@Article{info:doi/10.2196/69425, author="Seiter{\"o}, Anna and Henriksson, Pontus and Thomas, Kristin and Henriksson, Hanna and L{\"o}f, Marie and Bendtsen, Marcus and M{\"u}ssener, Ulrika", title="Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="22", volume="27", pages="e69425", keywords="mHealth", keywords="multiple behavior", keywords="high school students", keywords="digital behavior change intervention", keywords="public health", keywords="telemedicine", keywords="randomized controlled trial", abstract="Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ?4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69\%, 520/756 females; 31\%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71\% (539/756) of participants at 2 months and 57\% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58\%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95\% CI 0.13-0.52), physical activity (50 minutes per week, 95\% CI --0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95\% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95\% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95\% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95\% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 ", doi="10.2196/69425", url="https://www.jmir.org/2025/1/e69425" } @Article{info:doi/10.2196/63378, author="Meyer, Eric and Sauz{\'e}on, H{\'e}l{\`e}ne and Saint-Supery, Isabeau and Mazon, Cecile", title="Evaluating a Web-Based Application to Facilitate Family-School-Health Care Collaboration for Children With Neurodevelopmental Disorders in Inclusive Settings: Protocol for a Nonrandomized Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="17", volume="14", pages="e63378", keywords="neurodevelopmental disorders", keywords="coeducation", keywords="whole-school approach", keywords="family-professional partnership", keywords="web application", keywords="inclusive education", keywords="family-school-health care", abstract="Background: An individual education plan (IEP) is a key element in the support of the schooling of children with special educational needs or disabilities. The IEP process requires effective communication and strong partnership between families, school staff, and health care practitioners. However, these stakeholders often report their collaboration as limited and difficult to maintain, leading to difficulties in implementing and monitoring the child's IEP. Objective: This paper aims to describe the study protocol used to evaluate a technological tool (CoEd application) aiming at fostering communication and collaboration between family, school, and health care in the context of inclusive education. Methods: This protocol describes a longitudinal, nonrandomized controlled trial, with baseline, 3 month, and 6-month follow-up assessments. The intervention consisted of using the web-based CoEd application for 3 months to 6 months. This application is composed of a child's file in which stakeholders of the support team can share information about the child's profile, skills, aids and adaptations, and daily events. The control group is asked to function as usual to support the child in inclusive settings. To be eligible, a support team must be composed of at least two stakeholders, including at least one of the parents. Additionally, the pupil had to be aged between 10 years and 16 years, enrolled in secondary school, be taught in mainstream settings, and have an established or ongoing diagnosis of autism spectrum disorder, attention-deficit/hyperactivity disorder, or intellectual disability (IQ<70). Primary outcome measures cover stakeholders' relationships, self-efficacy, and attitudes toward inclusive education, while secondary outcome measures are related to stakeholders' burden and quality of life, as well as children's school well-being and quality of life. We plan to analyze data using ANCOVA to investigate pre-post and group effects, with a technological skills questionnaire as the covariate. Results: After screening for eligibility, 157 participants were recruited in 37 support teams, composed of at least one parent and one professional (school, health care). In September 2023, after the baseline assessment, the remaining 127 participants were allocated to the CoEd intervention (13 teams; n=82) or control condition (11 teams; n=45). Conclusions: We expect that the CoEd application will improve the quality of interpersonal relationships in children's IEP teams (research question [RQ]1), will show benefits for the child (RQ2), and improve the well-being of the child and the stakeholders (RQ3). Thanks to the participatory design, we also expect that the CoEd application will elicit a good user experience (RQ4). The results from this study could have several implications for educational technology research, as it is the first to investigate the impacts of a technological tool on co-educational processes. International Registered Report Identifier (IRRID): DERR1-10.2196/63378 ", doi="10.2196/63378", url="https://www.researchprotocols.org/2025/1/e63378" } @Article{info:doi/10.2196/60092, author="Wang, Naibo and Wang, Chen and Zhang, Puhong and Li, Yinghua and He, J. Feng and Li, Li and Li, Yuan and Luo, Rong and Wan, Dezhi and Xu, Lewei and Deng, Lifang and Wu, Lei", title="Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up", journal="J Med Internet Res", year="2025", month="Mar", day="27", volume="27", pages="e60092", keywords="school-based health education", keywords="EduSaltS", keywords="mobile health", keywords="salt reduction", keywords="cluster randomized trial", abstract="Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)-- and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention's effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96\%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02\%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48\%) children and 47 (8.97\%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren's salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were --0.24 g/day (95\% CI --0.82 to 0.33), --0.68 mm Hg (95\% CI --2.32 to 0.95), and --1.37 mm Hg (95\% CI --2.79 to 0.06), respectively. For adults, the intervention group's salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were --1.06 g/day (95\% CI --1.81 to --0.30), --2.26 mm Hg (95\% CI --4.26 to --0.26), and --2.33 mm Hg (95\% CI --3.84 to --0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 ", doi="10.2196/60092", url="https://www.jmir.org/2025/1/e60092", url="http://www.ncbi.nlm.nih.gov/pubmed/40017342" } @Article{info:doi/10.2196/64096, author="March, A. Christine and Naame, Elissa and Libman, Ingrid and Proulx, N. Chelsea and Siminerio, Linda and Miller, Elizabeth and Lyon, R. Aaron", title="School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners", journal="JMIR Diabetes", year="2025", month="Mar", day="26", volume="10", pages="e64096", keywords="type 1 diabetes", keywords="user-centered design", keywords="school health", keywords="collaborative care model", keywords="implementation research", keywords="pediatric", keywords="usability testing", keywords="virtual intervention", keywords="multisystem community partners", keywords="children", keywords="youth", keywords="diabetes management support", keywords="health system partners", keywords="psychosocial interventions", keywords="quantitative assessments", keywords="qualitative assessments", abstract="Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation. Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams. Methods: We recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA. Results: In the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100\% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10\%-60\% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30\% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60\% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue ($\rho$=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings. Conclusions: Cross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing. ", doi="10.2196/64096", url="https://diabetes.jmir.org/2025/1/e64096" } @Article{info:doi/10.2196/60424, author="Dol{\'o}n-Poza, Mar{\'i}a and Gabald{\'o}n-P{\'e}rez, Ana-Marta and Berrezueta-Guzman, Santiago and L{\'o}pez Gracia, David and Mart{\'i}n-Ruiz, Mar{\'i}a-Luisa and Pau De La Cruz, Iv{\'a}n", title="Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform", journal="JMIR Hum Factors", year="2025", month="Mar", day="14", volume="12", pages="e60424", keywords="developmental language disorder", keywords="simple language delay", keywords="adaptive screening system", keywords="early childhood education", keywords="pervasive therapy", abstract="Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform's utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7\% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3\%) than in girls (14/218, 6.4\%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41\%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 ", doi="10.2196/60424", url="https://humanfactors.jmir.org/2025/1/e60424" } @Article{info:doi/10.2196/65169, author="Fisher, Dominic and Maart, Rentia and Thabane, Lehana and Louw, Quinette", title="A Classroom-Based Intervention for Reducing Sedentary Behavior and Improving Spinal Health: Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Feb", day="24", volume="9", pages="e65169", keywords="sedentary behavior", keywords="spinal health", keywords="classroom-based intervention", keywords="sit-stand desks", keywords="spinal", keywords="African", keywords="Africa", keywords="primary school", keywords="child", keywords="youth", keywords="randomized controlled trial", keywords="RCT", keywords="infectious disease", keywords="acceptability", keywords="data collection", keywords="teacher", keywords="classroom-based interventions", keywords="primary school learners", keywords="physical activity", keywords="closed-cohort", keywords="interview", keywords="quantitative data", keywords="wearable", keywords="wearable sensor", keywords="spine", abstract="Background: Noncommunicable diseases (NCDs) resulting from sedentary behavior (SB) are adding a further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture, allowing learners to interrupt prolonged bouts of sitting with standing without interrupting their school work. Alternating between sitting and standing also benefits spinal health by interrupting prolonged periods of high spinal loading, but no such intervention has been trialed in South Africa. The potential to reduce strain on the health system by reducing the incidence of NCDs and improving spinal health requires further consideration. Before embarking on a large classroom-based trial, it is essential to determine the acceptability of the intervention, its impact on teachers' practices, and the logistical and pragmatic considerations of data collection. Objective: This study aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners, to assess the pragmatics of delivering and adherence to the intervention, and assess the pragmatics of measuring physical activity and postural dynamism data with wearable sensors. Methods: We used a stratified, closed-cohort, randomized, 2-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and grade 6 class each was recruited from contrasting socioeconomically categorized, state-funded primary schools in the Western Cape province, South Africa. Classroom furniture was substituted with sit-stand desks, and health education and movement videos (HEMVs) were shown during class time. Skin-mounted activPAL physical activity monitors were used to measure SB and postural topography and Noraxon myoMOTION inertial measurement units (IMUs) to measure spinal movement. The study was evaluated for feasibility by tracking school retention, successful delivery of the HEMVs, the use of sit-stand desks, compliance with the wearable sensors, and data accuracy. We deductively analyzed teachers' interviews and learners' focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was performed using Microsoft Excel. Results: Cluster 1 withdrew from the study before follow-up SB, postural topography, and spinal movements were measured. All feasibility outcomes, namely (1) classroom retention, (2) delivery of HEMVs, (3) learner and teacher acceptance and usage of sit-stand classroom furniture, (4) 100\% compliance with wearing skin-mounted sensors for the duration of the intended measurement period, and (5) minimum 80\% eligibility of sensor data gathered included in data analysis, were met in cluster 2. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology. Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualized teacher training on how sit-stand desks and HEMVs can be used as classroom management tools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR2-10.2196/18522 ", doi="10.2196/65169", url="https://formative.jmir.org/2025/1/e65169" } @Article{info:doi/10.2196/68840, author="Zuair, Areeg", title="Effect of the Reassured Self-Compassion--Based School Program on Anxiety, Video Game Addiction, and Body Image Among Rural Female Adolescents: Retrospective Study", journal="JMIR Form Res", year="2025", month="Feb", day="19", volume="9", pages="e68840", keywords="adolescents", keywords="rural", keywords="compassion-focused therapy", keywords="mental health", keywords="Saudi Arabia", keywords="school", abstract="Background: The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported. Objective: This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia. Methods: A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children's Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models. Results: Among the students, 25.8\% (32/124) were identified as having high anxiety levels, with 19.3\% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26\% (32/123) were classified as problem gamers, while 14\% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1\% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference --4.11, 95\% CI --6.98 to --1.24; P=.005) and video game addiction (mean difference --1.62, 95\% CI --2.83 to --0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95\% CI --0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention. Conclusions: The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions. ", doi="10.2196/68840", url="https://formative.jmir.org/2025/1/e68840" } @Article{info:doi/10.2196/54637, author="Grummitt, Lucinda and Bailey, Sasha and Kelly, V. Erin and Birrell, Louise and Gardner, A. Lauren and Halladay, Jillian and Chapman, Cath and Andrews, L. Jack and Champion, E. Katrina and Hunter, Emily and Egan, Lyra and Conroy, Chloe and Tiko, Raaya and Nguyen, An and Teesson, Maree and Newton, C. Nicola and Barrett, L. Emma", title="Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="21", volume="7", pages="e54637", keywords="mental health", keywords="prevention", keywords="school", keywords="depression", keywords="anxiety", keywords="proportionate universalism", abstract="Background: Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. Objective: This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). Methods: Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. Results: Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. Conclusions: The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools. ", doi="10.2196/54637", url="https://pediatrics.jmir.org/2024/1/e54637" } @Article{info:doi/10.2196/52224, author="He, Zonglin and Zhou, Botao and Feng, Haixiao and Bai, Jian and Wang, Yuechun", title="Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis", journal="JMIR Med Educ", year="2024", month="Jun", day="25", volume="10", pages="e52224", keywords="flipped classroom", keywords="flipped classroom teaching", keywords="physiology", keywords="scientific knowledge map", keywords="hot topics", keywords="frontier progress", keywords="evolution trend", keywords="classroom-based", keywords="bibliometric visual analysis", keywords="bibliometric", keywords="visual analysis", keywords="medical education", keywords="teaching method", keywords="bibliometric analysis", keywords="visualization tool", keywords="academic", keywords="academic community", keywords="inverted classroom", abstract="Background: Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students' and teachers' responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively. Objective: This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature. Methods: A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends. Results: A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013?2014), extensive practice stage (2015?2019), and modification and growth stage (2020?2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43\% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others. Conclusions: This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents. ", doi="10.2196/52224", url="https://mededu.jmir.org/2024/1/e52224" } @Article{info:doi/10.2196/25086, author="Davidson, Rosemary and Randhawa, Gurch", title="The Sign 4 Big Feelings Intervention to Improve Early Years Outcomes in Preschool Children: Outcome Evaluation", journal="JMIR Pediatr Parent", year="2022", month="May", day="20", volume="5", number="2", pages="e25086", keywords="language development", keywords="sign language", keywords="early years outcomes", keywords="well-being", abstract="Background: Any delays in language development may affect learning, profoundly influencing personal, social, and professional trajectories. The effectiveness of the Sign 4 Big Feelings (S4BF) intervention was investigated by measuring changes in early years outcomes (EYOs) after a 3-month period. Objective: This study aims to determine whether children's well-being and EYOs significantly improve (beyond typical, expected development) after the S4BF intervention period and whether there are differences between boys and girls in progress achieved. Methods: An evaluation of the S4BF intervention was conducted with 111 preschool-age children in early years settings in Luton, United Kingdom. Listening, speaking, understanding, and managing feelings and behavior, in addition to the Leuven well-being scale, were assessed in a quasi-experimental study design to measure pre- and postintervention outcomes. Results: Statistically and clinically significant differences were found for each of the 7 pre- and postmeasures evaluated: words understood and spoken, well-being scores, and the 4 EYO domains. Gender differences were negligible in all analyses. Conclusions: Children of all abilities may benefit considerably from S4BF, but a language-based intervention of this nature may be transformational for children who are behind developmentally, with English as an additional language, or of lower socioeconomic status. Trial Registration: ISRCTN Registry ISRCTN42025531; https://doi.org/10.1186/ISRCTN42025531 ", doi="10.2196/25086", url="https://pediatrics.jmir.org/2022/2/e25086", url="http://www.ncbi.nlm.nih.gov/pubmed/35594062" } @Article{info:doi/10.2196/28276, author="Ntalindwa, Theoneste and Nduwingoma, Mathias and Uworwabayeho, Alphonse and Nyirahabimana, Pascasie and Karangwa, Evariste and Rashid Soron, Tanjir and Westin, Thomas and Karunaratne, Thashmee and Hansson, Henrik", title="Adapting the Use of Digital Content to Improve the Learning of Numeracy Among Children With Autism Spectrum Disorder in Rwanda: Thematic Content Analysis Study", journal="JMIR Serious Games", year="2022", month="Apr", day="19", volume="10", number="2", pages="e28276", keywords="autism", keywords="learning", keywords="ICT", keywords="e-learning", keywords="education", keywords="children", keywords="ASD", keywords="teaching", keywords="teachers", keywords="communication", keywords="communication technology", keywords="online content", keywords="Rwanda", keywords="gamification", keywords="school", keywords="school-age children", keywords="behavior", abstract="Background: Many teachers consider it challenging to teach children with autism spectrum disorder (ASD) in an inclusive classroom due to their unique needs and challenges. The integration of information communication technology (ICT) in the education system allows children with ASD to improve their learning. However, these ICT tools should meet their needs to lead a productive life. Objective: This study aimed to examine the possibilities of re-creating and adapting digital content to improve the learning of numeracy among children with ASD in inclusive school settings. Methods: We conducted 7 focus group discussions (FGDs) with 56 teachers from 7 schools and 14 parents from April to November 2019. Each of the FGDs took around 1 hour. Two clustered sets of questions were used: (1) general knowledge about teaching children with ASD and (2) analysis of selected online educational video content of early math (specifically, counting numbers). The researchers used video to understand current methodologies used in teaching children with ASD, possibilities of adaptation of the content in the current teaching environment, future challenges when the content is adapted, and possible solutions to overcome those challenges. All data, including audio recordings, field notes, and participants' comments, were transcribed, recorded, and analyzed following the steps recommended in qualitative data analysis. Results: The researchers identified ten themes from the analysis of the data: (1) awareness of the existence of ASD among children in schools and the community, (2) acceptance of children with ASD in an inclusive classroom and the community, (3) methods and models used when teaching children with ASD, (4)realia used to improve the learning of children with ASD, (5) the design of educational digital content, (6) the accessibility of online educational content, (7) quality of the content of the educational multimedia, (8) the opportunity of using the translated and re-created content inside and outside the classroom, (9) the relevance of the digital content in the Rwandan educational system, and (10) enhancement of the accessibility and quality of the digital content. We found that participants assumed that the content translation, gamification, and re-creation would help teach children with ASD. Moreover, they recommended contextualizing the content, increasing access to digital devices, and further research in the education of different subjects. Conclusions: Although many studies have identified the possibilities of using ICT to support children with ASD, few studies have documented the possibilities of integrating the existing technologies tested in the international community. This study is charting new territory to investigate online content to suit the context of schools. This study recommends further exploration of possible methodologies, such as applied behavior analysis or verbal behavior therapy, and the development of contextualized technologies that respond to the educational needs of children with ASD. ", doi="10.2196/28276", url="https://games.jmir.org/2022/2/e28276", url="http://www.ncbi.nlm.nih.gov/pubmed/35438638" } @Article{info:doi/10.2196/27760, author="Pearson, Nicole and Finch, Meghan and Sutherland, Rachel and Kingsland, Melanie and Wolfenden, Luke and Wedesweiler, Taya and Herrmann, Vanessa and Yoong, Lin Sze", title="An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children's Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Mar", day="17", volume="24", number="3", pages="e27760", keywords="nutrition", keywords="mHealth", keywords="child", keywords="preschool", keywords="parents", abstract="Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children's diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children's (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47\%] intervention and 9 [53\%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children's lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children's lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8\% (355/400) of consenting children at baseline and 84.3\% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95\% CI ?163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (?1.98 kJ, 95\% CI ?343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8\% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26\% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80\% and 6/8, 75\%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children's lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 ", doi="10.2196/27760", url="https://www.jmir.org/2022/3/e27760", url="http://www.ncbi.nlm.nih.gov/pubmed/35297768" } @Article{info:doi/10.2196/30778, author="{\vS}orgo, Andrej and Crnkovi{\v c}, Nu{\vs}a and Gabrovec, Branko and Cesar, Katarina and Selak, {\vS}pela", title="Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study", journal="J Med Internet Res", year="2022", month="Mar", day="15", volume="24", number="3", pages="e30778", keywords="online study", keywords="stress", keywords="COVID-19", keywords="postsecondary students", keywords="pandemic", keywords="epidemiology", keywords="educational institutions", keywords="online education", keywords="pedagogy", keywords="mental health", abstract="Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students' mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study--related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students' negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. ", doi="10.2196/30778", url="https://www.jmir.org/2022/3/e30778", url="http://www.ncbi.nlm.nih.gov/pubmed/35171098" } @Article{info:doi/10.2196/31172, author="Abraham, Olufunmilola and Szela, Lisa and Khan, Mahnoor and Geddam, Amrita", title="Exploring Middle School Students' Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study", journal="JMIR Serious Games", year="2022", month="Jan", day="24", volume="10", number="1", pages="e31172", keywords="adolescents", keywords="adolescent education", keywords="adolescent health", keywords="older children", keywords="middle school students", keywords="cancer awareness", keywords="cancer education", keywords="cancer prevention", keywords="health education", keywords="serious games", abstract="Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students' preferences for the use of SGs for cancer prevention education. The study also characterized the students' perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on ``Cancer, Clear \& Simple,'' a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants' gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least ``some'' gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters' outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. ", doi="10.2196/31172", url="https://games.jmir.org/2022/1/e31172", url="http://www.ncbi.nlm.nih.gov/pubmed/34643533" } @Article{info:doi/10.2196/30565, author="Burn, Anne-Marie and Ford, J. Tamsin and Stochl, Jan and Jones, B. Peter and Perez, Jesus and Anderson, K. Joanna", title="Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study", journal="JMIR Form Res", year="2022", month="Jan", day="10", volume="6", number="1", pages="e30565", keywords="mental health", keywords="assessment", keywords="young people", keywords="youth", keywords="schools", keywords="computerized adaptive testing", keywords="mobile apps", keywords="user-centered design", keywords="coproduction", keywords="qualitative study", abstract="Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles---an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. ", doi="10.2196/30565", url="https://formative.jmir.org/2022/1/e30565", url="http://www.ncbi.nlm.nih.gov/pubmed/35006079" } @Article{info:doi/10.2196/34530, author="Stapinski, Lexine and Routledge, Kylie and Snijder, Mieke and Doyle, Michael and Champion, Katrina and Chapman, Cath and Ward, James and Baumgart, Amanda and Lee, Kylie K. S. and Teesson, Maree and Newton, Nicola", title="A Web-Based Alcohol and Other Drug Prevention Program (Strong \& Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jan", day="7", volume="11", number="1", pages="e34530", keywords="Aboriginal and Torres Strait Islander", keywords="prevention", keywords="alcohol", keywords="tobacco", keywords="substance use", keywords="universal prevention", keywords="well-being", keywords="harm minimization", keywords="Indigenous", keywords="web-based", abstract="Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong \& Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong \& Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40\% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong \& Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong \& Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038\&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 ", doi="10.2196/34530", url="https://www.researchprotocols.org/2022/1/e34530", url="http://www.ncbi.nlm.nih.gov/pubmed/34994696" } @Article{info:doi/10.2196/24792, author="Koziol-McLain, Jane and Wilson, Denise and Vandal, C. Alain and Eruera, Moana and Nada-Raja, Shyamala and Dobbs, Terry and Roguski, Michael and Barbarich-Unasa, Wai Te", title="Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="30", volume="10", number="12", pages="e24792", keywords="indigenous", keywords="M?ori", keywords="young people", keywords="relationships", keywords="school", keywords="mHealth", keywords="smartphone app", keywords="mobile phone", abstract="Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or wh?nau (indigenous M?ori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and M?ori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the M?ori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous M?ori--centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 ", doi="10.2196/24792", url="https://www.researchprotocols.org/2021/12/e24792", url="http://www.ncbi.nlm.nih.gov/pubmed/34967750" } @Article{info:doi/10.2196/25902, author="Barnes, Courtney and Yoong, Lin Sze and Nathan, Nicole and Wolfenden, Luke and Wedesweiler, Taya and Kerr, Jayde and Ward, S. Dianne and Grady, Alice", title="Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Dec", day="15", volume="23", number="12", pages="e25902", keywords="childcare center", keywords="web-based", keywords="nutrition", keywords="healthy eating", keywords="randomized controlled trial", keywords="intervention", keywords="implementation", abstract="Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children's healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47\%) provided consent to participate. Data collection components were completed by 100\% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91\% to 11/11, 100\%) and the web-based program (11/11, 100\%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91\% to 11/11, 100\%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19\% (2/11) to 64\% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w ", doi="10.2196/25902", url="https://www.jmir.org/2021/12/e25902", url="http://www.ncbi.nlm.nih.gov/pubmed/34914617" } @Article{info:doi/10.2196/30668, author="Davies, M. Sian and Jardine, Jenni and Gutridge, Kerry and Bernard, Zara and Park, Stephen and Dawson, Tom and Abel, M. Kathryn and Whelan, Pauline", title="Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e30668", keywords="digital mental health", keywords="acceptability", keywords="feasibility", keywords="child and adolescent mental health and well-being", keywords="school-based mental health care", keywords="prevention", keywords="digital assessment and monitoring", keywords="reading screening or ability", abstract="Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6\%) consented and took part; of these 34 children, all 34 (100\%) completed the baseline Lexplore assessment, and 30 (88\%) completed the follow-up. In addition, most children were classified by Lincus as regular (?1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. ", doi="10.2196/30668", url="https://formative.jmir.org/2021/12/e30668", url="http://www.ncbi.nlm.nih.gov/pubmed/34898446" } @Article{info:doi/10.2196/24840, author="Mastorci, Francesca and Piaggi, Paolo and Trivellini, Gabriele and Doveri, Cristina and Casu, Anselmo and Bastiani, Luca and Marinaro, Irene and Vassalle, Cristina and Pingitore, Alessandro", title="Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study", journal="JMIR Form Res", year="2021", month="Dec", day="2", volume="5", number="12", pages="e24840", keywords="adolescent", keywords="well-being management", keywords="schools", keywords="web tool", keywords="health promotion", abstract="Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups. ", doi="10.2196/24840", url="https://formative.jmir.org/2021/12/e24840", url="http://www.ncbi.nlm.nih.gov/pubmed/34860668" } @Article{info:doi/10.2196/31041, author="Brussoni, Mariana and Han, S. Christina and Jacob, John and Munday, Fritha and Zeni, Megan and Walters, Melanie and Cheng, Tina and Schneeberg, Amy and Fox, Emily and Oberle, Eva", title="A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators' Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="18", volume="10", number="11", pages="e31041", keywords="early years", keywords="risky play", keywords="teacher", keywords="childcare", keywords="early learning", keywords="risk perception", keywords="outdoor play", abstract="Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs' and ELCC administrators' perceptions and practices in support of children's outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children's play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children's play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children's access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041 ", doi="10.2196/31041", url="https://www.researchprotocols.org/2021/11/e31041", url="http://www.ncbi.nlm.nih.gov/pubmed/34792479" } @Article{info:doi/10.2196/31789, author="Kaiser, Sabine and Martinussen, Monica and Adolfsen, Frode and Breivik, Kyrre and Kyrrestad, Henriette", title="An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="8", volume="10", number="11", pages="e31789", keywords="cyberbullying", keywords="intervention", keywords="mobile app", keywords="adolescents", keywords="NettOpp", keywords="mental health", keywords="health care", abstract="Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 ", doi="10.2196/31789", url="https://www.researchprotocols.org/2021/11/e31789", url="http://www.ncbi.nlm.nih.gov/pubmed/34747704" } @Article{info:doi/10.2196/29989, author="Parker, L. Belinda and Anderson, Melissa and Batterham, J. Philip and Gayed, Aimee and Subotic-Kerry, Mirjana and Achilles, R. Melinda and Chakouch, Cassandra and Werner-Seidler, Aliza and Whitton, E. Alexis and O'Dea, Bridianne", title="Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators' Skills in Adolescent Mental Health) Program", journal="JMIR Ment Health", year="2021", month="Oct", day="22", volume="8", number="10", pages="e29989", keywords="mental health", keywords="training", keywords="high school teachers", keywords="youth", keywords="mental health programs", keywords="secondary schools", abstract="Background: Secondary schools are increasingly supporting adolescents' mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators' skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers' knowledge and confidence in caring for students' mental health. Objective: This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers. Methods: A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants' perceptions of program effectiveness. Results: A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness. Conclusions: Findings indicated that a web-based training program may be beneficial for improving secondary school teachers' abilities to care for students' mental health; however, program modifications are required to increase training completions. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529 ", doi="10.2196/29989", url="https://mental.jmir.org/2021/10/e29989", url="http://www.ncbi.nlm.nih.gov/pubmed/34677134" } @Article{info:doi/10.2196/30339, author="Gonsalves, P. Pattie and Sharma, Rhea and Hodgson, Eleanor and Bhat, Bhargav and Jambhale, Abhijeet and Weiss, A. Helen and Fairburn, G. Christopher and Cavanagh, Kate and Cuijpers, Pim and Michelson, Daniel and Patel, Vikram", title="A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="6", volume="10", number="10", pages="e30339", keywords="randomized controlled trial", keywords="internet-based intervention", keywords="smartphone", keywords="adolescent", keywords="schools", keywords="mental health", keywords="COVID-19", keywords="app", keywords="protocol", keywords="problem-solving", keywords="intervention", keywords="teenager", keywords="young adult", keywords="India", keywords="feasibility", keywords="effective", abstract="Background: ``POD Adventures'' is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 ", doi="10.2196/30339", url="https://www.researchprotocols.org/2021/10/e30339", url="http://www.ncbi.nlm.nih.gov/pubmed/34586075" } @Article{info:doi/10.2196/30899, author="Engler-Stringer, Rachel and Black, Jennifer and Muhajarine, Nazeem and Martin, Wanda and Gilliland, Jason and McVittie, Janet and Kirk, Sara and Wittman, Hannah and Mousavi, Amin and Elliott, Sinikka and Tu, Sylvana and Hills, Brent and Androsoff, Gordon and Field, Debbie and Macdonald, Brit and Belt, Chelsea and Vatanparast, Hassan", title="The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="21", volume="10", number="9", pages="e30899", keywords="school food programs", keywords="Canada", keywords="nutrition", keywords="intervention research", keywords="mHealth", abstract="Background: Good nutrition affects children's health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children's eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones. Objective: The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices. Methods: This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project. Results: This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention. Conclusions: The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent. International Registered Report Identifier (IRRID): DERR1-10.2196/30899 ", doi="10.2196/30899", url="https://www.researchprotocols.org/2021/9/e30899", url="http://www.ncbi.nlm.nih.gov/pubmed/34546171" } @Article{info:doi/10.2196/29454, author="Exner-Cortens, Deinera and Baker, Elizabeth and Gray, Shawna and Fernandez Conde, Cristina and Rivera, Ramirez Rocio and Van Bavel, Marisa and Vezina, Elisabeth and Ambrose, Aleta and Pawluk, Chris and Schwartz, D. Kelly and Arnold, D. Paul", title="School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review", journal="JMIR Ment Health", year="2021", month="Sep", day="21", volume="8", number="9", pages="e29454", keywords="suicide", keywords="risk assessment", keywords="youth", keywords="eHealth", keywords="school mental health", keywords="mobile phone", abstract="Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature---consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former's focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. ", doi="10.2196/29454", url="https://mental.jmir.org/2021/9/e29454", url="http://www.ncbi.nlm.nih.gov/pubmed/34546178" } @Article{info:doi/10.2196/30499, author="Anderson, Pamela and Coyle, Karin and Guinosso, Stephanie and Ferrand, L. John and Owora, Arthur and Houghton, F. Rebecca and Walsh-Buhi, Eric", title="Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial", journal="JMIR Res Protoc", year="2021", month="Sep", day="1", volume="10", number="9", pages="e30499", keywords="adolescents", keywords="youth", keywords="teens", keywords="healthy relationships", keywords="unintended pregnancy", keywords="teen pregnancy", keywords="sexually transmitted infections", keywords="sexually transmitted diseases", keywords="sexual health education", keywords="school-based health center", keywords="randomized controlled trial", abstract="Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study---the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov \#NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. Trial Registration: ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876 International Registered Report Identifier (IRRID): DERR1-10.2196/30499 ", doi="10.2196/30499", url="https://www.researchprotocols.org/2021/9/e30499", url="http://www.ncbi.nlm.nih.gov/pubmed/34468330" } @Article{info:doi/10.2196/28273, author="Van de Kop, Huib and Toussaint, Huub and Janssen, Mirka and Busch, Vincent and Verhoeff, Arnoud", title="Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="28", volume="10", number="7", pages="e28273", keywords="physical activity", keywords="participatory", keywords="adolescents", keywords="protocol", keywords="assets", keywords="school-based", keywords="students", keywords="participation", keywords="school-age children", keywords="teenagers", keywords="exercise", abstract="Background: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. Objective: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. Methods: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students' assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. Results: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10{\texttimes} 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). Conclusions: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. Trial Registration: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636 International Registered Report Identifier (IRRID): DERR1-10.2196/28273 ", doi="10.2196/28273", url="https://www.researchprotocols.org/2021/7/e28273", url="http://www.ncbi.nlm.nih.gov/pubmed/34121666" } @Article{info:doi/10.2196/26690, author="Mclaughlin, Matthew and Duff, Jed and McKenzie, Tom and Campbell, Elizabeth and Sutherland, Rachel and Wiggers, John and Wolfenden, Luke", title="Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2021", month="Jul", day="26", volume="4", number="3", pages="e26690", keywords="process evaluation", keywords="engagement", keywords="think-aloud methodology", keywords="mixed methods", keywords="physical activity", keywords="website", keywords="digital health intervention", keywords="implementation support", keywords="delivery mode", keywords="scale-up", abstract="Background: Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective: The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods: The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the ``following a thread'' approach. Results: For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions: Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870 ", doi="10.2196/26690", url="https://pediatrics.jmir.org/2021/3/e26690", url="http://www.ncbi.nlm.nih.gov/pubmed/34309565" } @Article{info:doi/10.2196/25513, author="Thornton, Louise and Gardner, Anne Lauren and Osman, Bridie and Green, Olivia and Champion, Elizabeth Katrina and Bryant, Zachary and Teesson, Maree and Kay-Lambkin, Frances and Chapman, Cath and ", title="A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App", journal="JMIR Form Res", year="2021", month="Apr", day="12", volume="5", number="4", pages="e25513", keywords="mHealth", keywords="mobile phone", keywords="chronic disease", keywords="adolescents", keywords="health promotion", abstract="Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. ", doi="10.2196/25513", url="https://formative.jmir.org/2021/4/e25513", url="http://www.ncbi.nlm.nih.gov/pubmed/33843590" } @Article{info:doi/10.2196/25838, author="Wang, Aiwei and Gao, Yang and Wang, Jingjing and Tong, K. Tomas and Sun, Yan and Yu, Siyue and Zhao, Hong and Zou, Daozhi and Zhang, Ziheng and Qi, Yuling and Zuo, Nan and Bu, Danran and Zhang, Dexing and Xie, Yaojie and Baker, S. Julien", title="Effects of a School-Based Physical Activity Intervention for Obesity and Health-Related Physical Fitness in Adolescents With Intellectual Disability: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Mar", day="22", volume="10", number="3", pages="e25838", keywords="children", keywords="intellectual disability", keywords="physical activity", keywords="overweight", keywords="obesity", keywords="intervention", abstract="Background: Childhood obesity accompanied by lower levels of health-related physical fitness (HRPF) is a major threat to public health both internationally and locally. Children with intellectual disability, especially adolescents, have a higher risk of being overweight/obese and having poor HRPF levels. Therefore, more interventions are needed to help this population attain their optimal health levels. However, there has been relatively limited research on this population compared with on their typically developing peers. Objective: The proposed study aims to fill this knowledge gap by developing and examining the success of a physical activity (PA) intervention for the target population. Methods: The proposed study will be a 12-week, school-based randomized controlled trial. The participants (N=48) will be recruited from special schools for students with mild intellectual disability and then randomly allocated to either the intervention group (IG) or the wait-list control group (CG). During the intervention period, the participants in the IG will receive a fun game--based moderate-to-vigorous PA (MVPA) training program (2 sessions/week, 60 minutes/session, for a total of 24 sessions). The intensity of the activities will increase in a progressive manner. Participants in the CG will receive no program during the study period, but the same PA program will be provided to them after the completion of the study. To observe and evaluate the sustaining effects of the intervention, follow-up testing will be scheduled for the participants 12 weeks after the intervention concludes. The study outcomes will include primary outcomes (obesity- and fitness-related outcomes) and a secondary outcome (blood pressure). All of the measurements will be taken at 3 time points. After the follow-up tests, the same PA training program will be provided to the participants in the CG. Results: This study is ongoing. The participants were recruited from October 2020 to November 2020. The total duration of the study is 13 months. Study results are expected at the end of 2021. Conclusions: The proposed study is expected to reduce obesity and improve HRPF levels in children with intellectual disability. If proven effective, the intervention will be made accessible to more special schools and mainstream schools with students with intellectual disability. Furthermore, the study can serve as an example for international researchers, policy makers, and members of the public who are seeking to tackle the problem of obesity and poor HRPF among children with intellectual disability. Trial Registration: ClinicalTrials.gov NCT04554355; https://www.clinicaltrials.gov/ct2/show/NCT04554355 International Registered Report Identifier (IRRID): PRR1-10.2196/25838 ", doi="10.2196/25838", url="https://www.researchprotocols.org/2021/3/e25838", url="http://www.ncbi.nlm.nih.gov/pubmed/33749611" } @Article{info:doi/10.2196/25870, author="Parker, L. Belinda and Chakouch, Cassandra and Subotic-Kerry, Mirjana and Batterham, J. Philip and Mackinnon, Andrew and Newby, M. Jill and Whitton, E. Alexis and McGoldrick, Janey and Cockayne, Nicole and O'Dea, Bridianne", title="The Building Educators' Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Feb", day="24", volume="10", number="2", pages="e25870", keywords="mental health training", keywords="schools", keywords="teachers", keywords="educators", keywords="mental health", keywords="student mental health", keywords="secondary school", abstract="Background: In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators' Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed. Objective: The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators' confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators' frequency of providing help to students and improving their mental health knowledge and reducing educators' psychological distress and stigma toward students with mental health issues. Methods: The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment. Results: Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021. Conclusions: This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students' mental health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208 International Registered Report Identifier (IRRID): DERR1-10.2196/25870 ", doi="10.2196/25870", url="https://www.researchprotocols.org/2021/2/e25870", url="http://www.ncbi.nlm.nih.gov/pubmed/33625374" } @Article{info:doi/10.2196/20898, author="Hirvonen, Maija and Purcell, Carrie and Elliott, Lawrie and Bailey, V. Julia and Simpson, Anne Sharon and McDaid, Lisa and Moore, Laurence and Mitchell, Rebecca Kirstin and ", title="Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial", journal="J Med Internet Res", year="2021", month="Feb", day="16", volume="23", number="2", pages="e20898", keywords="social media", keywords="sexual health", keywords="sex education", keywords="peer education", keywords="process evaluation", keywords="school", keywords="feasibility studies", keywords="adolescent", keywords="social networking", abstract="Background: There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources. Objective: The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention. Methods: Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data. Results: Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to---rather than embedded in---their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied. Conclusions: Invitation-only social media groups formed around peer supporters' existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding. ", doi="10.2196/20898", url="http://www.jmir.org/2021/2/e20898/", url="http://www.ncbi.nlm.nih.gov/pubmed/33591287" } @Article{info:doi/10.2196/19430, author="Sun, Yuewen and Luo, Rong and Li, Yuan and He, J. Feng and Tan, Monique and MacGregor, A. Graham and Liu, Hueiming and Zhang, Puhong", title="App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation", journal="JMIR Res Protoc", year="2021", month="Feb", day="10", volume="10", number="2", pages="e19430", keywords="mobile health", keywords="mobile phone", keywords="process evaluation", keywords="salt reduction", keywords="health education", abstract="Background: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/19430 ", doi="10.2196/19430", url="http://www.researchprotocols.org/2021/2/e19430/", url="http://www.ncbi.nlm.nih.gov/pubmed/33565991" } @Article{info:doi/10.2196/26567, author="Kuriyan, Aparajita and Kinkler, Grace and Cidav, Zuleyha and Kang-Yi, Christina and Eiraldi, Ricardo and Salas, Eduardo and Wolk, Benjamin Courtney", title="Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study", journal="JMIR Res Protoc", year="2021", month="Feb", day="8", volume="10", number="2", pages="e26567", keywords="teams", keywords="Team Strategies and Tools to Enhance Performance and Patient Safety", keywords="school mental health", keywords="school health", abstract="Background: Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. Objective: The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. Methods: Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. Results: Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. Conclusions: This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. Trial Registration: ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228 International Registered Report Identifier (IRRID): DERR1-10.2196/26567 ", doi="10.2196/26567", url="https://www.researchprotocols.org/2021/2/e26567", url="http://www.ncbi.nlm.nih.gov/pubmed/33555258" } @Article{info:doi/10.2196/25062, author="Sauch Valma{\~n}a, Gl{\`o}ria and Vidal-Alaball, Josep and Garcia Furi{\'o}, Victoria and Testoni, Giorgia and Espelt, Albert and Exposito, Katarin and Saig{\'i}-Rubi{\'o}, Francesc and Carr{\'e}, N{\'u}ria and Sanz, Ikuska and Vicens, Victor", title="An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study", journal="JMIR Res Protoc", year="2021", month="Feb", day="3", volume="10", number="2", pages="e25062", keywords="mHealth", keywords="telehealth", keywords="teenager", keywords="health promotion and sexual health", keywords="health promotion", keywords="sexual health", abstract="Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients' safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 ", doi="10.2196/25062", url="https://www.researchprotocols.org/2021/2/e25062", url="http://www.ncbi.nlm.nih.gov/pubmed/33533729" } @Article{info:doi/10.2196/21636, author="Li, Jie and Ning, Peishan and Cheng, Peixia and Schwebel, C. David and Yang, Yang and Wei, Xiang and He, Jieyi and Wang, Wanhui and Li, Ruotong and Hu, Guoqing", title="Factors Associated With Dropout of Participants in an App-Based Child Injury Prevention Study: Secondary Data Analysis of a Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Jan", day="29", volume="23", number="1", pages="e21636", keywords="app-based intervention", keywords="unintentional injury", keywords="attrition", keywords="influencing factors", abstract="Background: Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. Objective: We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. Methods: The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6--year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. Results: In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9\% (437/1510) in the intervention group and 35.7\% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95\% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95\% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95\% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95\% CI 1.11-5.15). Demographic characteristics were unrelated to attrition. Conclusions: Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 ", doi="10.2196/21636", url="https://www.jmir.org/2021/1/e21636", url="http://www.ncbi.nlm.nih.gov/pubmed/33512318" } @Article{info:doi/10.2196/22680, author="Balestrin, Mariana and Brasil, Bauermann Carla Cristina and Bellei, Andrei Ericles and Kirsten, Ramos Vanessa and Wagner, Bernardes Mario", title="Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Jan", day="19", volume="10", number="1", pages="e22680", keywords="school health services", keywords="healthy diet", keywords="pediatric obesity", keywords="schools", keywords="snacks", abstract="Background: School cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings. Objective: We aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil. Methods: We will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95\% CI. Results: This project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021. Conclusions: To our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals. Trial Registration: Brazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhk International Registered Report Identifier (IRRID): DERR1-10.2196/22680 ", doi="10.2196/22680", url="http://www.researchprotocols.org/2021/1/e22680/", url="http://www.ncbi.nlm.nih.gov/pubmed/33464219" } @Article{info:doi/10.2196/25860, author="Agley, Jon and Jun, Mikyoung and Eldridge, Lori and Agley, L. Daniel and Xiao, Yunyu and Sussman, Steve and Golzarri-Arroyo, Lilian and Dickinson, L. Stephanie and Jayawardene, Wasantha and Gassman, Ruth", title="Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Jan", day="6", volume="8", number="1", pages="e25860", keywords="cyberbullying", keywords="bullying", keywords="social-emotional learning", keywords="SEL", keywords="social-emotional competence", keywords="RCT", keywords="randomized controlled trial", keywords="outcome", keywords="emotion", keywords="bully", keywords="prevention", keywords="school", keywords="intervention", keywords="assessment", keywords="effectiveness", keywords="implementation", keywords="fidelity", keywords="reception", keywords="children", keywords="young adults", keywords="adolescents", abstract="Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96\% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. Trial Registration: Clinicaltrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID): RR2-10.2196/17900 ", doi="10.2196/25860", url="http://mental.jmir.org/2021/1/e25860/", url="http://www.ncbi.nlm.nih.gov/pubmed/33338986" } @Article{info:doi/10.2196/21100, author="Galanti, Rosaria Maria and Pulkki-Br{\"a}nnstr{\"o}m, Anni-Maria and Nilsson, Maria", title="Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation", journal="JMIR Res Protoc", year="2020", month="Oct", day="29", volume="9", number="10", pages="e21100", keywords="tobacco use", keywords="prevention", keywords="school", keywords="social influence", keywords="public commitment", keywords="cluster randomized trial", keywords="observational study", abstract="Background: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent's commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. Objective: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program's implementation. Methods: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. Results: The study was approved by the Ume{\aa} Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. Conclusions: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID): DERR1-10.2196/21100 ", doi="10.2196/21100", url="http://www.researchprotocols.org/2020/10/e21100/", url="http://www.ncbi.nlm.nih.gov/pubmed/33000762" } @Article{info:doi/10.2196/20976, author="Thabrew, Hiran and Kumar, Harshali and Goldfinch, Mary and Cavadino, Alana and Goodyear-Smith, Felicity", title="Repeated Psychosocial Screening of High School Students Using YouthCHAT: Cohort Study", journal="JMIR Pediatr Parent", year="2020", month="Oct", day="26", volume="3", number="2", pages="e20976", keywords="mass screening", keywords="mental health", keywords="school health services", keywords="eHealth", abstract="Background: Psychosocial problems are common during adolescence and can have long-lasting effects on health and on academic and social functioning. YouthCHAT, an electronic HEEADSSS (home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality and safety)-aligned instrument, has recently been demonstrated to be an acceptable and effective school-based psychosocial screener for 13-year-old (Year 9) high school students. Objective: This study aims to compare acceptability and detection rates with repeated YouthCHAT screenings of high school students when they are 13 years old (Year 9) and 14 years old (Year 10). Methods: We invited all Year-10 students to complete a YouthCHAT screening in 2018. Rates of positively identified issues were compared between the subset of students screened in both 2017 and 2018. Student acceptability toward YouthCHAT was investigated through focus group sessions. Onward clinical referral rates in 2018 were also investigated to explore the potential referral burden following screening. Data analysis for rates of positively identified issues were conducted with the McNemar test. Chi-square, Fisher exact test, and Kruskal-Wallis test were used to analyze the focus group data. Results: Of 141 eligible Year-10 students, 114 (81\%) completed a YouthCHAT screening during 2018, and 97 (85\%) of them completed it for a second time. Apart from depression, which increased (P=.002), and perceived life stress, which decreased (P=.04), rates of identified issues were broadly similar between 13 and 14 years of age. Repeated screenings via YouthCHAT was acceptable to students and time-efficient (mean, 6 minutes and 32 seconds) but did not reduce the overall number of individuals with identified issues. Onward clinical referrals from positive screens were mostly managed by school-based health services without the need for external referrals. Conclusions: Although further evaluation is needed, our results support the value of YouthCHAT as an acceptable and effective instrument with which to achieve routine identification of psychosocial issues and early intervention within a high school environment. ", doi="10.2196/20976", url="http://pediatrics.jmir.org/2020/2/e20976/", url="http://www.ncbi.nlm.nih.gov/pubmed/33104007" } @Article{info:doi/10.2196/21155, author="Katapally, Reddy Tarun", title="Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health", journal="JMIR Pediatr Parent", year="2020", month="Sep", day="25", volume="3", number="2", pages="e21155", keywords="Indigenous youth", keywords="mental health", keywords="school policies", keywords="health policy", keywords="digital health interventions", keywords="mHealth", keywords="systems integration", keywords="land-based learning", keywords="physical activity", doi="10.2196/21155", url="http://pediatrics.jmir.org/2020/2/e21155/", url="http://www.ncbi.nlm.nih.gov/pubmed/32975527" } @Article{info:doi/10.2196/17815, author="Bernal, Marie Caroline Maite and Lhuisset, Lena and Fabre, Nicolas and Bois, Julien", title="School-Based Multicomponent Intervention to Promote Physical Activity and Reduce Sedentary Time of Disadvantaged Children Aged 6-10 Years: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="Sep", day="23", volume="9", number="9", pages="e17815", keywords="children", keywords="school", keywords="intervention", keywords="promotion", keywords="physical activity", keywords="sedentary time", keywords="attention", keywords="academic achievement", abstract="Background: In our modern society, physical activity (PA) is decreasing and sedentary time (ST) is increasing, especially for children from disadvantaged neighborhoods. School-based interventions to promote PA and decrease ST are therefore required among this population in order to change children's lifestyle habits. Moreover, attentional capacities and academic achievement can be enhanced by chronic PA during childhood. The relationships between these variables have been poorly studied with this population. Objective: The objective of this study is to present the rationale and methods for a randomized controlled trial among 6-10-year-old children with low socioeconomic status that will (1) evaluate the effectiveness of a school-based intervention designed to promote PA and reduce ST and (2) study the relationships between PA, ST, motor skills, attentional capacities, and academic achievement. Methods: A randomized controlled trial was conducted in 2 eligible primary schools. During academic year 2016-2017, 1 school was randomly assigned as the experiment one and the other was assigned as the control one. Five assessments times were used: baseline (T1 [November 2016] to T2 [June 2017]), follow-up (T3 [November 2017] to T4 [June 2018]), and final assessment (T5 [June 2019]). The school-based intervention included various components on different levels of the socioecological model: (1) curriculum-based program for children; (2) sensitization workshops and newsletters for parents; (3) training workshops for teachers; (4) environmental adaptation of playgrounds and reorganization of recess time; (5) time adaptation of lunch breaks; and (6) collaboration with political groups. PA, ST, motor skills, and attentional capacities were evaluated and academic achievement was recorded. Results: The presented intervention and its different assessments have been successfully implemented. In order to achieve the 2 objectives of this randomized controlled trial, data analyses are about to be completed. Conclusions: The implementation of this randomized controlled trial can help to determine effective strategies to promote PA in the context of increasing prevalence of physical inactivity among children with sedentary lifestyle which will be useful for researchers, stakeholders, and public policy makers. Trial Registration: ClinicalTrials.gov NCT03983447; https://clinicaltrials.gov/ct2/show/NCT03983447 International Registered Report Identifier (IRRID): RR1-10.2196/17815 ", doi="10.2196/17815", url="http://www.researchprotocols.org/2020/9/e17815/", url="http://www.ncbi.nlm.nih.gov/pubmed/32965238" } @Article{info:doi/10.2196/14778, author="Langlet, Billy and Maramis, Christos and Diou, Christos and Maglaveras, Nikolaos and Fagerberg, Petter and Heimeier, Rachel and Lekka, Irini and Delopoulos, Anastasios and Ioakimidis, Ioannis", title="Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e14778", keywords="mHealth", keywords="eHealth", keywords="dietary behavior", keywords="lifestyle behavioral monitoring", keywords="lifestyle interventions", keywords="obesity", keywords="mobile phone", keywords="smartphone", keywords="weight management", keywords="overweight", abstract="Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the ``mHealth evidence reporting and assessment checklist,'' and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100\% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a `Good' grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70\% the first week to 76\% the second week. Participants reported that 40\% of the registered meals were home-prepared, while 34\% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. ", doi="10.2196/14778", url="http://mhealth.jmir.org/2020/7/e14778/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706684" } @Article{info:doi/10.2196/16338, author="Adrian, Molly and Coifman, Jessica and Pullmann, D. Michael and Blossom, B. Jennifer and Chandler, Casey and Coppersmith, Glen and Thompson, Paul and Lyon, R. Aaron", title="Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study", journal="JMIR Ment Health", year="2020", month="Jul", day="20", volume="7", number="7", pages="e16338", keywords="technology-enabled services", keywords="suicide prevention", keywords="school-based mental health", keywords="user-centered design", keywords="mobile phone", abstract="Background: Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. Objective: This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. Methods: A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. Results: Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. Conclusions: Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation. ", doi="10.2196/16338", url="https://mental.jmir.org/2020/7/e16338", url="http://www.ncbi.nlm.nih.gov/pubmed/32706691" } @Article{info:doi/10.2196/18226, author="Ma, Shuoxin and Guan, Yongqing and Yuan, Yazhen and Tai, Yuan and Wang, Tan", title="A One-Step, Streamlined Children's Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="13", volume="8", number="7", pages="e18226", keywords="vision screening", keywords="resource-limited application", keywords="photorefraction", keywords="strabismus", keywords="myopia", keywords="anisometropia", keywords="mHealth", keywords="screening", abstract="Background: Young children's vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. Objective: This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. Methods: A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child's personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child's risk for strabismus, myopia, and anisometropia was then derived and consultation given. Results: A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People's Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87\% and 100\%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. Conclusions: The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program's design specifications. ", doi="10.2196/18226", url="http://mhealth.jmir.org/2020/7/e18226/", url="http://www.ncbi.nlm.nih.gov/pubmed/32673243" }