``likes'' for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49\%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05\%) and nonrecommended sleep position (479/1134, 42.24\%). The number of ``likes'' was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. ", doi="10.2196/27297", url="https://pediatrics.jmir.org/2021/4/e27297", url="http://www.ncbi.nlm.nih.gov/pubmed/34779783" } @Article{info:doi/10.2196/30242, author="Mathur, Mala and Kerr, R. Bradley and Babal, C. Jessica and Eickhoff, C. Jens and Coller, J. Ryan and Moreno, A. Megan", title="US Parents' Acceptance of Learning About Mindfulness Practices for Parents and Children: National Cross-sectional Survey", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="2", volume="4", number="4", pages="e30242", keywords="mindfulness", keywords="mental health", keywords="general pediatrics", keywords="pediatrics", keywords="children", keywords="parents", keywords="acceptability", keywords="well-being", keywords="parenting", abstract="Background: Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents' acceptance of learning about mindfulness practices. Objective: This study aims to assess parents' beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds. Methods: We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds. Results: Participants (N=3000) were 87\% (n=2621) female and 82.5\% (n=2466) Caucasian. Most (n=1913, 64.2\%) reported beliefs that mindfulness can be beneficial when parenting, 56.4\% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8\% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6\% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1\% (n=768; P<.001). Parents interested in learning about mindfulness were more likely to be male 62.6\% (n=223; P<.001). There was no significant difference in interest in learning about mindfulness from a health care provider based on race. Conclusions: This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices. ", doi="10.2196/30242", url="https://pediatrics.jmir.org/2021/4/e30242", url="http://www.ncbi.nlm.nih.gov/pubmed/34726605" } @Article{info:doi/10.2196/28147, author="Oakley-Girvan, Ingrid and Watterson, L. Jessica and Jones, Cheryl and Houghton, C. Lauren and Gibbons, P. Marley and Gokal, Kajal and Magsamen-Conrad, Kate", title="Use of Social Media for Cancer Prevention Through Neighborhood Social Cohesion: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2021", month="Jul", day="30", volume="10", number="7", pages="e28147", keywords="social cohesion", keywords="mothers", keywords="neighborhood", keywords="physical activity", keywords="social media", keywords="social", keywords="behavior", keywords="health outcomes", keywords="socioeconomic status", keywords="community health", keywords="chronic disease", keywords="social network", keywords="feasibility", keywords="wellbeing", keywords="cancer", abstract="Background: Social cohesion is associated with healthier behaviors and better health outcomes, and therefore may offer a mechanism for promoting better health. Low socioeconomic status (SES) communities face higher rates of chronic disease due to both community- and individual-level factors. Objective: The aim of this study is to leverage social cohesion to promote healthier behaviors and prevent chronic disease in a low SES community. This protocol outlines the methodology for a pilot study to assess the feasibility of an intervention (Free Time For Wellness [FT4W]) using a social networking platform (Nextdoor) with mothers living in an urban, low-income community to improve social cohesion and promote healthy behaviors. Methods: The study will involve three phases: (I) co-designing the intervention with mothers in the neighborhoods of interest, (II) implementing the intervention with community leaders through the social networking platform, and (III) evaluating the intervention's feasibility. Phase I of the study will include qualitative data collection and analysis from in-depth, semistructured interviews and a co-design group session with mothers. Phases II and III of the study include a pre- and postintervention survey of participating mothers. Neighborhood-level data on social cohesion will also be collected to enable comparison of outcomes between neighborhoods with higher and lower baseline social cohesion. Results: As of March 2021, recruitment and data collection for this study are complete. This protocol outlines our original study plan, although the final enrollment numbers and intervention implementation deviated from our initial planned methodology that is outlined in this protocol. These implementation learnings will be shared in subsequent publications of our study results. Conclusions: Ultimately, this study aims to: (1) determine the barriers and facilitators to finding free time for wellness among a population of low-income mothers to inform the co-design process, and (2) implement and study the feasibility of an intervention that leverages social cohesion to promote physical activity in a community of low-income mothers. The results of this study will provide preliminary feasibility evidence to inform a larger effectiveness trial, and will further our understanding of how social cohesion might influence well-being. International Registered Report Identifier (IRRID): RR1-10.2196/28147 ", doi="10.2196/28147", url="https://www.researchprotocols.org/2021/7/e28147", url="http://www.ncbi.nlm.nih.gov/pubmed/34328445" } @Article{info:doi/10.2196/31013, author="Davidson, C. Jennifer and Karadzhov, Dimitar and Wilson, Graham", title="Practitioners' and Policymakers' Successes, Challenges, Innovations, and Learning in Promoting Children's Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey", journal="JMIR Res Protoc", year="2021", month="Jul", day="29", volume="10", number="7", pages="e31013", keywords="mobile phones", keywords="smartphone app", keywords="qualitative", keywords="mixed method", keywords="international", keywords="survey", keywords="service providers", keywords="policy", keywords="practice", keywords="children's rights", keywords="well-being", keywords="COVID-19", keywords="pandemic", keywords="app", keywords="mHealth", keywords="children", abstract="Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children's human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children's Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children's well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners', managers', and policymakers' efforts to support children's well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies---the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents' sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 ", doi="10.2196/31013", url="https://www.researchprotocols.org/2021/7/e31013", url="http://www.ncbi.nlm.nih.gov/pubmed/34323850" } @Article{info:doi/10.2196/29411, author="Hammons, J. Amber and Villegas, Elizabeth and Robart, Ryan", title="``It's Been Negative for Us Just All the Way Across the Board'': Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="8", volume="4", number="2", pages="e29411", keywords="children", keywords="COVID-19", keywords="experiences", keywords="family", keywords="outcomes", keywords="pandemic", keywords="parenting", keywords="parents", keywords="screen time", abstract="Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families' experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children's ST habits as the country attempts to establish a new normal. ", doi="10.2196/29411", url="https://pediatrics.jmir.org/2021/2/e29411", url="http://www.ncbi.nlm.nih.gov/pubmed/34081606" } @Article{info:doi/10.2196/23115, author="Manjong, Titu Florence and Verla, Siysi Vincent and Egbe, Obinchemti Thomas and Nsagha, Shey Dickson", title="Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="May", day="20", volume="10", number="5", pages="e23115", keywords="nutrition education", keywords="caregivers", keywords="nutrition outcomes", keywords="indigenous children", abstract="Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce. Objective: This study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers' knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon. Methods: A two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child--caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers' peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers' knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea. Results: Baseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child--caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript. Conclusions: The findings of this study will provide evidence on the impact of culturally tailored and health belief model--based nutrition education on behavior change as a complementary strategy for strengthening health facility--based approaches in the reduction of malnutrition burden among the study population International Registered Report Identifier (IRRID): DERR1-10.2196/23115 ", doi="10.2196/23115", url="https://www.researchprotocols.org/2021/5/e23115", url="http://www.ncbi.nlm.nih.gov/pubmed/34014173" } @Article{info:doi/10.2196/24196, author="Buabbas, Ali and Hasan, Huda and Shehab, Abdulmohsen Abrar", title="Parents' Attitudes Toward School Students' Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study", journal="JMIR Pediatr Parent", year="2021", month="May", day="20", volume="4", number="2", pages="e24196", keywords="smartphones", keywords="overuse impact", keywords="school students", keywords="parents' attitudes", abstract="Background: Parents' awareness of the risks of the overuse of smartphones (SPs) among their children and parents' attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue. Objective: This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it. Methods: The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait. Results: A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5\%) than male (45/120, 37.5\%) respondents. Almost all of the participants (118/120, 98.3\%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children's health (117/120, 97.5\%). Although the participants, mostly the mothers, supervised their children's use of SPs closely (106/120, 88.3\%), the majority could not control their children's length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children. Conclusions: Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested. ", doi="10.2196/24196", url="https://pediatrics.jmir.org/2021/2/e24196", url="http://www.ncbi.nlm.nih.gov/pubmed/33878024" } @Article{info:doi/10.2196/29048, author="Taylor, W. Rachael and Conlon, A. Cathryn and Beck, L. Kathryn and von Hurst, R. Pamela and Te Morenga, A. Lisa and Daniels, Lisa and Haszard, J. Jill and Meldrum, M. Alison and McLean, H. Neve and Cox, M. Alice and Tukuafu, Lesieli and Casale, Maria and Brown, J. Kimberley and Jones, A. Emily and Katiforis, Ioanna and Rowan, Madeleine and McArthur, Jenny and Fleming, A. Elizabeth and Wheeler, J. Ben and Houghton, A. Lisa and Diana, Aly and Heath, M. Anne-Louise", title="Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study", journal="JMIR Res Protoc", year="2021", month="Apr", day="21", volume="10", number="4", pages="e29048", keywords="infant", keywords="diet", keywords="complementary feeding", keywords="food pouch", keywords="baby-led weaning", keywords="iron", keywords="growth", keywords="eating behavior", keywords="feeding behavior", keywords="dental health", keywords="choking", keywords="breast milk", abstract="Background: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100\% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food ``pouches'' and ``baby-led weaning'' (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed pur{\'e}es, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. Objective: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. Methods: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide ``dose-to-mother'' technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. Results: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. Conclusions: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. International Registered Report Identifier (IRRID): DERR1-10.2196/29048 ", doi="10.2196/29048", url="https://www.researchprotocols.org/2021/4/e29048", url="http://www.ncbi.nlm.nih.gov/pubmed/33881411" } @Article{info:doi/10.2196/23514, author="Morris, Sara and Geraghty, Sadie and Sundin, Deborah", title="Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Feb", day="23", volume="10", number="2", pages="e23514", keywords="breech presentation", keywords="midwifery", keywords="methodology", keywords="Delphi technique", abstract="Background: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women's experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals' knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. International Registered Report Identifier (IRRID): DERR1-10.2196/23514 ", doi="10.2196/23514", url="https://www.researchprotocols.org/2021/2/e23514", url="http://www.ncbi.nlm.nih.gov/pubmed/33620329" } @Article{info:doi/10.2196/25388, author="Donelle, Lorie and Hall, Jodi and Hiebert, Bradley and Jackson, Kimberley and Stoyanovich, Ewelina and LaChance, Jessica and Facca, Danica", title="Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study", journal="JMIR Pediatr Parent", year="2021", month="Feb", day="17", volume="4", number="1", pages="e25388", keywords="parenting", keywords="digital health", keywords="technology", keywords="health literacy", keywords="information seeking", abstract="Background: The transition to parenting---that is, the journey from preconception through pregnancy and postpartum periods---is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents' experiences with and uses of digital technology during 4 stages---prenatal, pregnancy, labor, and postpartum---of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents' type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: ``Is this normal; is this happening to you?!'', ``Am I having a heart attack; what is this?'', and ``Anyone can put anything on Wikipedia'': Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers' perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents. ", doi="10.2196/25388", url="https://pediatrics.jmir.org/2021/1/e25388", url="http://www.ncbi.nlm.nih.gov/pubmed/33595440" } @Article{info:doi/10.2196/23157, author="Rhodes, Alexandra and Kheireddine, Sara and Smith, D. Andrea", title="Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App (Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="9", volume="8", number="12", pages="e23157", keywords="pregnancy", keywords="parenting", keywords="app", keywords="COVID-19", keywords="pregnancy support", keywords="postnatal support", keywords="perinatal", keywords="mental well-being", keywords="physical well-being", keywords="support", keywords="well-being", keywords="experience", keywords="attitude", keywords="needs", abstract="Background: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service--approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users' needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results: A total of 436 expectant (n=244, 56.0\%) and recent (n=192, 44.0\%) parents responded to the web-based survey, of which 79.1\% (n=345) were aged 25-39 years and 17.2\% (n=75) spoke English as their second language. Of the 436 respondents, 88.5\% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0\% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4\% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby's development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0\% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges. ", doi="10.2196/23157", url="http://mhealth.jmir.org/2020/12/e23157/", url="http://www.ncbi.nlm.nih.gov/pubmed/33264100" } @Article{info:doi/10.2196/18992, author="Lovell, Belinda and Steen, Mary and Esterman, Adrian and Brown, Angela", title="The Parenting Education Needs of Women Experiencing Incarceration in South Australia: Proposal for a Mixed Methods Study", journal="JMIR Res Protoc", year="2020", month="Aug", day="13", volume="9", number="8", pages="e18992", keywords="prison", keywords="parenting programs", keywords="education", keywords="women", keywords="mothers.", abstract="Background: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated. Objective: This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal; the authors acknowledge the diversity within Aboriginal cultures. Methods: This study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed. Results: A scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government. Conclusions: The scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women's voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study. International Registered Report Identifier (IRRID): PRR1-10.2196/18992 ", doi="10.2196/18992", url="http://www.researchprotocols.org/2020/8/e18992/", url="http://www.ncbi.nlm.nih.gov/pubmed/32673211" } @Article{info:doi/10.2196/13686, author="Fatori, Daniel and Argeu, Adriana and Brentani, Helena and Chiesa, Anna and Fracolli, Lislaine and Matijasevich, Alicia and Miguel, C. Euripedes and Polanczyk, Guilherme", title="Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of S{\~a}o Paulo, Brazil: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="28", volume="8", number="7", pages="e13686", keywords="mHealth", keywords="early childhood development", keywords="maternal care", keywords="randomized clinical trial", keywords="daily diary", keywords="ambulatory assessment", abstract="Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros La{\c{c}}os, a nurse home visiting program, for adolescent mothers living in an urban deprived area of S{\~a}o Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros La{\c{c}}os is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71\%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84\%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49\% to 70\%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95\% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95\% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros La{\c{c}}os intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 ", doi="10.2196/13686", url="https://mhealth.jmir.org/2020/7/e13686", url="http://www.ncbi.nlm.nih.gov/pubmed/32720906" } @Article{info:doi/10.2196/13023, author="Grace, Rebekah and Baird, Kelly and Elcombe, Emma and Webster, Vana and Barnes, Jacqueline and Kemp, Lynn", title="Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables", journal="JMIR Pediatr Parent", year="2019", month="Nov", day="21", volume="2", number="2", pages="e13023", keywords="volunteer home visiting", keywords="randomized controlled trial", keywords="families", keywords="support services", keywords="social relationships", keywords="community", keywords="Volunteer Family Connect", abstract="Background: Volunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children. Objective: This paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills. Methods: The RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group). Results: The intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the ``Guidance'' subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable ``parenting sense of competence'' and largely neutral findings for the primary outcome variable ``community connectedness,'' the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving. Conclusions: The Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 ", doi="10.2196/13023", url="http://pediatrics.jmir.org/2019/2/e13023/", url="http://www.ncbi.nlm.nih.gov/pubmed/31750834" } @Article{info:doi/10.2196/12664, author="Ponum, Mahvish and Hasan, Osman and Khan, Saadia", title="EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases", journal="Interact J Med Res", year="2019", month="May", day="14", volume="8", number="2", pages="e12664", keywords="infectious diseases", keywords="mHealth", keywords="causes of death", abstract="Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. ", doi="10.2196/12664", url="http://www.i-jmr.org/2019/2/e12664/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094329" } @Article{info:doi/10.2196/11561, author="De Roo, Monica and Wong, Gina and Rempel, R. Gwen and Fraser, N. Shawn", title="Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire", journal="JMIR Pediatr Parent", year="2019", month="May", day="09", volume="2", number="1", pages="e11561", keywords="mentalization", keywords="parent reflective functioning", keywords="questionnaire design", keywords="parenting", abstract="Background: Parental reflective functioning (PRF) is the capacity parents have to understand their own mental states and those of their children, as well as the influence of those mental states on behavior. Parents with greater capacity for PRF are more likely to foster secure attachment with their children. The Parental Development Interview is a gold standard measure of PRF but is hampered by cost, training, and length of administration. The 18-item Parent Reflective Functioning Questionnaire (PRFQ-18) is a simpler option developed to capture 3 types of PRF: (1) prementalizing, (2) parent's certainty, and (3) interest and curiosity surrounding a child's mental state. Objective: The aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents. Methods: We examined the factor structure and discriminant and construct validity of the PRFQ-18 among 306 parents (males=120 and females=186) across Canada; the age range of children was 0 to 12 years. Parents also completed Web-based measures of perceived stress, parental coping, parenting competence, and social support. Results: A confirmatory factor analysis confirmed the hypothesized 3-factor structure of the PRFQ-18 providing evidence that the PRFQ-18 may be a useful and practical measure of PRF in Canadian adults and showed minor revisions may improve the suitability of the PRFQ-18 for assessing PRF. Conclusions: These results add support for the construct validity of the PRFQ-18. ", doi="10.2196/11561", url="http://pediatrics.jmir.org/2019/1/e11561/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518301" }