@Article{info:doi/10.2196/12501,
author="Chung, Alicia
and Wallace, Barbara
and Stanton-Koko, Monica
and Seixas, Azizi
and Jean-Louis, Girardin",
title="Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Mar",
day="22",
volume="2",
number="1",
pages="e12501",
keywords="childhood obesity; eHealth; social justice",
abstract="Background: African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. Objective: This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. Methods: Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. Results: A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. Conclusions: Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions. ",
doi="10.2196/12501",
url="http://pediatrics.jmir.org/2019/1/e12501/",
url="https://doi.org/10.2196/12501",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518320"
}


@Article{info:doi/10.2196/12524,
author="Haragan, Adriane F
and Zuwiala, Carly A
and Himes, Katherine P",
title="Online Information About Periviable Birth: Quality Assessment",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="7",
volume="2",
number="1",
pages="e12524",
keywords="periviable birth; patient education; patient counseling; Internet resources",
abstract="Background: Over 20,000 parents in the United States face the challenge of participating in decisions about whether to use life support for their infants born on the cusp of viability every year. Clinicians must help families grasp complex medical information about their baby's immediate prognosis as well as the risk for significant long-term morbidity. Patients faced with this decision want supplemental information and frequently seek medical information on the Internet. Empirical evidence about the quality of websites is lacking. Objective: We sought to evaluate the quality of online information available about periviable birth and treatment options for infants born at the cusp of viability. Methods: We read a counseling script to 20 pregnant participants that included information typically provided by perinatal and neonatal providers when periviable birth is imminent. The women were then asked to list terms they would use to search the Internet if they wanted additional information. Using these search terms, two reviewers evaluated the content of websites obtained via a Google search. We used two metrics to assess the quality of websites. The first was the DISCERN instrument, a validated questionnaire designed to assess the quality of patient-targeted health information for treatment choices. The second metric was the Essential Content Tool (ECT), a tool designed to address key components of counseling around periviable birth as outlined by professional organizations. DISCERN scores were classified as low quality if scores were 2, fair quality if scores were 3, and high quality if scores were 4 or higher. Scores of 6 or higher on the ECT were considered high quality. Interreviewer agreement was assessed by calculated kappa statistic. Results: A total of 97 websites were reviewed. Over half (57/97, 59{\%}) were for-profit sites, news stories, or personal blogs; 28{\%} (27/97) were government or medical sites; and 13{\%} (13/97) were nonprofit or advocacy sites. The majority of sites scored poorly in DISCERN questions designed to assess the reliability of information presented as well as data regarding treatment choices. Only 7{\%} (7/97) of the websites were high quality as defined by the DISCERN tool. The majority of sites did not address the essential content defined by the ECT. Importantly, only 18{\%} of websites (17/97) indicated that there are often a number of reasonable approaches to newborn care when faced with periviable birth. Agreement was strong, with kappa ranging from .72 to .91. Conclusions: Most information about periviable birth found on the Internet using common search strategies is of low quality. News stories highlighting positive outcomes are disproportionately represented. Few websites discuss comfort care or how treatment decisions impact quality of life. ",
doi="10.2196/12524",
url="http://pediatrics.jmir.org/2019/1/e12524/",
url="https://doi.org/10.2196/12524",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518325"
}


@Article{info:doi/10.2196/12157,
author="White, Becky
and Giglia, Roslyn C
and White, James A
and Dhaliwal, Satvinder
and Burns, Sharyn K
and Scott, Jane A",
title="Gamifying Breastfeeding for Fathers: Process Evaluation of the Milk Man Mobile App",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="20",
volume="2",
number="1",
pages="e12157",
keywords="mHealth; app; breastfeeding; fathers; gamification; socially connected; push notifications",
abstract="Background: Mobile technology offers unique opportunities to reach people with health promotion interventions. Breastfeeding is an important public health issue, and fathers are a key support. Milk Man is a father-focused breastfeeding app that sought to engage fathers with information and conversation about breastfeeding, with the goal to impact positively on breastfeeding duration. Objective: The study aimed to describe the process evaluation of the Milk Man app that was trialed in the Parent Infant Feeding Initiative randomized controlled trial. Methods: The app used an information library, gamification, push notifications, and social connectivity via a Web-based conversation forum, which included polls and conversation starters, to engage fathers with breastfeeding information. Fathers had access to the app from approximately 32 weeks of gestation to 6 months postpartum. Process evaluation data were collected from a self-completed questionnaire administered via a Web-based link sent to participants at 6 weeks postpartum, and app analytics data were collected directly from the app. Quantitative data from both sources and qualitative responses to open-ended questions were used to triangulate findings to investigate patterns of usage and the effectiveness of each app engagement strategy to motivate and engage users. Results: A total of 80.3{\%} (586/730) of participants, who were randomized to receive the app, downloaded Milk Man. Push notifications and interest in what other fathers had posted in the forum were the 2 main motivators to app use. Fathers used the app most while their partners were still pregnant and in the weeks immediately after the birth of their baby. Perspectives on the gamification strategy were varied. However, at 6 weeks postpartum, approximately one-third of fathers still using the app said that the gamification elements were encouraging the app use. The ease of use of the app and the design were important elements that were rated positively. The conversation forum emerged as the hub of app activity; all but 1 of the most accessed library articles and external organization links had been prompted as part of a conversation starter. Fathers posted comments in the conversation forum 1126 times (average of 2.21 per user) and voted in polls 3096 times (average of 6 per user). Conclusions: These results demonstrate that the Milk Man app was an acceptable source of breastfeeding information and support that fathers and fathers-to-be are prepared to use throughout the perinatal period. The app showed encouraging results with facilitating conversation between partners. The conversation forum was clearly central to the success of the app, and fathers provided suggestions for improvement. Gamification results were varied, yet it was a key motivator for some users. These results provide valuable insight into the acceptability of the engagement strategies, including motivations for use and user perspectives on the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?ACTRN=12614000605695  ",
doi="10.2196/12157",
url="http://pediatrics.jmir.org/2019/1/e12157/",
url="https://doi.org/10.2196/12157",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518324"
}


@Article{info:doi/10.2196/11561,
author="De Roo, Monica
and Wong, Gina
and Rempel, Gwen R
and Fraser, Shawn N",
title="Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire",
journal="JMIR Pediatr Parent",
year="2019",
month="May",
day="09",
volume="2",
number="1",
pages="e11561",
keywords="mentalization; parent reflective functioning; questionnaire design; parenting",
abstract="Background: Parental reflective functioning (PRF) is the capacity parents have to understand their own mental states and those of their children, as well as the influence of those mental states on behavior. Parents with greater capacity for PRF are more likely to foster secure attachment with their children. The Parental Development Interview is a gold standard measure of PRF but is hampered by cost, training, and length of administration. The 18-item Parent Reflective Functioning Questionnaire (PRFQ-18) is a simpler option developed to capture 3 types of PRF: (1) prementalizing, (2) parent's certainty, and (3) interest and curiosity surrounding a child's mental state. Objective: The aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents. Methods: We examined the factor structure and discriminant and construct validity of the PRFQ-18 among 306 parents (males=120 and females=186) across Canada; the age range of children was 0 to 12 years. Parents also completed Web-based measures of perceived stress, parental coping, parenting competence, and social support. Results: A confirmatory factor analysis confirmed the hypothesized 3-factor structure of the PRFQ-18 providing evidence that the PRFQ-18 may be a useful and practical measure of PRF in Canadian adults and showed minor revisions may improve the suitability of the PRFQ-18 for assessing PRF. Conclusions: These results add support for the construct validity of the PRFQ-18. ",
doi="10.2196/11561",
url="http://pediatrics.jmir.org/2019/1/e11561/",
url="https://doi.org/10.2196/11561",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518301"
}


@Article{info:doi/10.2196/10658,
author="Sharaievska, Iryna
and Battista, Rebecca A
and Zwetsloot, Jennifer",
title="Use of Physical Activity Monitoring Devices by Families in Rural Communities: Qualitative Approach",
journal="JMIR Pediatr Parent",
year="2019",
month="Feb",
day="20",
volume="2",
number="1",
pages="e10658",
keywords="motion sensors; physical activity; family; rural community",
abstract="Background: Several studies support the impact of information communication technology--based interventions to promote physical activity among youth. However, little is known on how technology can be used by the entire family to encourage healthy behavior. Previous studies showed that children and youth rely and are dependent upon the decisions and values of their caregivers when it comes to having a healthy lifestyle. Thus, the exploration of behavior and attitudes of the entire family is needed. Objective: The study aimed to explore (1) perceptions of how the use of physical activity tracking devices (Fitbit Zip) by families in rural communities influence their patterns of participation in physical activity, (2) how attitudes toward physical activity change as a result of using physical activity tracking devices as a family, and (3) what factors influence participation in physical activity among families in rural communities. Methods: A total of 11 families with 1 to 3 children of different ages (7-13 years) took part in semistructured group interviews following 2 weeks of using physical activity tracking devices (Fitbit Zip) as a family. The participants were asked to discuss their experience using the Fitbit Zip as a family, the motivation to be physically active, the changes in their pattern of participation in those activities, the level of engagement by different family members, and the factors that affected their participation. All interviews were voice-recorded with the participants' permission and later transcribed verbatim using pseudonyms. To analyze the data, the principal investigator (IS) used open, axial, and selective coding techniques. Results: A total of 3 themes and several subthemes appeared from the data. The families in rural communities reported no or minimal changes in physical activities as a result of using physical activity tracking devices (Fitbit Zip) because of a lack of interest or an already active lifestyle. However, the attitude toward physical activity was altered. The family members reported an increased awareness of their activity level, introduced more conversations about active and healthy lifestyles, and changed their view of physical activity to a more positive one. The participants described the changes they were able to make and the constraining factors that stopped them from making further changes in their lifestyle. Conclusions: Technology might serve as a facilitator to participation in physical activity among families. Technology can motivate the change in attitude toward active recreation. As long-term changes in lifestyle require internal motivation, the change in the attitude might have a more long-lasting impact than the change in the immediate behavior. More longitudinal studies are needed to further explore long-term change in both behavior and attitude toward physical activity. Additional exploration of constraints to participation in physical activity among families is also an important area of exploration. ",
doi="10.2196/10658",
url="http://pediatrics.jmir.org/2019/1/e10658/",
url="https://doi.org/10.2196/10658",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518327"
}


@Article{info:doi/10.2196/12258,
author="Carlsen, Katrine
and Hald, Mette
and Dubinsky, Marla C
and Keefer, Laurie
and Wewer, Vibeke",
title="A Personalized eHealth Transition Concept for Adolescents With Inflammatory Bowel Disease: Design of Intervention",
journal="JMIR Pediatr Parent",
year="2019",
month="Apr",
day="24",
volume="2",
number="1",
pages="e12258",
keywords="inflammatory bowel disease; adolescents; transition; transfer; adult care",
abstract="Background: Transfer from pediatric to adult care is a crucial period for adolescents with inflammatory bowel disease (IBD). Objective: Our aim was to develop a personalized transition-transfer concept including relevant tools in an established eHealth (electronic health) program. Methods: Required transition skills and validated patient-reported outcome measures (PROMs) were identified via bibliographic search and clinical experience and were implemented into an existing eHealth program. Results: The following skills were identified: disease knowledge, social life, disease management, and making well-informed, health-related decisions. The PROMs included the following: self-efficacy (the IBD Self-Efficacy Scale---Adolescents), resilience (the 10-item Connor-Davidson Resilience Scale), response to stress (the Child Self-Report Responses to Stress---IBD), and self-management and health care transition skills (the Self-Management and Transition to Adulthood with Treatment questionnaire). Starting at age 14, the patient will be offered a 1-hour annual transition consultation with an IBD-specialized nurse. The consultation will be based on the results of the PROMs and will focus on the patient's difficulties. Patients will complete the PROMs on the eHealth program at home, allowing nurses and patients to prepare for the meeting. Symptom scores and medication will be filled out on the eHealth program to support disease self-management. The consultation will be a topic-centered dialogue with practical exercises. During routine outpatient visits with the provider, parents will be left out of half of the consultation when the patient is 16 years old; at 17 years old, the parents will not be present. At the transfer consultation, the pediatric provider, the adult gastroenterologist, the pediatric nurse, the patient, and the parents will be present to ensure a proper transfer. Conclusions: We have conducted a personalized eHealth transition concept consisting of basic elements that measure, train, and monitor the patients' transition readiness. The concept can be implemented and adjusted to local conditions. ",
doi="10.2196/12258",
url="http://pediatrics.jmir.org/2019/1/e12258/",
url="https://doi.org/10.2196/12258",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518331"
}


@Article{info:doi/10.2196/12022,
author="Roberts, Kristin J
and McAdams, Rebecca J
and Kristel, Orie V
and Szymanski, Alison M
and McKenzie, Lara B",
title="Qualitative and Quantitative Evaluation of the Make Safe Happen App: Mobile Technology--Based Safety Behavior Change Intervention for Parents",
journal="JMIR Pediatr Parent",
year="2019",
month="Mar",
day="14",
volume="2",
number="1",
pages="e12022",
keywords="smartphone; mobile phone; mobile app; parents; focus groups; technology",
abstract="Background: Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with proper injury prevention information that is easily accessible may help them make their homes safer for children. Objective: The aim of this study was to evaluate parental injury prevention awareness and home safety behaviors, motivations for and challenges to taking injury prevention and safety actions for parents as well as user experience following the use of the Make Safe Happen mobile app. Methods: A total of 40 parents with children aged 0-12 years living in Columbus, Ohio, participated in 1 of 5 focus group discussions following the completion of (1) a pretest survey, (2) use of the Make Safe Happen app, and (3) a posttest survey. Results: Following the use of the Make Safe Happen app, parents reported a significant increase in injury prevention awareness and completed 45{\%} more home safety behaviors in and around their homes. Nearly all of the parents felt the app provided them with the information needed to make their home safer for their children; the great majority of parents intended to make such changes in the future. Conclusions: The combination of qualitative and quantitative data collection allowed for rich data capture and provided a deeper understanding of parents' safety knowledge, behaviors, app use, and decision making regarding child injury prevention in and around the home. The Make Safe Happen app provides the information and motivation parents and caregivers need to help them take steps to prevent child injuries that may occur in and around their homes. ",
doi="10.2196/12022",
url="http://pediatrics.jmir.org/2019/1/e12022/",
url="https://doi.org/10.2196/12022",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518322"
}


@Article{info:doi/10.2196/14300,
author="Venkataramanan, Revathy
and Thirunarayan, Krishnaprasad
and Jaimini, Utkarshani
and Kadariya, Dipesh
and Yip, Hong Yung
and Kalra, Maninder
and Sheth, Amit",
title="Determination of Personalized Asthma Triggers From Multimodal Sensing and a Mobile App: Observational Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="27",
volume="2",
number="1",
pages="e14300",
keywords="personalized digital health; medical internet of things; asthma management; patient-generated health data; pediatric asthma; asthma control; medication adherence; childhood asthma; understanding and treatment of asthma",
abstract="Background: Asthma is a chronic pulmonary disease with multiple triggers. It can be managed by strict adherence to an asthma care plan and by avoiding these triggers. Clinicians cannot continuously monitor their patients' environment and their adherence to an asthma care plan, which poses a significant challenge for asthma management. Objective: In this study, pediatric patients were continuously monitored using low-cost sensors to collect asthma-relevant information. The objective of this study was to assess whether kHealth kit, which contains low-cost sensors, can identify personalized triggers and provide actionable insights to clinicians for the development of a tailored asthma care plan. Methods: The kHealth asthma kit was developed to continuously track the symptoms of asthma in pediatric patients and monitor the patients' environment and adherence to their care plan for either 1 or 3 months. The kit consists of an Android app--based questionnaire to collect information on asthma symptoms and medication intake, Fitbit to track sleep and activity, the Peak Flow meter to monitor lung functions, and Foobot to monitor indoor air quality. The data on the patient's outdoor environment were collected using third-party Web services based on the patient's zip code. To date, 107 patients consented to participate in the study and were recruited from the Dayton Children's Hospital, of which 83 patients completed the study as instructed. Results: Patient-generated health data from the 83 patients who completed the study were included in the cohort-level analysis. Of the 19{\%} (16/83) of patients deployed in spring, the symptoms of 63{\%} (10/16) and 19{\%} (3/16) of patients suggested pollen and particulate matter (PM2.5), respectively, to be their major asthma triggers. Of the 17{\%} (14/83) of patients deployed in fall, symptoms of 29{\%} (4/17) and 21{\%} (3/17) of patients suggested pollen and PM2.5, respectively, to be their major triggers. Among the 28{\%} (23/83) of patients deployed in winter, PM2.5 was identified as the major trigger for 83{\%} (19/23) of patients. Similar correlations were not observed between asthma symptoms and factors such as ozone level, temperature, and humidity. Furthermore, 1 patient from each season was chosen to explain, in detail, his or her personalized triggers by observing temporal associations between triggers and asthma symptoms gathered using the kHealth asthma kit. Conclusions: The continuous monitoring of pediatric asthma patients using the kHealth asthma kit generates insights on the relationship between their asthma symptoms and triggers across different seasons. This can ultimately inform personalized asthma management and intervention plans. ",
doi="10.2196/14300",
url="http://pediatrics.jmir.org/2019/1/e14300/",
url="https://doi.org/10.2196/14300",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518318"
}


@Article{info:doi/10.2196/12355,
author="Litchman, Michelle L
and Tran, MJ
and Dearden, Susan E
and Guo, Jia-Wen
and Simonsen, Sara E
and Clark, Lauren",
title="What Women With Disabilities Write in Personal Blogs About Pregnancy and Early Motherhood: Qualitative Analysis of Blogs",
journal="JMIR Pediatr Parent",
year="2019",
month="Mar",
day="14",
volume="2",
number="1",
pages="e12355",
keywords="disabled persons; pregnancy; blog; women's health; parenting; mothers; spinal cord injury; autism; traumatic brain injury",
abstract="Background: More than 1 in 10 women of reproductive age identify as having some type of disability. Most of these women are able to become pregnant and have similar desires for motherhood as women without disability. Women with disability, however, face greater stigma and stereotyping, additional risk factors, and may be less likely to receive adequate reproductive health care compared with their peers without disability. More and more individuals, including those with disability, are utilizing the internet to seek information and peer support. Blogs are one source of peer-to-peer social media engagement that may provide a forum for women with disability to both share and obtain peer-to-peer information and support. Nevertheless, it is not clear what content about reproductive health and pregnancy and/or motherhood is featured in personal blogs authored by women with spinal cord injury (SCI), traumatic brain injury (TBI), spina bifida, and autism. Objective: The objective of this study was twofold: (1) to examine the information being shared in blogs by women with 4 types of disabilities, namely, SCI, TBI, spina bifida, and autism, about reproductive health, disability, health care, pregnancy, and motherhood; and (2) to classify the content of reproductive health experiences addressed by bloggers to better understand what they viewed as important. Methods: Personal blogs were identified by searching Google with keywords related to disabilities, SCI, TBI, spina bifida, and autism, and a variety of keywords related to reproductive health. The first 10 pages of each database search in Google, based on the relevance of the search terms, were reviewed and all blogs in these pages were included. Blog inclusion criteria were as follows: (1) written by a woman or care partner (ie, parent or spouse) of a woman with a self-identified diagnosis of SCI, TBI, spina bifida, or autism; (2) focused on the personal experience of health and health care during the prepregnancy, prenatal, antepartum, intrapartum, and/or postpartum periods; (3) written in English; and (4) published between 2013 and 2017. A descriptive and thematic qualitative analysis of blogs and corresponding comments was facilitated with NVivo software and matrix analysis. Results: Our search strategy identified 125 blogs that met all the inclusion criteria; no blogs written by women with spina bifida were identified. We identified 4 reproductive health themes featured in the blog of women with disabilities: (1) (in)accessible motherhood, (2) (un)supportive others, (3) different, but not different, and (4) society questioning motherhood. Conclusions: This analysis of personal blogs about pregnancy and health care written by women with SCI, TBI, and autism provides a glimpse into their experiences. The challenges faced by these women and the adaptations they made to successfully navigate pregnancy and early motherhood provide insights that can be used to shape future research. ",
doi="10.2196/12355",
url="http://pediatrics.jmir.org/2019/1/e12355/",
url="https://doi.org/10.2196/12355",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518332"
}


@Article{info:doi/10.2196/12366,
author="Kohrt, Brandon A
and Rai, Sauharda
and Vilakazi, Khanya
and Thapa, Kiran
and Bhardwaj, Anvita
and van Heerden, Alastair",
title="Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal",
journal="JMIR Pediatr Parent",
year="2019",
month="Jan",
day="16",
volume="2",
number="1",
pages="e12366",
keywords="child development; confidentiality; culturally competent care; developing countries; global health; mental health; mobile phones; wireless technology",
abstract="Background: Populations in low-resource settings with high childhood morbidity and mortality increasingly are being selected as beneficiaries for interventions using passive sensing data collection through digital technologies. However, these populations often have limited familiarity with the processes and implications of passive data collection. Therefore, methods are needed to identify cultural norms and family preferences influencing the uptake of new technologies. Objective: Before introducing a new device or a passive data collection approach, it is important to determine what will be culturally acceptable and feasible. The objective of this study was to develop a systematic approach to determine acceptability and perceived utility of potential passive data collection technologies to inform selection and piloting of a device. To achieve this, we developed the Qualitative Cultural Assessment of Passive Data collection Technology (QualCAPDT). This approach is built upon structured elicitation tasks used in cultural anthropology. Methods: We piloted QualCAPDT using focus group discussions (FGDs), video demonstrations of simulated technology use, attribute rating with anchoring vignettes, and card ranking procedures. The procedure was used to select passive sensing technologies to evaluate child development and caregiver mental health in KwaZulu-Natal, South Africa, and Kathmandu, Nepal. Videos were produced in South Africa and Nepal to demonstrate the technologies and their potential local application. Structured elicitation tasks were administered in FGDs after showing the videos. Using QualCAPDT, we evaluated the following 5 technologies: home-based video recording, mobile device capture of audio, a wearable time-lapse camera attached to the child, proximity detection through a wearable passive Bluetooth beacon attached to the child, and an indoor environmental sensor measuring air quality. Results: In South Africa, 38 community health workers, health organization leaders, and caregivers participated in interviews and FGDs with structured elicitation tasks. We refined the procedure after South Africa to make the process more accessible for low-literacy populations in Nepal. In addition, the refined procedure reduced misconceptions about the tools being evaluated. In Nepal, 69 community health workers and caregivers participated in a refined QualCAPDT. In both countries, the child's wearable time-lapse camera achieved many of the target attributes. Participants in Nepal also highly ranked a home-based environmental sensor and a proximity beacon worn by the child. Conclusions: The QualCAPDT procedure can be used to identify community norms and preferences to facilitate the selection of potential passive data collection strategies and devices. QualCAPDT is an important first step before selecting devices and piloting passive data collection in a community. It is especially important for work with caregivers and young children for whom cultural beliefs and shared family environments strongly determine behavior and potential uptake of new technology. ",
doi="10.2196/12366",
url="https://pediatrics.jmir.org/2019/1/e12366/",
url="https://doi.org/10.2196/12366",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518316"
}


@Article{info:doi/10.2196/12364,
author="Sidhu, Suhail
and Ma, Kaoer
and Sadovnikova, Anna",
title="Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory",
journal="JMIR Pediatr Parent",
year="2019",
month="May",
day="01",
volume="2",
number="1",
pages="e12364",
keywords="milk production; milk supply; human lactation; breastfeeding; breastfeeding app; smartphone app; Social Cognitive Theory; breastfeeding self-efficacy",
abstract="Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production. Objective: The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production. Methods: Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience. Results: Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5{\%} (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively. Conclusions: Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery. ",
doi="10.2196/12364",
url="http://pediatrics.jmir.org/2019/1/e12364/",
url="https://doi.org/10.2196/12364",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518317"
}


@Article{info:doi/10.2196/13158,
author="Hodgson, Nikkie Saldivar
and Yom-Tov, Elad
and Strong, William F
and Flores, Priscilla L
and Ricoy, Giselle N",
title="Concerns of Female Adolescents About Menarche and First Sexual Intercourse: Mixed Methods Analysis of Social Media Questions",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="04",
volume="2",
number="1",
pages="e13158",
keywords="menarche; sexual intercourse; social media; infodemiology; infoveillance",
abstract="Background: Adolescents use social media for information on medical and social aspects of maturation. Objective: The aim of this study was to investigate the concerns and information needs of adolescents regarding menarche and first sexual intercourse. Methods: Questions about menarche or first sexual intercourse were obtained from Yahoo Answers, a community-based social media question-and-answer website. A total of 1226 questions were analyzed. We focused on 123 question pairs made by users who asked questions on both topics and reported their ages at each. Quantitative and qualitative analyses were performed on these question pairs. Results: Qualitative analysis identified uncertainty as a significant theme for both menarche and first intercourse. Quantitative analysis showed that uncertainty was expressed in 26{\%} (13/50) of menarche questions and 14{\%} (7/50) of intercourse questions. Lack of communication was expressed in 4{\%} (2/50) of menarche questions, compared with 8{\%} (4/50) of intercourse questions. Ages at menarche and at first sexual intercourse were correlated, with women reporting menarche at the age of 13 years or younger being 2.6 times more likely to experience first sexual intercourse before the age of 16 years (P<.001, chi-square test). Older age at menarche was associated with greater lack of communication with parents (analysis of variance, P=.002). Conclusions: The questions of adolescents on the topics of menarche and first sexual intercourse express anxiety and uncertainty and are associated with a lack of information and deficient communication with parents. The more normative and expected a behavior, the less these factors appear. Therefore, parents and educators should, to the extent possible, improve communication around these topics, especially when they occur at less typical ages. ",
doi="10.2196/13158",
url="http://pediatrics.jmir.org/2019/1/e13158/",
url="https://doi.org/10.2196/13158",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518326"
}


@Article{info:doi/10.2196/10814,
author="Johnson, Pamela Ryden
and Bushar, Jessica
and Dunkle, Margaret
and Leyden, Sharon
and Jordan, Elizabeth T",
title="Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Jan",
day="30",
volume="2",
number="1",
pages="e10814",
keywords="developmental screening; EPSDT; ITP; low income; Medicaid; mHealth; mobile health; Text4baby; text messaging; PEDS:DM; WIC",
abstract="Background: Only 30{\%} of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents. Objective: This study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers. Methods: Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George's County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents' Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County's Infants and Toddlers Program met with or called participants whose results indicated that their infants ``may be behind.'' Results: Eighty-one low-income mothers enrolled in the study, 93{\%} of whom reported that their infants received Medicaid (75/81). In addition, 49{\%} of the mothers were Hispanic/Latina (40/81) and 42{\%} were African American (34/81). A total of 80{\%} participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79{\%} immediately confirmed their responses (64/81), and 21{\%} made one or more changes (17/81). Based on the final responses, 63{\%} of participants received a text that the baby was ``doing well'' in all six developmental domains (51/81); furthermore, 37{\%} received texts listing domains where their baby was ``doing well'' and one or more domains where their baby ``may be behind'' (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as ``very good'' or ``good.'' Conclusions: A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants ``may be behind.'' Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby. ",
doi="10.2196/10814",
url="http://pediatrics.jmir.org/2019/1/e10814/",
url="https://doi.org/10.2196/10814",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518329"
}


@Article{info:doi/10.2196/12088,
author="Lindsay, Sally
and Cagliostro, Elaine
and Leck, Joanne
and Stinson, Jennifer",
title="A 12-Week Electronic Mentoring Employment Preparation Intervention for Youth With Physical Disabilities: Pilot Feasibility Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2019",
month="Mar",
day="29",
volume="2",
number="1",
pages="e12088",
keywords="social support; mentor; employment; youth; disabled persons; rehabilitation; occupational therapy",
abstract="Background: Youth with disabilities are at high risk of unemployment compared with youth without disabilities. They often encounter challenges in accessing vocational programs that meet their needs. One promising approach that could help to address barriers that youth encounter while also enhancing social support is through electronic mentoring (e-mentoring). Although there is an increase in e-mentoring for youth with disabilities, little is known about its impact for youth with physical disabilities. Objective: This study aimed to assess the acceptability and initial impact of a Web-based peer electronic mentor employment intervention for youth with physical disabilities. Methods: The Empowering Youth Towards Employment intervention was evaluated using a pilot randomized controlled trial (RCT). Youth, aged 15-21 years, with physical disabilities were randomly assigned to an intervention (ie, mentored) or control (ie, not mentored) group. Trained mentors (ie, near peers) with a physical disability led the online discussion forums and provided peer support and resources for 12 modules (1 topic per week over 12 weeks). Primary outcomes focused on self-determination, career maturity, and social support. We also explored program adherence and dosage, participant satisfaction, and areas for improvement. Results: A total of 13 youth (mean age 17.3 years, SD 1.88; 54{\%}, 7/13 female) completed the RCT. In the intervention group (n=9), 56{\%} (5/9) of the youth were females, and in the control group (n=4), 50{\%} (2/4) of the youth were female. Participants reported satisfaction with the program and that it was feasible and acceptable. Participants' mean engagement level with the program was 5.22 (SD 2.48) for the intervention group and 5.40 (SD 4.56) for controls. Participants in the intervention group demonstrated significant improvements in self-determination (t12=2.49; P<.04) compared with the control group. No adverse events were reported. Conclusions: The Empowering Youth Towards Employment is a promising intervention that enhances self-determination among youth with physical disabilities. Trial Registration: ClinicalTrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/6uD58Pvjc) International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8034 ",
doi="10.2196/12088",
url="http://pediatrics.jmir.org/2019/1/e12088/",
url="https://doi.org/10.2196/12088",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518315"
}


@Article{info:doi/10.2196/12653,
author="Lindsay, Sally
and Cagliostro, Elaine
and Stinson, Jennifer
and Leck, Joanne",
title="A 4-Week Electronic-Mentoring Employment Intervention for Youth With Physical Disabilities: Pilot Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2019",
month="Apr",
day="24",
volume="2",
number="1",
pages="e12653",
keywords="social support; mentor; youth; rehabilitation; occupational therapy",
abstract="Background: Youth with disabilities are more likely to live in poverty and be unemployed compared with youth without disabilities. Such trends are often a result of a lack of support, inaccessible jobs, environmental barriers, and discriminatory attitudes toward people with disabilities. Youth with disabilities also face barriers in accessing vocational preparation programs. One encouraging way that could help address challenges that youth encounter is by providing support through electronic mentoring (e-mentoring). Objective: The objective of this study was to assess the feasibility of a 4-week Web-based peer e-mentoring employment intervention for youth with physical disabilities. Methods: We conducted a pilot randomized controlled trial (RCT) to evaluate our intervention, Empowering youth towards employment. Participants included youth aged 15 to 25 years who were randomly assigned to an experimental (mentored) or control (nonmentored) group. Our intervention involved having trained youth mentors (ie, near peers who also had a disability) lead Web-based discussion forums while offering peer support and resources, which involved 12 modules (3 topics a week for 4 weeks). Primary outcomes focused on implementation (ie, feasibility and acceptability), whereas secondary outcomes focused on effectiveness (ie, measures of self-determination, career maturity, and social support). Results: A total of 28 youth (mean age 19.62, SD 3.53; 14/28, 50{\%} female) completed the RCT in 3 intervention groups and 2 control groups (intervention n=18, control n=10). Participants reported satisfaction with the program and that it was feasible and acceptable. Youth's mean engagement level with the program was 6.44 (SD 2.33) for the experimental group and 5.56 (SD 3.53) for controls. Participants in the intervention group did not demonstrate any significant improvements in social support, career maturity, or self-determination compared with those in the control group. No adverse events were reported. Conclusions: The Empowering youth towards employment e-mentoring intervention needs further testing with a larger sample and different length of formats to understand how it may have an impact on employment outcomes for youth with disabilities. Trial Registration: ClinicalTrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/77a3T4qrE) ",
doi="10.2196/12653",
url="http://pediatrics.jmir.org/2019/1/e12653/",
url="https://doi.org/10.2196/12653",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518302"
}


@Article{info:doi/10.2196/11791,
author="Lindsay, Ana Cristina
and Moura Arruda, Carlos Andr{\'e}
and Machado, M{\'a}rcia MT
and Greaney, Mary L",
title="``If You Let Them, They Will Be on It 24 Hours a Day'': Qualitative Study Conducted in the United States Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Screen Time Behaviors of Their Preschool-Age Children",
journal="JMIR Pediatr Parent",
year="2019",
month="Jan",
day="21",
volume="2",
number="1",
pages="e11791",
keywords="Brazil; immigrants; mothers; child, preschool; screen time",
abstract="Background: The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children. Objective: This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST behaviors. Methods: A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis. Results: In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their preschool-age children's ST, nearly all viewed ST as an acceptable part of their children's daily lives. Furthermore, mothers perceived that ST has more benefits than disadvantages. The mothers' positive beliefs about (eg, educational purposes and entertainment) and perceived functional benefits of ST (eg, ability to keep children occupied so tasks can be completed and facilitation of communication with family outside the United States) contributed to their acceptance of ST for their preschool-age children. Nevertheless, most mothers spoke of needing to balance their preschool-age children's ST with other activities. Mothers reported using several parenting practices including monitoring time and content, setting limits and having rules, and prompting their children to participate in other activities to manage their preschool-age children's ST. Conclusions: This study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at limiting preschool-age children's ST. ",
doi="10.2196/11791",
url="http://pediatrics.jmir.org/2019/1/e11791/",
url="https://doi.org/10.2196/11791",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518308"
}


@Article{info:doi/10.2196/11684,
author="Ashmore, Jonathan
and Di Pietro, Jerome
and Williams, Kelly
and Stokes, Euan
and Symons, Anna
and Smith, Martina
and Clegg, Louise
and McGrath, Cormac",
title="A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Apr",
day="18",
volume="2",
number="1",
pages="e11684",
keywords="virtual reality; MRI; anxiety",
abstract="Background: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. Objective: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. Methods: A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. Results: The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. Conclusions: Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process. ",
doi="10.2196/11684",
url="http://pediatrics.jmir.org/2019/1/e11684/",
url="https://doi.org/10.2196/11684",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518319"
}


@Article{info:doi/10.2196/12683,
author="Moreno, Megan Andreas
and Midamba, Nikita
and Berman, Henry S
and Moreno, Peter S
and Donlin, Mike
and Schlocker, Erik",
title="Cyberbullying Among Adolescents: Stakeholder-Driven Concept Mapping Approach",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="28",
volume="2",
number="1",
pages="e12683",
keywords="cyberbullying; adolescent",
abstract="Background: Cyberbullying includes bullying behaviors on the Web; these behaviors are inconsistently measured and lack standardized definitions. The Uniform Definition of Bullying provides a consensus-based definition of bullying, and it highlights the need for an evidence-based definition of a model for cyberbullying. Objective: Toward understanding the key elements and constructs defining cyberbullying, the objective of this study was to develop a stakeholder-driven conceptual model of cyberbullying. Methods: Concept mapping is a validated research method that leverages both qualitative and quantitative approaches to integrate stakeholder input on complex topics. This process was used to develop a concept map and adapt it through participant input to a conceptual model. The validated concept mapping approach includes 5 steps: preparation, generation (brainstorming), structuring (sorting), representation (statistical analysis), and interpretation. We recruited stakeholder participants, including adolescents, as well as parents and professionals representing education, health, and the justice system. Analysis included hierarchical cluster analysis to develop a cluster map representing cyberbullying, followed by adaptation of that map to a conceptual model through qualitative participant feedback. Results: A total of 177 participants contributed to the concept mapping process, including 69{\%} females, 50{\%} adults, and 68{\%} Caucasian, representing each of our stakeholder groups. A total of 228 brainstorming items were generated and sorted into a concept map that included 9 clusters. Clusters included topics that had strong overlap with traditional bullying, such as consequences for perpetrators and targets, with example items ``alienating'' and ``crippling.'' Some clusters were unique, such as cyberbullying techniques, with example item ``excessive messaging,'' and characteristics of the cyberbullying experience, with example item ``constant.'' Through the interpretation step, a conceptual model emerged, illustrating connections and distinctions between traditional bullying and cyberbullying. Conclusions: We found that in generating a stakeholder-driven concept map of cyberbullying, participants could not describe cyberbullying without integrating key concepts from traditional bullying. On the basis of our conceptual model, there are unique characteristics of cyberbullying that suggest that uniform definitions of bullying need to be evaluated to ensure their application to cyberbullying. ",
doi="10.2196/12683",
url="http://pediatrics.jmir.org/2019/1/e12683/",
url="https://doi.org/10.2196/12683",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518321"
}