%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 %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65391 %T BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study %A Mishina,Kaisa %A Baumel,Amit %A Kinnunen,Malin %A Ristkari,Terja %A Heinonen,Emmi %A Hinkka-Yli-Salomäki,Susanna %A Sourander,Andre %+ Research Centre for Child Psychiatry, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3, Turku, 20014, Finland, 358 50 310 135, kaemka@utu.fi %K parent training %K universal intervention %K online intervention %K irritability %K conduct problems %K hyperactivity %K preschool %K mental health %K strongest families %K positive parenting %K parenting skills %K parent-child relationships %K parent satisfaction %K BePresent %K feasibility study %K single-arm pre-post intervention study %D 2025 %7 13.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child’s behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child’s 3-year health check-up were recruited from children’s health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%–84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents’ ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P≤.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. %M 40080811 %R 10.2196/65391 %U https://www.jmir.org/2025/1/e65391 %U https://doi.org/10.2196/65391 %U http://www.ncbi.nlm.nih.gov/pubmed/40080811 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67051 %T Novel Smartphone App and Supportive Accountability for the Treatment of Childhood Disruptive Behavior Problems: Protocol for a Randomized Controlled Trial %A Lindhiem,Oliver %A Tomlinson,Claire S %A Kolko,David J %A Silk,Jennifer S %A Hafeman,Danella %A Wallace,Meredith %A Setiawan,I Made Agus %A Parmanto,Bambang %+ , University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, United States, 1 412 246 5909, lindhiemoj@upmc.edu %K mobile health %K disruptive behaviors %K parent management training %K randomized controlled trial %K externalizing behavior %D 2025 %7 11.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although evidence-based treatments have been developed for childhood behavior problems, many families encounter barriers to treatment access and completion (eg, local availability of services, transportation, cost, and perceived stigma). Smartphone apps offer a cost-efficient method to deliver content to families. Objective: The aim of this study is to evaluate the effectiveness of the UseIt! mobile health system as both stand-alone and coach-assisted interventions via a randomized controlled trial. The UseIt! System is designed to reduce disruptive behaviors in young children. Methods: A nationwide sample of parents of children aged 5 years to 8 years with disruptive behaviors (N=324 dyads) are randomly assigned to the stand-alone app (UseIt!; n=108), the coach-assisted app (UseIt! plus supportive accountability; n=108), or the control app (mindfulness app; n=108). The UseIt! App provides parents with tools and troubleshooting to address disruptive behaviors, along with a behavior diary to track behaviors and strategies over time. The coach-assisted condition includes a bachelor’s level paraprofessional who provides weekly phone calls to promote engagement with the app. The control condition is composed of a mindfulness app. The web-based, self-assessed outcome measures (post treatment and 6-month follow-up) include measures of app usage, parenting knowledge (eg, knowledge of parent management training and cognitive behavioral therapy skills), and strategies (use of evidence-based parenting strategies), symptom reduction (eg, behavior problems), and parent mental health (eg, anxiety, stress, and depression). We hypothesize that both intervention conditions will show greater parent knowledge and use of skills along with greater symptom reduction relative to the control condition. Further, we hypothesize that those assigned to the coach assisted condition will report greater knowledge, skill use, and symptom reduction than the stand-alone app. We will use intent-to-treat analyses to regress outcomes on study conditions to evaluate for differences across conditions. Results: Recruitment of study participants began in December of 2022 and is ongoing. We have recruited over half of our intended sample of 324 parent-child dyads (n=214) as of December 2024. These dyads have been randomly allocated to each of the intervention conditions, with 71 assigned to the coach-assisted condition, 72 assigned to the stand-alone app, and 71 assigned to the control app condition. Data collection is projected to be completed by late 2026. Conclusions: The current study aims to address a gap in the literature regarding the feasibility, effectiveness, and utility of a smartphone app that includes a coach-assisted arm. Digital therapeutics have the potential to enhance the reach and scalability of skills-based psychosocial interventions. Findings from this study will advance scientific knowledge and have implications for clinical practice. Trial Registration: ClinicalTrials.gov NCT05647772; https://clinicaltrials.gov/study/NCT05647772 International Registered Report Identifier (IRRID): DERR1-10.2196/67051 %M 40068698 %R 10.2196/67051 %U https://www.researchprotocols.org/2025/1/e67051 %U https://doi.org/10.2196/67051 %U http://www.ncbi.nlm.nih.gov/pubmed/40068698 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e57962 %T Nationwide Trends in Screen Time and Associated Risk Factors by Family Structures Among Adolescents, 2008-2022: Nationwide Cross-Sectional Study %A Kim,Seokjun %A Jo,Hyesu %A Son,Yejun %A Shin,Min Kyung %A Lee,Kyeongmin %A Park,Jaeyu %A Lee,Hayeon %A Smith,Lee %A Dragioti,Elena %A Fond,Guillaume %A Boyer,Laurent %A López Sánchez,Guillermo F %A Tully,Mark A %A Rahmati,Masoud %A Pizzol,Damiano %A Woo,Selin %A Yon,Dong Keon %+ , Department of Medicine, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 269352476, yonkkang@gmail.com %K adolescents %K family type %K pandemic %K screen time %K South Korea %K sedentary activity %K risk factor %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although understanding long-term trends in adolescent screen time and the influence of family structure is essential, there is a lack of research addressing these issues comprehensively. Objective: This study aimed to conduct comprehensive investigations into adolescent screen time before and during the COVID-19 pandemic, with a particular focus on family structures. Methods: This study used nationwide, large-scale data from the Korea Youth Risk Behavior Web-Based Survey from South Korea. We aimed to indicate the changes in adolescent screen time over 15 years from 2008 to 2022. Weighted linear regression was used to analyze annual trends in screen time before and during the pandemic, and stratified analyses were conducted to examine associated risk factors across different family structures. Results: This study used data from a total of 836,972 individuals (n=403,456, 48.2% women), with an age range of 12-18 years. The analysis revealed an overall increase in screen time prepandemic (β=8.06, 95% CI 7.74-8.39), with a notable increase observed at the onset of the pandemic (β=162.06, 95% CI 159.49-164.64). Among diverse family structures, the orphanage group showed the most substantial increase in screen time during the pandemic (βdiff=221.90, 95% CI 159.62-284.17). Risk factors associated with screen time during the pandemic varied by family structure. Notably, the nuclear family group presented distinct screen time–related risk factors, including grade, region of residence, physical activity frequency, sadness and despair, and the highest education level of parents. Conclusions: There has been a notable increase in average screen time among adolescents since the onset of the pandemic, with the orphanage group exhibiting a pronounced trend. The risk factors associated with screen time during the pandemic varied for each family structure. Findings from this study suggest that the implementation of individualized measures tailored to each family structure should be adopted to effectively address the increased issue of adolescent screen time since the pandemic. %M 40063937 %R 10.2196/57962 %U https://publichealth.jmir.org/2025/1/e57962 %U https://doi.org/10.2196/57962 %U http://www.ncbi.nlm.nih.gov/pubmed/40063937 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59215 %T Novel Profiles of Family Media Use: Latent Profile Analysis %A Hamp,Nicole %A Radesky,Jenny %A Weeks,Heidi M %A Miller,Alison L %A Kaciroti,Niko %K preschool %K child %K digital media %K mobile media %K media use %K latent profile analysis %K computer use %K LPA %K technology use %K survey %K questionnaire %K pediatrics %D 2025 %7 6.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as “screen time” must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information. Objective: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media. Methods: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership. Results: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership. Conclusions: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes. %R 10.2196/59215 %U https://pediatrics.jmir.org/2025/1/e59215 %U https://doi.org/10.2196/59215 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e60333 %T Efficacy, Feasibility, and Acceptability of an Emotional Competence Tele-Intervention for Mandarin-Speaking Children Aged 5 to 7 Years With Developmental Language Disorder: Pilot Study With an Interrupted Time-Series Design %A Lu,Hsin-Hui %A Liang,Shih-Yuan %A Huang,Yi-Chia %+ Division of Clinical Psychology, Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 33302 No 259, Wenhua 1st Rd, Guishan Dist, Taoyuan City, 33302, Taiwan, 886 03 2118800, hsinhuilupsy@gmail.com %K language disorder %K pediatrics %K evidence-based intervention %K telemedicine %K tele-practice %K visual support %K mobile phone %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with developmental language disorder (DLD) often experience language difficulties that hinder their ability to acquire emotional competence. Poor emotional competence is associated with emotional and behavioral problems in young children. Objective: This research involved two studies focusing on (1) the emotional competence of Mandarin-speaking children aged 5 to 7 years with DLD and (2) the efficacy, feasibility, and acceptability of a tele-intervention designed to enhance their emotional competence in Taiwan. Methods: Five children with DLD from study 1 declined to participate in study 2, the emotional competence tele-intervention, and were excluded from the analysis. We compared the emotional competence of 20 Mandarin-speaking children with DLD to that of 24 children with typical language development (TLD). The children with DLD were, on average, aged 5.79 (SD 0.47) years, whereas the children with TLD were, on average, aged 5.93 (SD 0.31) years. We assessed the children’s emotional competence, nonverbal ability, verbal comprehension, vocabulary acquisition, and expressive language skills. In study 2, all children with DLD included in study 1 engaged in an emotional competence tele-intervention. An interrupted time-series design was used to examine their emotional competence. In total, 20 children with DLD provided data on emotional competence evaluated using the Emotional Lexicon Test. These data were individually collected at 3 time points after study 1 (time 1). These phases included baseline (time 1 to time 2), during the tele-intervention (time 2 to time 3), and follow-up (time 3 to time 4), spanning approximately 18 to 20 weeks from time 1 to time 4. Recruitment, retention, and attendance rates were calculated to evaluate the intervention’s feasibility, and participant mood was evaluated after each session to calculate the intervention’s acceptability. Results: No significant changes in the children’s ability to understand basic or complex emotional terms were observed during the baseline period. However, changes were observed during the tele-intervention period, and these changes remained throughout the follow-up period. With a recruitment rate of 80% (20/25), all participants completed 4 intervention sessions, with retention and attendance rates exceeding 95% (19/20). A total of 90% (18/20) of the participants deemed each session to be acceptable. Conclusions: Mandarin-speaking children aged 5 to 7 years with DLD exhibited lower emotional competence compared with their counterparts with TLD. Tele-interventions are effective in enhancing the emotional competence of children with DLD, demonstrating feasibility and acceptability for these children and their parents in Taiwan. %M 39933173 %R 10.2196/60333 %U https://pediatrics.jmir.org/2025/1/e60333 %U https://doi.org/10.2196/60333 %U http://www.ncbi.nlm.nih.gov/pubmed/39933173 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67638 %T A Primary Care Group Resilience Intervention Promotes Child and Caregiver Behavioral Health %A Jeung,Joan %A Nguyen,Andrew %A Martinez,Jennifer %A Zhang,Li %K parenting education %K parent-child relationship %K adverse childhood experiences %K child behavior %K children %K caregiver %K caretaker %K parenting %K family %K stress %K anxiety %K behavior %K relational health %K psychoeducation %K psychological education %K resilience intervention %K group-based %K pilot study %D 2025 %7 10.2.2025 %9 %J JMIR Pediatr Parent %G English %X This pilot study of the redesigned Resilience Clinic, a group-based psychoeducational intervention designed to promote relational health and child and family resilience provides preliminary evidence that participation in this intervention is associated with decreased caregiver stress, anxiety, and child behavioral concerns. %R 10.2196/67638 %U https://pediatrics.jmir.org/2025/1/e67638 %U https://doi.org/10.2196/67638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58774 %T Families’ Experiences With Family-Focused Web-Based Interventions for Improving Health: Qualitative Systematic Literature Review %A Zhu,Diana %A Dordevic,Aimee L %A Davidson,Zoe E %A Gibson,Simone %+ Department of Nutrition Dietetics and Food, Monash University, 264 Ferntree Gully Rd, Level 1, Melbourne, 3168, Australia, 61 3 9902 4270, diana.zhu@monash.edu %K eHealth %K family based %K qualitative %K pediatric health %K internet %K mobile phone %D 2025 %7 30.1.2025 %9 Review %J J Med Internet Res %G English %X Background: eHealth interventions can favorably impact health outcomes and encourage health-promoting behaviors in children. More insight is needed from the perspective of children and their families regarding eHealth interventions, including features influencing program effectiveness. Objective: This review aimed to explore families’ experiences with family-focused web-based interventions for improving health. Methods: Five databases were searched on October 26, 2022—updated on October 24, 2023—for studies reporting qualitative data on participating children or their caregivers’ experiences with web-based programs. Study identification was performed in duplicate and studies were independently appraised for quality. Thematic synthesis was undertaken on qualitative data extracted from the results section of each included article. Results: Of 5524 articles identified, 28 articles were included. The studies examined the experiences of school-aged children (aged 5-18 years) and their caregivers (mostly mothers) with 26 web-based interventions that were developed to manage 17 different health conditions or influence health-supporting behaviors. Six themes were identified on families’ experiences: connecting with others, agency of learning, program reputability or credibility, program flexibility, meeting participants’ needs regarding program content or delivery, and impact on lifestyle. Conclusions: Families positively perceived family-focused web-based interventions, finding value in quality connections and experiencing social support; intervention features aligned with behavioral and self-management principles. Key considerations were highlighted for program developers and health care professionals on ways to adapt eHealth elements to meet families’ health-related needs. Continued research examining families’ experiences with eHealth interventions is needed, including the experiences of families from diverse populations and distinguishing the perspectives of children, their caregivers, and other family members, to inform the expansion of family-focused eHealth interventions in health care systems. Trial Registration: PROSPERO CRD42022363874; https://tinyurl.com/3xxa8enz %M 39883928 %R 10.2196/58774 %U https://www.jmir.org/2025/1/e58774 %U https://doi.org/10.2196/58774 %U http://www.ncbi.nlm.nih.gov/pubmed/39883928 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66496 %T Effect of a Short, Animated Storytelling Video on Transphobia Among US Parents: Randomized Controlled Trial %A Amsalem,Doron %A Greuel,Merlin %A Liu,Shuyan %A Martin,Andrés %A Adam,Maya %K public health communication %K vulnerable population %K stigma reduction %K stigma %K transphobia %K transgender %K gender diverse %K LGBTQ %K parent %K mental health %K mental illness %K transgender children %K children %K youth %K adolescent %K storytelling %K animation %D 2025 %7 20.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Parents play a pivotal role in supporting transgender and gender diverse (TGD) youth. Yet only 35% of TGD youth describe their home as a gender-affirming place. Lack of parental support contributes to recent findings that TGD youth are approximately three times more likely to attempt suicide than their cisgender peers. In contrast, parents’ affirmation of their children’s gender identity significantly improves their mental health outcomes, by reducing anxiety, depression, and suicidality. Objective: Addressing the urgent need for effective, scalable interventions, this study evaluates a novel digital approach: short, animated storytelling videos. We hypothesized that our 2.5-minute video intervention would reduce antitransgender stigma, or transphobia, and improve attitudes toward gender diverse children among US parents. Methods: We recruited 1267 US parents, through the Prolific Academic (Prolific) online research platform, and randomized them into video intervention or control groups. We measured transphobia using the Transgender Stigma Scale, and attitudes toward transgender children using the gender thermometer, before and after watching the video. We compared outcomes between the two groups using 2 × 3 ANOVA. Both groups were invited to return 30 days later for follow-up assessment, before being offered posttrial access to the intervention video, which portrayed an authentic conversation between a mother and her transgender child. Results: Single exposure to a short, animated story video significantly reduced transphobia and improved attitudes toward transgender children among US parents, immediately post intervention. We observed a significant group-by-time interaction in mean Transgender Stigma Scale scores (F2,1=3.7, P=.02) and significant between-group changes when comparing the video and control groups from baseline to post intervention (F1=27.4, P<.001). Effect sizes (Cohen d) indicated small to moderate immediate changes in response to the 2.5-minute video, though the effect was no longer observed at the 30-day follow-up. Gender thermometer scores revealed significant immediate improvements in the attitudes of participants in the video intervention arm, and this improvement was sustained at the 30-day time point. Conclusions: Short, animated storytelling is a novel digital approach with the potential to boost support and affirmation of transgender children, by offering authentic insights into the lived experiences of TGD youth. Repeated exposures to such interventions may be necessary to sustain improvements over time. Future studies could test a series of short, animated storytelling videos featuring the lived experiences of several TGD youth. Evaluating the effect of such a series could contribute to the fields of digital health communication and transgender health. Digital approaches, such as short, animated storytelling videos, that support empathy and acceptance of TGD youth could foster a more inclusive society in which every child can thrive. Trial Registration: AsPredicted.org 159248; https://aspredicted.org/ptmd-3kfs.pdf %R 10.2196/66496 %U https://publichealth.jmir.org/2025/1/e66496 %U https://doi.org/10.2196/66496 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e60666 %T Examining the Spillover Economic Impacts of Caregiving Among Families of Children With Medical Complexity to Inform Inclusive Economic Models: Qualitative Study %A Keim-Malpass,Jessica %A Muir,K Jane %A Letzkus,Lisa C %A Scheer,Eleanore %A Valdez,Rupa S %+ Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, 1215 Lee Street, Charlottesville, VA, 22908, United States, 1 4349240000, jlk2t@virginia.edu %K caregiving %K children with medical complexity %K social network %K qualitative %K self-management %K care coordination %K economic evaluation %K spillover %K economic model %K care %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J J Particip Med %G English %X Background: Children with medical complexity represent a heterogeneous group of children with multiple chronic health care conditions. Caregivers of children with medical complexity experience a high intensity of caregiving that is often variable, extends across several networks of care, and often lasts for the entirety of the child’s life. The spillover, or indirect, economic impacts of caregiving are understudied in the context the family units of children with medical complexity. There have been recognized limitations to the sole use of quantitative methods when developing economic models of disease, because they lack direct caregiver voice and context of caregiving activities, and existing methods have been noted to be ableist. Objective: This study aimed to explore the economic spillover impacts of caregiving among families of children with medical complexity using their own words and perspectives, with the intent of expanding caregiver-centered perspectives when developing economic models. Methods: This study was a secondary analysis of a qualitative study that was conducted to examine family management practices among caregivers of children with medical complexity and their social networks. Caregivers of children with medical complexity were recruited through a pediatric complex care clinic at an academic medical center in the mid-Atlantic region, United States. This study used inductive qualitative descriptive methods and a template to define features of the person impacted and to define the economic construct as either a direct or indirect (spillover) cost. Results: A total of 20 caregivers were included in this study. Perspectives from the caregivers of children with medical complexity revealed several key themes: (1) time lost from employment, impacting the primary caregivers; (2) physical and mental health impacts, impacting the child themselves, siblings, and the primary caregivers; (3) impacts to leisure activities and self-care, impacting the child themselves, siblings, and the primary caregivers; and (4) impacts to the social network or social capital. Conclusions: The themes described can be operationalized into inclusive family-centered models that represent the impacts of caregiving in the context of the family units of children with medical complexity. The use of qualitative methods to expand our development of quantitative economic models can be adapted to other populations where caregivers are involved in care. Caregivers can and should have an active voice in preference-based assessments that are operationalized in economic contexts to make them more inclusive. International Registered Report Identifier (IRRID): RR2-10.2196/14810 %M 38758728 %R 10.2196/60666 %U https://jopm.jmir.org/2024/1/e60666 %U https://doi.org/10.2196/60666 %U http://www.ncbi.nlm.nih.gov/pubmed/38758728 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57833 %T Improving Social Media-Based Support Groups for the Rare Disease Community: Interview Study With Patients and Parents of Children with Rare and Undiagnosed Diseases %A Doyle,Tom A %A Vershaw,Samantha L %A Conboy,Erin %A Halverson,Colin M E %+ Center for Bioethics, Indiana University School of Medicine, 410 W. 10th Street, Suite 3100, Indianapolis, IN, 46202, United States, 1 (317) 278 4052, doylet@iu.edu %K social media %K rare disease %K support groups %K pediatric rare disease %K Ehlers-Danlos syndrome %K collagen disease %K fibrillar collagen %K cutis elastica %K connective tissue disorders %K hyperelasticity %K hypermobility of joints, inherited %K genetic disorder %K genetics %K pediatric %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The rarity that is inherent in rare disease (RD) often means that patients and parents of children with RDs feel uniquely isolated and therefore are unprepared or unsupported in their care. To overcome this isolation, many within the RD community turn to the internet, and social media groups in particular, to gather useful information about their RDs. While previous research has shown that social media support groups are helpful for those affected by RDs, it is unclear what these groups are particularly useful or helpful for patients and parents of children with RDs. Objective: This study aimed to identify what specific features of disease-related support groups (DRSGs) the RD community finds particularly useful or supportive and provide a set of recommendations to improve social media–based RD support groups based on this information. Methods: Semistructured qualitative interviews were performed with patients and parents of patients with RDs. Interview participants had to be at least 18 years of age at the time of the interview, be seen by a genetics specialist at a partner health care institution and be proficient in the English language. Social media use was not a prerequisite for participation, so interview participants ranged from extensive users of social media to those who chose to remain off all social media. All interviews were conducted by phone, recorded, and then transcribed. Interview transcripts were then coded using the 6 steps outlined by Braun and Clarke. Three researchers (TAD, SLV, and CMEH) performed initial coding. After this, the study team conducted a review of themes and all members of the team agreed upon a final analysis and presentation of data. Results: We conducted 31 interviews (mean age 40, SD 10.04 years; n=27, 87% were women; n=30, 97% were non-Hispanic White). Thematic analysis revealed that social media DRSG users identified the informational usefulness of these groups as being related to the gathering and sharing of specific information about an RD, clarification about the importance and meaning of certain symptoms, and obtaining insight into an RD’s progression and prognosis. Participants also identified that DRSGs were useful sources of practical information, such as tips and tricks about managing RD-related issues and concerns. In addition, participants found DRSGs to be a useful space for sharing their disease-related stories but also highlighted a feeling of exhaustion from overexposure and overuse of DRSGs. Conclusions: This study identifies the usefulness of DRSGs for the RD community and provides a set of recommendations to improve future instances of DRSGs. These recommendations can be used to create DRSGs that are less prone to splintering into other DRSGs, thus minimizing the risk of having important RD-related information unhelpfully dispersed amongst a multitude of support groups. %M 39752188 %R 10.2196/57833 %U https://humanfactors.jmir.org/2024/1/e57833 %U https://doi.org/10.2196/57833 %U http://www.ncbi.nlm.nih.gov/pubmed/39752188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65619 %T An e-Learning Intervention for Professionals to Promote Family-Centered Cancer Care When a Significant Caregiver for Children Is at End of Life: Mixed Methods Evaluation Study %A Semple,Cherith Jane %A O'Neill,Carla %A Sheehan,Sarah %A McCance,Tanya %A Drury,Amanda %A Hanna,Jeffrey R %+ South Eastern Health & Social Care Trust, Ulster University, York Street, Belfast, BT15 1ED, United Kingdom, 44 2870123456, c.semple@ulster.ac.uk %K e-learning %K intervention evaluation %K mixed methods %K end-of-life care %K educational intervention %K professionals %K self-efficacy %K cancer %K family-centered care %K cancer care %K person-based approach %K qualitative %K evidence-based %K parent %K adverse outcome %K eHealth %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Families are often unsure how best to prepare dependent children for the death of a significant caregiver with a poor cancer prognosis and seek guidance and support from health care teams. Health and social care professionals (hereafter referred to as professionals) often lack educational opportunities to gain the desired knowledge, skills, and confidence to provide family-centered supportive cancer care. e-Learning has positively impacted access and reach, improving educational opportunities in health care. Objective: We aimed to evaluate the acceptability, usability, and effectiveness of an evidence-based, theory-driven e-learning intervention to equip and promote professionals’ self-efficacy to deliver family-centered supportive cancer care when a significant caregiving member for dependent children is at the end of life. Methods: Guided by the “person-based approach,” a mixed methods outcome evaluation was used. To determine the effect on self-efficacy, participants completed a validated pretest and posttest 12-item self-efficacy survey. The use of one-on-one, remote semistructured interviews and single-item questions determined the usability by professionals of the e-learning intervention and the acceptability of perceived learning in clinical practice. To generate enhanced insights, quantitative and qualitative data were integrated through a 4-stage, modified pillar integration process. Results: Overall, 158 participants completed the pretest survey for the e-learning resource, with 99 (62.7%) completing the posttest survey. Semistructured interviews were conducted with 12 professionals at least 1 month after the intervention. Findings highlighted a statistically significant improvement in posttest self-efficacy (99/158, 62.7%; P<.001). Usability of the e-learning intervention was positive, with participants reporting that it was clear and organized (mean 4.84, SD 0.373), the layout was appealing (mean 4.71, SD 0.539), the language was easy to understand (mean 4.71, SD 0.407), and graphics and media were purposeful (mean 4.76, SD 0.495) and engaging (mean 4.67, SD 0.703). Determining acceptability, participants considered that the intervention would positively impact practice (mean 4.60, SD 0.589) and increase knowledge (mean 4.56, SD 0.677), with appropriate practical examples to support learning (mean 4.58, SD 0.610). Following engagement with the e-learning intervention, professionals reported preparedness to deliver supportive adult-professional end-of-life cancer care, when an adult with significant caregiving responsibilities is dying. Findings demonstrated transferable learning to additional contexts, such as other close adult-child relational bonds (grandparents) and to life-limiting conditions. Conclusions: The systematic and iterative person-based approach optimized the acceptability of a novel e-learning intervention, having the potential to promote family-centered supportive end-of-life cancer care. This accessible e-learning intervention makes an important contribution to the recognized global gap of educational interventions in this field. Equipping professionals with family-centered supportive end-of-life care improves self-efficacy and preparedness to engage in challenging conversations, with the potential to promote better outcomes for affected adults and children and mediate adverse outcomes for adults and children before and after bereavement. %M 39657171 %R 10.2196/65619 %U https://www.jmir.org/2024/1/e65619 %U https://doi.org/10.2196/65619 %U http://www.ncbi.nlm.nih.gov/pubmed/39657171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60368 %T Strategies to Implement a Community-Based, Longitudinal Cohort Study: The Whole Communities-Whole Health Case Study %A Bouchacourt,Lindsay %A Smith,Sarah %A Mackert,Michael %A Almalki,Shoaa %A Awad,Germine %A Barczyk,Amanda %A Bearman,Sarah Kate %A Castelli,Darla %A Champagne,Frances %A de Barbaro,Kaya %A Garcia,Shirene %A Johnson,Karen %A Kinney,Kerry %A Lawson,Karla %A Nagy,Zoltan %A Quiñones Camacho,Laura %A Rodríguez,Lourdes %A Schnyer,David %A Thomaz,Edison %A Upshaw,Sean %A Zhang,Yan %+ Center for Health Communication, The University of Texas at Austin, 300 W Dean Keeton, Austin, TX, 78712, United States, 1 512 471 5775, lindsay.bouchacourt@austin.utexas.edu %K community-based %K longitudinal %K health disparities %K cohort study %K case study %K family health %K child %K children %K families %K child development %K mobile phone %D 2024 %7 5.12.2024 %9 Viewpoint %J JMIR Form Res %G English %X This paper discusses the implementation of the Whole Communities-Whole Health (WCWH) initiative, which is a community-based, longitudinal cohort study. WCWH seeks to better understand the impact of location on family health and child development while also providing support for families participating in the study. Implementing a longitudinal study that is both comprehensive in the data it is collecting and inclusive in the population it is representing is what makes WCWH extremely challenging. This paper highlights the learning process the initiative has gone through to identify effective strategies for implementing this type of research study and work toward building a new model for community-engaged research. Through iterative testing following the Plan-Do-Study-Act model, three main strategies for implementation were identified. These strategies are (1) creating a data collection schedule that balances participant burden and maintains temporality across data types; (2) facilitating multiple opportunities for qualitative and quantitative input from faculty, families, and nonparticipant community members; and (3) establishing an open-door policy for data analysis and interpretation. This paper serves as a guide and provides resources for other researchers wanting to implement a multidisciplinary and community-based cohort study. %M 39636676 %R 10.2196/60368 %U https://formative.jmir.org/2024/1/e60368 %U https://doi.org/10.2196/60368 %U http://www.ncbi.nlm.nih.gov/pubmed/39636676 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54619 %T Remotely Delivered Video Interaction Guidance for Families of Children With an Intellectual Disability Referred to Specialist Mental Health Services: Protocol for a Feasibility Randomized Controlled Trial %A Kohn,Charmaine %A Turner,Lauren %A Yang,Zhixing %A Absoud,Michael %A Casbard,Angela %A Gomes,Manuel %A Grant,Gemma %A Hassiotis,Angela %A Kennedy,Eilis %A Levitt,Sophie %A McNamara,Rachel %A Randell,Elizabeth %A Totsika,Vasiliki %+ University College London, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 0207 679 2000, v.totsika@ucl.ac.uk %K learning disability %K intellectual disability %K ID %K child mental health %K challenging behavior %K family therapy %K parent-child relations %K parenting %D 2024 %7 5.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children with an intellectual disability (ID) are 3-4 times more likely to present with behaviors that challenge and mental health problems than typically developing children. Parenting and the quality of parent-child relationships are risk factors for these families. The COVID-19 pandemic further exacerbated difficulties, leading to an increase in child mental health problems and behaviors that challenge, a deterioration in parental mental health, and further strain on family relationships. Remote family interventions could be an effective solution for both families and specialist mental health services. Video interaction guidance (VIG) has shown promise for improving child mental health. However, it is unclear whether it is widely acceptable to families and feasible to implement across specialist child mental health services. Objective: This randomized controlled trial aims to evaluate the feasibility of delivering VIG as a remote intervention for parents of children aged 6-12 years with ID who have been referred to specialist mental health services. Methods: The study will be undertaken across 5-7 National Health Service specialist mental health services in England, involving 50 participants randomly allocated on a 1:1 basis to either the intervention group (receiving remote VIG) or the treatment-as-usual (TAU) group. The intervention group will engage in 3-5 cycles of VIG delivered remotely over 12 weeks. The primary feasibility outcomes include the recruitment rate, retention at 6-month follow-up, and VIG cycle completion rate. The secondary outcomes will assess the acceptability of VIG and the feasibility of remote implementation, including fidelity to the intervention protocol. Data will be gathered through online surveys and telephone interviews at baseline, 3 months, and 6 months. Feasibility outcomes will be summarized using descriptive statistics, while thematic analysis will be applied to qualitative data from semistructured interviews with participants, VIG practitioners, and service managers. An embedded process evaluation will explore barriers and facilitators to engagement with VIG, and a parallel health economics evaluation will assess the feasibility of capturing service use data and intervention costs. Results: The trial was open to recruitment between December 2022 and March 2024. The first results should be available in 2025. Conclusions: The study is the first randomized evaluation of VIG as offered to parents of children with ID who have been referred to specialist mental health settings. The outcomes from this feasibility trial will inform the decision to proceed with a definitive trial, using a traffic light system to evaluate recruitment, retention, and VIG completion rates alongside qualitative insights and economic evaluations. Trial Registration: ISRCTN Registry ISRCTN13171328; http://www.isrctn.com/ISRCTN13171328 International Registered Report Identifier (IRRID): DERR1-10.2196/54619 %M 39636678 %R 10.2196/54619 %U https://www.researchprotocols.org/2024/1/e54619 %U https://doi.org/10.2196/54619 %U http://www.ncbi.nlm.nih.gov/pubmed/39636678 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e64994 %T Indigenous Parents’ Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study %A Butt,Michelle L %A Willett,Ysabella Jayne %A Miller,Vicky %A Jacobs,Brenda %A Ferron,Era Mae %A Wright,Amy L %+ Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada, 1 416 978 0695, amyl.wright@utoronto.ca %K child %K parenting %K qualitative %K Indigenous health %K support programs %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting support programs enhance parents’ health and their child’s development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents’ experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents’ experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. %M 39576680 %R 10.2196/64994 %U https://pediatrics.jmir.org/2024/1/e64994 %U https://doi.org/10.2196/64994 %U http://www.ncbi.nlm.nih.gov/pubmed/39576680 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53090 %T A Real-Life Laboratory Setting for Clinical Practice, Education, and Research in Family Systems Care: Protocol for a Transformational Action Research Study %A Huber,Evelyn %A Harju,Erika %A Stark,Elisabeth %A Fringer,André %A Preusse-Bleuler,Barbara %+ Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Postfach, Winterthur, 8401, Switzerland, 41 58 934 46 83, evelyn.huber@zhaw.ch %K family systems care %K family nursing %K family health %K family well-being %K therapeutic conversation %K real-life laboratory %K transformational action research %K case study research %K qualitative research %K vicarious learning %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Burdening health and illness issues such as physical or mental illnesses, accidents, disabilities, and life events such as birth or death influence the health and functioning of families and contribute to the complexity of care and health care costs. Considerable research has confirmed the benefits of a family systems–centered care approach for patients, family caregivers, families, and health care professionals. However, health care professionals face barriers in working with families, such as feeling unprepared. Family systems–centered therapeutic conversations support families’ day-to-day coping, resilience, and health. A family systems care unit (FSCU) was recently established as a real-life laboratory at one of the Swiss Universities of Applied Sciences. In this unit, health care professionals offer therapeutic conversations to families and individual family members to support daily symptom management and functioning, soften suffering, and increase health and well-being. These conversations are observed in real time through a 1-way window by other health care professionals, students, and trainees and are recorded with video for research and education. Little is known about how therapeutic conversations contribute to meaningful changes in burdened families and the benefits of vicarious learning in a real-life laboratory setting for family systems care. Objective: In this research program, we aim to deepen our understanding of how therapeutic conversations support families and individuals experiencing burdening health and illness issues and how the FSCU laboratory setting supports the learning of students, clinical trainees, and health care professionals. Methods: Here we apply a transformational action research design, including parallel and subsequent substudies, to advance knowledge and practice in family systems care. Qualitative multiple-case study designs will be used to explore the benefits of therapeutic conversations by analyzing recordings of the therapeutic conversations. The learning processes of students, trainees, and professionals will be investigated with descriptive qualitative study designs based on single and focus group interviews. The data will be analyzed with established coding methods. Results: Therapeutic conversations have been investigated in 3 single-case studies, each involving a sequence of 3 therapeutic conversation units. Data collection regarding the second research question is planned. Conclusions: Preliminary results confirm the therapeutic conversations to support families’ coping. This renders the FSCU a setting for ethically sensitive research. This program will not only support the health and well-being of families, but also contribute to relieving the financial and workforce burdens in the health and social care system. International Registered Report Identifier (IRRID): DERR1-10.2196/53090 %M 39476850 %R 10.2196/53090 %U https://www.researchprotocols.org/2024/1/e53090 %U https://doi.org/10.2196/53090 %U http://www.ncbi.nlm.nih.gov/pubmed/39476850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57939 %T Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation %A Folk,Johanna B %A Valencia-Ayala,Cynthia %A Holloway,Evan D %A Anvar,Sarah %A Czopp,Alison %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 5, 7M8, San Francisco, CA, 94110, United States, 1 4156029521, Johanna.folk@ucsf.edu %K family-based intervention %K affect management %K child welfare system %K telehealth %K formative evaluation %K trauma exposure %K substance misuse %K adverse childhood experiences %K trauma-informed care %K adolescent health %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. Objective: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Methods: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Results: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. Conclusions: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. Trial Registration: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523 %M 39405104 %R 10.2196/57939 %U https://formative.jmir.org/2024/1/e57939 %U https://doi.org/10.2196/57939 %U http://www.ncbi.nlm.nih.gov/pubmed/39405104 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e54715 %T Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study %A Deribe,Leul %A Girma,Eshetu %A Lindström,Nataliya %A Gidey,Abdulkadir %A Teferra,Solomon %A Addissie,Adamu %+ Department of Applied Information Technology, University of Gothenburg, Forskningsgången, Goteborg, Sweden, 46 733268716, nataliya.berbyuk.lindstrom@ait.gu.se %K child cancer %K psychological distress %K Ethiopia %K parent %K caregivers %K family %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. Objective: The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Methods: An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant. Results: A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD. Conclusions: A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse. %M 39388696 %R 10.2196/54715 %U https://cancer.jmir.org/2024/1/e54715 %U https://doi.org/10.2196/54715 %U http://www.ncbi.nlm.nih.gov/pubmed/39388696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52454 %T Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study %A Keim-Malpass,Jessica %A Lunsford,Christopher %A Letzkus,Lisa C %A Scheer,Eleanore %A Valdez,Rupa S %+ Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, Charlottesville, VA, 22901, United States, 1 4349245105, jlk2t@virginia.edu %K anticipatory symptom management %K children with medical complexity %K social network %K qualitative %K self-management %K care coordination %K precision health %K disease progression models %K disability %K networked models of disease %K social networking %K web-based network %K web-based networks %K social networks %K symptom management %K family management %K coordinated care %K precision %K pediatric %K pediatrics %K child %K children %K caregiver %K caregivers %K social support %K interview %K interviews %K family %K informal care %K caregiving %K conceptual %K grounded theory %K constructivist %K situational analysis %K model %K mobile phone %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. Objective: The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network. Methods: This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children’s Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here. Results: In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes. Conclusions: The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development. International Registered Report Identifier (IRRID): RR2-10.2196/14810 %M 37801346 %R 10.2196/52454 %U https://formative.jmir.org/2023/1/e52454 %U https://doi.org/10.2196/52454 %U http://www.ncbi.nlm.nih.gov/pubmed/37801346 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31475 %T The Shishu Pushti Trial–Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial %A Mihrshahi,Seema %A Ara,Gulshan %A Khanam,Mansura %A Rasheed,Sabrina %A Agho,Kingsley Emwinyore %A Kabir,AKM Iqbal %A Roy,S K %A Haider,Rukhsana %A Derakhshani Hamadani,Jena %A Tofail,Fahmida %A Alam,Ashraful %A Dibley,Michael J %+ Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, 75T Building, 75 Talavera Rd, Macquarie Park, 2109, Australia, 61 2 98502468, seema.mihrshahi@mq.edu.au %K child stunting %K prevention %K nutrition behavior change %K breastfeeding: infant and young child feeding %K peer counseling, child development %D 2022 %7 7.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. Objective: Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. Methods: This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). Results: We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. Conclusions: This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. Trial Registration: ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995 International Registered Report Identifier (IRRID): DERR1-10.2196/31475 %M 35129457 %R 10.2196/31475 %U https://www.researchprotocols.org/2022/2/e31475 %U https://doi.org/10.2196/31475 %U http://www.ncbi.nlm.nih.gov/pubmed/35129457 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31254 %T The Relationship Between Paternal Preconception Obesity and Health Behaviors and Childhood Obesity: Protocol for a Systematic Review %A Laforest,Marie-Eve %A Ward,Stephanie %A Landry,Liette-Andrée %A Mobetty,Fabrice %+ École de Science Infirmière, Faculté des Sciences de la Santé et des Services Communautaires, Université de Moncton, 18 Ave Antonine Maillet, Moncton, NB, E1A 3E9, Canada, 1 506 858 4463, marie-eve.laforest@umoncton.ca %K childhood obesity %K preconception %K paternal obesity %K health behaviours %K obesity %K public health %K children %K adolescents %K body weight %K parenting %K health behaviors %D 2021 %7 2.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity is a global public health concern and is a priority for researchers and policy makers. To overcome the epidemic of obesity, influencing factors throughout the life span need to be addressed, including those in the preconception period. A better understanding of the association between paternal preconception factors and childhood obesity is important for public health interventions. Objective: This systematic review will examine the relationship between paternal preconception obesity and health behaviors and their offspring’s overweight or obesity. Methods: Peer-reviewed quantitative studies and grey literature that report associations between paternal preconception obesity and health behaviors—such as smoking, exercise, and eating habits—and childhood overweight and obesity will be identified through a computerized literature search in 7 databases. The quality of each study will be assessed using the Quality Assessment Tool for Quantitative Studies. Characteristics of the included studies will be reported, and relevant findings from each paternal preconception exposure will be narratively synthesized. This review will follow the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. Results: This systematic review is anticipated to begin in December 2021 and be completed by the end of August 2022. Conclusions: This systematic review will contribute to a better understanding of the relationship between preconception paternal exposures and their offspring’s overweight or obesity. Findings will help support health professionals working with prospective parents to educate fathers on the benefits of improving their weight and health behaviors during the preconception period. International Registered Report Identifier (IRRID): PRR1-10.2196/31254 %M 34860672 %R 10.2196/31254 %U https://www.researchprotocols.org/2021/12/e31254 %U https://doi.org/10.2196/31254 %U http://www.ncbi.nlm.nih.gov/pubmed/34860672 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e25425 %T Mobile Apps as Audience-Centered Health Communication Platforms %A Mackert,Michael %A Mandell,Dorothy %A Donovan,Erin %A Walker,Lorraine %A Henson-García,Mike %A Bouchacourt,Lindsay %+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 348 8490, mackert@utexas.edu %K health communication %K mHealth %K mobile apps %K mobile health %K prenatal health %K pregnancy %K audience-centered %D 2021 %7 17.8.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms—particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father’s Playbook, a mobile app designed to encourage men to be more involved during their partner’s pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father’s Playbook as a vehicle for their messages. %M 34402797 %R 10.2196/25425 %U https://mhealth.jmir.org/2021/8/e25425 %U https://doi.org/10.2196/25425 %U http://www.ncbi.nlm.nih.gov/pubmed/34402797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26376 %T App-Tailoring Requirements to Increase Stress Management Competencies Within Families: Cross-sectional Survey Study %A Bischoff,Laura Luise %A Baumann,Hannes %A Meixner,Charlotte %A Nixon,Patricia %A Wollesen,Bettina %+ Department of Movement Science, Faculty of Psychology and Human Movement, University of Hamburg, Mollerstraße 10, Hamburg, 20148, Germany, 49 40 42838 93, laura.bischoff@uni-hamburg.de %K mhealth %K ehealth %K mobile applications %K stress management %K app features %K gamification %K family %K personality traits %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Families experiencing high levels of psychological distress are considered a particularly vulnerable population for adverse effects on mental and physical health. Moreover, highly stressed individuals engage less in mental health promoting activities and show low stress management competencies. App-based stress interventions seem promising for the treatment and prevention of stress outcomes and might be a low-threshold solution. Objective: The aim of this study was to identify the requirements for a tailored app to reduce stress in a cohort of highly stressed families that have low stress management skills. Methods: Parents (n=1008; age: mean 47.7 years, SD 6.1; female: 599/1008, 59.7%) completed an extensive web-based survey and were subdivided into a target (stressed individuals with low stress competency) and nontarget group according to their reported stress level and stress management competencies. Group differences were analyzed using analysis of variance. In principal component analysis with Kaiser varimax rotation, personally defined stress management goals were grouped into components. Linear regression models were also calculated. Results: A 3-factor solution cumulatively explained 56% of the variance in personally defined goals of interest for stress management with (1) active strategies (25.61% explained variance), (2) general competency (17.95% explained variance) and (3) passive strategies (12.45% explained variance). The groups differed in age (F1,978=27.67, P<.001), health index (F1,958=246.14, P<.001), personally defined general-competency goal (F1,958=94.16 P<.001), as well as “information acquisition” (F1,971=14.75, P<.001) and “need for stimulation” (F1,981=54.49, P<.001) personality traits. A regression model showed that for the active strategies goals of interest, only app feature information or instructional videos had a significant effect (P=.02). The general competency factor showed none, and the passive strategies factor showed significant effects for 2 app features—suggestions for planning possible activities with the family (P=.01) and diaries for documentation and development of strategies (P=.03). Conclusions: The results of this survey study highlight the need to develop an app to increase stress management competencies that takes into consideration perceived stress level, stress management skills, personality, and personally defined goals of the user. The content of the app should be tailored to previously detected personality traits, especially selective information acquisition and low need for stimulation. Furthermore, personally defined stress management goals seem to affect interest in some features. %M 34328439 %R 10.2196/26376 %U https://www.jmir.org/2021/7/e26376 %U https://doi.org/10.2196/26376 %U http://www.ncbi.nlm.nih.gov/pubmed/34328439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e24274 %T Patient and Family Engagement Approaches for Digital Health Initiatives: Protocol for a Case Study %A Shen,Nelson %A Jankowicz,Damian %A Strudwick,Gillian %+ Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 30132, nelson.shen@camh.ca %K digital health %K patient engagement %K case study %K patient and family engagement %K mental health %D 2021 %7 21.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health initiatives such as patient portals, virtual care platforms, and smartphone-based apps are being implemented at a rapid pace in health care organizations worldwide. This is often done to improve access beyond traditional in-person care and enhance care quality. Recent studies have indicated that better outcomes of using these initiatives and technologies may be achieved when patients and their family members are engaged in all aspects of planning, implementation, use, and evaluation. However, little guidance exists for how health care administrators can achieve effective engagement in digital health initiatives specifically. Objective: The objective of this study is to document processes related to planning and implementing patient and family engagement (PFE) in digital health initiatives. This information will be used to develop tangible resources (eg, a field guide) that other organizations can use to implement PFE approaches for digital health initiatives in their organizations. Methods: A previously developed multidimensional conceptual framework for PFE in health and health care contexts will be used to guide this work. To understand the intricacies involved in using PFE approaches in digital health strategies, a case study will be conducted. More specifically, this work will employ an embedded single-case design with PFE in digital health initiatives at a large Canadian mental health and addictions teaching hospital. Multiple digital health projects being undertaken at the study site will be explored to better understand where the PFE is intended to support the design, implementation, and operation of the digital health platform or technology. These projects will form the individual units of analysis. Data collection will involve field notes and artifact collection by a participant observer and interviews with the various digital health project teams. Data analysis will include a content and thematic analysis, triangulation of the findings, and a chronological mapping of data to a PFE process. Results: Funding for this work was provided by the Canadian Institutes of Health Research (CIHR), via a Health System Impact Fellowship. As of August 2020, digital health projects that will form the case study units have been identified, and the participant observer has started to embed themselves into these projects. Although the development and collection of field notes and artifacts, respectively, have begun, interviews have not been conducted. The study is expected to conclude in September 2021. Once this study is complete, the development of a field guide and resources to support the uptake of PFE strategies in digital health will begin. Conclusions: By better understanding the processes involved in PFE in digital health projects, guidance can be provided to relevant stakeholders and organizations about how to do this work in an effective manner. It is then anticipated that with the increasing use of PFE approaches, there may be improved uptake, experience, and outcomes associated with using digital health technologies. International Registered Report Identifier (IRRID): PRR1-10.2196/24274 %M 34287212 %R 10.2196/24274 %U https://www.researchprotocols.org/2021/7/e24274 %U https://doi.org/10.2196/24274 %U http://www.ncbi.nlm.nih.gov/pubmed/34287212 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24884 %T User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial %A Karra,Mahesh %A Zhang,Kexin %+ Frederick S Pardee School of Global Studies, Boston University, 152 Bay State Road, Room G04C, Boston, MA, 02215, United States, 1 617 358 0197, mvkarra@bu.edu %K user-centered counseling %K male involvement %K contraceptive use %K family planning %K randomized controlled trial %K Malawi %K Sub-Saharan Africa %D 2021 %7 5.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: To achieve informed choice within the framework of reproductive autonomy, family planning programs have begun to adopt user-centered approaches to service provision, which highlight the individual client as the focal point of interaction and key decision maker. However, little is known about how user-centered approaches to family planning, particularly family planning counseling, shape contraceptive preferences and choices. Objective: We conducted a multiarmed randomized controlled trial to identify the causal impact of user-centered approaches to family planning counseling on women’s contraceptive decision making in urban Malawi. This study aims to determine how a tailored, preference-driven approach to family planning counseling and the involvement of male partners during the counseling process may contribute to shaping women’s contraceptive preferences and choices. Methods: Married women aged 18-35 years were recruited and randomly assigned to 1 of the 3 intervention arms or a control arm characterized by the following two interventions: an intervention arm in which women were encouraged to invite their husbands to family planning counseling (husband invitation arm) and an intervention arm in which women received targeted, tailored counseling on up to five contraceptive methods (as opposed to up to 13 contraceptive methods) that reflected women’s stated preferences for contraceptive methods. Women were randomized into a control arm, T0 (no husband invitation, standard counseling); T1 (husband invitation, standard counseling); T2 (no husband invitation, targeted counseling); and T3 (husband invitation, targeted counseling). Following counseling, all women received a package of family planning services, which included free transportation to a local family planning clinic and financial reimbursement for family planning services. Follow-up surveys were conducted with women 1 month after counseling. Results: A total of 785 women completed the baseline survey, and 782 eligible respondents were randomized to 1 of the 3 intervention groups or the control group (T1, n=223; T2, n=225; T3, n=228; T0, n=108). Furthermore, 98.1% (767/782) of women were contacted for follow-up. Among the 767 women who were contacted, 95.3% (731/767) completed the follow-up survey. The analysis of the primary outcomes is ongoing and is expected to be completed by the end of 2021. Conclusions: The results from this trial will fill knowledge gaps on the effectiveness of tailored family planning counseling and male involvement in family planning on women’s stated and realized contraceptive preferences. More generally, the study will provide evidence on how user-centered counseling may affect women’s willingness to use and continue contraception to realize their contraceptive preferences. Trial Registration: American Economics Association’s Registry for Randomized Controlled Trials AEARCTR-0004194; https://www.socialscienceregistry.org/trials/4194/history/46808. Registry for International Development Impact Evaluations RIDIE-STUDY-ID-5ce4f42bbc2bf; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=823. International Registered Report Identifier (IRRID): DERR1-10.2196/24884 %M 33818398 %R 10.2196/24884 %U https://www.researchprotocols.org/2021/4/e24884 %U https://doi.org/10.2196/24884 %U http://www.ncbi.nlm.nih.gov/pubmed/33818398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18876 %T Association of Mobile Instant Messaging Chat Group Participation With Family Functioning and Well-Being: Population-Based Cross-sectional Study %A Zhao,Sheng Zhi %A Luk,Tzu Tsun %A Guo,Ningyuan %A Wang,Man Ping %A Lai,Agnes Yuen Kwan %A Wong,Bonny Yee Man %A Fong,Daniel Yee Tak %A Chan,Sophia Siu Chee %A Lam,Tai Hing %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K mobile instant messaging %K chat groups %K family communication %K family well-being %K family functioning %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Convenient and quality family communication improves family functioning and well-being. Using mobile instant messaging (IM) for family communication is increasingly popular, but its association with family functioning and family well-being has not been reported. Objective: The aim of this study was to examine the association of the use of family IM chat groups with family functioning and well-being, and the mediating effect of family communication quality among Chinese adults in Hong Kong. Methods: We analyzed data from the Family and Health Information Trend Survey (FHInTS), a territory-wide, probability-based telephone survey conducted in 2017. The quality of family communication, family functioning, and well-being was assessed using the Family Communication Scale; Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale; and Family Well-Being Scale (family heath, harmony, and happiness), respectively. Respondents also reported the number of family IM chat groups (0, 1, 2, ≥3), and numbers of IM messages received (<1, 1-2, 3-10, 11-20, >20) and sent (<1, 1-2, 3-10, 11-20, >20) daily. The frequency of family IM chat interaction (range 0-8) was calculated by combining the number of messages received from and sent to the family IM chat groups daily. Covariates included sociodemographic characteristics and the frequency of family face-to-face communication (often, sometimes, seldom, or never). Data were weighted by sex, age, and education of the general population. Adjusted β coefficients of family functioning and well-being in relation to having a family IM chat group, and numbers of messages received and sent were calculated. The mediation effects of family communication on these associations were assessed, controlling for the covariates. Results: A random sample of 1638 Chinese adults (45.6% men; 78.1% aged 25 to 64 years) were interviewed (response rate: 74.4%). Female, younger age, being married or cohabiting, higher education, higher income, better family functioning, and well-being were associated with having at least one family IM chat group (all P<.01). Higher scores of family communication, family APGAR, and family well-being were associated with having more family IM chat groups and more messages received from and sent to family IM chat groups daily (all P for trend <.01). More frequent family IM chat interaction was associated with higher scores of family communication, family APGAR, and family well-being (β=.16-.83, all P for trend <.001). The associations of family IM chat interaction with family functioning and well-being were moderately (51.0%-59.6%) mediated by family communication. Conclusions: Use of a family IM chat group was associated with higher family functioning and well-being, and the association was partially mediated by family communication. %M 33720034 %R 10.2196/18876 %U https://www.jmir.org/2021/3/e18876 %U https://doi.org/10.2196/18876 %U http://www.ncbi.nlm.nih.gov/pubmed/33720034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25060 %T Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study %A Kowatsch,Tobias %A Schachner,Theresa %A Harperink,Samira %A Barata,Filipe %A Dittler,Ullrich %A Xiao,Grace %A Stanger,Catherine %A v Wangenheim,Florian %A Fleisch,Elgar %A Oswald,Helmut %A Möller,Alexander %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 71 224 72 44, tkowatsch@ethz.ch %K digital health intervention %K intervention design %K mHealth %K eHealth %K chatbot %K conversational agent %K chronic diseases %K asthma %K feasibility study %D 2021 %7 17.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. Objective: With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent–delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent–patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. Methods: MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent–patient working alliance; (2) to offer hybrid (human- and conversational agent–supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. Results: Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. Conclusions: This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a “team player” role but also show potential to improve health-relevant outcomes in chronic disease management. %M 33484114 %R 10.2196/25060 %U http://www.jmir.org/2021/2/e25060/ %U https://doi.org/10.2196/25060 %U http://www.ncbi.nlm.nih.gov/pubmed/33484114 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25443 %T mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial %A Desrosiers,Alethea %A Schafer,Carolyn %A Esliker,Rebecca %A Jambai,Musu %A Betancourt,Theresa S %+ Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 01778, United States, 1 617 552 8398, alethea.desrosiers@bc.edu %K mHealth %K caregiver mental health %K family functioning %K early childhood development %K community health workers %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective: This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods: We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results: Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions: This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration: ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID): PRR1-10.2196/25443 %M 33528371 %R 10.2196/25443 %U https://www.researchprotocols.org/2021/2/e25443 %U https://doi.org/10.2196/25443 %U http://www.ncbi.nlm.nih.gov/pubmed/33528371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26130 %T A Couples-Based Intervention (Ghya Bharari Ekatra) for the Primary Prevention of Intimate Partner Violence in India: Pilot Feasibility and Acceptability Study %A Kalokhe,Ameeta Shivdas %A Iyer,Sandhya %A Gadhe,Keshav %A Katendra,Tuman %A Kolhe,Ambika %A Rahane,Girish %A Stephenson,Rob %A Sahay,Seema %+ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 5003 CNR Building, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 712 1924, akalokh@emory.edu %K intimate partner violence %K prevention %K pilot study %K gender-based violence %K domestic violence %K violence %K India %K intervention %K prevalence %K mental health %K acceptance %K safety %K feasibility %K efficacy %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharari Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly married couples residing in slum communities in Pune, India. Objective: Through this pilot study, we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE. Methods: Between January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3 to 5 couples by lay peer educators in the communities in which the participants resided. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). The process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context. Results: Half (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (17/20, 85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men with the lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention or at the 3-month follow-up. There were no reported physical or sexual IPV events in either group, but there were fewer incidents of psychological abuse in GBE participants (3/17, 18%) versus control participants (4/16, 25%) at 3-month follow-up. There was also significant improvement in the overall mental health of female intervention participants and declines in the control participants (change in mean General Health Questionnaire-12 score: –0.13 in intervention vs 0.13 in controls; P=.10). Conclusions: GBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining the intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134. Clinical Trials Registry of India CTRI/2018/01/011596; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=21443 International Registered Report Identifier (IRRID): RR2-10.2196/11533 %M 33459278 %R 10.2196/26130 %U https://formative.jmir.org/2021/2/e26130 %U https://doi.org/10.2196/26130 %U http://www.ncbi.nlm.nih.gov/pubmed/33459278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e17501 %T Development and Feasibility of a Family-Based Health Behavior Intervention Using Intelligent Personal Assistants: Randomized Controlled Trial %A Carlin,Angela %A Logue,Caomhan %A Flynn,Jonathan %A Murphy,Marie H %A Gallagher,Alison M %+ Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University, Shore Road, Newtownabbey, United Kingdom, 44 2871675037, a.carlin1@ulster.ac.uk %K children %K parent %K physical activity %K healthy eating %K technology %K mobile phone %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intelligent personal assistants such as Amazon Echo and Google Home have become increasingly integrated into the home setting and, therefore, may facilitate behavior change via novel interactions or as an adjunct to conventional interventions. However, little is currently known about their potential role in this context. Objective: This feasibility study aims to develop the Intelligent Personal Assistant Project (IPAP) and assess the acceptability and feasibility of this technology for promoting and maintaining physical activity and other health-related behaviors in both parents and children. Methods: This pilot feasibility study was conducted in 2 phases. For phase 1, families who were attending a community-based weight management project were invited to participate, whereas phase 2 recruited families not currently receiving any additional intervention. Families were randomly allocated to either the intervention group (received a smart speaker for use in the family home) or the control group. The IPAP intervention aimed to promote positive health behaviors in the family setting through utilization of the functions of a smart speaker and its linked intelligent personal assistant. Data were collected on recruitment, retention, outcome measures, intervention acceptability, device interactions, and usage. Results: In total, 26 families with at least one child aged 5 to 12 years were recruited, with 23 families retained at follow-up. Across phase 1 of the intervention, families interacted with the intelligent personal assistant a total of 65 times. Although device interactions across phase 2 of the intervention were much higher (312 times), only 10.9% (34/312) of interactions were coded as relevant (related to diet, physical activity or well-being). Focus groups highlighted that the families found the devices acceptable and easy to use and felt that the prompts or reminders were useful in prompting healthier behaviors. Some further intervention refinements in relation to the timing of prompts and integrating feedback alongside the devices were suggested by families. Conclusions: Using intelligent personal assistants to deliver health-related messages and information within the home is feasible, with high levels of engagement reported by participating families. This novel feasibility study highlights important methodological considerations that should inform future trials testing the effectiveness of intelligent personal assistants in promoting positive health-related behaviors. Trial Registration: ISRCTN Registry ISRCTN16792534; http://www.isrctn.com/ISRCTN16792534 %M 33507155 %R 10.2196/17501 %U http://formative.jmir.org/2021/1/e17501/ %U https://doi.org/10.2196/17501 %U http://www.ncbi.nlm.nih.gov/pubmed/33507155 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e23088 %T A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study %A Shegog,Ross %A Armistead,Laura %A Markham,Christine %A Dube,Sara %A Song,Hsing-Yi %A Chaudhary,Pooja %A Spencer,Angela %A Peskin,Melissa %A Santa Maria,Diane %A Wilkerson,J Michael %A Addy,Robert %A Tortolero Emery,Susan %A McLaughlin,Jeffery %+ Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, 7000 Fannin St, Suite 2668, Houston, TX, 77006, United States, 1 17135009677, Ross.Shegog@uth.tmc.edu %K serious game %K intervention mapping %K sexual health %K adolescents %K sexually transmitted infections %K teenage pregnancy %K parent, communication %K intergenerational %K mobile phone %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective: This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods: We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results: SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions: The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health. %M 33502323 %R 10.2196/23088 %U http://games.jmir.org/2021/1/e23088/ %U https://doi.org/10.2196/23088 %U http://www.ncbi.nlm.nih.gov/pubmed/33502323 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20841 %T A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype %A Benedict,Catherine %A Dauber-Decker,Katherine L %A King,D'Arcy %A Hahn,Alexandria %A Ford,Jennifer S %A Diefenbach,Michael %+ Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305-5718, United States, 1 2012077117, cbenedict@stanford.edu %K patient-centered care %K user-centered design %K decision support techniques %K decision aid %K cancer %K fertility %K internet-based intervention %K web-based intervention %K mobile phone %K psychosocial intervention %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients’ needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users’ needs, values, abilities, and limitations. Objective: This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building. Methods: User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed. Results: The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process. Conclusions: The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement. %M 33480848 %R 10.2196/20841 %U http://formative.jmir.org/2021/1/e20841/ %U https://doi.org/10.2196/20841 %U http://www.ncbi.nlm.nih.gov/pubmed/33480848 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e16029 %T Electronic Games for Facilitating Social Interaction Between Parents With Cancer and Their Children During Hospitalization: Interdisciplinary Game Development %A Piil,Karin %A Gyldenvang,Helle Holm %A Møller,Jeppe Kilberg %A Kjoelsen,Tine %A Juul,Jesper %A Pappot,Helle %+ Department of Oncology, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, Copenhagen Ø, 2100, Denmark, 45 35450733, Karin.piil@regionh.dk %K cancer patients %K children %K adolescents %K social relation %K emotional well-being %K gamification %K relatives %K visual design %K serious games %D 2021 %7 21.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Most cancer treatments today take place in outpatient clinics; however, it might be necessary for some patients to be admitted to hospital departments due to severe side effects or complications. In such situations, support from family and social relations can be crucial for the patients’ emotional well-being. Many young adolescents and children whose parents have cancer describe how they are not seen, heard, or listened to as the worried relatives they are. Within the intensive care unit, it has been recommended that early supportive interventions are tailored to include children of the intensive care patient; a similar approach might be relevant in the oncological setting. To our knowledge, no studies have explored how to involve young relatives who are visiting their parent at an oncological department. Recently, a framework for developing theory-driven, evidence-based serious games for health has been suggested. Such a process would include stakeholders from various disciplines, who only work toward one specific solution. However, it is possible that bringing together different disciplines, such as design, art, and health care, would allow a broader perspective, resulting in improved solutions. Objective: This study aims to develop tools to enhance the social interaction between a parent with cancer and their child when the child visits the parent in the hospital. Methods: In total, 4 groups of design students within the Visual Design program were tasked with developing games addressing the objective of strengthening relations in situ during treatment. To support their work, the applied methods included professional lectures, user studies, and visual communication (phase I); interviews with the relevant clinicians at the hospital (phase II), co-creative workshops with feedback (phase III), and evaluation sessions with selected populations (phase IV). The activities in the 4 phases were predefined. This modified user design had the child (aged 4-18 years) of a parent with cancer as its primary user. Results: Overall, 4 different games were designed based on the same information. All games had the ability to make adults with cancer and their children interact on a common electronic platform with a joint goal. However, the interaction, theme, and graphical expression differed between the games, suggesting that this is a wide and fertile field to explore. Conclusions: Playing a game can be an efficient way to create social interaction between a parent with cancer and a child or an adolescent, potentially improving the difficult social and psychological relations between them. The study showed that the development of serious games can be highly dependent on the designers involved and the processes used. This must be considered when a hospital aims to develop multiple games for different purposes. %M 33475523 %R 10.2196/16029 %U http://games.jmir.org/2021/1/e16029/ %U https://doi.org/10.2196/16029 %U http://www.ncbi.nlm.nih.gov/pubmed/33475523 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e14751 %T A Parenting Behavior Intervention (the Strengthening Families Program) for Families: Noninferiority Trial of Different Program Delivery Methods %A Kumpfer,Karol Linda %A Brown,Jaynie Litster %+ Health Sciences Center, University of Utah, 5215 Pioneer Fork Rd, Salt Lake City, UT, 84108, United States, 1 435 740 1453, kkumpfer@xmission.com %K parenting %K youth drug prevention %K family skills %K DVD %K Strengthening Families Program %K internet %K noninferiority trial %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The Strengthening Families Program (SFP) is an evidence-based parent training and youth life skills and drug prevention program traditionally delivered in group settings. Families attend parent and youth classes conducted by trained facilitators. Recently, a 2-disk home-use DVD series was created with the same SFP skills as the group classes for parents and the youth to watch together at home. Additional lesson material was added that included healthy brain development, school success, anger management, dangers of alcohol and drugs, and mindfulness. The SFP DVD reduces SFP delivery costs for agencies and logistic burdens to families. Creative applications of the DVD include holding SFP DVD family discussion groups of multiple families and using SFP DVD video clips as part of a shorter 10-week group class version for parents and the youth. Objective: This study aimed to examine three different DVD implementation scenarios using a noninferiority trial, contrasting target outcomes with an age-matched sample culled from a national norm database of families who completed a standard SFP 14-week class. Methods: The partial eta-square was used to compare effect sizes between the different delivery modalities for relevant programmatic outcomes. We adjusted the effect sizes by demographic measures to determine whether there were site-specific features influencing program outcomes. Results: For the unadjusted effect size comparisons, 13 of the 15 indicated that the home-use DVD outperformed group norms with an average 0.13 effect size estimate difference across the comparisons (28% improvement in the effect size for DVD condition). Comparisons of the home-use DVD condition with the mixed DVD use conditions showed no discernable pattern where one condition consistently outperformed another. Adjusted effect sizes still reinforced the superiority of the DVD conditions; however, there was some shrinkage in the effect sizes as expected with the inclusion of relevant covariates. Conclusions: The home-use DVD shows that it is possible to effectively deliver an affordable family-based intervention using alternative technology outside of the traditional group-based class format. In almost all of the comparisons, the DVD conditions outperformed the group norms, underscoring that low-cost DVDs or viewing the videos on the Web may provide a useful surrogate for costly group-based formats. Future studies may want to improve on the quasi-experimental design by examining programmatic differences based on delivery format using a randomized controlled trial, thus strengthening the causal framework regarding program effects. In addition, the assessment protocol relied on retrospective reporting, which, although this can limit response shift bias, does not separate data collection in time as with a true pre- and posttest design. %M 31738176 %R 10.2196/14751 %U http://pediatrics.jmir.org/2019/2/e14751/ %U https://doi.org/10.2196/14751 %U http://www.ncbi.nlm.nih.gov/pubmed/31738176