%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63483 %T Preventing Premature Family Maladjustment: Protocol for a Multidisciplinary eHealth Study on Preterm Parents’ Well-Being %A Decataldo,Alessandra %A Paleardi,Federico %A Lauritano,Giacomo %A Figlino,Maria Francesca %A Russo,Concetta %A Novello,Mino %A Fiore,Brunella %A Ciuffo,Giulia %A Ionio,Chiara %+ Dipartimento di Sociologia e Ricerca Sociale, Università degli Studi Milano-Bicocca, Piazza dell'Ateneo 1, Milano, 20126, Italy, 39 0264487418, alessandra.decataldo@unimib.it %K preterm birth %K parental well-being %K sociology of health %K digital-based monitoring %K mixed methods research %K eHealth %D 2025 %7 18.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The consequences of preterm birth extend beyond the clinical conditions of the newborn, profoundly impacting the functioning and well-being of families. Parents of preterm infants often describe the experience of preterm birth and subsequent admission to the neonatal intensive care unit (NICU) as a disruptive event in their lives, triggering feelings of guilt, helplessness, and fear. Although various research examines changes in parents’ well-being and perception of self-efficacy during the stay in the NICU, there is a lack of research analyzing what happens in the transition phase at home after the baby’s discharge. Recently, scholars have advocated for the use of web-based support programs to monitor and prevent preterm family maladjustment and assist parents. Objective: This interdisciplinary research will develop a sociopsychological model focused on assessing the well-being of parents of premature infants during and after their stay in a NICU. Specifically, the study aims to (1) monitor the mental health of parents of premature infants both at the time of the child’s discharge from the NICU and in the first 6 months after discharge to prevent family maladjustment, (2) deepen our understanding of the role of digital tools in monitoring and supporting preterm parents’ well-being, and (3) study the potential impact of the relationship with health care professionals on the overall well-being of parents. Methods: This project combines mixed methods of social research and psychological support with an eHealth approach. The well-being of parents of premature infants will be assessed using validated scales administered through a questionnaire to parents of preterm infants within 6 NICUs at the time of the child’s discharge. Subsequently, a follow-up assessment of parental well-being will be implemented through the administration of the validated scales in a web application. In addition, an ethnographic phase will be conducted in the NICUs involving observation of the interaction between health care professionals and parents as well as narrative interviews with health care staff. Finally, interactions within the digital environment of the web application will be analyzed using a netnographic approach. We expect to shed light on the determinants of well-being among parents of premature infants in relation to varying levels of prematurity severity; sociodemographic characteristics such as gender, age, and socioeconomic status; and parental involvement in NICU care practices. With the follow-up phase via web application, this project also aims to prevent family maladjustment by providing psychological support and using an eHealth tool. Results: The results are expected by October 2025, the expiration date of the Project of Relevant National Interest. Conclusions: The eHealth Study on Preterm Parents’ Well-Being aims to improve preterm parents’ well-being and, indirectly, children’s health by reducing social costs. Furthermore, it promotes standardized neonatal care protocols, reducing regional disparities and strengthening collaboration between parents and health care staff. International Registered Report Identifier (IRRID): PRR1-10.2196/63483 %M 40101208 %R 10.2196/63483 %U https://www.researchprotocols.org/2025/1/e63483 %U https://doi.org/10.2196/63483 %U http://www.ncbi.nlm.nih.gov/pubmed/40101208 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e65198 %T Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-Text Comments From a Postoperative Survey %A Luo,Jessica %A West,Nicholas C %A Pang,Samantha %A Robillard,Julie M %A Page,Patricia %A Chadha,Neil K %A Gan,Heng %A Correll,Lynnie R %A Ridgway,Randa %A Broemling,Natasha %A Görges,Matthias %A , %+ Research Institute, BC Children’s Hospital, Rm V3-324 - 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 6048752000 ext 5616, mgoerges@bcchr.ca %K narrative analysis %K qualitative data %K family feedback %K narrative feedback %K pediatric surgery %K perioperative care %K pain management %K surgical recovery %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Qualitative experience data can inform health care providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide health care quality improvement; positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. Objective: This study aimed to understand families’ perspectives regarding their children’s surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing a postoperative-outcome risk stratification model. Methods: Participants were parents or guardians of children aged 0-18 years who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. Participants with English as a second language were offered translational services during the consent process and were included if any family member could translate the surveys into their preferred language. Participants were ineligible if they and their families could not understand English or the child had a neurodevelopmental disability. Perioperative data were collected from families using web-based surveys, including 1 preoperative survey and follow-up surveys sent on postoperative days 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until postoperative day 90 was reached. Follow-up surveys included opportunities to leave free-text comments on the child’s surgical experience. Results: In total, 91% (453/500) of enrolled families completed at least 1 postoperative survey; 53% (242/453) provided at least 1 free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient’s age distribution was bimodal (modes at 2-3 and 14-15 years), with 66% (160/242) being male. Patients underwent orthopedic (60/242, 25%), urological (39/242, 16%), general (36/242,15%), otolaryngological (31/242, 13%), ophthalmological (32/242, 13%), dental (27/242, 11%), and plastic (17/242, 7%) surgeries. Largely positive comments (398/485, 82%) were made on the recovery and clinical care experience. A key theme for improvement included “communication,” with subthemes highlighting parental concerns regarding the “preoperative discussions,” “clarity of discharge instructions,” and “continuity of care.” Other themes included “length of stay” and “recovery experience.” Feedback also suggested survey design amendments for future iterations of this instrument. Conclusions: Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between health care providers and parents to align expectations and support proactive family-centered care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous quality improvement initiatives involving near-real-time patient feedback to improve the health care experience of patients and families. %M 39705676 %R 10.2196/65198 %U https://periop.jmir.org/2024/1/e65198 %U https://doi.org/10.2196/65198 %U http://www.ncbi.nlm.nih.gov/pubmed/39705676 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e63946 %T Factors That Affect the Quality of Life of Mothers Caring for Children With Medical Needs at Home: Cross-Sectional Questionnaire Study %A Nakamura,Kanako %A Hamada,Yuko %A Fujita,Ayaka %A Morokuma,Seiichi %+ Fukuoka Jo Gakuin Nursing University, 1-1-7 Chidori, Koga City, 811-3113, Japan, 81 92 943 4174, k_nakamura@fukujo.ac.jp %K home care %K children with special health care needs %K children with medical complexity %K mother %K quality of life %K caregiver %K questionnaire %D 2024 %7 18.12.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The number of children requiring daily medical care is on the rise, with many being cared for at home. This situation places a significant burden on mothers, who often serve as the primary caregivers. Objective: This study aimed to clarify the factors that affect the quality of life of mothers with children who require home health care. Methods: A questionnaire study was conducted among mothers of children needing medical care at home, with 46 participants responding. The questionnaire included items regarding the child’s condition, the mother’s situation, and the World Health Organization Quality of Life-26scale. Results: Factors influencing the quality of life of mothers included whether the child attended daycare or school (β=.274; P=.04), the duration of home care (β=.305; P=.02), and the presence or absence of position changes (β=–.410; P=.003). The presence or absence of position changes had the most significant impact (adjusted R2=.327). Conclusions: The most significant factor affecting the quality of life of mothers of children requiring home medical care is the presence or absence of positional changes. %M 39693614 %R 10.2196/63946 %U https://apinj.jmir.org/2024/1/e63946 %U https://doi.org/10.2196/63946 %U http://www.ncbi.nlm.nih.gov/pubmed/39693614 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57325 %T Fact or Fiction—Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study %A DeMatteo,Carol %A Randall,Sarah %A Jakubowski,Josephine %A Stazyk,Kathy %A Obeid,Joyce %A Noseworthy,Michael %A Mazurek,Michael %A Timmons,Brian W %A Connolly,John %A Giglia,Lucia %A Hall,Geoffrey %A Lin,Chia-Yu %A Perrotta,Samantha %K pediatric concussion %K guidelines %K adherence %K return to school %K return to sport %K actigraphy %D 2024 %7 9.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1‐17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population. Objective: This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury. Methods: Children and youth (N=139) aged 5‐18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution. Results: For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3). Conclusions: Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols. %R 10.2196/57325 %U https://pediatrics.jmir.org/2024/1/e57325 %U https://doi.org/10.2196/57325 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55695 %T Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis %A Hillyar,Christopher Robert Timothy %A Bishop,Natalie %A Nibber,Anjan %A Bell-Davies,Frances Jean %A Ong,Juling %+ Oxford Medical School, Green Templeton College, University of Oxford, 43 Woodstock Rd, Oxford, OX2 6HG, United Kingdom, 44 01865 274770, christopher.hillyar@gtc.ox.ac.uk %K deformational plagiocephaly %K plagiocephaly %K flat head syndrome %K back to sleep %K meta-analysis %K systematic review %K meta-analyses %K systematic reviews %K vitamin D %K vit D %K head position preference %K head position %K head positioning %K bottle feeding %K tummy time %K sleeping position %K motor milestones %K obesity %K maternal education level %K male sex %K formula feeding %K macrocephaly %K head circumference %K mechanical ventilation %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K toddler %K toddlers %K child %K children %D 2024 %7 18.9.2024 %9 Review %J Interact J Med Res %G English %X Background: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry. Objective: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP. Methods: The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots. Results: A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected. Conclusions: This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed. Trial Registration: PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979 %M 39292504 %R 10.2196/55695 %U https://www.i-jmr.org/2024/1/e55695 %U https://doi.org/10.2196/55695 %U http://www.ncbi.nlm.nih.gov/pubmed/39292504 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59237 %T Exploring the Birthday Week Effect on Hand, Foot, and Mouth Disease in Yunnan Province, China, From 2008 to 2022: Surveillance Data Analysis %A Jiang,Pei %A Yan,Xiangyu %A Cai,Tongjian %A Huang,Longxin %A Liu,Zhenzhong %A Hao,Linhui %A Huang,Tian %A Yang,Haijun %A Xu,Min %A Shi,Wenhui %A Shui,Tiejun %K hand, foot, and mouth disease %K birthday week effect %K infants %K children %K China %K surveillance %K HFMD %D 2024 %7 9.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Hand, foot, and mouth disease (HFMD) is a notable infectious disease predominantly affecting infants and children worldwide. Previous studies on HFMD have primarily focused on natural patterns, such as seasonality, but research on the influence of important social time points is lacking. Several studies have indicated correlations between birthdays and certain disease outcomes. Objective: This study aimed to explore the association between birthdays and HFMD. Methods: Surveillance data on HFMD from 2008 to 2022 in Yunnan Province, China, were collected. We defined the period from 6 days before the birthday to the exact birthday as the “birthday week.” The effect of the birthday week was measured by the proportion of cases occurring during this period, termed the “birthday week proportion.” We conducted subgroup analyses to present the birthday week proportions across sexes, age groups, months of birth, and reporting years. Additionally, we used a modified Poisson regression model to identify conditional subgroups more likely to contract HFMD during the birthday week. Results: Among the 973,410 cases in total, 116,976 (12.02%) occurred during the birthday week, which is 6.27 times the average weekly proportion (7/365, 1.92%). While the birthday week proportions were similar between male and female individuals (68,849/564,725, 12.19% vs 48,127/408,685, 11.78%; χ21=153.25, P<.001), significant differences were observed among different age groups (χ23=47,145, P<.001) and months of birth (χ211=16,942, P<.001). Compared to other age groups, infants aged 0‐1 year had the highest birthday week proportion (30,539/90,709, 33.67%), which is 17.57 times the average weekly proportion. Compared to other months, patients born from April to July and from October to December, the peak months of the HFMD epidemic, had higher birthday week proportions. Additionally, a decreasing trend in birthday week proportions from 2008 to 2022 was observed, dropping from 33.74% (3914/11,600) to 2.77% (2254/81,372; Cochran-Armitage trend test: Z=−102.53, P<.001). The results of the modified Poisson regression model further supported the subgroup analyses findings. Compared with children aged >7 years, infants aged 0‐1 year were more likely to contract HFMD during the birthday week (relative risk 1.182, 95% CI 1.177‐1.185; P<.001). Those born during peak epidemic months exhibited a higher propensity for contracting HFMD during their birthday week. Compared with January, the highest relative risk was observed in May (1.087, 95% CI 1.084‐1.090; P<.001). Conclusions: This study identified a novel “birthday week effect” of HFMD, particularly notable for infants approaching their first birthday and those born during peak epidemic months. Improvements in surveillance quality may explain the declining trend of the birthday week effect over the years. Higher exposure risk during the birthday period and potential biological mechanisms might also account for this phenomenon. Raising public awareness of the heightened risk during the birthday week could benefit HFMD prevention and control. %R 10.2196/59237 %U https://publichealth.jmir.org/2024/1/e59237 %U https://doi.org/10.2196/59237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31665 %T Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review %A Mörelius,Evalotte %A Robinson,Suzanne %A Arabiat,Diana %A Whitehead,Lisa %+ School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia, 61 8 6304 2272, e.morelius@ecu.edu.au %K child %K child health services %K digital technology %K health literacy %K infant %K internet-based intervention %K parents %K patient compliance %K pediatric hospitals %D 2021 %7 22.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child’s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents’ engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results: Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents’ health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386 %M 34941559 %R 10.2196/31665 %U https://www.jmir.org/2021/12/e31665 %U https://doi.org/10.2196/31665 %U http://www.ncbi.nlm.nih.gov/pubmed/34941559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29441 %T Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan %A Benoit,James %A Hartling,Lisa %A Chan,Michelle %A Scott,Shannon %+ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 4-472 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K internet %K mHealth %K mobile health %K digital health %K ehealth %K app %K mobile application %K Android %K Apple %K marketplace %K environmental scan %K review %K acute childhood illness %K knowledge translation %K child %K parent %K caregiver %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices.  Objective: The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved. Methods: We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores. Results: Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy. Conclusions: There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design. %M 34665144 %R 10.2196/29441 %U https://www.jmir.org/2021/10/e29441 %U https://doi.org/10.2196/29441 %U http://www.ncbi.nlm.nih.gov/pubmed/34665144 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30695 %T The Content and Quality of Publicly Available Information About Congenital Diaphragmatic Hernia: Descriptive Study %A Soltys,Frank Coyle %A Spilo,Kimi %A Politi,Mary C %+ Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, United States, 1 3176750010, fsoltys@wustl.edu %K congenital diaphragmatic hernia %K prenatal counseling %K fetal care %K online information %K parental decision making %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making. Objective: We aimed to examine the content and quality of publicly available, internet-based CDH information. Methods: We conducted internet searches across 2 popular search engines (Google and Bing). Websites were included if they contained CDH information and were publicly available. We developed a coding instrument to evaluate websites. Two coders (FS and KS) were trained, achieved interrater reliability, and rated remaining websites independently. Descriptive statistics were performed. Results: Searches yielded 520 websites; 91 met inclusion criteria and were analyzed. Most websites provided basic CDH information including describing the defect (86/91, 95%), need for neonatal intensive care (77/91, 85%), and surgical correction (79/91, 87%). Few mentioned palliative care, decisions about pregnancy termination (13/91, 14%), or support resources (21/91, 23%). Conclusions: Findings highlight the variability of information about CDH on the internet. Clinicians should work to develop or identify reliable, comprehensive information about CDH to support parents. %M 34665147 %R 10.2196/30695 %U https://pediatrics.jmir.org/2021/4/e30695 %U https://doi.org/10.2196/30695 %U http://www.ncbi.nlm.nih.gov/pubmed/34665147 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e27855 %T Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study %A Wharton-Smith,Alexandra %A Baker,Kevin %A Roca-Feltrer,Arantxa %A Rodrigues,Maria %A Richardson,Sol %A Bonnington,Craig A %A Rassi,Christian %A Marasciulo,Madeleine %A Enosse,Sonia %A Saute,Francisco %A Aide,Pedro %A Macete,Eusebio %A Candrinho,Baltazar %+ Malaria Consortium, The Green House 244-254 Cambridge Heath Road, London, E2 9DA, United Kingdom, 44 (0)20 35596431, k.baker@malariaconsortium.org %K malaria %K seasonal malaria chemoprevention %K sulfadoxine-pyrimethamine amodiaquine %K resistance %K children under five %K implementation research %K Mozambique %K Africa %K mobile phone %D 2021 %7 15.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective: This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods: This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results: Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions: This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs. International Registered Report Identifier (IRRID): DERR1-10.2196/27855 %M 34524109 %R 10.2196/27855 %U https://www.researchprotocols.org/2021/9/e27855 %U https://doi.org/10.2196/27855 %U http://www.ncbi.nlm.nih.gov/pubmed/34524109 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27504 %T Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review %A Milne-Ives,Madison %A Neill,Sarah %A Bayes,Natasha %A Blair,Mitch %A Blewitt,Jane %A Bray,Lucy %A Carrol,Enitan D %A Carter,Bernie %A Dawson,Rob %A Dimitri,Paul %A Lakhanpaul,Monica %A Roland,Damian %A Tavare,Alison %A Meinert,Edward %A , %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DT, United Kingdom, 44 1752600600, edward.meinert@plymouth.ac.uk %K acute disease %K telemedicine %K child %K pediatrics %K childhood disease %K childhood illness %K health education %K health literacy %K help-seeking behavior %K child health %K digital intervention %K mHealth %K primary care %K sick child %D 2021 %7 30.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child’s symptoms is one of many factors that play a role in parents’ decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents’ knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. Objective: The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home. Methods: The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references’ titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported. Results: The systematic review will commence during 2021. Conclusions: This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/27504 %M 34228628 %R 10.2196/27504 %U https://www.researchprotocols.org/2021/6/e27504 %U https://doi.org/10.2196/27504 %U http://www.ncbi.nlm.nih.gov/pubmed/34228628 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e24808 %T Phototherapy Using a Light-Emitting Fabric (BUBOLight) Device in the Treatment of Newborn Jaundice: Protocol for an Interventional Feasibility and Safety Study %A Lecomte,Fabienne %A Thecua,Elise %A Ziane,Laurine %A Deleporte,Pascal %A Duhamel,Alain %A Vamour,Clémence %A Mordon,Serge %A Rakza,Thameur %+ U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, 1 avenue Oscar Lambret, F-59000 Lille, 59037, France, 33 320446722, fabienne.lecomte@inserm.fr %K jaundice %K light emitting fabrics %K light %K neonate %K newborn jaundice %K perinatal %K phototherapy %D 2021 %7 25.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neonatal jaundice is a common condition occurring in 60%-80% of all healthy-term and late-preterm neonates. In the majority of cases, neonatal jaundice resolves spontaneously and causes no harm; however, in some neonates, significant hyperbilirubinemia can develop and lead to kernicterus jaundice, a serious neurological disease. Phototherapy (PT) is the preferred treatment for jaundice; however, to be effective, PT devices need to have a broad light emission surface to generate no or little heat and to provide an optimal wavelength and light intensity (420-490 nm and ≥30 µW/cm²/nm, respectively). Objective: This study aimed to investigate the feasibility, safety, and level of satisfaction of parents and health care teams with the BUBOlight device, an innovative alternative to conventional hospital PT, in which luminous textiles have been incorporated in a sleeping bag. Methods: This interventional, exploratory, simple group, nonrandomized, single-center trial will be conducted at Lille Hospital. In total, 10-15 neonates and their parents will be included to obtain evaluable data from 10 parent-neonate pairs. Neonates weighing more than 2500 g at birth and born with ≥37 weeks of amenorrhea that required PT in accordance with the guidelines of the National Institute For Health and Clinical Excellence will receive one 4-hour session of illumination. Total serum bilirubin and transcutaneous bilirubin levels were obtained at the start and 2 hours after the end of PT. Cutaneous and rectal temperatures, heart rate, and oxygen saturation will be measured at the beginning and during PT. The number of subjects is therefore not calculated on the basis of statistical assumptions. We aim to obtain a minimum proportion of 90% (ie, 9 of 10) of the neonates included, who have been able to undergo 4-hour PT without unacceptable and unexpected toxicities. We will calculate the mean, median, quartiles, minimum and maximum values of the quantitative parameters, and the frequency of the qualitative parameters. The rate of patients with no unacceptable and unexpected toxicities (ie, the primary endpoint) will be calculated. Results: The first patient is expected to be enrolled at the end of 2020, and clinical investigations are intended for up to June 2021. The final results of this study are expected to be available at the end of 2021. Conclusions: Our findings will provide insights into the safety and feasibility of a new PT device based on light-emitting fabrics for the treatment of newborn jaundice. This new system, if proven effective, will improve the humanization of neonatal care and help avoid mother-child separation. Trial Registration: ClinicalTrials.gov NCT04365998; https://clinicaltrials.gov/ct2/show/NCT04365998 International Registered Report Identifier (IRRID): PRR1-10.2196/24808 %M 34032584 %R 10.2196/24808 %U https://www.researchprotocols.org/2021/5/e24808 %U https://doi.org/10.2196/24808 %U http://www.ncbi.nlm.nih.gov/pubmed/34032584 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e19633 %T Home-Based Intervention for the Prevention and Treatment of Malaria Among Children Younger Than 5 Years in the West Region of Cameroon: Protocol for a Randomized Controlled Trial %A Dongmo Kenfack,Esther %A Tendongfor,Nicholas %A Nsagha,Dickson Shey %+ Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Molyko, Buea, Cameroon, 237 677499429 ext 699674201, nsaghads@hotmail.com %K home-based management %K malaria %K children younger than 5 years %K home caregivers %K West Region %K Cameroon %D 2021 %7 12.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home. Objective: The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs). Methods: A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies. Results: From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020. Conclusions: Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home. Trial Registration: Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788 International Registered Report Identifier (IRRID): DERR1-10.2196/19633 %M 33709938 %R 10.2196/19633 %U https://www.researchprotocols.org/2021/3/e19633 %U https://doi.org/10.2196/19633 %U http://www.ncbi.nlm.nih.gov/pubmed/33709938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e13908 %T Cultural Adaptation of Digital Knowledge Translation Tools for Acute Otitis Media in Low- to Middle-Income Countries: Mixed Methods Usability Study %A Meherali,Salima %A Hartling,Lisa %A Scott,Shannon D %+ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 7804921037, shannon.scott@ualberta.ca %K acute otitis media %K knowledge translation %K pediatric %K parent’s experiences %K information needs %K global health %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute otitis media (AOM) is the most common pediatric bacterial ear infection. AOM presents challenges to parents who lack accurate information. Digital knowledge translation tools offer a promising approach to communicating complex health information. We developed AOM knowledge translation tools for Canadian parents and augmented them for Pakistani parent end users. Objective: This pilot study aimed to (1) develop AOM knowledge translation tools for Canadian parents, (2) adapt the knowledge translation tools across cultural contexts, and (3) evaluate the usability of the adapted knowledge translation tools. Methods: Parents’ perceptions of the translated knowledge translation tools’ usability were explored using a mixed-methods design. We recruited parent participants from a hospital in Pakistan to complete usability surveys (n=47) and focus group interviews (n=21). Descriptive statistics and content analysis were used to analyze data. Results: Usability results showed the usefulness and effectiveness of both adapted knowledge translation tools. Parents reported preferring a digital media narrative format in their own language. Findings revealed that culturally adapted knowledge translation tools are effective in transferring health information to parents. Conclusions: Digital knowledge translation tools offer a promising approach to improving health literacy and communicating complex health information to parents of children with AOM. Culturally adapting the tools generated important knowledge that will contribute to knowledge translation advancements. Evaluation of the tool effectiveness is a critical next step to exploring the impact of knowledge translation tools on child health outcomes. %M 33470942 %R 10.2196/13908 %U http://formative.jmir.org/2021/1/e13908/ %U https://doi.org/10.2196/13908 %U http://www.ncbi.nlm.nih.gov/pubmed/33470942