%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67451 %T Ecological Momentary Assessment of Parental Well-Being and Time Use: Mixed Methods Compliance and Feasibility Study %A Altweck,Laura %A Tomczyk,Samuel %+ Department Health and Prevention, Institute of Psychology, Universität Greifswald, Robert-Blum-Str. 13, Greifswald, 17487, Germany, 49 3834 420 ext 3813, laura.altweck@uni-greifswald.de %K ecological momentary assessment %K parents %K feasibility %K compliance %K time use %K well-being %K stress %K EMA %K mixed methods %K daily life %K parents %K online questionnaires %K questionnaires %K surveys %K quantitative %K qualitative %K sociodemographic %K mobile phone %D 2025 %7 23.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents often juggle multiple conflicting responsibilities, including work, childcare, and the household, making them a particularly burdened group. However, the impact of daily routines and associated (poor) well-being among parents has received relatively little attention. Ecological Momentary Assessment (EMA) is increasingly being used to capture real-time data and can help address this research gap. Objective: This study aims to examine compliance rates and the feasibility of EMA for measuring daily well-being and time use among parents. Methods: An exploratory mixed-methods study was conducted with 74 German parents (57/74, 77% women, (age: mean 37.6, SD 5.9 years). Participants completed a baseline questionnaire, followed by 4 daily EMA surveys (at 7:30 AM, 12 PM, 16:30 PM, and 21:30 PM) over a 1-week period, and a follow-up questionnaire. A subset of parents was also subsequently interviewed. Sociodemographic background and expected feasibility (open-ended questions) were surveyed at baseline, and feasibility was assessed at follow-up (closed- and open-ended questions) and in the interviews. State well-being (affective and cognitive), state stress, state as well as retrospective time-use were measured in the EMA surveys. Compliance and feasibility were examined using a combination of quantitative (descriptive analyses) and qualitative methodologies. Results: Participants completed an average of 83% (SD 13%) of the daily surveys. Compliance varied by gender and age, where men (90% vs 80%) and older parents showed higher rates. Participants generally found the survey frequency and length manageable, though some suggested adjustments to the study period depending on their individual routines. The 7:30 AM survey was reported as the most challenging due to childcare drop-offs (40%-49%), followed by the 16:30 PM survey for similar reasons (7%-17%). The qualitative analysis further revealed additional points for improvement, for instance, the need for personalization (eg, individual adjustment of the survey timings and intervals), technical support, and the incorporation of gamification elements. Most interviewees (46% vs 23%) found the used measurement of well-being and stress to be appropriate. Regarding time use, they felt that the predefined activity groups (eg, personal care, working) were suitable (46%) but noted challenges assigning less frequent activities (eg, medical appointments) (5%-54%). Reporting the timings of time-use via consecutive questions (ie, specifying the duration or start and end times of an activity) was perceived as confusing (9%-69%), with participants expressing a preference for a visual overview, such as a Gantt chart. Conclusions: The study demonstrates that, when accounting for certain sociodemographic and study design factors, EMA can be a feasible method for data collection regarding daily well-being and time use, even in highly time-constrained populations like parents. This shows great potential for future research, such as exploring work-family conflict or performative gender roles and complementing established methods (eg, retrospective daily diaries). Trial Registration: OSF Registries osf.io/8qj3d; https://osf.io/8qj3d International Registered Report Identifier (IRRID): RR2-10.2196/54728 %M 40267468 %R 10.2196/67451 %U https://formative.jmir.org/2025/1/e67451 %U https://doi.org/10.2196/67451 %U http://www.ncbi.nlm.nih.gov/pubmed/40267468 %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 %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60102 %T Optimizing Engagement With a Smartphone App to Prevent Violence Against Adolescents: Results From a Cluster Randomized Factorial Trial in Tanzania %A Janowski,Roselinde %A Cluver,Lucie D %A Shenderovich,Yulia %A Wamoyi,Joyce %A Wambura,Mwita %A Stern,David %A Clements,Lily %A Melendez-Torres,G J %A Baerecke,Lauren %A Ornellas,Abigail %A Chetty,Angelique Nicole %A Klapwijk,Jonathan %A Christine,Laetitia %A Mukabana,Ateamate %A Te Winkel,Esmee %A Booij,Anna %A Mbosoli,Gervas %A Lachman,Jamie M %+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865270325, roselinde.janowski@spi.ox.ac.uk %K digital health %K engagement %K parenting %K adolescents %K low- and middle-income country %K violence against children %K Multiphase Optimization Strategy %K randomized factorial experiment %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Violence and abuse exert extensive health, social, and economic burdens on adolescents in low- and middle-income countries. Digital parenting interventions are promising for mitigating risks at scale. However, their potential for public health impact hinges on meaningful engagement with the digital platform. Objective: The objective of this study was to evaluate the impact of 3 intervention design and implementation factors aimed at increasing engagement with a noncommercialized, offline-first smartphone app for caregivers of adolescents in Tanzania, in partnership with the United Nations Children’s Fund, the World Health Organization, and the Tanzanian national government. Methods: Following Multiphase Optimization Strategy (MOST) principles, we conducted a 2×2×2 cluster randomized factorial trial involving caregivers of adolescents aged 10 to 17 years. Caregivers were recruited by community representatives from 16 urban and periurban communities (ie, clusters) in the Mwanza region of Tanzania. Each cluster was randomized to 1 of 2 levels of each factor: guidance (self-guided or guided via facilitator-moderated WhatsApp groups), app design (structured or unstructured), and preprogram digital support (basic or enhanced). Primary outcomes were automatically tracked measures of engagement (app launches, modules completed, and home practice activities reviewed), with secondary outcomes including modules started, time spent in the app, and positive behaviors logged. Generalized linear mixed-effects models assessed the impact of experimental factors on engagement. Results: Automatically tracked engagement data from 614 caregivers were analyzed, of which 205 (33.4%) were men. Compared to self-guided participants, receiving guidance alongside the app led to significantly more app launches (mean ratio [MR] 2.93, 95% CI 1.84-4.68; P<.001), modules completed (MR 1.29, 95% CI 1.05-1.58; P=.02), modules started (MR 1.20, 95% CI 1.02-1.42; P=.03), time spent in the app (MR 1.45, 95% CI 1.39-1.51; P<.001), and positive behavior logs (MR 2.73, 95% CI 2.07-3.60; P<.001). Compared to the structured design, unstructured design use resulted in significantly more modules completed (MR 1.49, 95% CI 1.26-1.76; P<.001), home practice activity reviews (MR 7.49, 95% CI 5.19-10.82; P<.001), modules started (MR 1.27, 95% CI 1.06-1.52; P=.01), time spent in the app (MR 1.84, 95% CI 1.70-1.99; P<.001), and positive behavior logs (MR 55.68, 95% CI 16.48-188.14; P<.001). While analyses did not detect an effect of enhanced digital support on directly observed engagement, the combination of enhanced digital support and guidance positively influenced engagement across a range of outcomes. Conclusions: This study is the first to systematically optimize engagement with a digital parenting intervention in a low- and middle-income country. Our findings offer important learnings for developing evidence-based, scalable digital interventions in resource-constrained settings. Trial Registration: Pan-African Clinical Trial Registry PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-023-15989-x %M 40063069 %R 10.2196/60102 %U https://www.jmir.org/2025/1/e60102 %U https://doi.org/10.2196/60102 %U http://www.ncbi.nlm.nih.gov/pubmed/40063069 %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 e64171 %T Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study %A Gaynor,Mathew %A Hesketh,Kylie %A Gebremariam,Kidane %A Wynter,Karen %A Laws,Rachel %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, 75 Pigdons Road, Geelong, 3216, Australia, 61 3 9244 6613, mgaynor@deakin.edu.au %K fathers %K parenting resources %K health promotion %K My Baby Now %K MBN %K app %K mobile phone %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Evolving societal trends are resulting in fathers having an increasing influence on the health-related behaviors that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child’s health. However, parenting resources typically target mothers, with fathers being excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find that mobile health (mHealth) technology does not provide material they can engage with. Objective: This study aimed to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource, the My Baby Now app, as a case study. Methods: A total of 14 purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups and interviews were transcribed verbatim, then coded using a combination of deductive and inductive methods. Reflexive thematic analysis was undertaken to identify patterns and themes. Results: Current parenting apps provide parenting information that can be unappealing for fathers. To improve paternal engagement with mHealth resources, fathers highlighted the need for father specific information, with an increase in positive imagery and positive descriptions of fathers in their parenting role. There should be father-exclusive domains such as forums, and also push notifications to provide positive reinforcement and encouragement for fathers. Conclusions: mHealth has the capacity to deliver information to fathers when needed. This reduces the risk of paternal frustration and disengagement from parenting. Further benefit will be gained by research to understand possible differences in mHealth app usage by fathers of differing socioeconomic position, cultural backgrounds, and family status, such as single fathers and same-sex couples. %M 39982774 %R 10.2196/64171 %U https://pediatrics.jmir.org/2025/1/e64171 %U https://doi.org/10.2196/64171 %U http://www.ncbi.nlm.nih.gov/pubmed/39982774 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65451 %T Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation %A Thompson,Jessica R %A Weber,Summer J %A Mulvaney,Shelagh A %A Goggans,Susanna %A Brown,Madeline %A Faiola,Anthony %A Maamari,Lynn %A Hull,Pamela C %+ , Department of Health Policy and Administration, The Pennsylvania State University, 601E Ford Building, University Park, PA, 16802-1503, United States, 1 8148638129, jrthompson@psu.edu %K mHealth %K childhood obesity %K mixed methods %K pediatric %K healthy lifestyle behaviors %K preschool children %K mobile application %K diet %K physical activity %K exercise %K media use %K sleep %K development %K semi-structured interviews %K healthy eating %K parents %K caregivers %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. %M 39970437 %R 10.2196/65451 %U https://pediatrics.jmir.org/2025/1/e65451 %U https://doi.org/10.2196/65451 %U http://www.ncbi.nlm.nih.gov/pubmed/39970437 %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 %@ 2563-6316 %I JMIR Publications %V 6 %N %P e59379 %T Mothers’ Knowledge of and Practices Toward Oral Hygiene of Children Aged 5-9 Years in Bangladesh: Cross-Sectional Study %A Tamannur,Tahazid %A Das,Sadhan Kumar %A Nesa,Arifatun %A Nahar,Foijun %A Nowshin,Nadia %A Binty,Tasnim Haque %A Shakil,Shafiul Azam %A Kundu,Shuvojit Kumar %A Siddik,Md Abu Bakkar %A Rafsun,Shafkat Mahmud %A Habiba,Umme %A Farhana,Zaki %A Sultana,Hafiza %A Kamil,Anton Abdulbasah %A Rahman,Mohammad Meshbahur %K mothers’ knowledge and practices %K oral hygiene %K child oral health %K Bangladesh %D 2025 %7 3.2.2025 %9 %J JMIRx Med %G English %X Background: Healthy oral hygiene is crucial for overall health and well-being. Parents’ dental care knowledge and practices affect their children’s oral health. Objective: This study examined mothers’ knowledge and practices regarding their children’s oral hygiene through a cross-sectional survey. Methods: This cross-sectional survey was conducted from January 1 to December 31, 2022, in Dhaka, Bangladesh. Mothers’ knowledge and practices regarding their children’s oral hygiene were assessed through a semistructured questionnaire. Statistical analyses, including the χ2 test and Pearson correlation test, were performed. The Mann-Whitney U and Kruskal-Wallis 1-way ANOVA tests were also used to show the average variations in knowledge and practices among different sociodemographic groups. Results: Of 400 participants, the mean age of mothers was 30.94 (SD 5.15) years, and 388 (97%) were of the Muslim faith, 347 (86.8%) were housewives, and 272 (68%) came from nuclear families. A total of 165 (41.3%) participants showed good knowledge of their children’s oral hygiene, followed by 86 (21.5%) showing moderately average knowledge, 75 (18.8%) showing average knowledge, and 74 (18.5%) showing poor knowledge. A total of 182 (45.5%) mothers had children with good oral hygiene practices, followed by mothers with children who had average (n=78, 19.5%), moderately average (n=75, 18.8%), and poor (n=65, 16.3%) oral hygiene practices. The mother’s knowledge level was significantly associated with age (P=.01), education (P<.001), family size (P=.03), and monthly income (P<.001). On the other hand, educational status (P=.002) and income (P=.04) were significantly associated with the mother’s practices regarding their children’s oral hygiene. Nonparametric analysis revealed that mothers who were older (mean knowledge score: 12.13, 95% CI 10.73-13.54 vs 11.21, 95% CI 10.85-11.58; P=.01), with a bachelor’s degree or higher (mean knowledge score: 12.93, 95% CI 12.55‐13.31 vs 9.66, 95% CI 8.95‐10.37; P<.001), who were working mothers (mean knowledge score: 12.30, 95% CI 11.72‐12.89 vs 11.45, 95% CI 11.17‐11.73; P=.03), and who had a higher family income (mean knowledge score: 12.49, 95% CI 12.0‐12.98 vs 10.92, 95% CI 10.48‐11.36; P<.001) demonstrated significantly higher levels of oral health knowledge. Conversely, good oral hygiene practices were significantly associated with higher maternal education (mean practice score: 6.88, 95% CI 6.54‐7.22 vs 6.01, 95% CI 5.63‐6.40; P<.001) and family income (mean practice score: 6.77, 95% CI 6.40‐7.14 vs 5.96, 95% CI 5.68‐6.24; P=.002). The mother’s knowledge was also significantly and positively correlated (Pearson correlation coefficient r=0.301; P<.001) with their children’s oral hygiene practices, shown by both the Pearson chi-square (χ2=25.2; P<.001) test and correlation coefficient. Conclusions: The mothers’ knowledge and their children’s oral hygiene practices were inadequate. The mother’s age, education level, family size, and monthly income significantly influenced their knowledge level. Children’s oral hygiene habits were significantly associated with family income and the mother’s educational status. This underscores the need for educational programs, accessible dental care services, oral health education in the curriculum, media and technology involvement in oral health educational campaigns, and proper research and monitoring. %R 10.2196/59379 %U https://xmed.jmir.org/2025/1/e59379 %U https://doi.org/10.2196/59379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52043 %T Parental Mental Health and Child Maltreatment in the COVID-19 Pandemic: Importance of Sampling in a Quantitative Statistical Study %A Engelke,Lara %A Calvano,Claudia %A Pohl,Steffi %A Winter,Sibylle Maria %A Renneberg,Babette %+ Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838 76522, engelke.l@fu-berlin.de %K COVID-19 %K parental stress %K parental mental health %K child maltreatment %K data collection methods %K web-based surveys %K convenience sample %K sampling methods %D 2025 %7 24.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Results on parental burden during the COVID-19 pandemic are predominantly available from nonrepresentative samples. Although sample selection can significantly influence results, the effects of sampling strategies have been largely underexplored. Objective: This study aimed to investigate how sampling strategy may impact study results. Specifically, we aimed to (1) investigate if outcomes on parental health and child maltreatment during the COVID-19 pandemic from a convenience sample differ from those of a specific representative sample and (2) investigate reasons for differences in the results. Methods: In 2020, we simultaneously conducted 2 studies: (1) a web-based survey using a convenience sample of 4967 parents of underage children, primarily recruited via social media, and (2) a study using a quota sample representative of the German adult population with underage children (N=1024), recruited through a combination of telephone interviews and computer-assisted web interviews. In both studies, the same questionnaire was used. To evaluate the impact of sampling, we compared the results on outcomes (parental stress, subjective health, parental mental health, general stress, pandemic-related stress, and the occurrence of child maltreatment) between the 2 samples. To explain differences in the results between the 2 studies, we controlled for sociodemographic data, parent-related risk factors, and COVID-19–related experiences. Results: Compared to parents from the quota sample, parents from the convenience sample reported significantly more parental stress (η2=0.024); decreased subjective health (η2=0.016); more anxiety and depression symptoms (η2=0.055); more general stress (η2=0.044); more occurrences of verbal emotional abuse (VEA; φ=0.12), witnessing domestic violence (WDV; φ=0.13), nonverbal emotional abuse (NEA; φ=0.03), physical abuse (φ=0.10), and emotional neglect (φ=0.06); and an increase of child maltreatment (VEA: exp(B)=2.95; WDV: exp(B)=3.19; NEA: exp(B)=1.65). Sociodemographic data, parent-related risk factors, and COVID-19–related experiences explained the differences in parental stress (remaining difference between samples after controlling for covariates: η2=0.002) and subjective health (remaining difference between samples after controlling for covariates: η2=0.004) and partially explained differences in parental mental health (remaining: η2=0.016), general stress (remaining: η2=0.014), and child maltreatment (remaining: VEA: exp(B)=2.05 and WDV: exp(B)=2.02) between the 2 samples. The covariates could not explain the difference in NEA (exp(B)=1.70). We discuss further factors that may explain the unexplained differences. Conclusions: Results of studies can be heavily impacted by the sampling strategy. Scientists are advised to collect relevant explaining variables (covariates) that are possibly related to sample selection and the outcome under investigation. This approach enables us to identify the individuals to whom the results apply and to combine findings from different studies. Furthermore, if data on the distribution of these explanatory variables in the population are available, it becomes possible to adjust for sample selection bias. %M 39854726 %R 10.2196/52043 %U https://www.jmir.org/2025/1/e52043 %U https://doi.org/10.2196/52043 %U http://www.ncbi.nlm.nih.gov/pubmed/39854726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57636 %T Parental Technoference and Child Problematic Media Use: Meta-Analysis %A Zhang,Jinghui %A Zhang,Qing %A Xiao,Bowen %A Cao,Yuxuan %A Chen,Yu %A Li,Yan %+ , Shanghai Institute of Early Childhood Education, Shanghai Normal University, 100 Guilin Road, Xuhui District, Shanghai, 200234, China, 86 18939892301, liyan@shnu.edu.cn %K parental technoference %K child %K problematic media use %K meta-analysis %K children %K youth %K adolescents %K phubbing %K screen distraction %K systematic reviews %K interventions %K mental health %K digital health %D 2025 %7 22.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Parental technoference, the interruption of parent-child interactions by technology, has been associated with negative outcomes in children’s media use. However, the magnitude of this relationship and its moderating factors remain unclear. Objective: This study aims to systematically examine the relationship between parental technoference and child problematic media use, as well as to identify moderating factors such as age, parental technoference group, study design, and type of problematic media use. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted up to August 2024 across multiple databases, including Web of Science, EBSCO, ProQuest, PubMed, PsycINFO, and China National Knowledge Infrastructure, using predefined search strings. A total of 53 studies with a total of 60,555 participants (mean age of 13.84, SD 1.18 years) were included. Inclusion criteria comprised studies involving children under the age of 22 years, assessing the association between parental technoference and child problematic media use with valid measures, and reporting necessary statistical data. Exclusion criteria included studies focusing on other child outcomes, having sample sizes <30, or being case reports or review papers. The risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A random-effects meta-analysis was performed using R (version 4.2.1; R Foundation for Statistical Computing) with the meta and metafor packages to evaluate the association and conduct moderator analyses. Results: The meta-analysis identified a significant positive association between parental technoference and child problematic media use (r=0.296, 95% CI 0.259-0.331). Moderator analyses revealed that both parental technoference group (P<.001) and study design (P=.008) significantly influenced this relationship. Specifically, the association was stronger when both parents engaged in technoference compared to when only 1 parent did, and in cross-sectional studies compared to longitudinal studies. Age, gender, publication status, and type of problematic media use did not significantly moderate the relationship (all P>.05). Conclusions: This meta-analysis provides robust evidence of the association between parental technoference and child problematic media use. The findings highlight the need for family-based interventions and underscore the importance of longitudinal research to understand the temporal dynamics of this relationship better. Trial Registration: PROSPERO CRD42023471997; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=471997 %M 39841982 %R 10.2196/57636 %U https://www.jmir.org/2025/1/e57636 %U https://doi.org/10.2196/57636 %U http://www.ncbi.nlm.nih.gov/pubmed/39841982 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66442 %T Early Intervention for Children With Developmental Disabilities and Their Families via Telehealth: Systematic Review %A Shin,Yoomi %A Park,Eun Ju %A Lee,Anna %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-Ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3284, annalee@yuhs.ac %K developmental disabilities %K developmental delay %K early intervention %K telehealth %K digital intervention %K autistic spectrum disorder %K cerebral palsy %K family-centered care %K multidisciplinary care %K systematic review %D 2025 %7 17.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Early intervention during the first 3 years of life is crucial for children with developmental disabilities to optimize developmental outcomes. However, access to such services is often limited by geographical distance and resource constraints. Telehealth can be part of a solution for overcoming these barriers, enabling the delivery of early intervention services. However, a comprehensive understanding of the efficacy and implementation of telehealth in early interventions remains elusive, particularly for children aged 0-3 years. Objective: This systematic review aims to synthesize existing research on the effectiveness and implementation of telehealth interventions in infants and toddlers (aged 0–3 years) who are at risk of or diagnosed with developmental disabilities. The primary objective of the study is to evaluate the ways that telehealth compares to conventional in-person interventions in improving developmental outcomes for children and supporting family well-being. Methods: A systematic search was conducted of 4 electronic databases (PubMed, Embase, CINAHL, and Web of Science), focusing on studies published between 2010 and 2024. The inclusion criteria were studies involving telehealth interventions for children aged 0-3 years who were at high risk or had developmental disabilities, which involved active interactions between the providers and the families. Study quality was assessed using the mixed methods appraisal tool, and a narrative synthesis was used to analyze the data. Results: Eighteen studies met the inclusion criteria: 12 single-case designs, 4 randomized controlled trials, and 2 nonequivalent control group designs. All studies involved caregiver-child dyads, with child ages ranging from 5 to 37 months and having or at risk of autistic spectrum disorder (n=10, 56%), cerebral palsy (n=4, 22%), and other conditions (n=4, 22%). Synchronous videoconferencing was the primary modality for caregiver training and coaching (n=17, 94%) while 1 intervention used an Internet of Things system. Outcomes were identified in child communication (n=9, 50%), physical (n=6, 33%), social or emotional (n=6, 33%), and adaptive behavior (n=4, 22%), as well as caregiver implementation (n=12, 66%). Telehealth demonstrated comparable or superior effectiveness to traditional in-person methods in 2 studies. However, the focus on specific conditions and limited research on cognitive development were notable gaps. Conclusions: Telehealth can be a viable alternative to traditional in-person early interventions for young children who have developmental disabilities and their families. It enhances accessibility and interactions between families and providers at a distance while promoting family-centered care. Challenges exist, including those of technological literacy, and the lack of research on cognitive outcomes must be addressed. Future work should explore more comprehensive interventions, including multidisciplinary approaches and expanded family outcomes, to solidify the role that telehealth plays in early intervention. Trial Registration: PROSPERO CRD42024551286; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=551286 %M 39819975 %R 10.2196/66442 %U https://www.jmir.org/2025/1/e66442 %U https://doi.org/10.2196/66442 %U http://www.ncbi.nlm.nih.gov/pubmed/39819975 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e55235 %T A Holistic Digital Health Framework to Support Health Prevention Strategies in the First 1000 Days %A Gabrielli,Silvia %A Mayora Ibarra,Oscar %A Forti,Stefano %K digital health %K digital therapeutics %K behavioral intervention technology %K prevention %K citizen science %K first 1000 days %D 2025 %7 16.1.2025 %9 %J JMIR Pediatr Parent %G English %X The first 1000 days of a child’s life, spanning from the time of conception until 2 years of age, are a key period of laying down the foundations of optimum health, growth, and development across the lifespan. Although the role of health prevention programs targeting families and children in the first 1000 days of life is well recognized, investments in this key period are scarce, and the provision of adequate health care services is insufficient. The aim of this viewpoint is to provide a holistic digital health framework cocreated with policy makers, health care professionals, and families to support more effective efforts and health care programs dedicated to the first 1000 days of life as the first line of prevention. The framework provides recommendations for leveraging on behavioral intervention technology and digital therapeutics solutions augmented by artificial intelligence to support the effective deployment of health prevention programs to families. The framework also encourages the adoption of a citizen science approach to co-design and evolve the digital health interventions with all relevant stakeholders in a real-world research perspective. %R 10.2196/55235 %U https://pediatrics.jmir.org/2025/1/e55235 %U https://doi.org/10.2196/55235 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62943 %T Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study %A Kakon,Shahria Hafiz %A Soron,Tanjir Rashid %A Hossain,Mohammad Sharif %A Haque,Rashidul %A Tofail,Fahmida %K screen time %K parental supervision %K Strength and Difficulties Questionnaire %K Spencer Children Anxiety Scale %K Pittsburgh Sleep Quality Scale %K children %K sleep quality %K headache %K behavioral problems %D 2025 %7 14.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Children’s screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6‐14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1% versus 161/336 students, 47.9%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3%) and peer difficulties (121/420 students, 28.8%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools. %R 10.2196/62943 %U https://pediatrics.jmir.org/2025/1/e62943 %U https://doi.org/10.2196/62943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58611 %T A Digital Parenting Intervention With Intimate Partner Violence Prevention Content: Quantitative Pre-Post Pilot Study %A Schafer,Moa %A Lachman,Jamie %A Zinser,Paula %A Calderón Alfaro,Francisco Antonio %A Han,Qing %A Facciola,Chiara %A Clements,Lily %A Gardner,Frances %A Haupt Ronnie,Genevieve %A Sheil,Ross %+ Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865 2703, moa.schafer@spi.ox.ac.uk %K intimate partner violence %K SMS text messaging %K chatbot %K user engagement %K parenting %K violence %K mobile phone %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) and violence against children are global issues with severe consequences. Intersections shared by the 2 forms of violence have led to calls for joint programming efforts to prevent both IPV and violence against children. Parenting programs have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting program ParentText, a digital parenting chatbot, this pilot study seeks to explore parents’ engagement with the IPV prevention content in ParentText and explore preliminary changes in IPV. Objective: This study aimed to assess parents’ and caregivers’ level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary changes in experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviors following the intervention. Methods: Caregivers of children aged between 0 and 18 years were recruited through convenience sampling by research assistants in Cape Town, South Africa, and by UNICEF (United Nations Children's Fund) Jamaica staff in 3 parishes of Jamaica. Quantitative data from women in Jamaica (n=28) and South Africa (n=19) and men in South Africa (n=21) were collected electronically via weblinks sent to caregivers’ phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviors and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Chi-square tests and 2-tailed paired dependent-sample t tests were used to investigate potential changes in IPV outcomes between pretest and posttest. Results: The average daily interaction rate with the program was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least 1 IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses indicated significant pre-post reductions in overall IPV experience among women in South Africa (P=.01) and Jamaica (P=.01) and in men’s overall harmful IPV attitudes (P=.01) and increases in men’s overall gender-equitable behaviors (P=.02) in South Africa. Conclusions: To the best of our knowledge, this is the first pilot study to investigate user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results suggest promising yet modest reductions in IPV and improvements in attitudes after the program. Further research using a randomized controlled trial is warranted to establish causality. %M 39753219 %R 10.2196/58611 %U https://formative.jmir.org/2025/1/e58611 %U https://doi.org/10.2196/58611 %U http://www.ncbi.nlm.nih.gov/pubmed/39753219 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58757 %T Parental Information-Use Strategies in a Digital Parenting Environment and Their Associations With Parental Social Support and Self-Efficacy: Cross-Sectional Study %A Onishi,Ryuta %+ Faculty of Nursing, Toyama Prefectural University, 2-2-78, Nishinagae, Toyama-shi, Toyama-ken, Japan, 81 76 464 5410, onishi.r1121@pu-toyama.ac.jp %K parenting %K information use %K digital society %K online information %K social support %K self-efficacy %K parents %K surveys %K information seeking %K information behaviors %K resources %K children %K youth %K pediatric %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In today’s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNSs) has become widespread. Amid the mix of online and offline information sources, there is a need to discover effective information-seeking methods for solving parenting problems. Objective: This study aimed to identify patterns of information use among parents of young children in the digital age and elucidate the characteristics of these patterns through a comparative analysis of parental social support and self-efficacy. Methods: An internet-based survey was administered to fathers and mothers of children aged 0-3 years. Convenience sampling, facilitated by an internet-based survey company, was adopted, and data from 227 fathers and 206 mothers were analyzed. The survey included questions on personal characteristics, frequency of use of different sources of parenting information (websites, SNSs, parenting apps, family, friends, and professionals), availability of parental social support, and parental self-efficacy. The Partitioning Around Medoids (PAM) clustering algorithm was used to identify patterns in parenting information use. Results: A total of 4 clusters were identified: multisource gatherers (n=161), offline-centric gatherers (n=105), online-centric gatherers (n=86), and minimal information gatherers (n=68). The availability of parental social support was perceived to be relatively higher among multisource and offline-centric gatherers compared with online-centric and minimal information gatherers. Parental self-efficacy was highest among multisource gatherers, followed by offline-centric and online-centric gatherers, and lowest among minimal information gatherers. Conclusions: This study contributes to the evidence that online information can effectively complement offline information in addressing parenting challenges, although its ability to fully replace offline sources remains limited. Parenting support professionals are encouraged to understand parents’ current information use strategies and actively foster their social relationships, helping them to adopt more diverse and comprehensive approaches to information use. %M 39700496 %R 10.2196/58757 %U https://pediatrics.jmir.org/2024/1/e58757 %U https://doi.org/10.2196/58757 %U http://www.ncbi.nlm.nih.gov/pubmed/39700496 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57702 %T Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study %A Pathak,Priya R %A Stockwell,Melissa S %A Lane,Mariellen M %A Robbins-Milne,Laura %A Friedman,Suzanne %A Pethe,Kalpana %A Krause,Margaret C %A Soren,Karen %A Matiz,Luz Adriana %A Solomon,Lauren B %A Burke,Maria E %A Bracho-Sanchez,Edith %+ Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, 622 W 168th Street, VC 417, New York, NY, 10032, United States, 1 6084404396, pp2841@cumc.columbia.edu %K telemedicine %K telehealth %K pediatric primary care %K COVID-19 pandemic %K disparities %K primary care %K pediatrics %K portals %K access %K accessibility %K accessible %K use %K demographics %K low income %K Latino %K Hispanic %K Spanish %K mobile phone %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. Methods: A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. Results: There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4% (n=8959) of the population. Nearly all patients (n=10,830, 87.5%) had an activated portal, and 33.8% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95% CI 0.51-0.76; 5-11 years: aOR 0.28, 95% CI 0.23-0.32; 12-14 years: aOR 0.29, 95% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95% CI 0.74-0.89 and aOR 0.71, 95% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1%), dermatology (n=1287, 19.5%), gastrointestinal (n=771, 11.7%), well and follow-up care (n=459, 7%), and other specialty-related care (n=415, 6.3%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. Conclusions: The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations. %M 39689903 %R 10.2196/57702 %U https://pediatrics.jmir.org/2024/1/e57702 %U https://doi.org/10.2196/57702 %U http://www.ncbi.nlm.nih.gov/pubmed/39689903 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54862 %T Stunting Super App as an Effort Toward Stunting Management in Indonesia: Delphi and Pilot Study %A Erika,Kadek Ayu %A Fadilah,Nur %A Latif,Aulia Insani %A Hasbiah,Nurhikmawaty %A Juliaty,Aidah %A Achmad,Harun %A Bustamin,Anugrayani %K stunting %K stunting prevention %K mobile app %D 2024 %7 17.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Currently, 30 million children are experiencing acute malnutrition, and 8 million children are severely underweight. Objective: This study aimed to develop a stunting super app, a one-stop app designed to prevent and manage stunting in Indonesia. Methods: This study consisted of three stages. Stage 1 used a 3-round Delphi study involving 12 experts. In stage 2, 4 experts and a parent of children with stunted growth created an Android app containing stunting educational materials. In stage 3, a pilot study involving a control group was conducted to evaluate parents’ knowledge about stunting prevention through the app and standard interventions. Results: In the Delphi study, 11 consensus statements were extracted; arranged in three major themes, including maternal health education, child health education, and environmental education; and applied in the form of the Sistem Evaluasi Kesehatan Anak Tumbuh Ideal (SEHATI) app. This app was assessed using a content validity index, with a cumulative agreement of ≥80% among the 5 individuals. The pilot study showed an increase in the knowledge of mothers of toddlers with stunted growth before and after the educational intervention (P=.001). Conclusions: The SEHATI app provides educational content on stunting prevention that can increase the knowledge of mothers of toddlers with stunted growth. %R 10.2196/54862 %U https://humanfactors.jmir.org/2024/1/e54862 %U https://doi.org/10.2196/54862 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59696 %T Gender Inequalities in Employment of Parents Caring for Children With Autism Spectrum Disorder in China: Cross-Sectional Study %A Zhao,Yanan %A Fan,Huiyun %A Luo,Yanan %A Zhang,Rong %A Zheng,Xiaoying %K autism spectrum disorder %K family %K employment status %K influencing factors %K autism %K child care %K children %K China %K parent %K online survey %K mother %K father %K adolescent %K youth %K ASD %K children with autism %D 2024 %7 17.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The increasing need for child care is placing a burden on parents, including those with children with autism. Objective: The aim of this study was to examine the employment status of Chinese mothers and fathers with children with autism spectrum disorder (ASD), as well as to investigate the factors that affected their employment decisions. Methods: An online national survey was completed by the parents of 5018 children and adolescents with ASD aged 2-17 years (4837 couples, 181 single mothers, and 148 single fathers). The dependent variable was employment status—whether they kept working or quit to take care of their child. The independent variables were those characterizing the needs of the child and the sociodemographic characteristics of the family. Results: The employment rate of mothers with children and adolescents with ASD was 37.3% (1874/5018), while 96.7% (4823/4988) of fathers were employed. In addition, 54.3% (2723/5018) of mothers resigned from employment outside the home to care for their children, while only 2.8% (139/4988) of fathers resigned due to caring obligations. Mothers’ employment was positively associated with their single marital status, lower educational level, and having assistance from grandparents. Having the grandparents’ assistance was positively associated with fathers’ employment. Conclusions: Gender inequalities in employment exist in China. Mothers caring for children with ASD had lower workforce participation than fathers. More female-friendly policies and a stronger gender equality ideology would be of benefit to Chinese society. %R 10.2196/59696 %U https://pediatrics.jmir.org/2024/1/e59696 %U https://doi.org/10.2196/59696 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60352 %T Electronic Communication Between Children’s Caregivers and Health Care Teams: Scoping Review on Parental Caregiver’s Perceptions and Experience %A Gamper,Mary Jo %A Singer Cohen,Rebecca %A Esperanza Razaz,Maryam %A Parrillo,Elaina %A Thornton,Clifton P %A Wec,Aleksandra %A McDonald,Kathryn %A Gleason,Kelly T %K electronic communication %K patient portal %K provider-patient relations %K parental caregiver %K relational coordination theory %K patient-clinician relationship %K mobile phone %D 2024 %7 13.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Asynchronous communication via electronic modes (e-communication), including patient portals, secure messaging services, SMS text messaging, and email, is increasingly used to supplement synchronous face-to-face medical visits; however, little is known about its quality in pediatric settings. Objective: This review aimed to summarize contemporary literature on pediatric caregivers’ experiences with and perspectives of e-communication with their child’s health care team to identify how e-communication has been optimized to improve patient care. Methods: A scoping review following the Arksey and O’Malley methodological framework searched PubMed, CINAHL, Embase, and Web of Science using terms such as “Electronic Health Records” and “Communication” from 2013 to 2023 that discussed caregiver experiences and perspectives of e-communication with their child’s health care provider. Studies were excluded if they were abstracts, non-English papers, nonscientific papers, systematic reviews, or quality improvement initiatives, or pertained to synchronous telemedicine. We conducted a two-step screening process by scanning the title and abstract and reviewing the full text by two independent screeners to confirm eligibility. From an initial 903 articles identified via the database search, 23 articles fulfilled all the inclusion criteria and are included in this review. Results: Of the 23 articles meeting the inclusion criteria, 11 used quantitative methods, 7 used qualitative methods, and 5 used mixed methods. The caregiver sample sizes ranged from 51 to 3339 in the quantitative studies and 8 to 36 in the qualitative and mixed methods studies. A majority (n=17) used the patient portal that was self-categorized by the study. Secure messaging through a portal or other mobile health app was used in 26% (n=6) of the studies, while nonsecure messaging outside of the portal was used 17% (n=4) of the time and email was used 33.3% (n=8) of the time. In 19 of the studies, parents reported positive experiences with and a desire for e-communication methods. Conclusions: The literature overwhelmingly supported caregiver satisfaction with and desire for e-communication in health care, but no literature intentionally studied how to improve the quality of e-communication, which is a critical gap to address. %R 10.2196/60352 %U https://pediatrics.jmir.org/2024/1/e60352 %U https://doi.org/10.2196/60352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55639 %T Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study %A Aldridge,Grace %A Wu,Ling %A Seguin,Joshua Paolo %A Robinson,Jennifer %A Battaglia,Elizabeth %A Olivier,Patrick %A Yap,Marie B H %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, 3800, Australia, 61 3 9905 0723, marie.yap@monash.edu %K co-design %K service design %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K health care services %K adverse childhood experience %K ACE %K mental disorder %K innovate %K social services %K community health %K evidence-based %K parenting intervention %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent’s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite’s design. Results: PaRK-Lite’s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents’ empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. %M 39576676 %R 10.2196/55639 %U https://formative.jmir.org/2024/1/e55639 %U https://doi.org/10.2196/55639 %U http://www.ncbi.nlm.nih.gov/pubmed/39576676 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60692 %T Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City %A Gerchow,Lauren %A Lanier,Yzette %A Fayard,Anne-Laure %A Squires,Allison %+ Rory Meyers College of Nursing, New York University, 433 1st Ave, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, lmg490@nyu.edu %K adolescent %K reproductive health %K sexual health %K cocreation %K co-design %K human-centered design %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. %M 39560978 %R 10.2196/60692 %U https://pediatrics.jmir.org/2024/1/e60692 %U https://doi.org/10.2196/60692 %U http://www.ncbi.nlm.nih.gov/pubmed/39560978 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56807 %T Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study %A Rivera Rivera,Jessica Nathalie %A AuBuchon,Katarina E %A Smith,Marjanna %A Starling,Claire %A Ganacias,Karen G %A Danielson,Aimee %A Patchen,Loral %A Rethy,Janine A %A Blumenthal,H Joseph %A Thomas,Angela D %A Arem,Hannah %+ Healthcare Delivery Research Network, MedStar Health Research Institute, 3007 Tilden Street NW, Suite 6N, Washington, DC, 20008, United States, 1 4436921138, jessica.n.riverarivera@medstar.net %K postpartum care %K newborn care %K health education %K chatbot %K mHealth %K mobile health %K feedback %K health equity %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The 42 days after delivery (“fourth trimester”) are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical “fourth trimester,” we developed 2 ruled-based chatbots—one for birthing individuals and one for newborn caregivers—that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot’s impact on health outcomes and reduce disparities. %M 39541147 %R 10.2196/56807 %U https://pediatrics.jmir.org/2024/1/e56807 %U https://doi.org/10.2196/56807 %U http://www.ncbi.nlm.nih.gov/pubmed/39541147 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e62878 %T Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review %A Garikipati,Anurag %A Ciobanu,Madalina %A Singh,Navan Preet %A Barnes,Gina %A Dinenno,Frank A %A Geisel,Jennifer %A Mao,Qingqing %A Das,Ritankar %K applied behavior analysis %K autism spectrum disorder %K parent training %K patient outcomes %K skill acquisition %K pediatrics %D 2024 %7 30.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual’s life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap. Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (“Forta”), as measured by progress toward skill acquisition within multiple focus areas (FAs). Methods: Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25‐40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13‐22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house. Results: Improved goal achievement success between weeks 1‐20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045). Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care. %R 10.2196/62878 %U https://pediatrics.jmir.org/2024/1/e62878 %U https://doi.org/10.2196/62878 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53657 %T Caregiver and Youth Characteristics That Influence Trust in Digital Health Platforms in Pediatric Care: Mixed Methods Study %A Chow,Eric %A Virani,Alice %A Pinkney,Susan %A Abdulhussein,Fatema S %A van Rooij,Tibor %A Görges,Matthias %A Wasserman,Wyeth %A Bone,Jeffrey %A Longstaff,Holly %A Amed,Shazhan %+ Department of Pediatrics, BC Children’s Hospital, 4480 Oak Street, Room K4-206, Vancouver, BC, V6H 3V4, Canada, 1 604 875 2117, SAmed@cw.bc.ca %K pediatrics %K patient trust %K security %K data privacy %K data sharing %K caregivers %K patient engagement %K co-design %K personal health information %K secondary use of data %D 2024 %7 28.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Combining patient-generated health data and digital health platforms may improve patient experience and population health, mitigate rising health care costs, reduce clinician burnout, and enable health equity. However, lack of trust may be a notable barrier to the data-sharing required by such platforms. Understanding sociodemographic, health, and personal characteristics will enable developers and implementers of such technologies to consider these in their technical design requirements. Objective: This study aims to understand relationships between sociodemographic characteristics of caregivers of children or adolescents and trust in and willingness to use digital platforms to store and share personal health information for clinical care and research. Methods: This study used a mixed methods approach, including surveys of caregivers of youth aged <18 years living in Canada or the United States and youth aged 16 to 17 years living in Canada, as well as web-based bulletin board discussions to further explore topics of trust in data sharing. Sociodemographic and survey data were tabulated and explored using proportional odds ordinal regression models. Comments from web-based group discussions were analyzed thematically using a coding approach to identify issues important to the participants. Results: Survey data from 1128 caregivers (female participants: n=549, 48.7%; 36-50 years old: n=660, 58.5%; Canadian: n=603, 53.5%; urban population: n=494, 43.8%) were collected, of which 685 (60.7%) completed all questions. Data from 173 youth (female participants: n=73, 42.2%; urban population: n=94, 54.3%) were collected, of which 129 (74.6%) completed all questions, and data were available for analysis. Furthermore, among 40 participants, 23 (58%) caregivers contributed to the web-based discussion boards. Related to trust, living in a rural area (vs urban; odds ratio [OR] 0.66, 95% CI 0.46-0.95) resulted in lower concern for data privacy and security, while having an undergraduate (OR 1.82, 95% CI 1.30-2.55) or graduate degree (vs secondary or trade school; OR 2.50, 95% CI 1.68-3.73) resulted in higher levels of concern. Living with a chronic disease (OR 1.81, 95% CI 1.35-2.44) increased levels of concern regarding data privacy and security. Interestingly, those with chronic disease were more willing to use digital platforms for clinical care and share personal health information for not-for-profit research. Caregivers were most concerned about data breaches involving data from their children but also highlighted that digital platforms would allow for better coordination of care for their children. Conclusions: Our research confirms the willingness of caregivers and youth to use digital platforms for both clinical care delivery and research and suggests that the value of a digital platform may outweigh the risks of its use. Engagement of end users in co-designing such platforms has the potential to enhance digital trust. However, digital trust varies across sociodemographic groups; therefore, diverse end user engagement is necessary when designing digital applications. %M 39467279 %R 10.2196/53657 %U https://www.jmir.org/2024/1/e53657 %U https://doi.org/10.2196/53657 %U http://www.ncbi.nlm.nih.gov/pubmed/39467279 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55372 %T Parenting Information on Social Media: Systematic Literature Review %A Mertens,Ellen %A Ye,Guoquan %A Beuckels,Emma %A Hudders,Liselot %+ Department of Communication Sciences, Ghent University, Sint-pietersnieuwstraat 41, Ghent, 9000, Belgium, 32 32 09 264 68 90, ellen.mertens@ugent.be %K parenting %K social media %K parenting information %K systematic literature review %K bibliometric literature review %K thematic analysis %D 2024 %7 23.10.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: Social media has become extremely popular among parents to seek parenting information. Despite the increasing academic attention to the topic, studies are scattered across various disciplines. Therefore, this study broadens the scope of the existing reviews by transcending narrow academic subdomains and including all relevant research insights related to parents’ information seeking on social media and its consequent effects. Objective: The aims of this systematic literature review were to (1) identify influential journals and scholars in the field; (2) examine the thematic evolution of research on parenting and social media; and (3) pinpoint research gaps, providing recommendations for future exploration. Methods: On the basis of a criteria for identifying scholarly publications, we selected 338 studies for this systematic literature review. We adopted a bibliometric analysis combined with a content thematic analysis to obtain data-driven insights with a profound understanding of the predominant themes in the realm of parenting and social media. Results: The analysis revealed a significant increase in research on parenting and social media since 2015, especially in the medical domain. The studies in our review spanned 232 different research fields, and the most prolific journal was JMIR Pediatrics and Parenting. The thematic analysis identified 4 emerging research themes in the studies: parenting motivations to seek information, nature of parenting content on social media, impact of parenting content, and interventions for parents on social media. Conclusions: This study provides critical insights into the current research landscape of parenting and social media. The identified themes, research gaps, and future research recommendations provide a foundation for future studies, guiding researchers toward valuable areas for exploration. %M 39442173 %R 10.2196/55372 %U https://pediatrics.jmir.org/2024/1/e55372 %U https://doi.org/10.2196/55372 %U http://www.ncbi.nlm.nih.gov/pubmed/39442173 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59029 %T Parenting-Related Social Networking Site Use and Psychological Distress in Parents of Infants: Cross-sectional Study Exploring the Moderating Effects of Loneliness and Parenting Anxiety %A Onishi,Ryuta %K social networking sites %K social media %K psychological distress %K loneliness %K anxiety %K social support %K mother %K father %K infant %K psychological %K distress %K children %K web-based questionnaire %K parent %D 2024 %7 11.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: In the digital age, social networking sites (SNSs) have revolutionized the approach to parenting. These platforms, widely used to access parenting information and support, affect parents both positively and negatively, with negative effects potentially increasing for those experiencing loneliness or anxiety. Objective: This study examined the relationship between SNS use and psychological distress among parents of young children, controlling for the moderating effects of loneliness and parenting anxiety. We hypothesized that higher SNS use correlates to greater psychological distress, particularly among parents with elevated levels of loneliness or parenting anxiety. Methods: A cross-sectional survey design using a closed web-based questionnaire was employed. Participants included 429 parents (205 mothers and 224 fathers) of children aged 0‐3 years recruited through a web-based survey company in Japan. The majority of the participants were couples, with some living with extended family members. The sample also encompassed individuals in cohabiting partnerships and single parents. The survey included measures of psychological distress, loneliness, parenting anxiety, frequency of SNS use for parenting, and covariates. Analytical models to explain psychological distress included interactions between loneliness or parenting anxiety and SNS use, individually for both fathers and mothers. Results: For mothers, a significant interaction effect was determined only between parenting anxiety and SNS use (b=0.247, SE 0.091; P=.008). Meanwhile, for fathers, significant interaction effects were observed for both loneliness (b=0.324, SE 0.127; P=.012) and parenting anxiety (b=0.144, SE 0.069; P=.038) with SNS use. A simple slope analysis for mothers indicated that SNS use was related to psychological distress only at higher levels of parenting anxiety (b=0.304, SE 0.090, β=.317; P<.001). Among fathers, SNS use was associated with psychological distress at higher levels of either parenting anxiety (b=0.330, SE 0.069, β=.346; P<.001) or loneliness (b=0.390, SE 0.098, β=.409; P<.001). Conclusions: The study concluded that the relationship between SNS use and psychological distress among parents of young children is moderated by loneliness and parenting anxiety. The findings highlight the need for tailored approaches to help parents manage SNS use, particularly focusing on those with higher levels of loneliness and parenting anxiety. It is imperative that health professionals provide nuanced guidance to parents on SNS use, considering individual psychological factors and potential gender differences in the impact of SNSs on mental well-being. %R 10.2196/59029 %U https://pediatrics.jmir.org/2024/1/e59029 %U https://doi.org/10.2196/59029 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53864 %T Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial %A Pokorna,Nikola %A Palmer,Melanie %A Pearson,Oliver %A Beckley-Hoelscher,Nicholas %A Shearer,James %A Kostyrka-Allchorne,Katarzyna %A Robertson,Olly %A Koch,Marta %A Slovak,Petr %A Day,Crispin %A Byford,Sarah %A Waite,Polly %A Creswell,Cathy %A Sonuga-Barke,Edmund J S %A Goldsmith,Kimberley %+ Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, edmund.sonuga-barke@kcl.ac.uk %K parenting %K intervention %K smartphone app %K randomized controlled trial %K COVID-19 pandemic %K moderators %K conduct problems %K emotional problems %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: A smartphone app, Parent Positive, was developed to help parents manage their children’s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children’s emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive’s effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=–0.41, 95% CI –0.82 to 0.0004; P=.05) or significant (T3: B=–0.76, 95% CI –1.22 to –0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive’s potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 %M 39378100 %R 10.2196/53864 %U https://pediatrics.jmir.org/2024/1/e53864 %U https://doi.org/10.2196/53864 %U http://www.ncbi.nlm.nih.gov/pubmed/39378100 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55726 %T The Feasibility and Acceptability of Using a Digital Conversational Agent (Chatbot) for Delivering Parenting Interventions: Systematic Review %A Klapow,Max C %A Rosenblatt,Andrew %A Lachman,Jamie %A Gardner,Frances %+ Department of Experimental Psychology, University of Oxford, Anna Watts Building, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 01865 271444, maxwell.klapow@psy.ox.ac.uk %K chatbot %K parenting intervention %K feasibility %K acceptability %K systematic review %K implementation %D 2024 %7 7.10.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: Parenting interventions are crucial for promoting family well-being, reducing violence against children, and improving child development outcomes; however, scaling these programs remains a challenge. Prior reviews have characterized the feasibility, acceptability, and effectiveness of other more robust forms of digital parenting interventions (eg, via the web, mobile apps, and videoconferencing). Recently, chatbot technology has emerged as a possible mode for adapting and delivering parenting programs to larger populations (eg, Parenting for Lifelong Health, Incredible Years, and Triple P Parenting). Objective: This study aims to review the evidence of using chatbots to deliver parenting interventions and assess the feasibility of implementation, acceptability of these interventions, and preliminary outcomes. Methods: This review conducted a comprehensive search of databases, including Web of Science, MEDLINE, Scopus, ProQuest, and Cochrane Central Register of Controlled Trials. Cochrane Handbook for Systematic Review of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to conduct the search. Eligible studies targeted parents of children aged 0 to 18 years; used chatbots via digital platforms, such as the internet, mobile apps, or SMS text messaging; and targeted improving family well-being through parenting. Implementation measures, acceptability, and any reported preliminary measures of effectiveness were included. Results: Of the 1766 initial results, 10 studies met the inclusion criteria. The included studies, primarily conducted in high-income countries (8/10, 80%), demonstrated a high mean retention rate (72.8%) and reported high acceptability (10/10, 100%). However, significant heterogeneity in interventions, measurement methods, and study quality necessitate cautious interpretation. Reporting bias, lack of clarity in the operationalization of engagement measures, and platform limitations were identified as limiting factors in interpreting findings. Conclusions: This is the first study to review the implementation feasibility and acceptability of chatbots for delivering parenting programs. While preliminary evidence suggests that chatbots can be used to deliver parenting programs, further research, standardization of reporting, and scaling up of effectiveness testing are critical to harness the full benefits of chatbots for promoting family well-being. %M 39374516 %R 10.2196/55726 %U https://pediatrics.jmir.org/2024/1/e55726 %U https://doi.org/10.2196/55726 %U http://www.ncbi.nlm.nih.gov/pubmed/39374516 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54914 %T Parent Education and Counseling (PairEd-C) Intervention to Improve Family-Centered Care: Protocol for a Prospective Acceptability Study Using the Theoretical Framework of Acceptability %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, Universitetsplatsen 1, Forskningsgången, Göteborg, 405 30, Sweden, 46 733268716, nataliya.berbyuk.lindstrom@ait.gu.se %K family-centered care %K child cancer %K theoretical framework of acceptability %K education and counseling %K acceptability %K parent education %K family centered %K care service %K theoretical framework %K study protocol %K family %K health care %K well-being %K children %K implementation %K design intervention %D 2024 %7 4.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family-centered care (FCC) is an intervention approach based on a respectful relationship between family and health care providers (HCPs) to ensure the health and well-being of children and their families. Although HCPs have a better perception of FCC, the level of its implementation is low. Reasons for low implementation include limited understanding, lack of training, and lack of implementation guidelines and tools to support implementation. Thus, we developed the Parent Education and Counseling (PairEd-C) intervention to improve FCC in pediatric oncology settings and assess its acceptability. Objective: The objective of this study is to assess the prospective acceptability of the PairEd-C intervention using the theoretical framework of acceptability (TFA) in the pediatric oncology department in a tertiary hospital in Ethiopia. Methods: The study was conducted using an exploratory qualitative study design. We aimed to recruit 10 to 15 participants for the in-depth interview. The study participants were health service leaders working in child cancer, HCPs, social workers, and parents of children with cancer. The intervention was developed using the integration of the first phase of the Medical Research Council (MRC) framework for developing and testing complex interventions and the behavior change wheel (BCW) framework. The main PairEd-C intervention components align with the intervention functions of education, persuasion, training, environmental restructuring, modeling, and enablement, which were intended to improve FCC in the pediatric oncology unit by providing structured and comprehensive education and counseling of parents of children with cancer. The intervention was implemented by providing training for the health care team, facilitating discussion among HCPs and setting a shared plan, improving the commitment of the health care team, providing education for parents, improving parents’ capacity to attend the intervention sessions, arranging discussion among parents of children with cancer, and provision of education and counseling on distress. The HCPs working in the unit received training on the designed intervention. The trained educators and the health care provider delivered the intervention. Data will be analyzed using deductive thematic coding with a framework analysis technique based on the 7 TFA constructs. Atlas ti. version 9 will be used for data analysis. Results: Funding was acquired in 2017, and ethical clearance for conducting the study was obtained. We conducted the interviews with the study participants from December 2023 to January 2024. As of the acceptance of this protocol (June 2024), 12 study participants were interviewed. The data analysis process was started subsequently, and the manuscript will be completed and submitted for publication in early 2025. Conclusions: This acceptability study is expected to show that the designed intervention is acceptable to study participants, and the findings will be used to improve the intervention before progressing to the next step of our project. International Registered Report Identifier (IRRID): DERR1-10.2196/54914 %M 39365661 %R 10.2196/54914 %U https://www.researchprotocols.org/2024/1/e54914 %U https://doi.org/10.2196/54914 %U http://www.ncbi.nlm.nih.gov/pubmed/39365661 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60604 %T Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial %A Horita,Hideki %A Seki,Yoichi %A Yamaguchi,Takumi %A Shiko,Yuki %A Kawasaki,Yohei %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 inohana, Chiba City, 2608670, Japan, 81 476207779, horitah@iuhw.ac.jp %K internet addiction %K adolescents %K parents %K cognitive behavioral therapy %K digital health %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent’s problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents’ hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 %M 39361415 %R 10.2196/60604 %U https://pediatrics.jmir.org/2024/1/e60604 %U https://doi.org/10.2196/60604 %U http://www.ncbi.nlm.nih.gov/pubmed/39361415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48695 %T Assessing the Feasibility of Using Parents’ Social Media Conversations to Inform Burn First Aid Interventions: Mixed Methods Study %A Bennett,Verity %A Spasić,Irena %A Filimonov,Maxim %A Muralidaran,Vigneshwaran %A Kemp,Alison Mary %A Allen,Stuart %A Watkins,William John %+ Children’s Social Care Research and Development Centre, School of Social Sciences, Cardiff University, SPARK Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom, 44 029 2251 2360, bennettcv@cardiff.ac.uk %K social media %K burn first aid %K health interventions %K parents %K burns %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Burns are common childhood injuries, which can lead to serious physical and psychological outcomes. Appropriate first aid is essential in managing the pain and severity of these injuries; hence, parents who need timely access to such information often seek it from the web. In particular, social media allow them to reach other parents, hence these conversations may provide insight to aid the design and evaluation of burn first aid interventions for parents. Objective: This study aims to determine the feasibility of finding, accessing, and analyzing parent burn first aid conversations on social media to inform intervention research. Methods: The initial choice of the relevant social media was made based on the results of a parent focus group and survey. We considered Facebook (Meta Platforms, Inc), Mumsnet (Mumsnet Limited), Netmums (Aufeminin Group), Twitter (subsequently rebranded as “X”; X Corp), Reddit (Reddit, Inc), and YouTube (Google LLC). To locate the relevant data on these platforms, we collated a taxonomy of search terms and designed a search strategy. A combination of natural language processing and manual inspection was used to filter out irrelevant data. The remaining data were analyzed manually to determine the length of conversations, the number of participants, the purpose of the initial post (eg, asking for or offering advice), burn types, and distribution of relevant keywords. Results: Facebook parenting groups were not accessed due to privacy, and public influencer pages yielded scant data. No relevant data were found on Reddit. Data were collected from Mumsnet, Netmums, YouTube, and Twitter. The amount of available data varied across these platforms and through time. Sunburn was identified as a topic across all 4 platforms. Conversations on the parenting forums Mumsnet and Netmums were started predominantly to seek advice (112/116, 96.6% and 25/25, 100%, respectively). Conversely, YouTube and Twitter were used mainly to provide advice (362/328, 94.8% and 126/197, 64%, respectively). Contact burns and sunburn were the most frequent burn types discussed on Mumsnet (30/94, 32% and 23/94, 25%, respectively) and Netmums (2/25, 8% and 14/26, 56%, respectively). Conclusions: This study provides a suite of bespoke search strategies, tailored to a range of social media platforms, for the extraction and analysis of burn first aid conversation data. Our methodology provides a template for other topics not readily accessible via a specific search term or hashtag. YouTube and Twitter show potential utility in measuring advice offered before and after interventions and extending the reach of messaging. Mumsnet and Netmums present the best opportunity for informing burn first aid intervention design via an in-depth qualitative investigation into parents’ knowledge, attitudes, and behaviors. %M 39326036 %R 10.2196/48695 %U https://formative.jmir.org/2024/1/e48695 %U https://doi.org/10.2196/48695 %U http://www.ncbi.nlm.nih.gov/pubmed/39326036 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51273 %T The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review %A Magnuson,Katherine I %A Li,Kexin %A Beuley,Grace %A Ryan-Pettes,Stacy R %+ Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building, 101 Bagby Ave, Waco, TX, 76706, United States, 1 (254) 710 2961, katherine.magnuson@childrens.com %K behavioral parent training %K mobile health %K mHealth %K mobile app %K adolescent %K substance use %K child mental health condition %K mobile phone %D 2024 %7 24.9.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. Objective: This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. Results: Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. Conclusions: Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings. %M 39316435 %R 10.2196/51273 %U https://mhealth.jmir.org/2024/1/e51273 %U https://doi.org/10.2196/51273 %U http://www.ncbi.nlm.nih.gov/pubmed/39316435 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58344 %T Effectiveness of a Parent-Based eHealth Intervention for Physical Activity, Dietary Behavior, and Sleep Among Preschoolers: Protocol for a Randomized Controlled Trial %A Zhou,Peng %A Song,Huiqi %A Lau,Patrick W C %A Shi,Lei %A Wang,Jingjing %+ Department of Sport, Physical Education and Health, Faculty of Arts and Social Sciences, Hong Kong Baptist University, Room AAB 1103, 11/F, Academic and Administration Building, Baptist University Road Campus, Kowloon Tong, Hong Kong, China (Hong Kong), 852 93774078, wclau@hkbu.edu.hk %K physical activity %K dietary behavior %K sleep %K electronic health %K eHealth %K preschoolers %K parenting %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preschoolers’ lifestyles have become physically inactive and sedentary, their eating habits have become unhealthy, and their sleep routines have become increasingly disturbed. Parent-based interventions have shown promise to improve physical activity (PA), improve dietary behavior (DB), and reduce sleep problems among preschoolers. However, because of the recognized obstacles of face-to-face approaches (eg, travel costs and time commitment), easy access and lower costs make eHealth interventions appealing. Previous studies that examined the effectiveness of parent-based eHealth for preschoolers’ PA, DB, and sleep have either emphasized 1 variable or failed to balance PA, DB, and sleep modules and consider the intervention sequence during the intervention period. There is an acknowledged gap in parent-based eHealth interventions that target preschoolers raised in Chinese cultural contexts. Objective: This study aims to investigate the effectiveness of a parent-based eHealth intervention for PA, DB, and sleep problems among Chinese preschoolers. Methods: This 2-arm, parallel, randomized controlled trial comprises a 12-week intervention with a 12-week follow-up. A total of 206 parent-child dyads will be randomized to either an eHealth intervention group or a control group. Participants allocated to the eHealth intervention group will receive 12 interactive modules on PA, DB, and sleep, with each module delivered on a weekly basis to reduce the sequence effect on variable outcomes. The intervention is grounded in social cognitive theory. It will be delivered through social media, where parents can obtain valid and updated educational information, have a social rapport, and interact with other group members and facilitators. Participants in the control group will receive weekly brochures on PA, DB, and sleep recommendations from kindergarten teachers, but they will not receive any interactive components. Data will be collected at baseline, 3 months, and 6 months. The primary outcome will be preschoolers’ PA. The secondary outcomes will be preschoolers’ DB, preschoolers’ sleep duration, preschoolers’ sleep problems, parents’ PA, parenting style, and parental feeding style. Results: Parent-child dyads were recruited in September 2023. Baseline and posttest data collection occurred from October 2023 to March 2024. The follow-up data will be obtained in June 2024. The results of the study are expected to be published in 2025. Conclusions: The parent-based eHealth intervention has the potential to overcome the barriers of face-to-face interventions and will offer a novel approach for promoting a healthy lifestyle among preschoolers. If this intervention is found to be efficacious, the prevalence of unhealthy lifestyles among preschoolers may be alleviated at a low cost, which not only has a positive influence on the health of individuals and the well-being of the family but also reduces the financial pressure on society to treat diseases caused by poor lifestyle habits. Trial Registration: ClinicalTrials.gov NCT06025019; https://clinicaltrials.gov/study/NCT06025019 International Registered Report Identifier (IRRID): DERR1-10.2196/58344 %M 39264108 %R 10.2196/58344 %U https://www.researchprotocols.org/2024/1/e58344 %U https://doi.org/10.2196/58344 %U http://www.ncbi.nlm.nih.gov/pubmed/39264108 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54323 %T Capitalizing on Community Groups to Improve Women’s Resilience to Maternal and Child Health Challenges: Protocol for a Human-Centered Design Study in Tanzania %A Isangula,Kahabi Ganka %A Usiri,Aminieli Itaeli %A Pallangyo,Eunice Siaity %+ School of Nursing and Midwifery, Aga Khan University, Salama House, 344 Urambo Street, P.O.Box 125, Dar Es Salaam, 255, United Republic of Tanzania, 255 754030726, kahabi.isangula@aku.edu %K maternal and child health %K maternal and child deaths %K human-centered design %K income generating associations %K sub-Saharan Africa %K Tanzania %K community groups %K community %K capitalizing %K resilience %K maternal deaths %K neonatal deaths %K mortality %K co-design %D 2024 %7 10.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. Objective: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. Methods: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women’s engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. Results: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women’s resilience and readiness to handle MCH challenges will be generated. Conclusions: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/54323 %M 39255483 %R 10.2196/54323 %U https://www.researchprotocols.org/2024/1/e54323 %U https://doi.org/10.2196/54323 %U http://www.ncbi.nlm.nih.gov/pubmed/39255483 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55411 %T Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study %A Piris-Borregas,Salvador %A Bellón-Vaquerizo,Beatriz %A Velasco-Echeburúa,Leticia %A Niño-Díaz,Lidia %A Sánchez-Aparicio,Susana %A López-Maestro,María %A Pallás-Alonso,Carmen Rosa %K family-centered care %K neonatal intensive care unit %K kangaroo mother care %K mother %K mothers %K parent %K parents %K parental %K ICU %K intensive care %K training %K education %K educational %K premature %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K intensive care unit %D 2024 %7 30.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low–birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning “Take Care of Me” in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5‐20 vs 7, IQR 4‐10.5 d; P<.001), feeding (median 53.5, IQR 34‐68 vs 44.5, IQR 37‐62 d; P=.049), and observation of neurobehavior (median 18, IQR 9‐33 vs 11, IQR 7‐16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7‐23 vs 21, IQR 10‐31 d; P=.02), diaper change (median 9.5, IQR 4‐20 vs 14.5, IQR 9‐32 d; P=.04), and infection prevention (median 1, IQR 1‐2 vs 6, IQR 3‐12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. %R 10.2196/55411 %U https://pediatrics.jmir.org/2024/1/e55411 %U https://doi.org/10.2196/55411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63220 %T Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial %A Zhu,Shimin %A Hu,Yuxi %A Wang,Ruobing %A Qi,Di %A Lee,Paul %A Ngai,So Wa %A Cheng,Qijin %A Wong,Paul Wai Ching %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom , Kowloon, Hong Kong, 999077, China (Hong Kong), 852 27665787, jasmine.zhu@polyu.edu.hk %K implicit theory %K fixed mindset %K mental health %K secondary school students %K belief in change %D 2024 %7 30.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children’s affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child’s internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Objective: Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children’s academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. Methods: A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Results: Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. Conclusions: This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/63220 %R 10.2196/63220 %U https://www.researchprotocols.org/2024/1/e63220 %U https://doi.org/10.2196/63220 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48339 %T Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review %A Ou,Christine %A Corby,Kathryn %A Booth,Kelsey %A Ou,Hui-Hui %+ Canadian Institute for Substance Use Research, School of Nursing, University of Victoria, HSD Building Room 402, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 721 7954, christineou@uvic.ca %K parent %K alcohol use %K COVID-19 %K scoping review %K parenting %K alcohol %K addict %K addiction %K substance use %K health behavior %K health behaviors %K scoping %K review methods %K review methodology %K drink %K drinking %K alcoholic %K alcoholism %D 2024 %7 26.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration. Objective: This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both. Methods: A scoping review informed by the methodology of Arksey and O’Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic. Results: The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety. Conclusions: This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use. %M 39186759 %R 10.2196/48339 %U https://www.i-jmr.org/2024/1/e48339 %U https://doi.org/10.2196/48339 %U http://www.ncbi.nlm.nih.gov/pubmed/39186759 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e50978 %T Acceptance of a French e–Mental Health Information Website (CléPsy) for Families: A Web-Based Survey %A Landman,Benjamin %A Khoury,Elie %A Cohen,Alicia %A Trebossen,Vincent %A Michel,Alexandre %A Lefebvre,Aline %A Delorme,Richard %K mental health education %K children %K family %K child %K pediatrics %K pediatric %K mental health %K parent %K parents %K parenting %K psychiatry %K website %K acceptance %K patient education %K online information %K health information %K ease of use %K usefulness %K survey %K surveys %K user %K experience %K questionnaire %K questionnaires %K families %D 2024 %7 15.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children’s difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. %R 10.2196/50978 %U https://pediatrics.jmir.org/2024/1/e50978 %U https://doi.org/10.2196/50978 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e54623 %T Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial %A Li,Yun %A Xiao,Qiuli %A Chen,Min %A Jiang,Chunhua %A Kang,Shurong %A Zhang,Ying %A Huang,Jun %A Yang,Yulin %A Li,Mu %A Jiang,Hong %K health literacy %K WeChat %K cluster randomized controlled trial %K RCT %K randomized %K controlled trial %K controlled trials %K parental %K parenting %K parents %K parent %K China %K Chinese %K mHealth %K mobile health %K app %K apps %K applications %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K toddler %K toddlers %D 2024 %7 4.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Parental health literacy is important to children’s health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)–based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children’s health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention’s effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children’s health outcomes. Furthermore, despite slight subgroup differences in the intervention’s effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model–based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740 %R 10.2196/54623 %U https://publichealth.jmir.org/2024/1/e54623 %U https://doi.org/10.2196/54623 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55280 %T Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation %A McGrane Minton,Heather %A Murray,Linda %A Allan,Marjorie J %A Perry,Roslyn %A Bettencourt,Amie F %A Gross,Deborah %A Strano,Lauri %A Breitenstein,Susan M %+ College of Nursing, The Ohio State University, 1577 Neil Ave., Columbus, OH, 43210, United States, 1 6146884614, breitenstein.5@osu.edu %K COVID-19 %K implementation %K internet-based intervention %K parenting %K community dissemination %K hybrid delivery %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. Objective: This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. Methods: This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. Results: In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child’s behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Conclusions: Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed. %M 38959504 %R 10.2196/55280 %U https://pediatrics.jmir.org/2024/1/e55280 %U https://doi.org/10.2196/55280 %U http://www.ncbi.nlm.nih.gov/pubmed/38959504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62775 %T Author’s Reply: Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective %A Aldridge,Grace %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, 3168, Australia, 61 39905 072, grace.aldridge@monash.edu %K parenting interventions %K technology %K sports sociology %K child mental health %K adolescent mental health %K adverse childhood experiences %K systematic review %K intervention %K digital technology, parenting %K parenting program %K engagement %K support %D 2024 %7 3.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38959063 %R 10.2196/62775 %U https://www.jmir.org/2024/1/e62775 %U https://doi.org/10.2196/62775 %U http://www.ncbi.nlm.nih.gov/pubmed/38959063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60513 %T Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective %A Li,Yuan %A Zhai,Qun %A Peng,Weihang %+ Faculty of Health Sciences and Sports, Macao Polytechnic University, Comes Street, Macao, 999078, Macao, 853 68911106, zqun@mpu.edu.mo %K sociology of sport %K children %K adolescents %K mental health %K systematic review %K intervention %K digital technology, parenting %K technology %K parenting program %K engagement %K support %K adverse childhood experiences %D 2024 %7 3.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38959025 %R 10.2196/60513 %U https://www.jmir.org/2024/1/e60513 %U https://doi.org/10.2196/60513 %U http://www.ncbi.nlm.nih.gov/pubmed/38959025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54892 %T A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology %A Hodson,Nathan %A Woods,Peter %A Sobolev,Michael %A Giacco,Domenico %+ Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA, 90089, United States, 1 2133480086, nathan.hodson@warwick.ac.uk %K parenting %K child behavior %K mental health %K app development %K digital %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. Objective: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. Methods: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Results: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. Conclusions: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non–English speakers and individuals who participate in parenting programs in settings outside the United Kingdom. %M 38941594 %R 10.2196/54892 %U https://formative.jmir.org/2024/1/e54892 %U https://doi.org/10.2196/54892 %U http://www.ncbi.nlm.nih.gov/pubmed/38941594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56894 %T Parents’ Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot—A Digital Healthcare Assistant): Qualitative Process Evaluation %A Chua,Joelle Yan Xin %A Choolani,Mahesh %A Chee,Cornelia Yin Ing %A Yi,Huso %A Chan,Yiong Huak %A Lalor,Joan Gabrielle %A Chong,Yap Seng %A Shorey,Shefaly %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K perinatal %K parents %K mobile app %K chatbot %K qualitative study %K interviews %K experiences %K mobile phone %D 2024 %7 21.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents experience many challenges during the perinatal period. Mobile app–based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. Objective: This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app–based intervention with an in-built chatbot titled Parentbot—a Digital Healthcare Assistant (PDA). Methods: A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. Results: Three themes with 10 subthemes describing parents’ perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. Conclusions: Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users’ experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents. %M 38905628 %R 10.2196/56894 %U https://www.jmir.org/2024/1/e56894 %U https://doi.org/10.2196/56894 %U http://www.ncbi.nlm.nih.gov/pubmed/38905628 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57849 %T Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops %A So,Jeffrey Tsz Hei %A Nambiar,Smita %A Byrne,Rebecca %A Gallegos,Danielle %A Baxter,Kimberley A %+ Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, 62 Graham Street, South Brisbane, Brisbane, 4101, Australia, 61 73069 7308, jeffrey.so@hdr.qut.edu.au %K co-design %K fathers %K child nutrition %K child feeding %K intervention design %K digital delivery %K parenting %K participatory %K videoconference %K communication technology %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers’ experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers’ experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation–Behavior model. The interview data illuminated factors influencing fathers’ initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers’ diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men’s caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child’s age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. %M 38815260 %R 10.2196/57849 %U https://pediatrics.jmir.org/2024/1/e57849 %U https://doi.org/10.2196/57849 %U http://www.ncbi.nlm.nih.gov/pubmed/38815260 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e51429 %T Effects of Food Depictions in Entertainment Media on Children’s Unhealthy Food Preferences: Content Analysis Linked With Panel Data %A Matthes,Jörg %A Binder,Alice %A Naderer,Brigitte %A Forrai,Michaela %A Spielvogel,Ines %A Knupfer,Helena %A Saumer,Melanie %K children %K health %K unhealthy food preferences %K food depictions %K centrality %K coviewing %K longitudinal linkage study %K child %K food %K eating %K diet %K dietary %K preference %K preferences %K nutrition %K nutritional %K diet %K media %K entertainment %K panel %K foods %K pediatric %K pediatrics %K food preference %K food preferences %D 2024 %7 22.5.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Entertainment media content is often mentioned as one of the roots of children’s unhealthy food consumption. This might be due to the high quantity of unhealthy foods presented in children’s media environments. However, less is known about the role of the centrality of food placement, that is, whether foods are interacted with, consumed, verbally mentioned, or appear unobtrusively. We also lack longitudinal research measuring both children’s unhealthy and healthy food consumption behaviors as outcomes. Objective: The aim is to connect content analytical data based on children’s actual media diet with panel data in order to explain children’s food preferences. Moreover, this study not only focuses on the amount of healthy and unhealthy foods children are exposed to, but also on how these foods are presented (ie, centrally or not). Furthermore, we looked at the question of how parental coviewing can diminish (or enhance) the effects of unhealthy (or healthy) food depictions, and we measured healthy and unhealthy consumption as dependent variables. Methods: We conducted a 2-wave panel study with children and one of their parents (of 2250 parents contacted, 829 responded, for a response rate of 36.84%; 648 valid cases, ie, parent-child pairs, were used for analysis), with 6 months between the 2 panel waves. We linked the 2-wave panel data for the children and their parents to content analytical data for movies (n=113) and TV series (n=134; 3 randomly chosen episodes per TV series were used) that children were exposed to over the course of 6 months. Results: There was no significant relationship between exposure to unhealthy food presentation and unhealthy (b=0.008; P=.07) or healthy (b=−0.003; P=.57) food consumption over time. Also, healthy food presentation was unrelated to unhealthy (b=0.009; P=.18) or healthy (b=0.000; P=.99) food consumption over time. However, there was a significant, positive interaction between unhealthy food presentation and presentation centrality on unhealthy food consumption (b=0.000; P=.03), suggesting that the effects of unhealthy food presentation rise with increasing levels of centrality. There was no interaction between unhealthy food presentation and presentation centrality on the consumption of healthy foods (b=0.000; P=.10). Also, exposure to healthy food presentation interacted with centrality (b=−0.001; P=.003). That is, when a healthy product was presented at maximum centrality, it led to less unhealthy food consumption in children. Coviewing did not interact with exposure to unhealthy foods when explaining unhealthy (b=0.003; P=.08) or healthy (b=−0.001; P=.70) food consumption. Conclusions: We conclude that simply presenting more healthy foods is not sufficient to combat children’s unhealthy food preferences. Further regulations may be necessary with respect to representations of unhealthy foods in children’s media. %R 10.2196/51429 %U https://pediatrics.jmir.org/2024/1/e51429 %U https://doi.org/10.2196/51429 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e43315 %T Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study %A Glassman,Jill %A Humphreys,Kathryn L %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center (CERC), Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, United States, 1 8314195302, jill.r.glassman@stanford.edu %K child health %K parent-child relationship %K screen time %K technoference %K health equity %D 2024 %7 22.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. Objective: We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. Methods: In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. Results: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Conclusions: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based “screen time rules” not only for their children but also for themselves. %M 38446995 %R 10.2196/43315 %U https://pediatrics.jmir.org/2024/1/e43315 %U https://doi.org/10.2196/43315 %U http://www.ncbi.nlm.nih.gov/pubmed/38446995 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53461 %T Accuracy of a Web-Based Time-Use Diary (MEDAL) in Assessing Children’s Meal Intakes With Food Photography by Parents as Reference: Instrument Validation Study %A Chong,Kar Mun %A Chia,Airu %A Shah Budin,Nur Syahirah %A Poh,Bee Koon %A Jamil,Nor Aini %A Koh,Denise %A Chong,Mary Foong-Fong %A Wong,Jyh Eiin %+ Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz,, Kuala Lumpur, 50300, Malaysia, 60 3 9289 7683, wjeiin@ukm.edu.my %K children %K dietary intake %K time-use diary %K food photography %K accuracy %K mobile phone %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children. Objective: This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children’s meals taken by their parents as an objective reference. Methods: A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children’s reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents. Results: Overall, the match, omission, and intrusion rates were 62% (IQR 46%-86%), 39% (IQR 16%-55%), and 20% (IQR 6%-44%), respectively. Carbohydrate-based items from the food categories “rice and porridge”; “breads, spreads, and cereals”; and “noodles, pasta, and potatoes” were reported most accurately (total match rates: 68%-76%). “Snack and dessert” items were omitted most often (omission rate: 54%). Furthermore, side dishes from “vegetables and mushrooms,” “eggs and tofu,” “meat and fish,” and “curry” food groups were often omitted (omission rates: 42%-46%). Items from “milk, cheese, and yogurt”; “snacks and desserts”; and “drinks” food groups intruded most often (intrusion rates: 37%-46%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69% vs 53%) and lesser omission rates (31% vs 49%; P=.03, respectively). Conclusions: In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children. %M 38713499 %R 10.2196/53461 %U https://pediatrics.jmir.org/2024/1/e53461 %U https://doi.org/10.2196/53461 %U http://www.ncbi.nlm.nih.gov/pubmed/38713499 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55491 %T A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial %A Cooper,Hal %A Nadzri,Farah Zeehan Mohd %A Vyas,Seema %A Juhari,Rumaya %A Ismail,Nellie %A Arshat,Zarinah %A Rajandiran,Durgesh %A Markle,Laurie %A Calderon,Francisco %A Vallance,Inge %A Melendez-Torres,G J %A Facciolà,Chiara %A Senesathith,Vanisa %A Gardner,Frances %A Lachman,Jamie M %+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865 270325, hallam.cooper@spi.ox.ac.uk %K parenting intervention %K chatbot-led public health intervention %K engagement %K implementation science %K feasibility %K evidence-based program %D 2024 %7 26.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United Nations’ Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings. Objective: This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components. Methods: This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers’ use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders. Results: Overall, 208 parents were recruited at baseline December 2023: 151 (72.6%) primary caregivers and 57 (27.4%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024. Conclusions: This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention. Trial Registration: OSF Registries; https://osf.io/f32ky International Registered Report Identifier (IRRID): DERR1-10.2196/55491 %M 38669679 %R 10.2196/55491 %U https://www.researchprotocols.org/2024/1/e55491 %U https://doi.org/10.2196/55491 %U http://www.ncbi.nlm.nih.gov/pubmed/38669679 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55364 %T Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K addiction therapist %K children %K digital intervention %K internet addiction %K digital devices %K parents %K parental control %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps’ functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children’s competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children’s internet use, providing tailored or personalized content to suit users’ characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. %M 38669672 %R 10.2196/55364 %U https://pediatrics.jmir.org/2024/1/e55364 %U https://doi.org/10.2196/55364 %U http://www.ncbi.nlm.nih.gov/pubmed/38669672 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e54610 %T Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images %A Pretorius,Kelly %A Kang,Sookja %A Choi,Eunju %K SUID %K SIDS %K parenting %K safe sleep %K photo analysis %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K sleep %K safety %K death %K mortality %K social media %K picture %K pictures %K photo %K photos %K photographs %K image %K images %K Facebook %K mother %K mothers %K parent %K co-sleeping %K sudden infant death %K sudden unexpected infant death %K adherence %K parent education %K parents' education %K awareness %D 2024 %7 23.4.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers’ group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers’ group in May 2019. After trialing various search terms, searching for the term “SIDS” on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers. %R 10.2196/54610 %U https://pediatrics.jmir.org/2024/1/e54610 %U https://doi.org/10.2196/54610 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e48478 %T Evaluation of Parents’ Use of a Child Health Care Information App and Their Health Literacy: Cross-Sectional Study %A Sakamoto,Masahiko %A Ishikawa,Hirono %A Suzuki,Asuka %K health literacy %K European Health Literacy Survey Questionnaire %K HLS-EU-Q47 %K child %K preschool %K parent education %K health care knowledge %K apps %K digital media %K emergency room visit %K mobile phone %D 2024 %7 11.4.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Recently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents’ health literacy. Objective: This study aims to evaluate whether parents’ use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children. Methods: Participants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits. Results: In total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non–app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non–app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non–app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non–app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables. Conclusions: This study showed a significant association between parents’ use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children’s health care. Future studies are needed to evaluate the association between app use and emergency room visits. %R 10.2196/48478 %U https://pediatrics.jmir.org/2024/1/e48478 %U https://doi.org/10.2196/48478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51058 %T Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study %A Thomas,Amy %A Asnes,Andrea %A Libby,Kyle %A Hsiao,Allen %A Tiyyagura,Gunjan %+ Department of Pediatrics, Yale University School of Medicine, Pediatric Emergency Medicine, PO Box 208064, New Haven, CT, 06520, United States, 1 203 464 6343, gunjan.tiyyagura@yale.edu %K child abuse %K clinical decision support %K CDS %K pediatrics %K child %K children %K natural language processing %K usability %K clinical decision support system %K physical abuse %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the impact of physical abuse on children, it is often underdiagnosed, especially among children evaluated in emergency departments (EDs). Electronic clinical decision support (CDS) can improve the recognition of child physical abuse. Objective: We aimed to develop and test the usability of a natural language processing–based child abuse CDS system, known as the Child Abuse Clinical Decision Support (CA-CDS), to alert ED clinicians about high-risk injuries suggestive of abuse in infants’ charts. Methods: Informed by available evidence, a multidisciplinary team, including an expert in user design, developed the CA-CDS prototype that provided evidence-based recommendations for the evaluation and management of suspected child abuse when triggered by documentation of a high-risk injury. Content was customized for medical versus nursing providers and initial versus subsequent exposure to the alert. To assess the usability of and refine the CA-CDS, we interviewed 24 clinicians from 4 EDs about their interactions with the prototype. Interview transcripts were coded and analyzed using conventional content analysis. Results: Overall, 5 main categories of themes emerged from the study. CA-CDS benefits included providing an extra layer of protection, providing evidence-based recommendations, and alerting the entire clinical ED team. The user-centered, workflow-compatible design included soft-stop alert configuration, editable and automatic documentation, and attention-grabbing formatting. Recommendations for improvement included consolidating content, clearer design elements, and adding a hyperlink with additional resources. Barriers to future implementation included alert fatigue, hesitancy to change, and concerns regarding documentation. Facilitators of future implementation included stakeholder buy-in, provider education, and sharing the test characteristics. On the basis of user feedback, iterative modifications were made to the prototype. Conclusions: With its user-centered design and evidence-based content, the CA-CDS can aid providers in the real-time recognition and evaluation of infant physical abuse and has the potential to reduce the number of missed cases. %M 38551639 %R 10.2196/51058 %U https://www.jmir.org/2024/1/e51058 %U https://doi.org/10.2196/51058 %U http://www.ncbi.nlm.nih.gov/pubmed/38551639 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55960 %T A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads: Protocol for a Randomized Controlled Trial %A Phipps,Daniel %A Green,Weldon Thomas %A Aho,Reetta %A Kettunen,Eeva %A Biddle,Stuart %A Hamilton,Kyra %A Laukkanen,Arto %A Aunola,Kaisa %A Chan,Derwin King %A Hankonen,Nelli %A Hassandra,Mary %A Kärkkäinen,Tommi %A Kykyri,Virpi-Liisa %A Polet,Juho %A Rhodes,Ryan %A Ruiz,Montse C %A Sääkslahti,Arja %A Schneider,Jekaterina %A Toivonen,Hanna-Mari %A Lintunen,Taru %A Hagger,Martin %A Knittle,Keegan %+ Health Sciences Research Institute, University of California - Merced, 5200 North Lake Rd, Merced, CA, 95343, United States, 1 (209) 228 4400, mhagger@ucmerced.edu %K dyadic behavior change %K family behavior change %K intervention %K physical activity %K theory of planned behavior %D 2024 %7 21.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children’s behavioral patterns are largely governed by familial structures. Similarly, parents’ activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents. Objective: This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline. Methods: Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures. Results: This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention’s effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024. Conclusions: The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes. Trial Registration: ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038 International Registered Report Identifier (IRRID): DERR1-10.2196/55960 %M 38512336 %R 10.2196/55960 %U https://www.researchprotocols.org/2024/1/e55960 %U https://doi.org/10.2196/55960 %U http://www.ncbi.nlm.nih.gov/pubmed/38512336 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54807 %T The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study %A Hölgyesi,Áron %A Luczay,Andrea %A Tóth-Heyn,Péter %A Muzslay,Eszter %A Világos,Eszter %A Szabó,Attila J %A Baji,Petra %A Kovács,Levente %A Gulácsi,László %A Zrubka,Zsombor %A Péntek,Márta %+ Health Economics Research Center, University Research and Innovation Center, Óbuda University, Bécsi St. 96/B, Budapest, 1034, Hungary, 36 16665603, pentek.marta@uni-obuda.hu %K electronic health literacy %K parents %K caregivers %K diabetes mellitus %K child %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents’ skills to deal with electronic health information sources. Objective: We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children’s outcomes. Methods: A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents’ electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children’s treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. Results: Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents’ average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children’s treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=−0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children’s HbA1c (r=−0.143; P=.08), PedsQL Diab (r=−0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=−0.13; P=.12). Regression analysis revealed significant associations of the child’s HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=−0.66; P=.03; pump + sensor: β=−0.93; P=.007), and parents’ self-efficacy (PSESDM; β=−0.08; P=.001). Conclusions: Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents’ diabetes management attitude but not with the child’s glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged. %M 38506893 %R 10.2196/54807 %U https://pediatrics.jmir.org/2024/1/e54807 %U https://doi.org/10.2196/54807 %U http://www.ncbi.nlm.nih.gov/pubmed/38506893 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55193 %T Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study %A Edwards,Katie %A Croker,Helen %A Farrow,Claire %A Haycraft,Emma %A Herle,Moritz %A Llewellyn,Clare %A Pickard,Abigail %A Blissett,Jacqueline %+ School of Psychology and Institute of Health and Neurodevelopment, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom, 44 121 204 3784, k.edwards4@aston.ac.uk %K ecological momentary assessment %K avid eating %K children’s eating behavior %K parental feeding practices %K feeding behaviour %K parent %K children %K eating behaviour %K obesity %K environmental factors %K observational study %K feeding %K United Kingdom %D 2024 %7 19.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents’ daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children’s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers’ daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children’s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 %M 38502178 %R 10.2196/55193 %U https://www.researchprotocols.org/2024/1/e55193 %U https://doi.org/10.2196/55193 %U http://www.ncbi.nlm.nih.gov/pubmed/38502178 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54163 %T Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study %A Sánchez-Fernández,Sergio %A Lasa,Eva María %A Terrados,Soledad %A Sola-Martínez,Francisco Javier %A Martínez-Molina,Sara %A López de Calle,Marta %A Cabrera-Freitag,Paula %A Goikoetxea,María José %+ Allergy and Clinical Immunology Department, Clínica Universidad de Navarra, Pío XII, 36, Pamplona, 31008, Spain, 34 948255400, mjgoiko@unav.es %K adverse reactions %K egg allergy %K food oral immunotherapy %K mHealth %K milk allergy %K monitoring %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment. Objective: This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT. Methods: Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient’s adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction. Results: Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%). Conclusions: The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT. %M 38477961 %R 10.2196/54163 %U https://pediatrics.jmir.org/2024/1/e54163 %U https://doi.org/10.2196/54163 %U http://www.ncbi.nlm.nih.gov/pubmed/38477961 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53170 %T Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Study %A Li,Jinxuan %A Xu,Jianying %A Yang,Lan %A Xu,Yongjian %A Zhang,Xiangyan %A Bai,Chunxue %A Kang,Jian %A Ran,Pixin %A Shen,Huahao %A Wen,Fuqiang %A Huang,Kewu %A Yao,Wanzhen %A Sun,Tieying %A Shan,Guangliang %A Yang,Ting %A Lin,Yingxiang %A Zhu,Jianguo %A Wang,Ruiying %A Shi,Zhihong %A Zhao,Jianping %A Ye,Xianwei %A Song,Yuanlin %A Wang,Qiuyue %A Hou,Gang %A Zhou,Yumin %A Li,Wen %A Ding,Liren %A Wang,Hao %A Chen,Yahong %A Guo,Yanfei %A Xiao,Fei %A Lu,Yong %A Peng,Xiaoxia %A Zhang,Biao %A Wang,Zuomin %A Zhang,Hong %A Bu,Xiaoning %A Zhang,Xiaolei %A An,Li %A Zhang,Shu %A Cao,Zhixin %A Zhan,Qingyuan %A Yang,Yuanhua %A Liang,Lirong %A Cao,Bin %A Dai,Huaping %A Chung,Kian Fan %A Chen,Zhengming %A He,Jiang %A Wu,Sinan %A Xiao,Dan %A Wang,Chen %A , %+ Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Yinghua Street, Beijing, 100029, China, 86 010 8420 5425, danxiao@263.net %K chronic obstructive pulmonary disease %K tobacco dependence %K smoking %K mediating effects %K lung function %D 2024 %7 22.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Maternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD), but the underlying mechanism remains unclear. Objective: This study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD). Methods: This case-control study used data from the nationwide cross-sectional China Pulmonary Health study, with controls matched for age, sex, and smoking status. TD was defined as smoking within 30 minutes of waking, and the severity of TD was assessed using the Fagerstrom Test for Nicotine Dependence. COPD was diagnosed when the ratio of forced expiratory volume in 1 second to forced vital capacity was <0.7 in a postbronchodilator pulmonary function test according to the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria. Logistic regression was used to examine the correlation between MSDP and COPD, adjusting for age, sex, BMI, educational attainment, place of residence, ethnic background, occupation, childhood passive smoking, residential fine particulate matter, history of childhood pneumonia or bronchitis, average annual household income, and medical history (coronary heart disease, hypertension, and diabetes). Mediation analysis examined TD as a potential mediator in the link between MSDP and COPD risk. The significance of the indirect effect was assessed through 1000 iterations of the “bootstrap” method. Results: The study included 5943 participants (2991 with COPD and 2952 controls). Mothers of the COPD group had higher pregnancy smoking rates (COPD: n=305, 10.20%; controls: n=211, 7.10%; P<.001). TD was more prevalent in the COPD group (COPD: n=582, 40.40%; controls: n=478, 33.90%; P<.001). After adjusting for covariates, MSDP had a significant effect on COPD (β=.097; P<.001). There was an association between MSDP and TD (β=.074; P<.001) as well as between TD and COPD (β=.048; P=.007). Mediation analysis of TD in the MSDP-COPD association showed significant direct and indirect effects (direct: β=.094; P<.001 and indirect: β=.004; P=.03). The indirect effect remains present in the smoking population (direct: β=.120; P<.001 and indirect: β=.002; P=.03). Conclusions: This study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. These findings contribute to a deeper understanding of the impact of prenatal tobacco exposure on lung health, laying the groundwork for the development of relevant prevention and treatment strategies. %M 38386387 %R 10.2196/53170 %U https://publichealth.jmir.org/2024/1/e53170 %U https://doi.org/10.2196/53170 %U http://www.ncbi.nlm.nih.gov/pubmed/38386387 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e49952 %T A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner %A Pease,Anna %A Ingram,Jenny %A Lambert,Becky %A Patrick,Karen %A Pitts,Kieren %A Fleming,Peter J %A Blair,Peter S %A , %+ Population Health Sciences, Bristol Medical School, University of Bristol, 3.02 Canynge Hall, 39 Whatley Road, Bristol, BS82PS, United Kingdom, 44 117 455 625, a.pease@bristol.ac.uk %K safer sleep %K parent education %K co-design %K process evaluation %K sudden infant death syndrome %K SIDS %K sleep %K baby %K babies %K infant %K infants %K prototype %K interface %K develop %K development %K sleeping %K pattern %K tool %K parent %K infant mortality %K risk %K risks %K assessment %K death %K mortality %K parents %K parenting %K risk assessment %K sudden unexpected death in infancy %K SUDI %K approach %K antenatal %K postnatal %K user testing %K user experience %K web-based %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %D 2024 %7 22.2.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Successful national safer sleep campaigns in the United Kingdom have lowered the death rates from sudden unexpected death in infancy (SUDI) over the past 3 decades, but deaths persist in socioeconomically deprived families. The circumstances of current deaths suggest that improvements in support for some families to follow safer sleep advice more consistently could save lives. Objective: This study aimed to develop and evaluate a risk assessment and planning tool designed to improve the uptake of safer sleep advice in families with infants at increased risk of SUDI. Methods: A co-design approach was used to develop the prototype interface of a web-based tool with 2 parts: an individual SUDI risk assessment at birth and a downloadable plan for safety during times of disruption. The advice contained within the tool is concordant with national guidance from the Lullaby Trust, the United Nations International Children’s Emergency Fund (UNICEF), and the National Institute for Health and Care Excellence. User testing of the prototype tool was conducted by inviting health visitors, midwives, and family nurses to use it with families eligible for additional support. Qualitative interviews with health professionals and families allowed for iterative changes to the tool and for insights into its function and influence on parental behavior. Results: A total of 22 health professionals were enrolled in the study, of whom 20 (91%) were interviewed. They reported appreciating the functionality of the tool, which allowed them to identify at-risk families for further support. They felt that the tool improved how they communicated about risks with families. They suggested expanding its use to include relevance in the antenatal period and having versions available in languages other than English. They reported using the tool with 58 families; 20 parents gave consent to be interviewed by the research team about their experiences with the tool. Families were positive about the tool, appreciated the trustworthy information, and felt that it was useful and appropriate and that the plans for specific infant sleeps would be of benefit to them and other family members. Conclusions: Our tool combines risk assessment and safety planning, both of which have the potential to improve the uptake of lifesaving advice. Refinements to the tool based on these findings have ensured that the tool is ready for further evaluation in a larger study before being rolled out to families with infants at increased risk. %M 38386377 %R 10.2196/49952 %U https://pediatrics.jmir.org/2024/1/e49952 %U https://doi.org/10.2196/49952 %U http://www.ncbi.nlm.nih.gov/pubmed/38386377 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51908 %T Effect of a Mobile Game–Based Intervention to Enhance Child Safety: Randomized Controlled Trial %A Wong,Rosa S %A Tung,Keith T S %A Ho,Frederick K W %A Wong,Wilfred H S %A Chow,Chun Bong %A Chan,Ko Ling %A Fu,King Wa %A Ip,Patrick %+ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China (Hong Kong), 852 22554090, patricip@hku.hk %K mobile game %K injury prevention %K safety education %K unintentional injuries %K gamification %K game %K games %K gaming %K safety %K injury %K injuries %K gamify %K gamified %K child %K children %K youth %K pediatric %K pediatrics %K danger %K hazard %K hazards %K RCT %K randomized %K controlled trial %K controlled trials %K mobile phone %D 2024 %7 14.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population. Objective: This study aimed to investigate the potential of a mobile game–based safety education program in improving children’s safety and psychosocial outcomes. Methods: Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models. Results: No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3. Conclusions: Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries. Trial Registration: ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196 International Registered Report Identifier (IRRID): RR2-10.2196/17756 %M 38354042 %R 10.2196/51908 %U https://www.jmir.org/2024/1/e51908 %U https://doi.org/10.2196/51908 %U http://www.ncbi.nlm.nih.gov/pubmed/38354042 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e47545 %T A Web-Based Peer-Patient Navigation Program (Compassionate Online Navigation to Enhance Care Transitions) for Youth Living With Childhood-Acquired Disabilities Transitioning From Pediatric to Adult Care: Qualitative Descriptive Study %A Kokorelias,Kristina Marie %A Lee,Tin-Suet Joan %A Bayley,Mark %A Seto,Emily %A Toulany,Alene %A Nelson,Michelle L A %A Dimitropoulos,Gina %A Penner,Melanie %A Simpson,Robert %A Munce,Sarah E P %+ KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Room 106, 345 Rumsey Road, Toronto, ON, M4G 1R7, Canada, 1 416 597 3422, sarah.munce@uhn.ca %K youth %K patient navigation %K web-based intervention %K peer support %K transition %K childhood disability %K caregiver %K transitional care intervention %K social support %K usability %K program %K children %K pediatric %K disability %K digital health %K eHealth %K web-based support %K web-based health %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Studies have highlighted significant challenges associated with the transition from pediatric to adult health and social care services for youth living with childhood-acquired disabilities and their caregivers. Patient navigation has been proposed as an effective transitional care intervention. Better understanding of how patient navigation may support youth and their families during pediatric to adult care transitions is warranted. Objective: This study aims to describe the preferred adaptations of an existing web-based platform from the perspectives of youth with childhood-onset disabilities and their family caregivers to develop a web-based peer-patient navigation program, Compassionate Online Navigation to Enhance Care Transitions (CONNECT). Methods: A qualitative descriptive design was used. Participants included youth living with childhood-acquired disabilities (16/23, 70%) and their caregivers (7/23, 30%). Semistructured interviews and focus groups were conducted, digitally recorded, and transcribed. Thematic analysis was used to analyze the data and was facilitated through NVivo software (Lumivero). Results: Participants desired a program that incorporated (1) self-directed learning, (2) a library of reliable health and community resources, and (3) emotional and social supports. On the basis of participants’ feedback, CONNECT was deemed satisfactory, as it was believed that the program would help support appropriate transition care through the provision of trusted health-related information. Participants highlighted the need for options to optimize confidentiality in their health and social care and the choice to remain anonymous to other participants. Conclusions: Web-based patient navigation programs such as CONNECT may deliver peer support that can improve the quality and experience of care for youth, and their caregivers, transitioning from pediatric to adult care through personalized support, health care monitoring, and health and social care resources. Future studies are needed to test the feasibility, acceptability, usability, use, and effectiveness of CONNECT among youth with childhood-onset disabilities. %M 38324351 %R 10.2196/47545 %U https://pediatrics.jmir.org/2024/1/e47545 %U https://doi.org/10.2196/47545 %U http://www.ncbi.nlm.nih.gov/pubmed/38324351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47372 %T Explainable Machine Learning Classification to Identify Vulnerable Groups Among Parenting Mothers: Web-Based Cross-Sectional Questionnaire Study %A Hanai,Akiko %A Ishikawa,Tetsuo %A Sugao,Shoko %A Fujii,Makoto %A Hirai,Kei %A Watanabe,Hiroko %A Matsuzaki,Masayo %A Nakamoto,Goji %A Takeda,Toshihiro %A Kitabatake,Yasuji %A Itoh,Yuichi %A Endo,Masayuki %A Kimura,Tadashi %A Kawakami,Eiryo %+ Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, W507/509 West Research Building,, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, 230-0045, Japan, 81 455039455, tetsuo.ishikawa@riken.jp %K explainable machine-learning %K unsupervised clustering %K perceived support %K resilience %K adaptation %K mother’s health %K mobile phone %K machine learning %K web-based %K parenting %K postpartum %K antenatal %K survey %K mother %K women %K newborn %K psychosocial %K infant %K parents %K children %K depression %K digital health %K maternal %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. Objective: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. Methods: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. Results: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child’s temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. Conclusions: The classifier, based on a combination of resilience and adaptation to the child’s temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality. %M 38324356 %R 10.2196/47372 %U https://formative.jmir.org/2024/1/e47372 %U https://doi.org/10.2196/47372 %U http://www.ncbi.nlm.nih.gov/pubmed/38324356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53439 %T Administrative Dashboard for Monitoring Use of a Web-Based Parent Training Intervention: Usability Study %A Breitenstein,Susan M %A Berteletti,Julia %A Smoske,Shea %A Barger,Charles %A Tipps,Kyrie %A Helsabeck,Nathan P %+ College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, United States, 1 6146884614, breitenstein.5@osu.edu %K usability %K development %K dashboard %K portal %K implementation %K design %K System Usability Scale %K internet-based intervention %K parents %K parent %K child %K children %K web-based %K web-based parent training %K PT %K descriptive survey %K single group %K survey %K system usability %K ezParent %K videoconference %K information %K reviews on usage %K improvement %K qualitative %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based parent training (PT) programs can strengthen parent-child relationships by equipping caregivers with knowledge and evidence-based strategies to manage behavior. Hybrid facilitation of PT includes facilitator interaction paired with self-administered and web-based PT. Web-based administrative dashboards provide users (eg, administrators, facilitators, and researchers) with an integrated platform to monitor parent progress and activities within a PT program or website. Despite the utility and prevalence of administrative dashboards for web-based behavioral interventions, to our knowledge, no research studies have explored the perspectives and insights of dashboard users to enhance user experience and program delivery. Objective: The purpose of this study is to evaluate the usability of the administrative dashboard (ezDashboard) for the ezParent program, a 6-module web-based PT program for parents of children aged 2-5 years. Methods: This study used a descriptive, single-group design with administrators who were overseeing the implementation of the ezParent program and trained facilitators for hybrid ezParent delivery. Participants spent at least 30 minutes reviewing and evaluating the ezDashboard and then completed a survey of their experience with the dashboard. The survey included the validated 10-item System Usability Scale and open-ended questions focusing on user performance, navigation ease, and overall usefulness of the ezDashboard. Results: Participants (N=15) indicated high usability of the ezDashboard with System Usability Scale scoring a total mean score of 83.5 (SD 16.3). Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%). Open-ended questions revealed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%) and for reviewing topics for discussion and communicating with parents (n=5, 33%). ezParent administrators (n=4) identified that real-time data for ezParent use helps overall management of program uptake. Suggestions for features to add to the ezDashboard included the ability to track partial progress of program modules (4/14, 29%), total time spent per module (2/14, 14%), and exportable reports (4/14, 29%). Other ideas for improvement included direct messaging capabilities, videoconferencing platform integration, and being able to modify participant account and contact information. Conclusions: Results indicate that the ezDashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Qualitative results indicate that integrating suggested features into the ezDashboard may help provide a smoother experience for facilitators, administrators, and ultimately the parents using the program. Providing resources for facilitators and administrators in real time to monitor intervention participants’ progress in a program can be helpful in tracking progress and providing facilitated support in tailoring program content and program completion. %M 38289675 %R 10.2196/53439 %U https://formative.jmir.org/2024/1/e53439 %U https://doi.org/10.2196/53439 %U http://www.ncbi.nlm.nih.gov/pubmed/38289675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43994 %T Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review %A Aldridge,Grace %A Tomaselli,Alessandra %A Nowell,Clare %A Reupert,Andrea %A Jorm,Anthony %A Yap,Marie Bee Hui %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Australia, 61 3 9905 0723, marie.yap@monash.edu %K systematic review %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K engagement %K support %K adverse childhood experiences %D 2024 %7 19.1.2024 %9 Review %J J Med Internet Res %G English %X Background: Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent’s capacity to modify. However, engagement with such programs is suboptimal. Objective: This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent’s capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. Results: We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program’s design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. Conclusions: This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. Trial Registration: PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819 %M 38241066 %R 10.2196/43994 %U https://www.jmir.org/2024/1/e43994 %U https://doi.org/10.2196/43994 %U http://www.ncbi.nlm.nih.gov/pubmed/38241066 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e49170 %T Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study %A Burns,Sarah K %A Krishnamurti,Tamar %A Doan,Tran T %A Hanmer,Janel %A Hoberman,Alejandro %A Kahn,Jeremy M %A Schweiberger,Kelsey %A Ray,Kristin N %+ Department of Pediatrics, University of Pittsburgh School of Medicine, CHOB 3rd Floor, 3414 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 412 692 7518, kristin.ray@chp.edu %K telemedicine %K telehealth %K acute care %K acute %K pediatrics %K pediatric %K family medicine %K family-centered %K child %K children %K parent %K parents %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K expectation %K expectations %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). Objective: This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. Methods: We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children’s acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Results: Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). Conclusions: In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care–based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care. %M 38227360 %R 10.2196/49170 %U https://pediatrics.jmir.org/2024/1/e49170 %U https://doi.org/10.2196/49170 %U http://www.ncbi.nlm.nih.gov/pubmed/38227360 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e47361 %T Exploring the Potential of a Behavior Theory–Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study %A Cooray,Nipuna %A Ho,Catherine %A Bestman,Amy %A Adams,Susan %A Nassar,Natasha %A Keay,Lisa %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, 2000, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K digital behavior change interventions %K user experience %K falls %K infant fall %K injury %K mobile app %K digital intervention %K users %K mixed methods longitudinal study %K behavior %K development %K fall risk %K fall prevention %K acceptability %K app %K children %K internet %K parents %K maternal, paternal %K accidents %K infancy %K infant %K accidental fall %K accidental falls %K infant behavior %K longitudinal design %K mixed methods %K parent %K mobile phone %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. Objective: This study aims to evaluate a behavior theory–informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. Methods: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. Results: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. Conclusions: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app. %M 38170580 %R 10.2196/47361 %U https://pediatrics.jmir.org/2024/1/e47361 %U https://doi.org/10.2196/47361 %U http://www.ncbi.nlm.nih.gov/pubmed/38170580 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e50892 %T Exploring Parental Experiences With School-Aged Children Receiving Web-Based Learning: Cross-Sectional Study %A Al Anazi,Samaa %A Bajamal,Eman %A Hantira,Neama %A Esheaba,Ola %K education %K obstacles %K online learning %K stress reduction %K obstacle %K parent %K parents %K parental %K parenting %K e-learning %K child %K children %K school %K schools %K student %K students %K experiences %K experience %K interaction %K health outcome %K health outcomes %K family %K dynamic %K dynamics %K parental experiences %D 2023 %7 19.12.2023 %9 %J JMIR Pediatr Parent %G English %X Background: Web-based learning has transformed education. Its ability to overcome physical barriers and deliver knowledge at the click of a button has made web-based learning popular and ensured that it will continue to be used in the future. The involvement of parents in web-based learning is fundamental to the success of the educational process, but limited attention has been paid to the impact of web-based learning on parents. Objective: This study examined parental experiences with school-aged children receiving web-based learning in Jeddah, Saudi Arabia. Methods: We sent cross-sectional, anonymous web-based questionnaires to school-aged children’s parents. A total of 184 parents completed the survey. Results: Parents’ negative experiences of web-based learning (mean 4.13, SD 0.62) exceeded their positive experiences (mean 3.52, SD 0.65). The most negative experience reported by parents was their child’s boredom due to prolonged sitting in front of a device (mean 4.56, SD 0.69). The most positive experience was their child’s technological skill enhancement (mean 3.98, SD 88). Their child’s lack of social interaction and friendship building promoted stress among parents (r=−0.190; P=.01). At the same time, their child’s technological skill enhancement reduced stress among parents (r=0.261; P=.001). The most reported (63/184, 34.2%) obstacle to web-based learning was having multiple learners in the same household. Conclusion: Web-based learning is a fundamental learning method and will continue to be used in the future because of its ability to overcome many barriers to education. Parental involvement in the continuity and success of the web-based learning process is crucial. However, the findings of this study illustrated that parents’ experiences of web-based learning were more negative than positive. Parents who reported negative experiences reported an increase in stress and faced more obstacles due to web-based learning. Thus, more attention and intervention are needed to promote positive web-based learning experiences among parents. %R 10.2196/50892 %U https://pediatrics.jmir.org/2023/1/e50892 %U https://doi.org/10.2196/50892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46631 %T Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study %A Strouf Motley,Haley %A Kerr,Bradley %A Sklansky,Daniel J %A Eickhoff,Jens %A Moreno,Megan A %A Babal,Jessica C %+ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, United States, 1 6082852942, hstrouf@wisc.edu %K latent class analysis %K medical student %K resident %K trainee %K medical education %K trust %K comfort %K parents %K pediatrics %K parent perception %K pediatric care %K clinical autonomy %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. Objective: This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. Methods: We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. Results: Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). Conclusions: Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine. %M 38090789 %R 10.2196/46631 %U https://formative.jmir.org/2023/1/e46631 %U https://doi.org/10.2196/46631 %U http://www.ncbi.nlm.nih.gov/pubmed/38090789 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e53120 %T Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study %A Wood,Michael %A Gandhi,Kavi %A Chapman,Andrea %A Skippen,Peter %A Krahn,Gordon %A Görges,Matthias %A Stewart,S Evelyn %K pediatric delirium education %K pediatric ICU %K focus groups, prototyping %K end users %K users %K education %K educational %K educational tool %K tool %K development %K caregiver %K Canada %K PICU %K pediatric intensive care unit %K quality of life %K child %K children %K family resource %K cognition %K clinical utility %K intensive care unit %D 2023 %7 11.12.2023 %9 %J JMIR Pediatr Parent %G English %X Background: Pediatric intensive care unit (PICU)–associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child’s PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary. %R 10.2196/53120 %U https://pediatrics.jmir.org/2023/1/e53120 %U https://doi.org/10.2196/53120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48402 %T The Effects of a Parent-Focused Social Media Intervention on Child Sun Safety: Pilot and Feasibility Study %A Manne,Sharon %A Wu,Yelena %A Buller,David %A Heckman,Carolyn %A Devine,Katie %A Frederick,Sara %A Solleder,Justin %A Schaefer,Alexis %A Lu,Shou-En %+ Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 120 Albany Street Tower II, New Brunswick, NJ, 08901, United States, 1 7323577978, mannesl@cinj.rutgers.edu %K health behavior %K health promotion and prevention %K parenting %K prevention science %K parents %K parent %K Facebook %K social media %K sun %K prevention %K skin %K dermatology %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child’s increasing independence while providing practical assistance to ensure sun protection is implemented. Objective: The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. Methods: The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. Results: Enrollment (64.3%, 92/143) and retention (94.6%, 87/92) were good. On average, participants viewed 67.6% (56.8/84) of posts, “liked” 16.4% (13.77/84) of posts, commented on 14.8% (12.43/84) of posts, and voted on 46% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). Conclusions: This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted. %M 38064250 %R 10.2196/48402 %U https://formative.jmir.org/2023/1/e48402 %U https://doi.org/10.2196/48402 %U http://www.ncbi.nlm.nih.gov/pubmed/38064250 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46927 %T Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study %A Ingeman,Katrine %A Frostholm,Lisbeth %A Wellnitz,Kaare Bro %A Wright,Kristi %A Frydendal,Ditte Hoffmann %A Onghena,Patrick %A Rask,Charlotte Ulrikka %+ Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, entrence K, Aarhus, 8200, Denmark, 45 20542556, katbec@rm.dk %K health anxiety by proxy %K health anxiety %K internet-delivered treatment %K single-case experimental design %K SCED %K protocol %D 2023 %7 24.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health anxiety (HA) by proxy is described as parents’ obsessive worries that their child is severely ill although this is not medically confirmed. Research on HA by proxy suggests that it is highly distressing for the parent and that the child may be at risk of developing maladaptive symptom coping strategies. No targeted treatment for this group exists. We developed PROXY, an 8-week psychological internet-delivered treatment for parents with HA by proxy. The treatment components of PROXY are informed by cognitive behavioral therapy as well as acceptance and commitment therapy, and it was developed in collaboration with parents experiencing HA by proxy and clinical experts. Objective: This paper describes the protocol for a study investigating the potential effects of PROXY on parents’ worries about their children’s health using a single-case experimental design (SCED). Methods: Five parents clinically evaluated as experiencing HA by proxy will be included. A replicated randomized SCED study will be conducted in which each participant will be randomized to receive treatment after a baseline period of between 7 and 26 days (phase A). The treatment phase duration is 8 weeks for all participants (phase B), followed by a follow-up phase lasting between 14 and 33 days (phase C), ensuring that all participants remain in the study for 96 days. Participants will report daily anxiety level by SMS text message throughout the study. They will also answer self-report questionnaires, including questions on HA by proxy and own HA, 4 times during the study. Data will be submitted to structured visual analysis to inspect anxiety level, the variability of anxiety, trends, the overlap of data points among phases, when effects occur, and the consistency of data patterns across participants. Furthermore, randomization tests will be conducted for each participant to test the null hypothesis that PROXY will have no effect on participants’ anxiety. Results: The recruitment of parents began in June 2022. As of March 2, 2023, a total of 4 parents have been included in the study. Data collection was expected to cease in April 2023. Conclusions: To the best of our knowledge, this protocol describes the only study of treatment for HA by proxy. As the prevalence of this condition is still unknown, a SCED was chosen because this method allows the inclusion of very few participants while still providing information on effects and treatment courses. Conducting the study with a replicated randomized phase design enables methodologically sound testing despite the inclusion of very few participants. The results will inform researchers on individual treatment courses and effects, which may direct future research in terms of the possible mechanisms of change, ideas for how to refine the treatment content, and how the treatment may be offered to patients in the future. Trial Registration: ClinicalTrials.gov NCT04830605; https://clinicaltrials.gov/study/NCT04830605 International Registered Report Identifier (IRRID): DERR1-10.2196/46927 %M 37999936 %R 10.2196/46927 %U https://www.researchprotocols.org/2023/1/e46927 %U https://doi.org/10.2196/46927 %U http://www.ncbi.nlm.nih.gov/pubmed/37999936 %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 %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46640 %T Improving Knowledge, Engagement, and Self-Efficacy in the Creation of Healthy Home Environments for Mothers Using a Facebook Intervention (Design for Wellness): Randomized Controlled Trial %A Aperman-Itzhak,Tal %A Prilleltensky,Isaac %A Rosen,Laura %+ Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, PO Box 39040, Ramat Aviv, Tel Aviv, 6997801, Israel, 972 508342585, talap1@gmail.com %K environmental home design %K wellness %K Facebook intervention %K nudging %K healthy living %K social media %K Israel %D 2023 %7 7.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Designing the home environment can promote well-being. Social networks provide learning opportunities to improve health. Objective: This study aimed to develop and evaluate a Facebook intervention called Design for Wellness (DWELL). The program was created to improve knowledge, engagement, and self-efficacy in the creation of healthy home environments. Methods: A randomized controlled trial was conducted to assess the effects of the intervention program DWELL. Content was uploaded to the Facebook group and gave the participants practical solutions for how to design their home environment for wellness. The intervention addressed multiple components of health behaviors, such as healthy eating, physical activity, tobacco-free environment, hygiene, family conversations regarding wellness issues, and stress reduction. The main outcome was the participants’ overall score on the DWELL index, which we developed to assess the elements of our intervention: knowledge, awareness, engagement, and self-efficacy regarding home design for wellness. The intervention was conducted in Israel and lasted 6 weeks during the third wave of the COVID-19 pandemic. The primary analysis included a multivariable model to assess the DWELL score at the end of the study while controlling for baseline characteristics. The waitlist control group did not receive an intervention between the 2 administrations of the questionnaire. Results: In total, 643 participants began the program: 322 (50.1%) in the intervention group and 321 (49.9%) in the control group. Of the 643 participants, 476 (74%) completed the study. At the end of the study, there was a statistically significant benefit of the intervention as assessed using a one-way analysis of covariance: there was a mean difference of 8.631 (SD 1.408) points in the DWELL score in favor of the intervention group (intervention: mean 61.92, SD 14.30; control: mean 53.29, SD 16.374; P<.001). Qualitative feedback from participants in the intervention group strengthened the positive results as most of them found the group beneficial. The Facebook group was very active. Being more engaged in the group correlated with having a higher DWELL score, but this relationship was weak (r=0.37; P<.001). The mean significant difference of 26.281 (SD 19.24) points between the overall DWELL score and the overall engagement score indicated that participants who were not active in the group still followed the posts and benefited. We found no improvements in the secondary outcome regarding participants’ well-being. The COVID-19 lockdown may have prevented this. Conclusions: DWELL was found to be a beneficial intervention for improving perceptions of the design of home environments to foster wellness. Facebook was an effective platform to deliver this intervention. DWELL may become a prototype for other health promotion interventions. Trial Registration: ClinicalTrials.gov NCT03736525; https://clinicaltrials.gov/study/NCT03736525?term=DWELL&rank=1 %M 37934566 %R 10.2196/46640 %U https://www.jmir.org/2023/1/e46640 %U https://doi.org/10.2196/46640 %U http://www.ncbi.nlm.nih.gov/pubmed/37934566 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e48934 %T Understanding the Tensions of “Good Motherhood” Through Women’s Digital Technology Use: Descriptive Qualitative Study %A Facca,Danica %A Hall,Jodi %A Hiebert,Bradley %A Donelle,Lorie %+ College of Nursing, University of South Carolina, 1601 Greene Street, Colombia, SC, 29208, United States, 1 803 777 6528, ldonelle@mailbox.sc.edu %K motherhood %K parenting %K digital health %K apps %K social media %K mother %K parent %K technology use %K use %K computer use %K interview %K interviews %K perspective %K perspectives %K mothers %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of “good motherhood.” Given the ways in which digital technologies can both support and hinder women’s perceptions of their parenting abilities, understanding expectant and new mothers’ experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. Objective: This study aims to understand mothers’ use of digital technologies during the transition to parenting period. Methods: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. Results: Participants’ experiences of using digital technologies in the transition to parenting period were captured within the overarching theme “balancing the tensions of digital technology use in the transition to parenting” and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered “in-the-moment” access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. Conclusions: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers. %M 37878372 %R 10.2196/48934 %U https://pediatrics.jmir.org/2023/1/e48934 %U https://doi.org/10.2196/48934 %U http://www.ncbi.nlm.nih.gov/pubmed/37878372 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e41779 %T Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation %A Weber,Summer Joy %A Mulvaney,Shelagh A %A Faiola,Anthony %A Brown,Madeline %A Koyama,Tatsuki %A Sun,Lili %A Goggans,Susanna Lynn %A Hull,Pamela Carmen %+ Markey Cancer Center, University of Kentucky, 760 Press Avenue, Suite 460, Lexington, KY, 40536, United States, 1 859 562 3233, pam.hull@uky.edu %K goal setting %K goal tracking %K nutrition %K health behavior %K nutrition %K parents %K children %K mobile apps %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. Objective: This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps’ general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). Methods: Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. Results: Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. Conclusions: Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals. %M 37831486 %R 10.2196/41779 %U https://pediatrics.jmir.org/2023/1/e41779 %U https://doi.org/10.2196/41779 %U http://www.ncbi.nlm.nih.gov/pubmed/37831486 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46989 %T Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial %A Kerimaa,Heli %A Hakala,Mervi %A Haapea,Marianne %A Vähänikkilä,Hannu %A Serlo,Willy %A He,Hong-Gu %A Pölkki,Tarja %+ Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu, 90220, Finland, 358 294485602, heli.kerimaa@oulu.fi %K anxiety %K day surgery %K fear %K mobile app %K pain %K parents %K preparation %K preschool child %K randomized controlled trial %K stress %K mobile phone %D 2023 %7 29.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. Objective: This study aims to evaluate the effectiveness of a mobile app intervention on preschool children’s fear and pain and parents’ anxiety and stress in preparing children for day surgery. Methods: This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents’ and children’s outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. Results: Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children’s pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children’s fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). Conclusions: The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. Trial Registration: ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303 %M 37773624 %R 10.2196/46989 %U https://www.jmir.org/2023/1/e46989 %U https://doi.org/10.2196/46989 %U http://www.ncbi.nlm.nih.gov/pubmed/37773624 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46735 %T An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial %A Jia,Xiao Yang %A Andreou,Pantelis %A Brown,Cary %A Constantin,Evelyn %A Godbout,Roger %A Hanlon-Dearman,Ana %A Ipsiroglu,Osman %A Reid,Graham %A Shea,Sarah %A Smith,Isabel M %A Zwicker,Jennifer D %A Weiss,Shelly K %A Corkum,Penny %+ The School of Public Policy, University of Calgary, 5th Floor, 906 8th Avenue SW, Calgary, AB, T2P 1H9, Canada, 1 4032103802, xiaoyangsean.jia@ucalgary.ca %K eHealth intervention %K pediatric insomnia %K neurodevelopmental disorders %K attention-deficit/hyperactivity disorder %K autism spectrum disorder %K cerebral palsy %K fetal alcohol spectrum disorder %K economic evaluation %K cost-effectiveness %D 2023 %7 12.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. Objective: This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. Methods: The BNBD-NDD RCT evaluates the impacts of the intervention on children’s sleep and quality of life, as well as parents’ daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children’s insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. Results: Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. Conclusions: To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation’s findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. Trial Registration: ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003 International Registered Report Identifier (IRRID): DERR1-10.2196/46735 %M 37698915 %R 10.2196/46735 %U https://www.researchprotocols.org/2023/1/e46735 %U https://doi.org/10.2196/46735 %U http://www.ncbi.nlm.nih.gov/pubmed/37698915 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47035 %T Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study %A Kostyrka-Allchorne,Katarzyna %A Chu,Petrina %A Ballard,Claire %A Lean,Nancy %A French,Blandine %A Hedstrom,Ellen %A Byford,Sarah %A Cortese,Samuele %A Daley,David %A Downs,Johnny %A Glazebrook,Cristine %A Goldsmith,Kimberley %A Hall,Charlotte L %A Kovshoff,Hanna %A Kreppner,Jana %A Sayal,Kapil %A Shearer,James %A Simonoff,Emily %A Thompson,Margaret %A Sonuga-Barke,Edmund J S %+ Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE58AF, United Kingdom, 44 02078483682, edmund.sonuga-barke@kcl.ac.uk %K parenting intervention %K mobile app %K attention-deficit/hyperactivity disorder %K ADHD %K behavior problems %K mobile health %K mHealth %K children %K usability %K mobile phone %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants’ recruitment and the app’s usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients’ data. Parents’ and clinicians’ feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS’ usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0 %M 37695667 %R 10.2196/47035 %U https://pediatrics.jmir.org/2023/1/e47035 %U https://doi.org/10.2196/47035 %U http://www.ncbi.nlm.nih.gov/pubmed/37695667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42921 %T Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT %A Long,Millie D %A van Deen,Welmoed K %A Weisbein,Laura %A Khalil,Carine %A Appel,Keren L %A Zhang,Xian %A Chen,Wenli %A Zubrod,Lori %A Maris,Robbie %A Ghafari,Afsoon %A Dupuy,Taylor %A Ha,Christina Y %A Spiegel,Brennan M R %A Almario,Christopher V %A Melmed,Gil Y %+ Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, 130 Mason Farm Rd, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7080, United States, 1 919 962 2211, millie_long@med.unc.edu %K preventative %K education %K inflammatory bowel disease (IBD) %K education %K adults %K inflammation %K disease %K risk %K infections %K bone %K cancer %K development %K patient %K interview %K intervention %K prevention %K vaccination %K influenza %D 2023 %7 23.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with inflammatory bowel disease (IBD) are at increased risk of infections, bone fractures, and skin cancers. Objective: We developed preventive health videos using a patient-centered approach and tested their impact on preventive health uptake. Methods: Five animated videos explaining preventive health recommendations in IBD were iteratively developed with patient-centered focus groups and interviews. A randomized controlled trial was then conducted in a web-based IBD cohort to test the impact of video- versus text-based educational interventions. The primary outcome was receipt of the influenza vaccine. Secondary outcomes included intention to receive other preventive health services. Results: Five animated videos were developed with patient input. A total of 1056 patients with IBD were then randomized to receive the video (n=511) or text-only (n=545) interventions; 55% (281/511) of the video group and 57% (311/545) of the text-only group had received their influenza vaccine in the prior year. Immediately after the intervention, 73% (502/683) of patients reported their intention to receive the vaccine, with no difference by the type of intervention (75%, 231/307, for the video group and 72%, 271/376, for the text-only group). The proportion of patients who actually received the influenza vaccine after the intervention also did not differ by messaging type (P=.07). The strongest predictor of both intention to receive and actual receipt of the influenza vaccine was prior influenza vaccination. Older age was also associated with a higher likelihood of the intention to receive (age 36-75 years relative to 18-35 years; P=.006) and actual receipt (age >75 years relative to 18-35 years; P=.05) of the influenza vaccine. Conclusions: The proportion of patients receiving the influenza vaccine was high in both groups, but there was no difference in receipt of or in the intention to receive preventive health recommendations by type of messaging. Notably, a portion of patients in both groups had intended to be vaccinated but did not ultimately receive the vaccine. Further evaluation of patient-education strategies is warranted to improve preventive health uptake among patients with IBD. Trial Registration: ClinicalTrials.gov NCT05997537; https://clinicaltrials.gov/ct2/show/NCT05997537 %M 37610821 %R 10.2196/42921 %U https://www.jmir.org/2023/1/e42921 %U https://doi.org/10.2196/42921 %U http://www.ncbi.nlm.nih.gov/pubmed/37610821 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43837 %T Novel At-Home Mother’s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment %A Haramati,Sharon %A Firsow,Anastasia %A Navarro,Daniela Abigail %A Shechter,Ravid %+ MyMilk Laboratories Ltd, Glil Yam, Kibbutz, Glil Yam, 4690500, Israel, 972 526166705, shechter.ravid@gmail.com %K breastfeeding %K feasibility %K human milk %K biomarker %K remote sensing technology %K mobile health %K retrospective %K secretory activation %K lactogenesis %K milk supply %K milk %K sensing technology %K monitoring tool %K lactation %K exclusive breastfeeding %K breastfeed %K maternal health %K maternal and infant health %K infant health %K maternal and child health %K prolactin %K lactation consultant %K lactation support provider %K mother %K milk maturation %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth–dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system’s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth–dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. %M 37464893 %R 10.2196/43837 %U https://pediatrics.jmir.org/2023/1/e43837 %U https://doi.org/10.2196/43837 %U http://www.ncbi.nlm.nih.gov/pubmed/37464893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46953 %T Association Between Online Health Information–Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China %A Wang,Jiamin %A Zhen,Xuemei %A Coyte,Peter C %A Shao,Di %A Zhao,Ni %A Chang,Lele %A Feng,Yujia %A Sun,Xiaojie %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, West-Wenhua Road, 44, Jinan, 250012, China, 86 531 88382526, xiaojiesun@sdu.edu.cn %K online health information–seeking behaviors %K patient delay %K diagnostic delay %K treatment delay %K mixed methods study %D 2023 %7 16.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information–seeking (OHIS) behaviors by caregivers. Objective: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children’s health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers’ OHIS behaviors impacted the cancer care pathway by influencing caregivers’ symptom appraisal before the first medical contact and caregivers’ acceptance of health care providers’ diagnostic and treatment decisions. Conclusions: Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers’ cancer symptom appraisal before the first medical contact. %M 37585244 %R 10.2196/46953 %U https://www.jmir.org/2023/1/e46953 %U https://doi.org/10.2196/46953 %U http://www.ncbi.nlm.nih.gov/pubmed/37585244 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47950 %T Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study %A Sarhaddi,Fatemeh %A Azimi,Iman %A Niela-Vilen,Hannakaisa %A Axelin,Anna %A Liljeberg,Pasi %A Rahmani,Amir M %+ Department of Computer Science, University of California, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 949 824 5011, azimii@uci.edu %K health monitoring %K internet of things %K maternal loneliness %K passive sensing %K wearable device %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child. Objective: The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection. Methods: We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants’ smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction. Results: The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness. Conclusions: Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness. %M 37556183 %R 10.2196/47950 %U https://formative.jmir.org/2023/1/e47950 %U https://doi.org/10.2196/47950 %U http://www.ncbi.nlm.nih.gov/pubmed/37556183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43720 %T The Use of Travel as an Appeal to Motivate Millennial Parents on Facebook to Get Vaccinated Against COVID-19: Message Framing Evaluation %A Arshanapally,Suraj %A Starr,Tiearra %A Elsberry,Lauren Blackmun %A Rinker,Robin %+ National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H16-4, Atlanta, GA, 30329, United States, 1 404 498 1007, otv1@cdc.gov %K COVID-19 %K coronavirus %K vaccination %K travel %K parents %K millennial %K appeal %K health communication %K social media %K Facebook %K infectious disease %K message testing %K public health %K messaging %K parenting %K program %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In summer 2021, the Centers for Disease Control and Prevention recommended that people get fully vaccinated against COVID-19 before fall travel to protect themselves and others from getting and spreading COVID-19 and new variants. Only 61% of parents had reported receiving at least 1 dose of the COVID-19 vaccine, according to a Kaiser Family Foundation study. Millennial parents, ages 25 to 40 years, were a particularly important parent population because they were likely to have children aged 12 years or younger (the age cutoff for COVID-19 vaccine eligibility during this time period) and were still planning to travel. Since Facebook has been identified as a popular platform for millennials and parents, the Centers for Disease Control and Prevention’s Travelers’ Health Branch determined an evaluation of public health messages was needed to identify which message appeals would resonate best with this population on Facebook. Objective: The objective was to evaluate which travel-based public health message appeals aimed at addressing parental concerns and sentiments about COVID-19 vaccination would resonate most with Millennial parents (25 to 40 years old) using Facebook Ads Manager and social media metrics. Methods: Six travel-based public health message appeals on parental concerns and sentiments around COVID-19 were developed and disseminated to millennial parents using Facebook Ads Manager. The messages ran from October 23, 2021, to November 8, 2021. Primary outcomes included the number of people reached and the number of impressions delivered. Secondary outcomes included engagements, clicks, click-through rate, and audience sentiments. A thematic analysis was conducted to analyze comments. The advertisement budget was evaluated by cost-per-mille and cost-per-click metrics. Results: All messages reached a total of 6,619,882 people and garnered 7,748,375 impressions. The Family (n=3,572,140 people reached, 53.96%; 4,515,836 impressions, 58.28%) and Return to normalcy (n=1,639,476 people reached, 24.77%; 1,754,227 impressions, 22.64%) message appeals reached the greatest number of people and garnered the most impressions out of all 6 message appeals. The Family message appeal received 3255 engagements (60.46%), and the Return to normalcy message appeal received 1148 engagements (21.28%). The Family appeal also received the highest number of positive post reactions (n=82, 28.37%). Most of the comments portrayed negative opinions about COVID-19 vaccination (n=46, 68.66%). All 6 message appeals were either on par with or outperformed cost-per-mille benchmarks set by other similar public health campaigns. Conclusions: Health communicators can use travel, specifically the Family and Return to normalcy message appeals, to successfully reach parents in their future COVID-19 vaccination campaigns and potentially inform health communication messaging efforts for other vaccine-preventable infectious disease campaigns. Public health programs can also utilize the lessons learned from this evaluation to communicate important COVID-19 information to their parent populations through travel messaging. %M 37437085 %R 10.2196/43720 %U https://formative.jmir.org/2023/1/e43720 %U https://doi.org/10.2196/43720 %U http://www.ncbi.nlm.nih.gov/pubmed/37437085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44079 %T The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort %A Palmer,Melanie %A Beckley-Hoelscher,Nicholas %A Shearer,James %A Kostyrka-Allchorne,Katarzyna %A Robertson,Olly %A Koch,Marta %A Pearson,Oliver %A Slovak,Petr %A Day,Crispin %A Byford,Sarah %A Goldsmith,Kimberley %A Waite,Polly %A Creswell,Cathy %A Sonuga-Barke,Edmund J S %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 0207 848 0269, edmund.sonuga-barke@kcl.ac.uk %K parenting %K intervention %K digital application %K randomized controlled trial %K COVID-19 pandemic %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 %M 37498669 %R 10.2196/44079 %U https://www.jmir.org/2023/1/e44079 %U https://doi.org/10.2196/44079 %U http://www.ncbi.nlm.nih.gov/pubmed/37498669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43219 %T Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies %A Xie,Elisabeth Bailin %A Jung,James Wonkyu %A Kaur,Jasleen %A Benzies,Karen M %A Tomfohr-Madsen,Lianne %A Keys,Elizabeth %+ School of Nursing, The University of British Columbia, Okanagan Campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 (250) 807 8344, elizabeth.keys@ubc.ca %K eHealth %K digital intervention %K father %K perinatal %K infant %K parenting %K mobile phone %K review %D 2023 %7 26.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions help address barriers to traditional health care services. Fathers play an important parenting role in their families, and their involvement is beneficial for family well-being. Although digital interventions are a promising avenue to facilitate father involvement during the perinatal period, most are oriented toward maternal needs and do not address the unique needs of fathers. Objective: This systematic review describes the digital interventions that exist or are currently being developed for fathers of infants from conception to 12 months postpartum. Methods: A systematic search of the MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Embase (using Ovid), and CINAHL (using EBSCO) databases was conducted to identify articles from database inception to June 2022, of which 39 met the inclusion criteria. Articles were included if they were peer-reviewed and described a digital intervention that targeted fathers of fetuses or infants aged ≤12 months. Systematic reviews, meta-analyses, and opinion pieces were excluded. Data from these studies were extracted and themed using a narrative synthesis approach. Quality appraisal of the articles was conducted using the Mixed Methods Appraisal Tool. Results: A total of 2816 articles were retrieved, of which 39 (1.38%) met the inclusion criteria for eligibility after removing duplicates and screening. Eligible articles included 29 different interventions across 13 countries. Most articles (22/29, 76%) described interventions that were exclusively digital. There were a variety of digital modalities, but interventions were most commonly designed to be delivered via a website or web-based portal (14/29, 48%). Just over half (21/39, 54%) of the articles described interventions designed to be delivered from pregnancy through the postpartum period. Only 26% (10/39) of the studies targeted fathers exclusively. A wide range of outcomes were included, with 54% (21/39) of the studies including a primary outcome related to intervention feasibility. Qualitative and mixed methods studies reported generally positive experiences with digital interventions and qualitative themes of the importance of providing support to partners, improving parenting confidence, and normalization of stress were identified. Of the 18 studies primarily examining efficacy outcomes, 13 (72%) reported a statistically significant intervention effect. The studies exhibited a moderate quality level overall. Conclusions: New and expecting fathers use digital technologies, which could be used to help address father-specific barriers to traditional health care services. However, in contrast to the current state of digital interventions for mothers, father-focused interventions lack evaluation and evidence. Among the existing studies on digital interventions for fathers, there seem to be mixed findings regarding their feasibility, acceptability, and efficacy. There is a need for more development and standardized evaluation of interventions that target father-identified priorities. This review was limited by not assessing equity-oriented outcomes (eg, race and socioeconomic status), which should also be considered in future intervention development. %M 37494086 %R 10.2196/43219 %U https://www.jmir.org/2023/1/e43219 %U https://doi.org/10.2196/43219 %U http://www.ncbi.nlm.nih.gov/pubmed/37494086 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43214 %T Caregivers’ Experiences With a Web- and Mobile-Based Platform for Children With Medical Complexity and the Role of a Live Platform Coach: Thematic Analysis %A Shouldice,Ainslie Claire %A Beatty,Madison %A Adams,Sherri %A Dharmaraj,Blossom %A Moore,Clara %A Stinson,Jennifer Nan %A Desai,Arti %A Bartlett,Leah %A Culbert,Erin %A Cohen,Eyal %A Orkin,Julia %+ Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada, 1 4168137654, ainslie.shouldice@gmail.com %K care coordination %K care %K children with medical complexity %K children %K chronic condition %K electronic data %K engagement %K health information exchange %K medical %K patient care planning %K pediatrics %K usage %K utilization %D 2023 %7 5.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with medical complexity (CMC) are individuals with complex chronic conditions who have substantial health care needs, functional limitations, and significant use of health care. By nature of their health status, they have many care providers across multiple settings, making information sharing critical to their health and safety. Connecting2gether (C2), a web- and mobile-based patient-facing platform, was codeveloped with families to support and empower parental caregivers, improve information sharing, and facilitate care delivery. C2 also provided a live platform coach to conduct parental feedback and coaching sessions, which included answering questions, providing advice on usage, and addressing technological issues. Objective: This study was conducted to understand the experience of parental caregivers using the C2 platform and the role of the live platform coach. This study is a subset of a larger study assessing the feasibility of C2 in the care of CMC. Methods: Parental caregivers (n=33) participated in biweekly sessions to provide feedback and receive real-time platform use support from a trained research team member acting as a live platform coach. Parental caregivers were asked about the utility and usability of C2’s features. Questions, platform issues, and feedback were recorded on a standardized electronic data collection tool. A thematic analysis was performed to analyze parental comments, and codes were categorized into key themes. The number of comments corresponding with each code was quantified. Results: A total of 166 parental feedback and coaching sessions were conducted, with an average of 5 sessions per parental caregiver (range 1-7). There were 33 (85%) parental caregivers that participated in at least one coaching session. Technical issues and difficulties navigating C2 were addressed in real time during the sessions to encourage platform engagement. Four key themes were identified: (1) live platform coach, (2) barriers to platform usage and technical challenges, (3) platform requests and modifications, and (4) parent partnership and empowerment. Conclusions: Parental caregivers describe C2 as a valuable tool, acting as a facilitator for enhanced care coordination and communication. Parental caregiver feedback showed that the live platform coach was a critical tool in educating on platform use and addressing technological concerns. Further study of the use of the C2 platform and its role in the care of CMC is needed to understand the possible benefits and cost-effectiveness of this technology. %M 37405834 %R 10.2196/43214 %U https://pediatrics.jmir.org/2023/1/e43214 %U https://doi.org/10.2196/43214 %U http://www.ncbi.nlm.nih.gov/pubmed/37405834 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47358 %T Parents’ Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework %A Kuschke,Silva %A Moodie,Sheila %A Kirubalingam,Keshinisuthan %A O'Hagan,Robin %A Glista,Danielle %+ School of Communication Sciences and Disorders, Faculty of Health Sciences, The University of Western Ontario, 1201 Western Road, London, ON, N6G 1H1, Canada, 1 519 661 2111 ext 88913, dglista@uwo.ca %K audiology %K care %K child engagement %K children %K concept mapping %K cost %K hearing aid %K hearing loss %K hearing %K integration %K parents %K pediatric audiology %K pediatric %K remote hearing aid support %K support %K virtual care %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. Objective: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. Methods: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. Conclusions: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries. %M 37279061 %R 10.2196/47358 %U https://pediatrics.jmir.org/2023/1/e47358 %U https://doi.org/10.2196/47358 %U http://www.ncbi.nlm.nih.gov/pubmed/37279061 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43626 %T Features, Design, and Adherence to Evidence-Based Behavioral Parenting Principles in Commercial mHealth Parenting Apps: Systematic Review %A Li,Kexin %A Magnuson,Katherine I %A Beuley,Grace %A Davis,Logan %A Ryan-Pettes,Stacy R %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798-7334, United States, 1 2547102544, Stacy_Ryan-Pettes@baylor.edu %K mobile phone %K parent %K behavioral parent training %K parent management training %K mobile apps %K mobile health %K mHealth %K child %K adolescent %D 2023 %7 1.6.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy for such concerns, they have limitations and challenges when disseminated in the community. Behavioral-based parenting techniques form an integral part of well-established, family-based interventions for adolescent behavioral problems and are ideal for dissemination through coupling with smartphone technology. Despite the vast number of “parent” apps currently available in commercial markets, there is a dearth of reviews focused on evaluating mobile health apps through the lens of behavioral parenting training (BPT). Objective: This study aimed to conduct a systematic review of commercial mobile health apps for parents to increase effective parenting skills that include behavioral components. Methods: A search of the Google Play and Apple App Stores identified 57 apps that were included in the review and coded for availability, popularity, and infrastructure. In total, 89% (51/57) of them were sufficiently functional to be assessed for app design quality (engagement, functionality, esthetics, and information), and 53% (30/57) proceeded to the final evaluation of level of adherence to BPT principles. Results: In total, 57 apps met the initial inclusion criteria. Accessibility was high across these apps given that 44% (25/57) were available on both the Google Play and Apple App Stores and 68% (39/57) were free of charge. However, privacy concerns were addressed inconsistently among the apps. App design quality was average across the included apps, and apps with positive user star ratings or a high number of downloads received higher ratings on app design quality. In contrast, the identified apps largely fell short in providing BPT components adequately and with high interactivity, with low levels of adherence to BPT (mean 20.74%, SD 11%) across all commercial apps evaluated. Commercially popular apps did not show higher levels of adherence to BPT. Overall, a moderate relationship between app design quality and adherence to BPT was found. App features that have been found to increase user engagement, such as gamification and individualization, were only observed in a small minority of apps. Overall, there was a lack of focus on teenage development. Conclusions: Future app developers hoping to increase the dissemination of BPT should aim for free and accessible apps that balance high-quality design features (eg, simple esthetics, interactivity, and individualization) with content consistent with BPT principles. They should also consider key issues that are inconsistently addressed in current apps, including privacy and teenage development. Future app developments will likely benefit from multisector (industry and academic) collaboration throughout the design process and involving end users (ie, parents) during different stages of app development. %M 37261886 %R 10.2196/43626 %U https://pediatrics.jmir.org/2023/1/e43626 %U https://doi.org/10.2196/43626 %U http://www.ncbi.nlm.nih.gov/pubmed/37261886 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43673 %T Evaluation of an mHealth Intervention (Growin’ Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Health Sciences Building, Level 2, Sturt Road, Bedford Park, South Australia, 5042, Australia, 61 8 72218410, billie.bonevski@flinders.edu.au %K mobile health %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women’s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin’ Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin’ Up Healthy Jarjums—a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages—for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin’ Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin’ Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin’ Up Healthy Jarjums program at improving health outcomes. %M 37234043 %R 10.2196/43673 %U https://pediatrics.jmir.org/2023/1/e43673 %U https://doi.org/10.2196/43673 %U http://www.ncbi.nlm.nih.gov/pubmed/37234043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45276 %T Web-Based Knowledge Translation Tool About Pediatric Acute Gastroenteritis for Parents: Pilot Randomized Controlled Trial %A Hartling,Lisa %A Elliott,Sarah A %A Munan,Matthew %A Scott,Shannon D %+ Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy 4-472, 11405-87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K knowledge translation %K pediatric acute gastroenteritis %K emergency department %K health care decision-making %K multiple methods %K randomized controlled trial %K qualitative interviews %K web-based tool %D 2023 %7 25.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video). Objective: The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value. Methods: A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged <16 years presenting to the ED with an acute episode of diarrhea or vomiting, ability to communicate in English, and agreeable to follow-up via email. Parents were randomized to receive the web-based KT tool (intervention) about AGE or a sham video (control) during their ED visit. The primary outcome was knowledge assessed before the intervention (baseline), immediately after the intervention, and at follow-up 4 to 14 days after ED discharge. Other outcomes included decision regret, health care use, and KT tool usability and satisfaction. The intervention group participants were invited to participate in a semistructured interview to gather additional feedback about the KT tool. Results: A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; P<.001) and at follow-up (mean 9.1, SD 2.7 vs mean 6.8, SD 1.6; P<.001) were significantly higher in the intervention group. After the intervention, parents in the intervention group reported greater confidence in knowledge than those in the control group. No significant difference in decision regret was found at any time point. Parents rated the KT tool higher than the sham video across 5 items assessing usability and satisfaction. Conclusions: The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents’ decision-making regarding their child’s health. Trial Registration: ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-018-0318-0 %M 37227758 %R 10.2196/45276 %U https://formative.jmir.org/2023/1/e45276 %U https://doi.org/10.2196/45276 %U http://www.ncbi.nlm.nih.gov/pubmed/37227758 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43196 %T Effectiveness of a Mobile App (KhunLook) Versus the Maternal and Child Health Handbook on Thai Parents’ Health Literacy, Accuracy of Health Assessments, and Convenience of Use: Randomized Controlled Trial %A Areemit,Rosawan %A Saengnipanthkul,Suchaorn %A Sutra,Sumitr %A Lumbiganon,Pagakrong %A Pornprasitsakul,Phenphitcha %A Paopongsawan,Pongsatorn %A Sripanidkulchai,Kunwadee %+ Department of Pediatrics, Faculty of Medicine, Khon Kaen University, 123, Mittraphap Road, Muang District, Khon Kaen, 40002, Thailand, 66 885101031, suchsa@kku.ac.th %K health literacy %K mobile app %K mHealth %K KhunLook %K Maternal and Child Health Handbook %K parent %K health assessment %K child health supervision %K Thailand %D 2023 %7 9.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Children of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents’ HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child’s health in complement to the standard Maternal and Child Health Handbook (MCHH). Objective: This trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents’ HL. Data on accuracy of parents’ assessment of their child’s health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2). Methods: Parents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child’s handbook to assess their child’s growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire. Results: A total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; Δ 8.2%; P=.04), specifically in the health management (30/182; Δ 16.4%; P<.001) and child health management (18/182; Δ 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child’s head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit. Conclusions: Our results suggest the potential of a smartphone app (KhunLook) to improve parents’ HL as well as to promote superior accuracy of parents’ assessment of their child’s head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood. Trial Registration: Thai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR20200312003 %M 37159258 %R 10.2196/43196 %U https://www.jmir.org/2023/1/e43196 %U https://doi.org/10.2196/43196 %U http://www.ncbi.nlm.nih.gov/pubmed/37159258 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40955 %T Stop and Play Digital Health Education Intervention for Reducing Excessive Screen Time Among Preschoolers From Low Socioeconomic Families: Cluster Randomized Controlled Trial %A Raj,Diana %A Ahmad,Norliza %A Mohd Zulkefli,Nor Afiah %A Lim,Poh Ying %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Hospital Serdang, Serdang, 43400, Malaysia, 60 397692582, lizaahmad@upm.edu.my %K child %K preschool %K screen time %K mother-child %K randomized controlled trial %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention. Objective: This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia. Methods: A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child’s screen time, whereas secondary outcomes included mother’s screen time knowledge, perception about the influence of screen time on the child’s well-being, self-efficacy to reduce the child’s screen time and increase physical activity, mother’s screen time, and presence of screen device in the child’s bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention’s effectiveness was evaluated using generalized linear mixed models. Results: A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child’s screen time compared with the control group (β=−202.29, 95% CI −224.48 to −180.10; P<.001). Parental outcome scores also improved in the intervention group as compared with that in the control group. Mother’s knowledge significantly increased (β=6.88, 95% CI 6.11-7.65; P<.001), whereas perception about the influence of screen time on the child’s well-being reduced (β=−.86, 95% CI −0.98 to −0.73; P<.001). There was also an increase in the mother’s self-efficacy to reduce screen time (β=1.59, 95% CI 1.48-1.70; P<.001) and increase physical activity (β=.07, 95% CI 0.06-0.09; P<.001), along with reduction in mother’s screen time (β=−70.43, 95% CI −91.51 to −49.35; P<.001). Conclusions: The Stop and Play intervention was effective in reducing screen time among preschool children from low socioeconomic families, while improving the associated parental factors. Therefore, integration into primary health care and preschool education programs is recommended. Mediation analysis is suggested to investigate the extent to which secondary outcomes are attributable to the child’s screen time, and long follow-up could evaluate the sustainability of this digital intervention. Trial Registration: Thai Clinical Trial Registry (TCTR) TCTR20201010002; https://tinyurl.com/5frpma4b %M 37140970 %R 10.2196/40955 %U https://www.jmir.org/2023/1/e40955 %U https://doi.org/10.2196/40955 %U http://www.ncbi.nlm.nih.gov/pubmed/37140970 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40043 %T How People Use Web-Based Parenting Information to Support Others in Their Social Circle: Qualitative Descriptive Study %A El Sherif,Reem %A Pluye,Pierre %A Paquet,Virginie %A Ibekwe,Fidelia %A Grad,Roland %+ Department of Family Medicine, McGill University, Suite 300, Ch Cotes-des-neiges, Montreal, QC, H3S 1Z1, Canada, 1 5143987375, reem.elsherif@mail.mcgill.ca %K consumer health information %K information seeking behavior %K child development %K child health %K information outcomes %K health information %K digital health %K parenting %K web-based information %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Almost two-thirds of the North American population have searched for health information on the web, and the majority report searching on behalf of someone else in their social circle, a phenomenon referred to as proxy seeking. Little is known about how proxy seekers use web-based health information and the outcomes they experience. Objective: The main aim of this study was to explore why proxy seekers used a parenting website on behalf of parents in their social circle and the outcomes they reported. Methods: A qualitative descriptive study was conducted in the context of a partnership with a web-based parenting resource to explore the contexts and motivations for proxy web-based health information seeking, use of information, and subsequent outcomes. A total of 14 participants who self-identified as family members, friends of parents of young children, or professionals who worked with young children were interviewed, and a thematic analysis was conducted. Results: The following 4 reasons for proxy seeking were uncovered: for reassurance, out of personal curiosity, as part of a professional role, or following an explicit request from the parents. Information was used to provide informational support for parents or material support for a child. Positive outcomes of using the information and some of the resulting interpersonal tensions were described. Conclusions: This study provides an in-depth look at proxy seeking behavior and outcomes among users of a web-based parenting resource. %M 37115603 %R 10.2196/40043 %U https://pediatrics.jmir.org/2023/1/e40043 %U https://doi.org/10.2196/40043 %U http://www.ncbi.nlm.nih.gov/pubmed/37115603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37839 %T Exploring the Acceptability, Feasibility, and Effectiveness of a Digital Parenting Program to Improve Parental Well-being After the Christchurch Earthquakes: Cluster-Randomized Trial %A Donkin,Liesje %A Merry,Sally %A Moor,Stephanie %A Mowat,Anna %A Hetrick,Sarah %A Hopkins,Sarah %A Seers,Kara %A Frampton,Chris %A D'Aeth,Lucy %+ Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K psychology %K eHealth %K app %K parenting %K digital health %K children %K parent %K well-being %K earthquake %K cluster-randomized trial %K distress %K child %K mental health %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children’s mental health. Objective: The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. Methods: A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. Results: A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. Conclusions: Kākano is an app co-designed with parents to help manage their children’s mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true %M 37103986 %R 10.2196/37839 %U https://formative.jmir.org/2023/1/e37839 %U https://doi.org/10.2196/37839 %U http://www.ncbi.nlm.nih.gov/pubmed/37103986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42161 %T Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation %A Till,Sarina %A Mkhize,Mirriam %A Farao,Jaydon %A Shandu,Londiwe Deborah %A Muthelo,Livhuwani %A Coleman,Toshka Lauren %A Mbombi,Masenyani %A Bopape,Mamara %A Klingberg,Sonja %A van Heerden,Alastair %A Mothiba,Tebogo %A Densmore,Melissa %A Verdezoto Dias,Nervo Xavier %A , %+ School of Information Technology, Independent Institute of Education, 12 Radar Drive, Durban, South Africa, 27 718682991, ctill@varsitycollege.co.za %K maternal health %K child health %K digital health %K community %K scoping review %K low- and middle-income countries %K LMIC %K technology %K co-design %K mobile phone %D 2023 %7 7.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. Objective: This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. Methods: We conducted a scoping review using the 6-stage framework by Arksey and O’Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. Results: During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. Conclusions: Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy. %M 37027199 %R 10.2196/42161 %U https://www.jmir.org/2023/1/e42161 %U https://doi.org/10.2196/42161 %U http://www.ncbi.nlm.nih.gov/pubmed/37027199 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42272 %T Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents %A Champion,Katrina E %A Hunter,Emily %A Gardner,Lauren A %A Thornton,Louise K %A Chapman,Cath %A McCann,Karrah %A Spring,Bonnie %A Slade,Tim %A Teesson,Maree %A Newton,Nicola C %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, Sydney, 2006, Australia, 61 8627 9006, katrina.champion@sydney.edu.au %K parents %K adolescents %K prevention %K risk behaviors %K intervention %K mobile phone %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective: This study aimed to assess parents’ knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention. Methods: An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents’ perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data. Results: A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4%), vegetable intake (7/126, 5.6%), and weekend recreational screen time (7/130, 5.4%) was very low. Overall, parents’ perceived knowledge of health guidelines was moderate, ranging from 50.6% (80/158) for screen time to 72.8% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2% (46/104) and 42% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7% rated very or extremely important), and other important program features were ease of use (89/122, 72.9%), paced learning (79/126, 62.7%), and appropriate program length (74/126, 58.8%). Conclusions: The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents. %M 37014696 %R 10.2196/42272 %U https://pediatrics.jmir.org/2023/1/e42272 %U https://doi.org/10.2196/42272 %U http://www.ncbi.nlm.nih.gov/pubmed/37014696 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43867 %T A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study %A Mehdizadeh,Hamed %A Asadi,Farkhondeh %A Nazemi,Eslam %A Mehrvar,Azim %A Yazdanian,Azade %A Emami,Hassan %+ Health Information Technology Department, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Farah Abad Blvd,, Sari, 4818911916, Iran, 98 1133543246, hamed13sep@gmail.com %K Digital health %K eHealth %K Telehealth %K mHealth %K Mobile app %K self-management %K cancer %K child %K parent %K caregiver %K usability evaluation %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children’s evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. %M 36995746 %R 10.2196/43867 %U https://pediatrics.jmir.org/2023/1/e43867 %U https://doi.org/10.2196/43867 %U http://www.ncbi.nlm.nih.gov/pubmed/36995746 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41436 %T Parents’ and Health Care Professionals’ Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study %A Hörold,Madlen %A Apfelbacher,Christian %A Gerhardinger,Katharina %A Rohr,Magdalena %A Schimmelpfennig,Maria %A Weigt,Julia %A Brandstetter,Susanne %+ Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 3916724348, madlen.hoerold@med.ovgu.de %K parents %K health care professionals %K content analysis %K grounded theory %K food allergy %K children %K allergic reaction %K information needs %K information seeking %K prevention %K prediction %K risk factors %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade—away from allergen avoidance toward a tolerance induction approach—challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information–seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking. Objective: The aim of the study is to explore and understand parents’ and health care professionals’ perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families’ experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored. Methods: This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals’ predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents’ experiences, interactions, and social processes in families in daily life. Results: Recruitment and data collection started in February 2022 and is still ongoing. Conclusions: The qualitative study will provide insight into parents’ information-seeking behavior and needs regarding the prevention of food allergy in children, parents’ use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user’s perspective and inform the development of the NAMIBIO apps. International Registered Report Identifier (IRRID): DERR1-10.2196/41436 %M 36947117 %R 10.2196/41436 %U https://www.researchprotocols.org/2023/1/e41436 %U https://doi.org/10.2196/41436 %U http://www.ncbi.nlm.nih.gov/pubmed/36947117 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41804 %T Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial %A Augustin,Michaela %A Licata-Dandel,Maria %A Breeman,Linda D %A Harrer,Mathias %A Bilgin,Ayten %A Wolke,Dieter %A Mall,Volker %A Ziegler,Margret %A Ebert,David Daniel %A Friedmann,Anna %+ Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr.65, Munich, 81377, Germany, 49 8971009149, michaela.augustin@tum.de %K children %K crying problems %K sleeping problems %K feeding problems %K feeding %K regulatory problems %K intervention study %K Mobile Health Care %K health app %K mobile app %K patient education %K psychoeducation %K eHealth %K mobile health %K mHealth %K parenting %K baby %K babies %K sleep %K crying %K newborn %K mobile phone %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. Objective: We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children’s symptoms decreased more than those of the parents who did not use the app. Methods: Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. Results: The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). Conclusions: This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children’s symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. Trial Registration: German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001 %M 36897641 %R 10.2196/41804 %U https://mhealth.jmir.org/2023/1/e41804 %U https://doi.org/10.2196/41804 %U http://www.ncbi.nlm.nih.gov/pubmed/36897641 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38667 %T COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study %A Brusk,John J %A Bensley,Robert J %+ School of Interdisciplinary Health Programs, Western Michigan University, 2414 CHHS Bldng, 1903 W. Michigan Ave., Kalamazoo, MI, 49008, United States, 1 2697162301, bobbensley@gmail.com %K COVID-19 %K user engagement %K infodemic %K Women, Infants, and Children %K WIC %K educational resource %K health care %K digital health %K nutrition %K web-based education %K web-based nutrition %K pediatric %K parenting %K dashboard %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site’s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19–specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. %M 36787232 %R 10.2196/38667 %U https://formative.jmir.org/2023/1/e38667 %U https://doi.org/10.2196/38667 %U http://www.ncbi.nlm.nih.gov/pubmed/36787232 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43814 %T Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in an Eye Hospital in Nepal: Nonrandomized Study %A Shrestha,Manisha %A Bhandari,Gopal %A Kamalakannan,Sureshkumar %A Murthy,Gudlavalleti Venkata Satyanarayana %A Rathi,Suresh Kumar %A Gudlavalleti,Anirudh Gaurang %A Agiwal,Varun %A Pant,Hira %A Pandey,Binod %A Ghimire,Ramesh %A Ale,Daman %A Kayastha,Sajani %A Karki,Rakshya %A Chaudhary,Daya Shankar %A Byanju,Raghunandan %A , %+ Bharatpur Eye Hospital, Bypass Rd-10, Bharatpur Metropolitan City, Chitwan, 42201, Nepal, 977 9845023273, maneeshasht9845@gmail.com %K counseling %K follow-up %K intervention study %K Nepal %K ophthalmology %K pediatrics %K public health %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions—(1) counseling and (2) SMS text messaging and phone calls—to improve the follow-up rates. Objective: This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. Methods: A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. Results: The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. Conclusions: We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): RR2-10.2196/31578 %M 36821366 %R 10.2196/43814 %U https://pediatrics.jmir.org/2023/1/e43814 %U https://doi.org/10.2196/43814 %U http://www.ncbi.nlm.nih.gov/pubmed/36821366 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43885 %T Evaluating the Effects of the Supportive Parenting App on Infant Developmental Outcomes: Longitudinal Study %A Shorey,Shefaly %A Chong,Yap Seng %A Shi,Luming %A Chua,Jing Shi %A , %A Mathews,Jancy %A Lim,Siew Hoon %A Du,Ruochen %A Chan,Yiong Huak %A Tan,Thiam Chye %A Chee,Cornelia %A Law,Evelyn %+ Alice Lee Centre for Nursing Studies, National University of Singapore, Clinical Research Centre, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K infant development %K parenting %K mobile health technology %K social support %K psychoeducation %K peer support %K mobile phone %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previous studies have investigated the various effects of parenting on infant developmental outcomes. In particular, parental stress and social support have been found to significantly affect the growth of the newborn. Although many parents today use mobile apps to obtain more support in parenting and perinatal care, few studies have examined how these apps could affect infant development. Objective: This study aimed to examine the effectiveness of the Supportive Parenting App (SPA) in improving infant developmental outcomes during the perinatal period. Methods: This study adopted a 2-group parallel prospective longitudinal design and recruited 200 infants and their parents (N=400 mothers and fathers). The parents were recruited at 24 weeks of gestation for a randomized controlled trial conducted from February 2020 to July 2022. They were randomly allocated to either the intervention or control group. The infant outcome measures included cognition, language, motor skills, and social-emotional development. Data were collected from the infants when they were aged 2, 4, 6, 9, and 12 months. Linear and modified Poisson regressions were used to analyze the data to examine between- and within-group changes. Results: At 9 and 12 months post partum, the infants in the intervention group were found to have better communication and language skills than those in the control group. An analysis of motor development revealed that a larger proportion of the infants in the control group fell under the at-risk category, where they scored approximately 2 SDs below the normative scores. The control group infants scored higher on the problem solving domain at 6 months post partum. However, at 12 months postpartum, the infants in the intervention group performed better on cognitive tasks than those in the control group. Despite not being statistically significant, the intervention group infants were found to have consistently scored better on the social components of the questionnaires than the control group infants. Conclusions: Overall, the infants whose parents had received the SPA intervention tended to fare better in most developmental outcome measures than those whose parents had received standard care only. The findings of this study suggest that the SPA intervention exerted positive effects on the communication, cognition, motor, and socioemotional development of the infants. Further research is needed to improve the content and support provided by the intervention to maximize the benefits gained by infants and their parents. Trial Registration: ClinicalTrials.gov NCT04706442; https://clinicaltrials.gov/ct2/show/NCT04706442 %M 36811952 %R 10.2196/43885 %U https://mhealth.jmir.org/2023/1/e43885 %U https://doi.org/10.2196/43885 %U http://www.ncbi.nlm.nih.gov/pubmed/36811952 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40371 %T Web-Based Conversations Regarding Fathers Before and During the COVID-19 Pandemic: Qualitative Content Analysis %A Bouchacourt,Lindsay %A Henson-García,Mike %A Sussman,Kristen Leah %A Mandell,Dorothy %A Wilcox,Gary %A Mackert,Michael %+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 471 5775, lbouchacourt@utexas.edu %K social media %K expecting fathers %K new fathers %K Twitter %K Reddit %K content analysis %K topic model %K topic analysis %K parent %K father %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Studies of new and expecting parents largely focus on the mother, leaving a gap in knowledge about fathers. Objective: This study aimed to understand web-based conversations regarding new and expecting fathers on social media and to explore whether the COVID-19 pandemic has changed the web-based conversation. Methods: A social media analysis was conducted. Brandwatch (Cision) captured social posts related to new and expecting fathers between February 1, 2019, and February 12, 2021. Overall, 2 periods were studied: 1 year before and 1 year during the pandemic. SAS Text Miner analyzed the data and produced 47% (9/19) of the topics in the first period and 53% (10/19) of the topics in the second period. The 19 topics were organized into 6 broad themes. Results: Overall, 26% (5/19) of the topics obtained during each period were the same, showing consistency in conversation. In total, 6 broad themes were created: fatherhood thoughts, fatherhood celebrations, advice seeking, fatherhood announcements, external parties targeting fathers, and miscellaneous. Conclusions: Fathers use social media to make announcements, celebrate fatherhood, seek advice, and interact with other fathers. Others used social media to advertise baby products and promote baby-related resources for fathers. Overall, the arrival of the COVID-19 pandemic appeared to have little impact on the excitement and resiliency of new fathers as they transition to parenthood. Altogether, these findings provide insight and guidance on the ways in which public health professionals can rapidly gather information about special populations—such as new and expecting fathers via the web—to monitor their beliefs, attitudes, emotional reactions, and unique lived experiences in context (ie, throughout a global pandemic). %M 36790850 %R 10.2196/40371 %U https://pediatrics.jmir.org/2023/1/e40371 %U https://doi.org/10.2196/40371 %U http://www.ncbi.nlm.nih.gov/pubmed/36790850 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41839 %T Physiological and Psychological Effects of Parent-Delivered Traditional Thai Massage in Children With Autism: Protocol for a Randomized Controlled Trial %A Ruan,Hui %A Eungpinichpong,Wichai %A Wu,Hua %A Aonsri,Chanada %+ Research Center in Back, Neck, Other Joint Pain and Human Performance, Division of Physical Therapy, Khon Kaen University, 123 Faculty of Associated Medical Sciences, Khon Kaen, 4000, Thailand, 66 817494748, wiceun@gmail.com %K autism %K massage %K randomized controlled trial %K protocol %D 2023 %7 8.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although many autistic children receive massage as a complementary therapy, it is not included in evidence-based practice for autism because evidence of its efficacy is lacking. Further, prior studies have failed to identify objective indicators of core symptoms or elucidate their mechanisms. Objective: We developed a parent-delivered traditional Thai massage (TTM) intervention for children with autism, aiming to experimentally determine whether children with autism truly experience positive effects from parent-delivered TTM and determine possible mechanisms of the observed effects. Methods: A 2-armed, parallel randomized controlled trial was conducted between February 2022 and June 2022. Forty-eight children with autism (aged 7-12 years) were recruited from the Hainan Special Education School and randomly assigned to either a parental TTM or control group at a ratio of 1:1 based on random numbers generated with Online Research Randomizer. The generated sequences were concealed in an opaque envelope. Individuals in the parental TTM group received 16 parent-delivered TTM sessions over 8 weeks at the school’s health room after school, and the control group maintained a normal daily routine. Outcomes were assessed on admission, after 8 weeks, and at a 2-month follow-up and included the effect of massage treatment on autism symptoms, measured with the Autism Treatment Evaluation Checklist score (evaluated by parents and a blinded teacher), physiological parameters (ie, heart rate variability and gait), and the Parenting Stress Index, Fourth Edition–Short Form. Results: We finished all data collection on June 20, 2022. Data analysis will be started, and we expect to publish results in 2023. Conclusions: This study will provide further evidence for massage treatment of autism and provide support for family-based care. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100051355; https://tinyurl.com/3dwjxsw5 International Registered Report Identifier (IRRID): DERR1-10.2196/41839 %M 36753320 %R 10.2196/41839 %U https://www.researchprotocols.org/2023/1/e41839 %U https://doi.org/10.2196/41839 %U http://www.ncbi.nlm.nih.gov/pubmed/36753320 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43689 %T Caregiver Perceptions of Children’s and Adolescents’ Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study %A Liu,Xu %A Wu,Jing %A Yang,Hongyang %A Zhao,Fangjie %A Qin,Yuchen %A Wu,Jiali %A Yan,Hongli %A Xu,Yan %A Zhang,Lulu %+ College of Health Service, Second Military Medical University, 800# Xiangyin Road, Yangpu, Shanghai, 200433, China, 86 02181871421, zllrmit@163.com %K COVID-19 exposure %K psychosocial function %K parenting %K children and adolescents %K China %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families’ daily lives, including the mental health of children and adolescents. Objective: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. Methods: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. Results: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children’s interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. Conclusions: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers’ parenting and psychosocial functioning of children and adolescents. %M 36749625 %R 10.2196/43689 %U https://publichealth.jmir.org/2023/1/e43689 %U https://doi.org/10.2196/43689 %U http://www.ncbi.nlm.nih.gov/pubmed/36749625 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e38435 %T Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment %A Tenfelde,Kim %A Antheunis,Marjolijn %A Krahmer,Emiel %A Bunt,Jan Erik %+ Department of Communication and Cognition, Tilburg University, Warandelaan 2, Tilburg, 5037AB, Netherlands, k.tenfelde@tilburguniversity.edu %K mobile health %K mHealth %K physician-patient communication %K questions asking %K needs assessment %K explorative %K mobile phone %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. Objective: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. Methods: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. Results: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents’ personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. Conclusions: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders. %M 36749606 %R 10.2196/38435 %U https://pediatrics.jmir.org/2023/1/e38435 %U https://doi.org/10.2196/38435 %U http://www.ncbi.nlm.nih.gov/pubmed/36749606 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e32282 %T Gamification to Support Adherence to a Therapeutic Ambylopia Treatment for Children: Retrospective Study Using a Focal Ambient Visual Acuity Stimulation Game %A Bocqué,Catheline %A Wang,Jingyun %A Rickmann,Annekatrin %A Julich-Haertel,Henrike %A Kaempf,Uwe %A Januschowski,Kai %+ Klaus Heimann Eye Research Institute, An der Klinik 10, Sulzbach, 66280, Germany, 49 6897 574 1119, cathelinebocque@gmail.com %K amblyopia %K children %K compliance %K adherence %K occlusion %K patching %K therapeutic game %K FAVAS %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The gold standard treatment for amblyopia is patching the better eye. Improvement of visual acuity in the amblyopic eye is significantly impacted by the adherence to the patching therapy. It is known that the overall adherence is rather low. Objective: This retrospective study evaluated whether an updated version of attention-binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in improved patient adherence in 4- to 16-year-old patients with amblyopia associated with anisometropia or strabismus. Methods: We analyzed electronically pseudonymized recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older version (2015) and the other group used a newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the number of minutes using the therapeutic games as monitored in the automatized logbook versus the prescribed number of minutes for using the games. Results: Children in group 2015 (n=138) spent on average 2009.3 (SD 1372.1; range 36-5556) minutes using FAVAS; children in group 2020 (n=129) spent on average 2651.2 (SD 1557.1; range 38-5672) minutes using the newer version. Group 2020 spent on average 641.9 more minutes on FAVAS than group 2015 (t255.49=3.56, P<.001, d=0.45; 95% CI 0.69-0.20). Although patient adherence was very variable, compared to the 55.0% (SD 29.4%) in group 2015, it significantly improved up to 68.5% (SD 33.7%) in group 2020 (t254.38=3.48, P=.001, d=0.44; 95% CI 0.68-0.19). Conclusions: FAVAS 2020, with improved gamification aspect as well as tablet computer functionality, increased adherence significantly compared to the earlier version of FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. Trial Registration: German Clinical Trials Register (DRKS) DRKS00017633; https://drks.de/search/de/trial/DRKS00017633 %M 36724007 %R 10.2196/32282 %U https://pediatrics.jmir.org/2023/1/e32282 %U https://doi.org/10.2196/32282 %U http://www.ncbi.nlm.nih.gov/pubmed/36724007 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42265 %T The Effectiveness of an After-school Sport Sampling Intervention on Urban Middle School Youth in the Midwest: Posttest-Only Study %A Lightner,Joseph %A Eighmy,Katlyn %A Valleroy,Ella %A Wray,Bridget %A Grimes,Amanda %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108-2718, United States, 1 8162351703, lightnerj@umkc.edu %K physical activity %K adolescent %K sport sampling %K physical literacy %K BMI %K health intervention %K parenting %K healthy lifestyle %K youth %K health inequality %K underserved population %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. Objective: The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. Methods: Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. Results: The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). Conclusions: An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. International Registered Report Identifier (IRRID): RR2-10.2196/37126 %M 36696161 %R 10.2196/42265 %U https://pediatrics.jmir.org/2023/1/e42265 %U https://doi.org/10.2196/42265 %U http://www.ncbi.nlm.nih.gov/pubmed/36696161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41859 %T Evaluating the Effectiveness of the Supportive Parenting App on Parental Outcomes: Randomized Controlled Trial %A Shorey,Shefaly %A Law,Evelyn %A , %A Mathews,Jancy %A Lim,Siew Hoon %A Shi,Luming %A Chua,Jing Shi %A Du,Ruochen %A Chan,Yiong Huak %A Tan,Thiam Chye %A Chee,Cornelia %A Chong,Yap Seng %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, Singapore, Singapore 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K postnatal depression %K mobile health technology %K social support %K COVID-19 %K psychoeducation %K peer support %K mobile phone %D 2023 %7 16.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Adjusting to new or additional parenting responsibilities increases stress and affects parental well-being. Existing research has highlighted both parents’ desire to receive more support. It has also been found that receiving sufficient social support enhances parenting outcomes. With the increasing popularity of mobile health apps, a Supportive Parenting App (SPA) intervention was developed to fulfill the support needs of parents during the perinatal period. Objective: This study aimed to examine the effectiveness of the SPA on parental outcomes during the perinatal period. Methods: A 2-group pretest and repeated posttest randomized controlled trial was conducted wherein 200 couples (N=400 mothers and fathers) were recruited from 2 public health care institutions in Singapore. Parents were randomly assigned to intervention (100/200, 50%) or control (100/200, 50%) groups. The SPA intervention consisted of a mobile app–based psychoeducation and peer support program to support parents from pregnancy to 6 months post partum. The outcome measures included postnatal depression, anxiety, parental bonding, parental self-efficacy, perceived social support, and parenting satisfaction. Data were collected at baseline (at >24 weeks of gestation—age of viability in Singapore) and at the first, second, fourth, sixth, ninth, and 12th month post partum. Linear mixed models were used to compare parental outcomes between the groups, and a linear mixed model for repeated measures was used to examine within-group changes. Results: Parents in the intervention group mostly showed better outcomes compared with those in the control group. Parents in the intervention group had higher perceived social support than those in the control group at the first (effect size=1.59, 95% CI 0.38-2.80; Cohen standardized effect size=1.31; P=.01), second (effect size=1.98, 95% CI 1.09-2.88; Cohen standardized effect size=2.21; P=.003), and fourth (effect size=2.57, 95% CI 1.62-3.51; Cohen standardized effect size=2.72; P=.048) months post partum. However, parents in the intervention group showed significantly poorer parental bonding (effect size=1.67, 95% CI 0.24-3.11; Cohen standardized effect size=1.16; P=.02). The other parental outcomes did not differ significantly between groups. The scores of mothers and fathers also differed significantly for all outcomes except parental self-efficacy. Conclusions: Parents in the intervention group generally fared better, especially regarding perceived social support. However, the lack of statistical significance in most outcomes showed the limited effectiveness of the SPA intervention, which may be because of the COVID-19 pandemic. Parental differences in outcome scores suggest that mothers and fathers have different support needs; therefore, interventions should be tailored accordingly. Further improvements and evaluations are needed to examine the effectiveness of the SPA intervention in enhancing parental outcomes. Despite statistically insignificant results, limitations should be considered to further improve mobile health app–based interventions such as SPA, as they could serve as reliable and convenient sources of support for parents. Trial Registration: Clinicaltrails.gov NCT4706442; https://clinicaltrials.gov/ct2/show/NCT04706442 %M 36645699 %R 10.2196/41859 %U https://www.jmir.org/2023/1/e41859 %U https://doi.org/10.2196/41859 %U http://www.ncbi.nlm.nih.gov/pubmed/36645699 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40231 %T The Acceptability of Using Augmented Reality as a Mechanism to Engage Children in Asthma Inhaler Technique Training: Qualitative Interview Study With Deductive Thematic Analysis %A O'Connor,Antonia %A Tai,Andrew %A Brinn,Malcolm %A Hoang,Amy Nguyen Thuc Hien %A Cataldi,Daniele %A Carson-Chahhoud,Kristin %+ Respiratory and Sleep Department, Women's and Children's Hospital, South Australia, 72 King William Road, North Adelaide, Adelaide, 5006, Australia, 61 08 8161 7234, antonia.chan@sa.gov.au %K asthma %K asthma education %K pediatric asthma %K augmented reality %K mobile phone %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. Objective: The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). Methods: An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. Results: Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users’ value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. Conclusions: AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 %M 36637889 %R 10.2196/40231 %U https://pediatrics.jmir.org/2023/1/e40231 %U https://doi.org/10.2196/40231 %U http://www.ncbi.nlm.nih.gov/pubmed/36637889 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e39704 %T Acceptability of Telemedicine Among Parents of Adolescent Patients in an Adolescent Clinic: Cross-sectional Survey Study %A Olateju,Adetola %A Cervantes,Marbella %A Dowshen,Nadia %A Kuhns,Lisa M %A Dhar,Cherie Priya %+ Ann and Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, United States, 1 312 227 6800, cpdhar@luriechildrens.org %K adolescent medicine %K telemedicine %K acceptability %K privacy %K confidentiality %K satisfaction %K caregivers %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since the beginning of the COVID-19 pandemic, new literature has described the perceptions of adolescent patients on the use of telemedicine for their health care, but less attention has been devoted to parents’ and caregivers’ perspectives on telemedicine usage for their adolescents. Parents’ perspectives are important, as they undoubtedly influence how children learn to make decisions about their health care. Objective: This study describes the level of acceptability (measured based on accessibility and satisfaction) expressed by caregivers of adolescent patients with regard to telemedicine visits in an urban adolescent medicine practice. Methods: A cross-sectional survey was sent electronically to parents and guardians of patients aged <18 years who completed outpatient telemedicine visits to an adolescent medicine practice in Chicago, Illinois, from March 2020 to February 2021. The questions focused on accessibility and satisfaction. The data were analyzed to describe response frequencies. Results: Among a sample of 71 survey respondents, the vast majority reported that telemedicine was very easy to use (58/71, 82%) and was at least as convenient as in-person visits (70/71, 99%). Over 90% of respondents reported that their adolescents’ needs were addressed (69/69, 100%) and that they were at least as comfortable with the level of privacy and the confidential conversations between their adolescents and medical providers in telemedicine visits (65/71, 92%) as they were with those in in-person visits. Conclusions: Our findings suggest that parents and guardians find telemedicine to be an acceptable way for their children and adolescents to receive appropriate health care. %M 36542447 %R 10.2196/39704 %U https://pediatrics.jmir.org/2022/4/e39704 %U https://doi.org/10.2196/39704 %U http://www.ncbi.nlm.nih.gov/pubmed/36542447 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e33624 %T Comprehensive Comparisons of Family Health Between Families With One Immigrant Parent and Native Families in Taiwan: Nationwide Population-Based Cohort Study %A Chen,Yi-Lung %A Ho,Hsing-Ying %+ Department of Healthcare Administration, Asia University, 500 Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan, 886 4 23323456, elong@asia.edu.tw %K international marriage immigrant family %K family health %K physical health %K mental health %K mortality %K reduced inequalities %K good health and well-being %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mothers and children in families with one immigrant parent have been reported to be healthier than those in native families; however, the health of the fathers in these families has rarely been discussed in literature. Objective: We aimed to comprehensively compare the health of all the family members between families with one immigrant parent (native fathers, immigrant mothers, and their children) and native families (native fathers, native mothers, and their children). Methods: We conducted a cohort study by using the Taiwan Maternal and Child Health Database to recruit live-born children and their parents from 2004 to 2016. Overall, we identified 90,670 fathers, 91,270 mothers, and 132,457 children in families with one immigrant parent and 1,666,775 fathers, 1,734,104 mothers, and 2,637,191 children in native families and followed up with them from 2004 to 2017. The outcomes comprised common physical and mental disorders, catastrophic illnesses, mortality, and child adversities and accidents. The covariates comprised the child’s year of birth, parental age, low-income status, and physical or mental disorder status. Logistic regression was performed to compare the risks of the outcomes between families with one immigrant parent and native families. Results: The parents in families with one immigrant parent were more likely to be of low-income status and were older than the parents in native families. After adjusting for the covariates, fathers in families with one immigrant parent were found to have higher risks of physical and mental disorders, catastrophic illness, and mortality than fathers in native families. Conversely, mothers in families with one immigrant parent had lower risks of physical and mental disorders, catastrophic illness, and mortality than mothers in native families. Finally, the children in families with one immigrant parent generally had better physical and mental health but higher risks for leukemia, liver diseases, autism spectrum disorder, and road traffic accidents than children in native families. Conclusions: The health status of the members of families with one immigrant parent was nonhomogeneous, and the poorer general health of fathers in such families suggests health inequalities in families with one immigrant parent. %M 36534459 %R 10.2196/33624 %U https://publichealth.jmir.org/2022/12/e33624 %U https://doi.org/10.2196/33624 %U http://www.ncbi.nlm.nih.gov/pubmed/36534459 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e40340 %T Individual and Parental Factors of Adolescents’ mHealth App Use: Nationally Representative Cross-sectional Study %A Gulec,Hayriye %A Smahel,David %+ Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Joštova 10, Brno, 602 00, Czech Republic, 420 549 49 4180, hayriyegulec@uludag.edu.tr %K mobile health %K mHealth %K eHealth literacy %K parental mediation %K health anxiety %K sleep %K body mass index %K digital skills %K phone attitudes %K mobile phone %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited. Objective: We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500). Methods: Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample’s representativeness. The sociodemographic factors were the adolescents’ age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children’s online health information–seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate). Results: More than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information–seeking behaviors and adolescents’ mHealth app use. Conclusions: These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents’ mHealth app use. We initially showed parents as significant role models for their children’s adoption of, and engagement with, mHealth apps when they actively mediate their online health information–seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents’ mHealth app use longitudinally. %M 36525286 %R 10.2196/40340 %U https://mhealth.jmir.org/2022/12/e40340 %U https://doi.org/10.2196/40340 %U http://www.ncbi.nlm.nih.gov/pubmed/36525286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e37455 %T The Socioeconomic Indicators Linked to Parent Health-Related Technology Use: Cross-sectional Survey %A McCall,Madison P %A Hineline,Megan T %A Anton,Margaret T %A Highlander,April %A Jones,Deborah J %+ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E Cameron Avenue, Chapel Hill, NC, 27599, United States, 1 919 843 2351, mmccall@unc.edu %K parenting %K child %K health behavior %K information seeking %K health-related technology use %K health information %K digital health %K mobile health %K socioeconomic status %K accessibility %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the prevalence of parent health information seeking on the internet and its impact on parenting behavior, there is a paucity of research on parents of young children (ages 3 to 8 years). Given the importance of this developmental period, exploring how family socioeconomic indicators linked to the digital divide and health inequities affect parent proxy- and self-seeking is critical to further understanding variability in health information seeking and associated outcomes. Objective: This study aimed to explore parental health-related technology use (HTU), the process by which parents engage in support, advice, and information-seeking behavior related to their (self-seeking) and their children’s (proxy seeking) health across a range of hardware devices (eg, tablet, wearable, smartphone, laptop, and desktop computer) and sources (eg, search engines, mobile applications, social media, and other digital media). Methods: A cross-sectional study including 313 parents and guardians of children ages 3 to 8 years recruited through Amazon Mechanical Turk (MTurk) was conducted. Parents were asked to complete a self-administered questionnaire on a broad range of parenting and parent-related constructs, including sociodemographic information, technology device ownership, and engagement in and use, features, and perceptions of HTU. Descriptive and bivariate analyses (chi-square tests) were performed to identify patterns and investigate associations between family socioeconomic indicators and parent HTU. Results: The overwhelming majority (301/313, 96%) of parents of young children reported engaging in HTU, of which 99% (300/301) reported using search engines (eg, Google), followed by social media (62%, 188/301), other forms of digital media (eg, podcasts; 145/301, 48%), and mobile applications (114/301, 38%). Parents who engaged in HTU reported seeking information about their child’s behavior and discipline practices (260/313, 83%), mental or physical health (181/313, 58%), and academic performance (142/313, 45%). Additionally, nearly half (134/313, 43%) of parents reported searching for advice on managing their stress. Among parents who reported using each source, an overwhelming majority (280/300, 93%) indicated that search engines were a helpful online source for proxy- and self-seeking, followed by social media (89%, 167/188), other digital media (120/145, 83%), and mobile apps (87/114, 76%). Among parents who reported using any technology source, approximately one-fifth reported that technology sources were most comfortable (61/311, 20%), most understanding (69/311, 22%), and most influential toward behavior change (73/312, 23%) compared to traditional sources of health information–seeking, including mental health professionals, other health care professionals, school professionals, community leaders, friends, and family members. Indicators of family socioeconomic status were differentially associated with frequency and perceptions of and search content associated with parent HTU across technology sources. Conclusions: The findings of this study underscore critical considerations in the design and dissemination of digital resources, programs, and interventions targeting parent and child health, especially for families in traditionally underserved communities. %M 36449346 %R 10.2196/37455 %U https://www.jmir.org/2022/11/e37455 %U https://doi.org/10.2196/37455 %U http://www.ncbi.nlm.nih.gov/pubmed/36449346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40328 %T Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review %A Hagström,Josefin %A Blease,Charlotte %A Haage,Barbara %A Scandurra,Isabella %A Hansson,Scharlett %A Hägglund,Maria %+ Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, 1st Floor, Uppsala, 75237, Sweden, 46 734697474, josefin.hagstrom@kbh.uu.se %K electronic health record %K patient-accessible electronic health record %K adolescents %K parents %K children %K patient experience %K patient portal %K electronic portal %K review %K scoping review %K youth %K patient perspective %K user experience %K patient access %K mobile phone %D 2022 %7 22.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Ongoing efforts worldwide to provide patients with patient-accessible electronic health records (PAEHRs) have led to variability in adolescent and parental access across providers, regions, and countries. There is no compilation of evidence to guide policy decisions in matters such as access age and the extent of parent proxy access. In this paper, we outline our scoping review of different stakeholders’ (including but not limited to end users) views, use, and experiences pertaining to web-based access to electronic health records (EHRs) by children, adolescents, and parents. Objective: The aim of this study was to identify, categorize, and summarize knowledge about different stakeholders’ (eg, children and adolescents, parents, health care professionals [HCPs], policy makers, and designers of patient portals or PAEHRs) views, use, and experiences of EHR access for children, adolescents, and parents. Methods: A scoping review was conducted according to the Arksey and O’Malley framework. A literature search identified eligible papers that focused on EHR access for children, adolescents, and parents that were published between 2007 and 2021. A number of databases were used to search for literature (PubMed, CINAHL, and PsycINFO). Results: The approach resulted in 4817 identified articles and 74 (1.54%) included articles. The papers were predominantly viewpoints based in the United States, and the number of studies on parents was larger than that on adolescents and HCPs combined. First, adolescents and parents without access anticipated low literacy and confidentiality issues; however, adolescents and parents who had accessed their records did not report such concerns. Second, the main issue for HCPs was maintaining adolescent confidentiality. This remained an issue after using PAEHRs for parents, HCPs, and other stakeholders but was not an experienced issue for adolescents. Third, the viewpoints of other stakeholders provided a number of suggestions to mitigate issues. Finally, education is needed for adolescents, parents, and HCPs. Conclusions: There is limited research on pediatric PAEHRs, particularly outside the United States, and on adolescents’ experiences with web-based access to their records. These findings could inform the design and implementation of future regulations regarding access to PAEHRs. Further examination is warranted on the experiences of adolescents, parents, and HCPs to improve usability and utility, inform universal principles reducing the current arbitrariness in the child’s age for own and parental access to EHRs among providers worldwide, and ensure that portals are equipped to safely and appropriately manage a wide variety of patient circumstances. International Registered Report Identifier (IRRID): RR2-10.2196/36158 %M 36413382 %R 10.2196/40328 %U https://www.jmir.org/2022/11/e40328 %U https://doi.org/10.2196/40328 %U http://www.ncbi.nlm.nih.gov/pubmed/36413382 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e33806 %T Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study %A She,Rui %A Zhang,Youmin %A Yang,Xue %+ The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F, Ngan Shing Street, Shatin, Hong Kong, HKG, China, 852 2647 5108, sherryxueyang@cuhk.edu.hk %K internet gaming disorder %K adolescents %K parental factors %K longitudinal study %K parenting %K gaming %K gaming disorder %K health intervention %K treatment %K mental health %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Parents play central roles in adolescents’ socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. Objective: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. Methods: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. Results: Of all the participants, 12.4% (148/1200) and 11.7% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support (β=–.06, P=.02) and parental abuse (β=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control (β=.03, P=.25) and a positive relationship with parents (β=–.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. Conclusions: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD. %M 36346660 %R 10.2196/33806 %U https://games.jmir.org/2022/4/e33806 %U https://doi.org/10.2196/33806 %U http://www.ncbi.nlm.nih.gov/pubmed/36346660 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38793 %T Quality of Mobile Apps for Child Development Support: Search in App Stores and Content Analysis %A DeWitt,Akeiylah %A Kientz,Julie %A Liljenquist,Kendra %+ Department of Human-Centered Design and Engineering, 423 Sieg Building, Seattle, WA, 98195, United States, 1 206 543 2567, adewitt@uw.edu %K mobile health technologies %K early childhood health promotion %K child development %K parent support technologies %K pediatrics %K parenting %K mobile app %K mobile health %K mHealth %K mobile phone %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Following increases in smartphone access, more parents seek parenting advice through internet sources, including blogs, web-based forums, or mobile apps. However, identifying quality apps (ones that respond to the diverse experiences of families) for guidance on child development can be challenging. Objective: This review of mobile health apps aimed to document the landscape, design, and content of apps in the United States available to parents as they promote their child’s developmental health. Methods: To understand the availability and quality of apps for early childhood health promotion, we completed a content analysis of apps in 2 major app stores (Google Play and Apple App stores). Results: We found that most apps do not provide tailored experiences to parents, including cultural considerations, and instead promote generic guidance that may be useful to parents in some contexts. We discuss the need for an evaluative framework to assess apps aimed to support parents on child development topics. Conclusions: Future work is needed on how to support designers in this area, specifically related to avoiding potential burdens on users and providing culturally informed and equity-driven experiences. %M 36346656 %R 10.2196/38793 %U https://pediatrics.jmir.org/2022/4/e38793 %U https://doi.org/10.2196/38793 %U http://www.ncbi.nlm.nih.gov/pubmed/36346656 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40614 %T An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study %A Sourander,Saana %A Sourander,Andre %A Hinkka-Yli-Salomäki,Susanna %A Ristkari,Terja %A Kurki,Marjo %+ Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd floor, Turku, 20014, Finland, 358 469212562, saana.sourander@utu.fi %K parent training %K disruptive behavior %K child psychopathology %K child functioning %K internet-based %K COVID-19 pandemic %K COVID-19 %K mental health %K psychological well-being %K digital health %K parenting %K telehealth %K behavioral problem %K psychopathology %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings. Objective: This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland. Methods: In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents. Results: We found that 44 (88%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90%), this dropped to 58% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90%), 42 (93%) reported high satisfaction in the skills and 44 (98%) in the professionalism of the family coaches. Conclusions: The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic. %M 36194895 %R 10.2196/40614 %U https://pediatrics.jmir.org/2022/4/e40614 %U https://doi.org/10.2196/40614 %U http://www.ncbi.nlm.nih.gov/pubmed/36194895 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35510 %T Data Completeness and Concordance in the FeverApp Registry: Comparative Study %A Rathjens,Larisa %A Fingerhut,Ingo %A Martin,David %A Hamideh Kerdar,Sara %A Gwiasda,Moritz %A Schwarz,Silke %A Jenetzky,Ekkehart %+ Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany, 49 2302 926 ext 7730, Ekkehart.Jenetzky@uni-wh.de %K registry %K data quality %K completeness %K concordance %K ecological momentary assessment %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The FeverApp registry uses ecological momentary assessment (EMA) to collect parental data on pediatric fever for scientific research. The mobile app FeverApp educates parents on safe fever management and serves as a fever diary. Objective: The focus of this study was to evaluate the completeness and concordance of the EMA-based FeverApp registry with regard to its data quality from a multilevel perspective. Methods: Structured descriptions of fever episodes by health care professionals from an office were used as reference. The number of children, their sociodemographic data, and agreement of fever episodes, with maximum temperature, intake of antipyretics and antibiotics, and physician visits, were compared with the entries in the corresponding physician’s reference records. The data quality indicators for completeness, meaning the extent to which the necessary data for the registry has actually been submitted, and concordance, which is the correspondence of the value of a data element with a reference source, were chosen to analyze whether EMA may be a suitable method for this kind of registry. Results: In both data sources, 1012 children were available for comparison over 16 months. The completeness of gender (1012/1012, 100%) and date of birth (1004/1012, 99.2%) information was high, and the mismatches were 0.69% (7/1012) and 1.19% (12/1012), respectively, between the sources. Of these 1012 children, 668 (66%) registered fever episodes in FeverApp. They relate to 534 families with 953 fever episodes in the reference records and 1452 episodes in the FeverApp registry. Of the 534 families, 183 (34.3%) refrained from visiting the office during fever episodes but nevertheless documented them in FeverApp. Largest part (766/1452, 52.75%) episodes were recorded exclusively in the FeverApp registry by 371 (371/534, 69.5%) families. The remaining 686 (47.2%) episodes of 391 (58.5%) children from 351 (65.7%) families were comparable with the reference data source in terms of physician visits, medication, and temperature. The completeness ranged, depending on the kind of variable, from 11.5% to 65% in the registry and from 7.6% to 42.6% in the office. The 953 fever episodes reported by the reference office consisted of 681 (71.5%) acute and 272 (28.5%) past episodes. In FeverApp, most past (262/272, 96.3%) but less acute (424/681, 62.3%) episodes have been entered. The concordance rates were varied: 90.2% for antibiotic use, 66.6% for antipyretic use, 61.7% for physician visits, and 16% for the highest temperature during the fever episode. Conclusions: Both sources delivered only partial data, and the rates of completeness and concordance depended on the kind of variable. However, the FeverApp registry showed higher documentation and precision rates than professional records for all considered variables. Therefore, EMA may play a unique supplement for research in ambulatory care. FeverApp could support pediatric offices, especially during the pandemic. %M 36322119 %R 10.2196/35510 %U https://pediatrics.jmir.org/2022/4/e35510 %U https://doi.org/10.2196/35510 %U http://www.ncbi.nlm.nih.gov/pubmed/36322119 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40704 %T Youth Perspectives on the Recommended Age of Mobile Phone Adoption: Survey Study %A Richter,Aliah %A Adkins,Victoria %A Selkie,Ellen %+ Child Health Evaluation and Research Center, University of Michigan, 300 N Ingalls St, Ann Arbor, MI, 48104, United States, 1 419 779 4111, vadkins@wisc.edu %K adolescent %K youth %K child %K mobile phone %K technology %K media %K phone use %K phone ownership %K parental guidance %K parenting %K cell phone %K smartphone %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite increasing prevalence of phone ownership in early adolescence, there is a deficit of evidence-based guidance on the appropriate time to provide youth their first phone. Objective: This survey study explored age recommendations for phone ownership among a diverse panel of youths, as their experiences are an important contribution to the development of ownership guidelines. Methods: Participants were recruited from MyVoice, a national panel of over 765 youth (14 to 24 years old) who respond to weekly SMS text message–based surveys. Questions were distributed between January 24 2018, and March 20, 2018. Inductive qualitative analysis was used to identify major themes among youths’ open-ended responses. Results: In all, 469 youth (mean age 18.8 years; female: 299/469, 63.8%; White race: 332/468, 70.8%) responded. On average, respondents obtained their first phone at 12.2 years of age. Most participants (325/459, 71.1%) stated they received their first phone out of necessity rather than for entertainment or social reasons. Youth recommended that early adolescents receive their first phone between 12 and 13 years of age primarily for reasons of necessity (146/448, 32.6%). Conclusions: According to the participants, phones supported safety and independence by allowing communication with parents and participation in activities. Youth-serving professionals and parents can incorporate these youth perspectives into shared decision-making about phone ownership among families. This can include discussions about essential features, safety, or phone use, as well as maturity and responsibility milestones, which were all key considerations reported by participants in the survey. %M 36315219 %R 10.2196/40704 %U https://pediatrics.jmir.org/2022/4/e40704 %U https://doi.org/10.2196/40704 %U http://www.ncbi.nlm.nih.gov/pubmed/36315219 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e37581 %T Evaluation of Breastfeeding App Features: Content Analysis Study %A Dinour,Lauren M %A Pole,Antoinette %+ Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, 1 Normal Avenue, Montclair, NJ, 07043, United States, 1 973 655 5395, dinourl@montclair.edu %K breastfeeding %K breastmilk expression %K bottle feeding %K infant food %K infant health %K infant care %K consumer health informatics %K mobile apps %K smartphone %K cross-sectional study %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. Objective: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. Methods: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. Conclusions: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users. %M 36287596 %R 10.2196/37581 %U https://pediatrics.jmir.org/2022/4/e37581 %U https://doi.org/10.2196/37581 %U http://www.ncbi.nlm.nih.gov/pubmed/36287596 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35240 %T Associations Between Adolescent Problematic Internet Use and Relationship Problems in Chinese Families: Findings from a Large-scale Survey %A Hayixibayi,Alimila %A Strodl,Esben %A Chen,Wei-Qing %A Kelly,Adrian B %+ School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, 149 Victoria Park Road, Brisbane, 4059, Australia, 61 0478793214, alimila.hayixibayi@hdr.qut.edu.au %K problematic internet use %K parental bonding %K verbal conflict %K emotional abuse %K physical abuse %K adolescent %K teenager %K internet use %K internet usage %K abuse %K abusive %K conflict %K family %K parental bond %K student %K Asia %K China %K parent-child bond %K high school %K child %D 2022 %7 24.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Problematic internet use (PIU) is prevalent among Chinese adolescents. There is a need to better understand how the quality of parent-adolescent relationship is associated with adolescent PIU to guide the development of effective prevention and early intervention programs. Objective: This study aims to evaluate parent-adolescent conflict and parenting styles as potential risk factors associated with adolescent PIU. Methods: A sample of 6552 students (aged 10-19 years) from 22 schools in Guangdong, China, was recruited. The participants completed self-report questionnaires measuring their perceptions of conflict with their parents (involving verbal conflict, emotional abuse, and physical abuse) as well as their perceptions of their parents’ parenting styles (including parental care and parental control as measured by the Parental Bonding Inventory), and PIU using the Adolescent Pathological Internet Use Scale. Grade level and gender were examined as moderators of these associations. Results: Using multiple regression analyses, we found that greater mother-adolescent conflict, father-adolescent conflict, and parental control, and lower levels of parental care, were associated with higher levels of adolescent PIU (P<.001). The association between mother-adolescent conflict and PIU was stronger in older students than in younger students (P=.04), whereas the association between father-adolescent conflict and PIU was stronger in male students than in female students (P=.02). Compared with those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU (P<.001). Compared with those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse, and physical abuse from their fathers had significantly higher levels of PIU (P<.001, P<.001, and P=.02, respectively). Conclusions: These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse, and physical abuse, and to increase positive parenting styles, to lower the risk of PIU in Chinese adolescents. %M 36279160 %R 10.2196/35240 %U https://pediatrics.jmir.org/2022/4/e35240 %U https://doi.org/10.2196/35240 %U http://www.ncbi.nlm.nih.gov/pubmed/36279160 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e38183 %T Preventing Revictimization Through a Web-Based Intervention for Primary Caregivers of Youth in Care (EMPOWERYOU): Protocol for a Randomized Factorial Trial %A Heinrichs,Nina %A Brühl,Antonia %+ Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Str 6, Bremen, 28334, Germany, 49 42121868542, nina.heinrichs@uni-bremen.de %K multiphase optimization strategy %K foster children %K parenting %K revictimization %K web-based intervention %K online intervention %D 2022 %7 24.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in foster care are at a higher risk for relationship problems than their counterparts raised by their biological family because of higher exposure to or prevalence of neglect or maltreatment early in life. Consequently, these children may also show more challenging behavior in their foster families, which in turn increases the parental stress experience of foster caregivers. Furthermore, the children may engage in a vicious cycle of risky relationship behaviors and expectations that put them at a greater risk for revictimization. Objective: To support foster caregivers in reducing the risk for revictimization, several intervention modules delivered via the internet were developed using a consumer-based approach (phase 1 of the multiphase optimization strategy). This project (phase 2 of the multiphase optimization strategy) aimed to develop a sustainable intervention by selecting promising intervention components based on their contribution to the outcome. Methods: In a 24 factorial trial, a total of 317 foster caregivers with children aged 8 to 13 years are randomly assigned to 1 of 16 conditions. The primary outcome is the rate of revictimization from baseline to 3 months after intervention. Secondary outcomes include risk-taking and functional behaviors in relationships. All caregivers will receive access to all the intervention components after the follow-up assessment. The participants assigned to the condition with all component levels on are expected to show the best improvement in the primary and secondary outcomes. Results: Recruitment and data collection for the factorial trial started in March 2022 and is ongoing. As of October 2022, we recruited 181 families. Although it is difficult to predict the exact study timeline owing to COVID-19 pandemic–related delays, results are expected in February 2024. Conclusions: There is a need for easily accessible information related to raising children in foster care who have experienced early life adversities to interrupt the cycle of violence and enhance the developmental pathway of health and emotional stability. It might be useful, in addition to generally useful parenting information (eg, parental self-care or emotion regulation management), to specifically focus on the needs of these caregivers (eg, how to support the child to reduce dysfunctional relationship behaviors that may have developed because of early adverse experiences). Trial Registration: ClinicalTrials.gov NCT05235659; https://clinicaltrials.gov/ct2/show/NCT05235659 International Registered Report Identifier (IRRID): DERR1-10.2196/38183 %M 36279162 %R 10.2196/38183 %U https://www.researchprotocols.org/2022/10/e38183 %U https://doi.org/10.2196/38183 %U http://www.ncbi.nlm.nih.gov/pubmed/36279162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40452 %T The Family Level Assessment of Screen Use–Mobile Approach: Development of an Approach to Measure Children’s Mobile Device Use %A Perez,Oriana %A Kumar Vadathya,Anil %A Beltran,Alicia %A Barnett,R Matthew %A Hindera,Olivia %A Garza,Tatyana %A Musaad,Salma M %A Baranowski,Tom %A Hughes,Sheryl O %A Mendoza,Jason A %A Sabharwal,Ashutosh %A Veeraraghavan,Ashok %A O'Connor,Teresia M %+ United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, United States, 1 713 798 6782, teresiao@bcm.edu %K screen time %K mobile media apps %K children %K mobile phone use %K tablet use %K mobile phone %D 2022 %7 21.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children’s screen time has been the most common method of measuring screen time, which may be imprecise or biased. Objective: The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)–mobile approach, an innovative method that leverages the existing features of the Android platform. Methods: This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. Results: The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child’s mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. Conclusions: The FLASH-mobile approach offers an important new research approach to measure children’s use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children. %M 36269651 %R 10.2196/40452 %U https://formative.jmir.org/2022/10/e40452 %U https://doi.org/10.2196/40452 %U http://www.ncbi.nlm.nih.gov/pubmed/36269651 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e38908 %T Motivational Interviewing Conversational Agent for Parents as Proxies for Their Children in Healthy Eating: Development and User Testing %A Smriti,Diva %A Kao,Tsui-Sui Annie %A Rathod,Rahil %A Shin,Ji Youn %A Peng,Wei %A Williams,Jake %A Mujib,Munif Ishad %A Colosimo,Meghan %A Huh-Yoo,Jina %+ College of Computing and Informatics, Drexel University, 3675 Market Street, 10th floor, Philadelphia, PA, 19104, United States, 1 2158952474, ds3659@drexel.edu %K conversational agents %K voice user interface %K voice agents %K proxy %K motivational interviewing %K parents %K healthy eating %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children. Objective: We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children. Methods: We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents’ interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents’ perceptions and suggestions for improvements in MICA. Results: Findings showed participants’ perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children’s eating behaviors and provide customized support for their proxy needs and goals. Conclusions: We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change. %M 36206036 %R 10.2196/38908 %U https://humanfactors.jmir.org/2022/4/e38908 %U https://doi.org/10.2196/38908 %U http://www.ncbi.nlm.nih.gov/pubmed/36206036 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35466 %T Parents’ Perspectives on Their Relationship With Their Adolescent Children With Internet Addiction: Survey Study %A Horita,Hideki %A Seki,Yoichi %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan, 81 43 226 2027, horitah@iuhw.ac.jp %K internet addiction %K mental health %K parent-child relationship %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of adolescents with internet addiction are confronted with their children’s internet problems on a daily basis. Parents may notice that adolescents with addiction may also have emotional and behavioral problems, including impulsivity and violence. Parenting styles have been found to be related to internet addiction. Objective: The purpose of this study is to investigate parents’ perspectives on their parenting style, relationship with their child, and the degree of internet addiction and emotional and behavioral problems of their child. Methods: A web survey was conducted with 600 parents of children between the ages of 12 and 17 years, from October 14 to 18, 2021, across Japan. Respondents were recruited by an internet research company and were asked to complete an anonymous online questionnaire. The survey was divided into two groups: 300 parents who answered “yes” to the question “Do you think your child is dependent on the internet?” and 300 parents who answered “no” to that question. Questionnaires were collected until each group had 300 participants. The questionnaire included (1) the Parent-Child Internet Addiction Test (PCIAT), (2) the daily time spent using the internet, (3) the Strengths and Difficulties Questionnaire (SDQ), (4) the Parenting Style and Dimensions Questionnaire (PSDQ), and (5) the Relationship Questionnaire (RQ) measuring self-report attachment style prototypes. Results: Mean scores of the PCIAT and the daily time spent using the internet for the group with probable internet addiction were significantly higher than those of the group without probable internet addiction (50%; P<.001). The total difficulties score from the SDQ for the group with probable internet addiction (mean 10.87, SD 5.9) was significantly higher than that for the group without probable internet addiction (mean 8.23, SD 5.64; P<.001). The mean score for authoritarian parenting from the PSDQ for the group with probable internet addiction (mean 2.1, SD 0.58) was significantly higher than that for the group without probable internet addiction (mean 2.1, SD 0.58; P<.001). Regarding the RQ, there were no significant differences between the two groups. Conclusions: Our findings suggest that parents who think their child is addicted to the internet may recognize emotional and behavioral problems of the child and have an authoritarian parenting style. %M 36197716 %R 10.2196/35466 %U https://pediatrics.jmir.org/2022/4/e35466 %U https://doi.org/10.2196/35466 %U http://www.ncbi.nlm.nih.gov/pubmed/36197716 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e37449 %T Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis %A Mirzadegan,Isaac A %A Blanton,Amelia C %A Meyer,Alexandria %+ Department of Psychology, Florida State University, 1107 W Call Street, Tallahassee, FL, 32306-4301, United States, 1 (850) 644 2040, mirzadegan@gmail.com %K parental engagement %K parenting intervention %K parenting education %K intent to enroll %K measure development %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement. Objective: We aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated. Methods: In a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria. Results: Three PRAM factors emerged (“Acceptability of Parenting Resources,” “Interest in Learning Parenting Strategies,” and “Acceptability of Parenting Websites”), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited. Conclusions: The findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement. %M 36178725 %R 10.2196/37449 %U https://pediatrics.jmir.org/2022/3/e37449 %U https://doi.org/10.2196/37449 %U http://www.ncbi.nlm.nih.gov/pubmed/36178725 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e38725 %T Positive Psychology Themes in Interviews of Children With Atopic Dermatitis: Qualitative Study %A Lou,Terry M %A Zhang,Kenneth L %A Slesinger,Noël C %A Taddeo,Michelle %A Serrano,Eloisa %A Begolka,Wendy Smith %A Capozza,Korey %A Paller,Amy S %A Griffith,James W %A Fishbein,Anna B %+ Department of Pediatrics, Ann & Robert Lurie Children's Hospital, 255 E Chicago Avenue, Box #60, Chicago, IL, 60611, United States, 1 312 227 6010, terry.lou@northwestern.edu %K positive psychology %K PERMA %K positive emotion, engagement, relationships, meaning, and accomplishment %K atopic dermatitis %K pediatric %K dermatology %K children %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Atopic dermatitis is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with atopic dermatitis may promote coping strategies to improve quality of life. Positive psychology is one strategy that can be used to strengthen resiliency. Objective: Our objective was to identify positive psychology concepts mentioned by children with atopic dermatitis and their parent to inform strategies to strengthen resiliency in children with atopic dermatitis. Methods: A total of 20 patient-parent dyads were interviewed to share their experience with atopic dermatitis to help develop a novel psychologic intervention for atopic dermatitis. Patients were 8 to 17 years old and diagnosed with atopic dermatitis. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman’s PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations was captured. Transcripts were also separately coded for resiliency, which is the ultimate goal of PERMA. Results: Positive psychology concepts were mentioned by 100% (20/20) of children and 95% (19/20) of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (14/20, 70%) and parents (13/20, 65%). Emotion elicited the most negative comments from children (19/20, 95%) and parents (17/20, 85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code mentioned PERMA concepts 9.1 (SD 4.7) times compared to those who mentioned none (mean 5.9, SD 4.6) (P=.14). When participants were stratified by disease severity, on average, more positive psychology concepts were mentioned by patients with mild atopic dermatitis (mean 13, SD 3.0) than those with moderate symptoms (mean 6.2, SD 4.9) or severe symptoms (mean 6.1, SD 4.0) (P=.03). Conclusions: Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with atopic dermatitis. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial well-being and resiliency in pediatric atopic dermatitis. Future directions will look at incorporating “positive medicine” into atopic dermatitis treatment to not only relieve symptoms but also strengthen positive aspects of life. %M 36103242 %R 10.2196/38725 %U https://pediatrics.jmir.org/2022/3/e38725 %U https://doi.org/10.2196/38725 %U http://www.ncbi.nlm.nih.gov/pubmed/36103242 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e38297 %T Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey %A Thompson,Erika L %A Preston,Sharice M %A Francis,Jenny K R %A Rodriguez,Serena A %A Pruitt,Sandi L %A Blackwell,James-Michael %A Tiro,Jasmin A %+ Department of Biostatistics & Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, United States, 1 817 735 5162, Erika.Thompson@unthsc.edu %K HPV vaccination %K human papillomavirus %K social media %K decision-making %K vaccination %K teens %K adolescents %K parent %K USA %K United States %K misinformation %K internet %K survey %K unvaccinated %K child %K online %K health %K literacy %K decision %K health care %K decision %K teen %K vaccine %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents’ perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be “undecided/not wanting the vaccine” if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. %M 36103216 %R 10.2196/38297 %U https://pediatrics.jmir.org/2022/3/e38297 %U https://doi.org/10.2196/38297 %U http://www.ncbi.nlm.nih.gov/pubmed/36103216 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e32520 %T Feasibility and Acceptability of Delivering Pivotal Response Treatment for Autism Spectrum Disorder via Telehealth: Pilot Pre-Post Study %A Drapalik,Krista N %A Grodberg,David %A Ventola,Pamela %+ Center for Autism and Related Disabilities, University at Albany, State University of New York, 1535 Western Avenue, Albany, NY, 12203, United States, 1 518 442 5412, kdrapalik@albany.edu %K autism spectrum disorder %K ASD %K pivotal response treatment %K PRT %K telehealth %K parent-implemented intervention %K parent training %K pediatrics %K autism %K children %K digital health %K online modules %K online health %K online treatment %K pilot study %K communication %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pivotal response treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in autistic individuals. Objective: The aim of this study was to assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health, a telehealth platform that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their autistic children. Methods: Male and female autistic children, aged 2-7 years with single-word to phrase-level speech, and their parents were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Credibility Questionnaire (CCQ) at week 2 and at the study endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at the study endpoint to assess parental expectancies, and treatment acceptability and effectiveness. Results: Nine of 14 participants completed the study curriculum in the online parent training condition, and 6 of 12 participants completed the control condition. Thus, a total of 58% (15/26) participants across both groups completed the study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ total scores, from 25.38 (SD 3.25) at baseline to 27.5 (SD 3.74) at study endpoint (P=.04); mean CCQ confidence scores, from 6.0 (SD 1.07) at baseline to 6.75 (SD 0.89) at study endpoint (P=.02); and mean CCQ other improvement scores, from 5.25 (SD 0.89) at baseline to 6.25 (SD 1.28) at study endpoint (P=.009). Within the control condition, a modest increase in mean CCQ scores was noted (Confidence, difference=+0.25; Recommend, difference=+0.25; Total Score, difference=+0.50), but the differences were not statistically significant (Confidence P=.38, Recommend P=.36, Total Score P=.43). Among the 11 parents who completed the BIRS at the study endpoint, 82% (n=9) endorsed that they slightly agree or agree with over 93% of the Acceptability factor items on the BIRS. Conclusions: The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores, as well as strong ratings on the BIRS. This study’s small sample size limits the conclusions that can be drawn; however, the PRT MindNest Health platform holds promise to support parents of autistic children who are unable to access traditional, in-person parent-mediated interventions for their child. %M 36066927 %R 10.2196/32520 %U https://pediatrics.jmir.org/2022/3/e32520 %U https://doi.org/10.2196/32520 %U http://www.ncbi.nlm.nih.gov/pubmed/36066927 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37285 %T Examining the Relationship Between Pediatric Behavioral Health and Parent Productivity Through a Parent-Reported Survey in the Time of COVID-19: Exploratory Study %A Grodberg,David %A Bridgewater,Jesse %A Loo,Theoren %A Bravata,Dena %+ Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT, 06520, United States, 1 2037852513, david.grodberg@yale.edu %K adolescent %K child, family health %K mental health %K behavioral health %K stress %K protective factors %K productivity %K COVID-19 %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pediatric behavioral health needs skyrocketed during the COVID-19 pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families’ behavioral health needs. Objective: The aim of this study is to investigate the associations of known pediatric behavioral health risk factors and parents’ reports of workplace productivity. Methods: A clinical research team at Brightline—a virtual, pediatric behavioral health solution—drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents’ reports of workplace productivity. Results: Participants (N=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children’s behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents’ workplace productivity. Conclusions: This survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first step in understanding the relationship between these variables. The results from this study can empower parents by providing insights to help manage their child’s behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers. %M 35616439 %R 10.2196/37285 %U https://formative.jmir.org/2022/8/e37285 %U https://doi.org/10.2196/37285 %U http://www.ncbi.nlm.nih.gov/pubmed/35616439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35881 %T A Group Videoconferencing Intervention (C@nnected) to Improve Maternal Sensitivity: Protocol for a Randomized Feasibility Trial %A Binda,Victoria %A Olhaberry,Marcia %A Castañon,Carla %A Abarca,Constanza %A Caamaño,Catalina %+ Deparment of Family Medicine, Medicine Faculty, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul, Santiago, 7820436, Chile, 56 223548535, vbinda@uc.cl %K maternal sensitivity %K group intervention %K primary care %K eHealth %K responsive caregiving %K videoconferencing %K Early childhood %K caregiver %K eHealth intervention %K health intervention %K parenting %K children %K peer-support %D 2022 %7 15.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early childhood development is highly dependent on the sensitive care provided by caregivers, and interventions focused on supporting parents to improve their sensitivity have shown to be effective. The COVID-19 pandemic has had a significant impact on mental health, with pregnant women and mothers of infants being an especially vulnerable group and maternal sensitivity particularly affected. However, access to face-to-face interventions is restricted; thus, it is important to have remote interventions to support this group of mothers. Objective: The objective of this study is to evaluate the feasibility and acceptability of C@nnected, a group videoconferencing intervention to improve maternal sensitivity aimed at mother-infant dyads attending primary health care centers in vulnerable areas of Santiago, Chile. Methods: This is a randomized feasibility single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation ratio (with more people allocated to the intervention arm). The intervention consists of 4 group videoconferencing sessions adapted from a face-to-face intervention with proven effectiveness. The control group will receive treatment as usual, along with educational brochures. The feasibility and acceptability of this study will be quantitatively and qualitatively assessed. Changes in clinical outcomes relating to maternal sensitivity, depressive symptoms, postpartum maternal attachment, and infant socioemotional development will also be evaluated. Results: We finished adapting the face-to-face intervention to the videoconferencing format in July 2021. The study began recruitment in August 2021, and enrollment is expected to end in August 2022, with final study results expected in December 2022. Conclusions: This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial. Trial Registration: ClinicalTrials.gov NCT04904861; https://clinicaltrials.gov/ct2/show/NCT04904861 International Registered Report Identifier (IRRID): DERR1-10.2196/35881 %M 35969451 %R 10.2196/35881 %U https://www.researchprotocols.org/2022/8/e35881 %U https://doi.org/10.2196/35881 %U http://www.ncbi.nlm.nih.gov/pubmed/35969451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38326 %T Associations of Maternal and Paternal Parenting Practices With Children’s Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study %A Lopez,Nanette Virginia %A Lai,Mark HC %A Yang,Chih-Hsiang %A Dunton,Genevieve Fridlund %A Belcher,Britni Ryan %+ Department of Health Sciences, Northern Arizona University, 1100 S Beaver St, Box 15095, Flagstaff, AZ, 86011, United States, 1 928 523 7913, nanette.lopez@nau.edu %K parenting %K ecological momentary assessment %K fruit and vegetable consumption %K physical activity %K pediatrics %K obesity %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevention interventions routinely focus on changing maternal parenting practices. Failure to assess how fathers’ weight-related (ie, diet and physical activity) parenting practices contribute to children’s energy balance behaviors limits the understanding of their paternal role within the family. Examining the independent and interacting effects of fathers’ and mothers’ weight-related parenting practices on children’s diet and physical activity addresses this important research gap. Objective: This study used ecological momentary assessment (EMA) to investigate the within-subject and between-subject independent and interactive effects of maternal and paternal encouragement to eat and preparation of fruits and vegetables (F/V) and encouragement of and taking their child to be physically active on their child’s self-reported F/V intake and physical activity engagement. Methods: Participants included mother-father-child triads (n=22 triads, n=205-213 prompts/occasions) in the Mothers and Their Children’s Health Study and the University of Southern California Fathers Study. Simultaneously, mothers and fathers (agesmean 44.2 years, SD 5.6, and 45.2 years, SD 8.1, respectively), and their children (agemean 12.0 years, SD 0.7) completed up to 8 randomly prompted EMA surveys per day on separate smartphones for 7 days. At each prompt, mothers and fathers each reported whether they did the following in the past 2 hours: (1) encouraged their child to eat F/V, (2) prepared F/V for their child, (3) encouraged their child to be physically active, or (4) took their child to be physically active. Children self-reported whether they consumed F/V or were physically active in the past 2 hours. Results: Results from Bayesian multilevel logistic models (all in log-odd units) indicated that at the within-subject level, greater maternal encouragement (β=2.28, 95% CI 0.08 to 5.68) of eating F/V was associated with greater child report of eating F/V, but paternal encouragement (β=1.50, 95% CI –0.83 to 4.52) showed no effects above and beyond maternal encouragement. Additionally, greater than usual paternal encouragement (β=2.28, 95% CI 0.08 to 5.54) and maternal encouragement (β=2.94, 95% CI 0.36 to 6.69) of physical activity had significant independent effects and were associated with greater child report of physical activity. No other within-subject or between-subject associations nor interactive effects were significant. Conclusions: Findings from this study suggest that fathers play a role in supporting their children’s physical activity but not their intake of F/V. Future EMA studies should recruit larger samples to evaluate the independent and interacting roles of mothers’ and fathers’ weight-related parenting practices on child’s obesogenic behaviors. %M 35947425 %R 10.2196/38326 %U https://formative.jmir.org/2022/8/e38326 %U https://doi.org/10.2196/38326 %U http://www.ncbi.nlm.nih.gov/pubmed/35947425 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e33485 %T Co-designing Improved Communication of Newborn Bloodspot Screening Results to Parents: Mixed Methods Study %A Chudleigh,Jane %A Shakespeare,Lynette %A Holder,Pru %A Chinnery,Holly %A Hack,Gemma %A Gill,Tanya %A Gould,Rachel %A Southern,Kevin W %A Olander,Ellinor K %A Morris,Stephen %A Bonham,James R %A Simpson,Alan %A Moody,Louise %+ Cicely Saunders Institute, King’s College London, Denmark Hill, London, SE5 9RS, United Kingdom, 44 02078485590, jane.2.chudleigh@kcl.ac.uk %K experience-based co-design %K neonatal screening %K health communication %K participatory research %D 2022 %7 27.7.2022 %9 Original Paper %J J Particip Med %G English %X Background: Each year in England, almost 10,000 parents are informed of their child’s positive newborn bloodspot screening (NBS) results. This occurs approximately 2 to 8 weeks after birth depending on the condition. Communication of positive NBS results is a subtle and skillful task, demanding thought, preparation, and evidence to minimize potentially harmful negative sequelae. Evidence of variability in the content and the way the result is currently communicated has the potential to lead to increased parental anxiety and distress. Objective: This study focused on the development of co-designed interventions to improve the experiences of parents receiving positive NBS results for their children and enhance communication between health care professionals and parents. Methods: An experience-based co-design approach was used to explore experiences and co-design solutions with 17 health professionals employed in 3 National Health Service Trusts in England and 21 parents (13/21, 62% mothers and 8/21, 38% fathers) of 14 children recruited from the same 3 National Health Service Trusts. Experiences with existing services were gathered via semistructured interviews with health professionals. Filmed narrative interviews with parents were developed into a composite film. The co-design process identified priorities for improving communication of positive NBS results through separate parent and health professional feedback events followed by joint feedback events. In total, 4 interventions were then co-designed between the participants through a web-based platform. Results: Parents and health professionals provided positive feedback regarding the process of gathering experiences and identifying priorities. Themes identified from the parent interviews included impact of initial communication, parental reactions, attending the first clinic appointment, impact of health professionals’ communication strategies and skills, impact of diagnosis on family and friends, improvements to the communication of positive NBS results, and parents’ views on NBS. Themes identified from the health professional interviews included communication between health professionals, process of communicating with the family, parent- and family-centered care, and availability of resources and challenges to effective communication. In response to these themes, 4 interventions were co-designed: changes to the NBS card; standardized laboratory proformas; standardized communication checklists; and an email or letter for providing reliable, up-to-date, condition-specific information for parents following the communication of positive NBS results. Conclusions: Parents and health professionals were able to successfully work together to identify priorities and develop co-designed interventions to improve communication of positive NBS results to parents. The resulting co-designed interventions address communication at different stages of the communication pathway to improve the experiences of parents receiving positive NBS results for their children. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-019-0487-5 %M 35896023 %R 10.2196/33485 %U https://jopm.jmir.org/2022/1/e33485 %U https://doi.org/10.2196/33485 %U http://www.ncbi.nlm.nih.gov/pubmed/35896023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33541 %T Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 451994827, sarah.perkes@newcastle.edu.au %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. Objective: The aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. Methods: Aboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group. Results: In total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women’s health: Smoke-free families, Safe drinking, Feeling good, Women’s business, Eating, and Exercising. The content also includes 6 modules for children’s health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos. Conclusions: An mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention. %M 35802404 %R 10.2196/33541 %U https://formative.jmir.org/2022/7/e33541 %U https://doi.org/10.2196/33541 %U http://www.ncbi.nlm.nih.gov/pubmed/35802404 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e33172 %T Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study %A Kelly,Katherine Jennifer %A Doucet,Shelley %A Luke,Alison %A Azar,Rima %A Montelpare,William %+ Health Centred Research Clinic, Department of Applied Human Sciences, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada, 1 902 566 0827, kjkelly@upei.ca %K caregiver experiences %K peer-to-peer support %K social support %K social media %K children with complex care needs %K Facebook group %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known. Objective: This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers. Methods: A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers’ experiences and perceived impacts of participation. Results: A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging. Conclusions: Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment. %M 35793139 %R 10.2196/33172 %U https://pediatrics.jmir.org/2022/3/e33172 %U https://doi.org/10.2196/33172 %U http://www.ncbi.nlm.nih.gov/pubmed/35793139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36925 %T The Role of Mealtimes in Fostering Language Development and Aligning Home and School Learning: Protocol for a Multi-Method Study of Preschool Children in Rural Kenya and Zambia %A Zeidler,Henriette %A Farrow,Claire %A Jarman,Megan %A Koteng,Grace %A Simatende,Barnabas %A Matthews,Danielle %A Mooya,Haatembo %A Shapiro,Laura R %A Wadende,Pamela %+ School of Psychology, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom, 44 702349027, h.zeidler1@aston.ac.uk %K language development %K nutrition %K preschool education %K school %K education %K home %K environment %K academic %K children %K student %K language learning %K language %K caregiving %K responsive caregiving %K speech %K child-directed speech %K nutritional level %D 2022 %7 5.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The association between school and home is fundamental to sustainable education: parents’ understanding of the school’s priorities and teachers’ understanding of their pupils’ home environment are both vital for children to remain in school and succeed academically. The relationship between parents and teachers is closest in preschool settings, providing a valuable opportunity to build bridges between home and school. In this protocol paper, we outline our planned methods for identifying beneficial home and school behaviors. Objective: Our project aims to identify culture-specific structures and behaviors in home and school settings, which influence the quantity and quality of child-directed speech and identify positive experiences that can help improve children’s linguistic development and nutrition. Methods: Using a mixed methods approach and focusing on early language learning, nutrition, and responsive caregiving, we will video-record and analyze mealtime language and eating behaviors at home and in school, targeting 80 preschool children and their families in rural Kenya and Zambia. In addition, we will assess children’s language skills through audio recordings and use questionnaire-based interviews to collect extensive sociodemographic and dietary data. Results: Between the start of our project in January 2020 and the end of December 2021, we had collected complete sets of sociodemographic, observational, and food recall data for 40 children in Kenya and 16 children in Zambia. By the end of May 2022, we had started data collection for an additional 24 children in Zambia and transcribed and coded approximately 85% of the data. By the end of September, 2022, we plan to complete data collection, transcription, and coding for the entire sample of 80 children across both countries. From September 2022 onwards, we will focus on analyzing our language data, and we hope to have results ready for publication in early 2023. By relating children’s language outcomes and nutritional intake to the observed mealtime behaviors, we hope to identify practices that increase the quantity and quality of child-directed speech and improve children’s nutritional intake. Conclusions: Good nutrition and the promotion of language learning are key issues in early childhood development. By using a cross-cultural approach, combining a variety of methods, and working closely with stakeholders and policy makers throughout the project, we hope to find and share best practices for improving children’s linguistic outcomes and nutrition and lay the foundation for the development of practitioner networks and parent outreach programs. International Registered Report Identifier (IRRID): DERR1-10.2196/36925 %M 35788473 %R 10.2196/36925 %U https://www.researchprotocols.org/2022/7/e36925 %U https://doi.org/10.2196/36925 %U http://www.ncbi.nlm.nih.gov/pubmed/35788473 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e35285 %T The Aim2Be mHealth Intervention for Children With Overweight or Obesity and Their Parents: Person-Centered Analyses to Uncover Digital Phenotypes %A De-Jongh González,Olivia %A Tugault-Lafleur,Claire N %A Buckler,E Jean %A Hamilton,Jill %A Ho,Josephine %A Buchholz,Annick %A Morrison,Katherine M %A Ball,Geoff DC %A Mâsse,Louise C %+ School of Population and Public Health, University of British Columbia, BC Children's Hospital Research Institute, 4480 Oak St., Vancouver, BC, V6H 3V4, Canada, 1 6048752000 ext 5563, lmasse@bcchr.ubc.ca %K mobile health %K mHealth %K childhood obesity %K digital phenotypes %K latent class analysis %D 2022 %7 22.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals’ patterns of interactions with specific app features (digital phenotypes). Objective: This study aims to identify digital phenotypes among 214 parent-child dyads who used the Aim2Be mHealth app as part of a randomized controlled trial conducted between 2019 and 2020, and explores whether participants’ characteristics and health outcomes differed across phenotypes. Methods: Latent class analysis was used to identify distinct parent and child phenotypes based on their use of the app’s behavioral, gamified, and social features over 3 months. Multinomial logistic regression models were used to assess whether the phenotypes differed by demographic characteristics. Covariate-adjusted mixed-effect models evaluated changes in BMI z scores (zBMI), diet, physical activity, and screen time across phenotypes. Results: Among parents, 5 digital phenotypes were identified: socially engaged (35/214, 16.3%), independently engaged (18/214, 8.4%) (socially and independently engaged parents are those who used mainly the social or the behavioral features of the app, respectively), fully engaged (26/214, 12.1%), partially engaged (32/214, 15%), and unengaged (103/214, 48.1%) users. Married parents were more likely to be fully engaged than independently engaged (P=.02) or unengaged (P=.01) users. Socially engaged parents were older than fully engaged (P=.02) and unengaged (P=.01) parents. The latent class analysis revealed 4 phenotypes among children: fully engaged (32/214, 15%), partially engaged (61/214, 28.5%), dabblers (42/214, 19.6%), and unengaged (79/214, 36.9%) users. Fully engaged children were younger than dabblers (P=.04) and unengaged (P=.003) children. Dabblers lived in higher-income households than fully and partially engaged children (P=.03 and P=.047, respectively). Fully engaged children were more likely to have fully engaged (P<.001) and partially engaged (P<.001) parents than unengaged children. Compared with unengaged children, fully and partially engaged children had decreased total sugar (P=.006 and P=.004, respectively) and energy intake (P=.03 and P=.04, respectively) after 3 months of app use. Partially engaged children also had decreased sugary beverage intake compared with unengaged children (P=.03). Similarly, children with fully engaged parents had decreased zBMI, whereas children with unengaged parents had increased zBMI over time (P=.005). Finally, children with independently engaged parents had decreased caloric intake, whereas children with unengaged parents had increased caloric intake over time (P=.02). Conclusions: Full parent-child engagement is critical for the success of mHealth interventions. Further research is needed to understand program design elements that can affect participants’ engagement in supporting behavior change. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 %M 35731547 %R 10.2196/35285 %U https://www.jmir.org/2022/6/e35285 %U https://doi.org/10.2196/35285 %U http://www.ncbi.nlm.nih.gov/pubmed/35731547 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33170 %T Exploring the Use of a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study %A Kelly,Katherine Jennifer %A Doucet,Shelley %A Luke,Alison %A Azar,Rima %A Montelpare,William %+ Health Centred Research Clinic, Department of Applied Human Sciences, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada, 1 902 566 0827, kjkelly@upei.ca %K peer-to-peer support %K children %K youth %K complex care needs %K social media %K social support %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Caregivers of children and youth with complex care needs (CCN) require substantial support to ensure the well-being of their families. Web-based peer-to-peer (P2P) support groups present an opportunity for caregivers to seek and provide timely informational and emotional support. Despite the widespread use of social media for health-related support across diverse patient and caregiver populations, it is unclear how caregivers of children and youth with CCN use and potentially benefit from these groups. Objective: The aim of this study is to explore the use of a web-based P2P support group for caregivers of children and youth with CCN in New Brunswick, Canada, and investigate factors related to its use by members. Methods: The study sample consisted of individuals who joined a closed Facebook group and an analysis of content published to the group. In phase 1, a Facebook group was developed in consultation with a patient and family advisory council, and members were recruited to the group. Phase 2 of this study consisted of an observation period during which posts and related interactions (ie, likes, loves, and comments) by members were collected. In phase 3, a web-based survey was distributed, and semistructured interviews were conducted with a subsample of group members. Survey and interview data were analyzed using thematic analysis. Results: A total of 108 caregivers joined the Facebook group between October 2020 and March 2021. There were 93 posts with 405 comments and 542 associated interactions (448/542, 82.7% likes and 94/542, 17.3% loves). Of these 93 posts, 37 (40%) were made by group members, and 56 (60%) were made by moderators. Of the 108 members, a subsample of 39 (36.1%) completed a web-based survey, and 14 (13%) participated in the interviews. Content analyses of posts by members revealed that inquiry (17/37, 46%), informational (15/37, 41%), and emotional posts (4/37, 11%) were the most common. Emotional posts received the highest number of interactions (median 24.5). In total, 5 themes emerged from the interviews related to the use of the group and mediating factors of interactions between group members: resource for information, altruistic contribution, varying level of engagement, perceived barriers to and facilitators of group activity, and moderators as contributing members. Conclusions: These findings demonstrate that caregivers of children and youth with CCN seek geography-specific P2P support groups to meet informational and social support needs. This study contributes to the knowledge on how caregivers use Facebook groups to meet their support needs through moderate and passive engagement. %M 35671082 %R 10.2196/33170 %U https://pediatrics.jmir.org/2022/2/e33170 %U https://doi.org/10.2196/33170 %U http://www.ncbi.nlm.nih.gov/pubmed/35671082 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e28238 %T Apps for Promoting Children’s Oral Health: Systematic Search in App Stores and Quality Evaluation %A Ho,Teresa C Y %A McGrath,Colman %A Yiu,Cynthia K Y %A Lee,Gillian H M %+ Paediatric Dentistry & Orthodontics, Faculty of Dentistry, University of Hong Kong, Room 2A20A, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, China (Hong Kong), 852 28590255, lee.gillian@gmail.com %K apps %K oral health %K evidence-based %K oral hygiene %K children %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Increasingly, mobile apps are being used to promote oral care. Many of them are aimed at children. Objective: This study aimed to systematically search and evaluate apps that promote oral care and hygiene for children. Methods: A broad search strategy (13 keywords) was developed to identify apps from Apple’s App Store and the Google Play Store in April 2019. After reviewing the apps’ titles and summaries, potentially relevant apps were downloaded for viewing. The quality of the apps that met the inclusion criteria was assessed by the Health on the Net Foundation Code of Conduct (HONcode) criteria for medical and health websites and the Scientific Basis of Oral Self-care (SBOSC). Results: More than 3000 Apps were identified and 54 relevant apps informed the review. The quality of the apps according to the HONcode criteria was generally low. The mean HONcode score was 1.8/8.0. One-quarter of the apps had a HONcode score of 0 (14/54, 26%). The SBOSC score of the apps was evaluated based on a 6-point scale. The mean SBOSC score was 1.5/6.0; 19% (10/54) of the apps had a score of 0. There was a significant and positive correlation between HONcode and SBOSC scores (r=0.37; P<.01). More recently uploaded apps had significantly higher HONcode scores (P<.05). Conclusions: There are many apps aiming to promote oral self-care among children. The quality and scientific basis of these apps are low. Newer apps are of higher quality in terms of scientific basis. There is a need to ensure high-quality and evidence-based apps are available. The effectiveness of apps in terms of oral care and clinical outcomes among children needs to be evaluated. %M 35666565 %R 10.2196/28238 %U https://pediatrics.jmir.org/2022/2/e28238 %U https://doi.org/10.2196/28238 %U http://www.ncbi.nlm.nih.gov/pubmed/35666565 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34715 %T The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial %A Suzuki,Yukio %A Sukegawa,Akiko %A Ueda,Yutaka %A Sekine,Masayuki %A Enomoto,Takayuki %A Melamed,Alexander %A Wright,Jason D %A Miyagi,Etsuko %+ Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2800, yetii@yokohama-cu.ac.jp %K human papilloma virus vaccination %K vaccination %K vaccine %K vaccine hesitancy %K cancer survivor %K narrative story %K web based %K randomized controlled trial %K RCT %K HPV %K human papilloma virus %K virus %K hesitancy %K cancer %K willingness %K behavior %K parent %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective: The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods: In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results: Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions: A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf %M 35421848 %R 10.2196/34715 %U https://publichealth.jmir.org/2022/5/e34715 %U https://doi.org/10.2196/34715 %U http://www.ncbi.nlm.nih.gov/pubmed/35421848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34120 %T Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: Study Protocol for Single-Case Experimental Design With Multiple Baselines %A Scherpbier,Iza C A %A Abrahamse,Mariëlle E %A Belleman,Robert G %A Popma,Arne %A Lindauer,Ramón J L %+ Amsterdam UMC Location University of Amsterdam, Child and Adolescent Psychiatry, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 890 1000, i.c.a.scherpbier@amsterdamumc.nl %K PCIT %K virtual reality %K single-case experimental design %K positive parenting skills %K disruptive behavioral problems %K parenting %K child %K disruptive behavior %K behavioral %K mental health %K mobile phone %D 2022 %7 20.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Disruptive behavior is a common reason for young children to be referred to mental health care services worldwide. Research indicates that treatments for child disruptive behavior where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, this study focuses on creating the opportunity for parents to practice positive parenting skills more outside of the clinical setting by adding virtual reality (VR) as an additional homework element. PCIT has shown to make impactful long-term improvements in parental warmth, responsiveness, and the parent-child relationship. Through VR, parents practice the taught parenting skills out loud in the comfort of their own homes in VR scenarios. We expect that VR addition will innovatively increase the effectiveness of PCIT. Objective: This study aimed to evaluate the added value of VR to PCIT by using a multiple baseline single-case experimental design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR element, we secondarily expected that meeting the skill criteria will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will be better, whereas parental stress and child disruptive behavior will decrease. Methods: A total of 15 children (aged 2-7 years) with disruptive behavior and their parents will be followed throughout the PCIT-VR treatment. Using a multiple baseline SCED with 3 phases, 15 families will fill out questionnaires weekly, in addition to having pre- and posttreatment and follow-up measurements to monitor their positive parenting skills, child disruptive behavior, parenting stress, and VR progress. Moreover, quantitative information and qualitative interviews will be analyzed visually and statistically and summarized to provide a complete picture of experiences. Results: As of February 2021, 6 families have been enrolled in the study at the moment of submission. Data collection is projected to be completed in 2023. Quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences. Conclusions: The SCED—with its phased design, randomization, and the opportunity to replicate and assess both individual and group treatment effects—and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects, or technological failure will be mitigated with the right statistical support. This study aims to magnify the scope of the treatment through additional skill training, ultimately in support of routinely implementing VR within PCIT. International Registered Report Identifier (IRRID): DERR1-10.2196/34120 %M 35594138 %R 10.2196/34120 %U https://www.researchprotocols.org/2022/5/e34120 %U https://doi.org/10.2196/34120 %U http://www.ncbi.nlm.nih.gov/pubmed/35594138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e29787 %T The Effects of a Web-Based Tool for Parents of Children With Juvenile Idiopathic Arthritis: Randomized Controlled Trial %A Mulligan,Kathleen %A Hirani,Shashivadan P %A Harris,Sally %A Taylor,Jo %A Wedderburn,Lucy R %A Newman,Stanton %A , %+ Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom, 44 020 7040 3090, Stanton.Newman.1@city.ac.uk %K parenting stress %K juvenile idiopathic arthritis %K web-based intervention %K randomized controlled trial %K parenting %K pediatrics %K arthritis %K RCT %K rheumatology %K children %K youth %K web-based tool %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Juvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child’s treatment and may experience anxiety and powerlessness concerning their child’s illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents’ confidence in managing their child’s illness and reduce parenting stress. Objective: The aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. Methods: A multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ≤12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child’s health care, satisfaction with health care, and child’s health-related quality of life. Results: A total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. Conclusions: The WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730 %M 35551065 %R 10.2196/29787 %U https://www.jmir.org/2022/5/e29787 %U https://doi.org/10.2196/29787 %U http://www.ncbi.nlm.nih.gov/pubmed/35551065 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e36317 %T Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study %A Campbell,Alyson %A Hartling,Lisa %A Plourde,Vickie %A Scott,Shannon D %+ Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 492 1037, shannon.scott@ualberta.ca %K concussion %K mTBI %K usability evaluation %K knowledge assessment %K knowledge translation %K parent knowledge %K parent confidence %K patient engagement %K educational tool %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. Objective: The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. Methods: A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. Results: A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=−0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=−5.083; P<.001). Conclusions: Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents’ knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents’ confidence in managing their child’s concussion. %M 35536631 %R 10.2196/36317 %U https://pediatrics.jmir.org/2022/2/e36317 %U https://doi.org/10.2196/36317 %U http://www.ncbi.nlm.nih.gov/pubmed/35536631 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34413 %T Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study %A Cooray,Nipuna %A Sun,Si Louise %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1 King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K falls %K child injury %K online discussion forums %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. Objective: The objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. Methods: Online parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. Results: We identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. Conclusions: The findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior. %M 35536607 %R 10.2196/34413 %U https://pediatrics.jmir.org/2022/2/e34413 %U https://doi.org/10.2196/34413 %U http://www.ncbi.nlm.nih.gov/pubmed/35536607 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e29618 %T Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search %A Kubb,Christian %A Foran,Heather M %+ Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Universitätsstr. 65-67, Klagenfurt, 9020, Austria, 43 463 2700 1631, christian.kubb@aau.at %K online health information seeking %K digital health %K parents %K parent-child %K eHealth literacy %K human computer interaction %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics. Objective: This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers. Methods: In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child’s (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants’ search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined. Results: Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (rs=−0.39, P=.01), stress after the search (rs=−0.33, P=.02), and the number of search queries (rs=−0.29, P=.04) but was not significantly associated with eHealth literacy (rs=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (rs=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (rs=0.08, P=.56), number of performed search queries (rs=0.20, P=.17), or total clicks (rs=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child’s symptoms. Conclusions: This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public. %M 35532970 %R 10.2196/29618 %U https://pediatrics.jmir.org/2022/2/e29618 %U https://doi.org/10.2196/29618 %U http://www.ncbi.nlm.nih.gov/pubmed/35532970 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e33416 %T A Tailored Web-Based Video Intervention (ParentCoach) to Support Parents With Children With Sleeping Problems: User-Centered Design Approach %A Preuhs,Katharina %A van Keulen,Hilde %A Andree,Rosa %A Wins,Sophie %A van Empelen,Pepijn %+ Expertise Group Child Health, Netherlands Organization for Applied Scientific Research (TNO), Schipholweg 77, Leiden, 2316 ZL, Netherlands, 31 611700552, pepijn.vanempelen@tno.nl %K positive parenting %K usability testing %K lower health literacy %K user-centered design %K iterative development %K eHealth %K web-based intervention %K mobile health %K mHealth %K parenting %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many parents frequently struggle with undesirable or problematic behavior (ie, temper tantrums and whining) displayed by their child. To support parents in promoting positive parenting skills (ie, recognizing challenging situations and reacting appropriately), the interactive video e-learning tool ParentCoach was developed. The tool aims to teach parents generic behavioral responses by means of situational learning, tailoring, and problem solving. The first demonstration focused on sleeping problems. Objective: The aim of this paper is to illustrate the user-centered development of ParentCoach. Methods: We conducted usability, understandability, and acceptance tests among the target group (29 parents, 7 youth health care professionals, and 4 individuals with former lower health literacy) in different phases of the development process via focus groups, interviews, and surveys. This allowed for relevant insights on specifications and user requirements to guide the development and revision of the tool in each iteration. Results: Iterative testing and development allowed for the final demonstration of ParentCoach to be experienced as a relevant and accessible parenting intervention that can be used as a stand-alone program or in combination with another program. Conclusions: This paper elaborates on the iterative development process and its benefits for the final demonstration of ParentCoach. %M 35438640 %R 10.2196/33416 %U https://formative.jmir.org/2022/4/e33416 %U https://doi.org/10.2196/33416 %U http://www.ncbi.nlm.nih.gov/pubmed/35438640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e32693 %T The Effectiveness and Cost-effectiveness of Well Parent Japan for Japanese Mothers of Children With ADHD: Protocol for a Randomized Controlled Trial %A Shimabukuro,Shizuka %A Daley,David %A Endo,Takahiro %A Harada,Satoshi %A Tomoda,Akemi %A Yamashita,Yushiro %A Oshio,Takashi %A Guo,Boliang %A Ishii,Atsuko %A Izumi,Mio %A Nakahara,Yukiko %A Yamamoto,Kazushi %A Yao,Akiko %A Tripp,Gail %+ Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna-son, Okinawa, 904-0495, Japan, 81 98 966 8802, shizuka.shimabukuro@oist.jp %K ADHD %K parent training %K Japan %K New Forest Parent Programme %K parent stress management %D 2022 %7 19.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently, in Japan, there are limited interventions available to target ADHD. Well Parent Japan (WPJ), a new hybrid parent-training program, provides a culturally acceptable and effective way to help support Japanese children with ADHD and their parents. Objective: This pragmatic multicenter randomized controlled trial aims to provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services. Methods: Mothers of children (aged 6-12 years) diagnosed with ADHD were recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka, and Okinawa). The mothers were randomized to receive immediate treatment or TAU. The effectiveness and cost-effectiveness of WPJ over TAU at the end of the intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal parent domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being; and the parent-child relationship and maternal child domain parenting stress. Data analysis will follow intention-to-treat principles with treatment effects quantified through analysis of covariance using multilevel modeling. An incremental cost-effectiveness ratio will be used to analyze the cost-effectiveness of the WPJ intervention. Results: Study funding was secured through a proof-of-concept grant in July 2018. Approval by the institutional review board for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 and was completed in April 2022. Participant recruitment (N=124) was completed in May 2021. Effectiveness and cost-effectiveness analyses are expected to be completed by July 2022 and December 2022, respectively. These timelines are subject to change owing to the COVID-19 pandemic. Conclusions: This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ in children and families by comparing WPJ directly with the usual clinical care offered for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost-effectiveness of WPJ with TAU in Japan. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN66978270; https://www.isrctn.com/ISRCTN66978270 International Registered Report Identifier (IRRID): DERR1-10.2196/32693 %M 35438647 %R 10.2196/32693 %U https://www.researchprotocols.org/2022/4/e32693 %U https://doi.org/10.2196/32693 %U http://www.ncbi.nlm.nih.gov/pubmed/35438647 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e34987 %T Cognitive Function, Mental Health, and Quality of Life in Siblings of Preterm Born Children: Protocol for a Systematic Review %A Silva,Wnurinham %A Virtanen,Eeva %A Kajantie,Eero %A Sebert,Sylvain %+ Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Aapistie 5, Oulu, Finland, 358 45355318, wnurinham.silva@oulu.fi %K preterm birth %K birth weight %K siblings %K cognitive %K mental health %K quality of life %K family %D 2022 %7 14.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children and adults born preterm are at increased risk of cognitive impairments, mental health disorders, and poorer quality of life. Epidemiological studies have shown that the impact of preterm birth extends to the immediate family members; however, existing research have focused on parents, and little attention has been given to siblings. Objective: The aim of the systematic review described in this protocol is to synthesize currently available evidence on the impact of exposure to preterm birth (ie, having a sibling born preterm) on cognition, mental health, and quality of life of term born siblings (index child) of preterm born children, and to critically appraise the evidence. Methods: This protocol outlines a systematic review designed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist. We will include all studies that assess outcomes in siblings of children born preterm. Quantitative and qualitative studies will be eligible for the systematic review, and only studies in English will be included. Firstly, search will be conducted electronically on PubMed, Scopus, Embase, Mednar, and opengrey.eu databases and, secondly, manually in Google Scholar and reference lists. The search strategy will include keywords and synonyms, Boolean operators, and text words (ie, within title and abstract). The team of reviewers will screen the search results, extract data from eligible studies, and critically appraise the studies. Analysis will involve both descriptive and quantitative approaches. Meta-analysis will be conducted if appropriate. Results: This systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) on December 18, 2020, and it is currently in progress. The findings will be synthesized to determine the effect of preterm birth on full-term siblings and the quality of the available evidence. Conclusions: The evidence derived from this study will shed light on gaps and limitations in the field of preterm birth, more specifically, the effect of preterm birth on full-term siblings. In addition, we hope that understanding the impact of preterm birth on family members will inform targeted interventions and policies for those identified at high risk and how to mitigate health risks. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021222887; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222887 International Registered Report Identifier (IRRID): DERR1-10.2196/34987 %M 35436229 %R 10.2196/34987 %U https://www.researchprotocols.org/2022/4/e34987 %U https://doi.org/10.2196/34987 %U http://www.ncbi.nlm.nih.gov/pubmed/35436229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e26438 %T Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study %A Korpilahti-Leino,Tarja %A Luntamo,Terhi %A Ristkari,Terja %A Hinkka-Yli-Salomäki,Susanna %A Pulkki-Råback,Laura %A Waris,Otto %A Matinolli,Hanna-Maria %A Sinokki,Atte %A Mori,Yuko %A Fukaya,Mami %A Yamada,Yuko %A Sourander,Andre %+ Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3, Turku, 20520, Finland, 358 50 365 3447, andre.sourander@utu.fi %K adolescent %K anxiety %K child %K cognitive behavioral therapy %K coping %K COVID-19 %K Internet %K mental health %K parents %K web-based %D 2022 %7 13.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. %M 35138265 %R 10.2196/26438 %U https://www.jmir.org/2022/4/e26438 %U https://doi.org/10.2196/26438 %U http://www.ncbi.nlm.nih.gov/pubmed/35138265 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e29102 %T Explaining Adherence to American Academy of Pediatrics Screen Time Recommendations With Caregiver Awareness and Parental Motivation Factors: Mixed Methods Study %A Lammers,Shea M %A Woods,Rebecca J %A Brotherson,Sean E %A Deal,James E %A Platt,Carrie Anne %+ Department of Human Development and Family Science, North Dakota State University, Department No 2615, P.O. Box 6050, Fargo, ND, 58108-6050, United States, 1 701 231 6143, sean.brotherson@ndsu.edu %K infancy %K screen time %K screen time recommendations %K mothers and infants %K American Academy of Pediatrics recommendations %K parental motivations %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: With the increasing integration of technology into society, it is advisable that researchers explore the effects of repeated digital media exposure on our most vulnerable population—infants. Excessive screen time during infancy has been linked to delays in language, literacy, and self-regulation. Objective: This study explores the awareness of and adherence to the American Academy of Pediatrics’ (AAP) recommendations related to avoiding screen time for infants younger than 2 years and the motivational factors associated with screen time exposure. Methods: A mixed methods survey design was used to gather responses from 178 mothers of infants younger than 2 years. The measures included infant screen time use and duration, maternal awareness of screen time use recommendations, and motivations related to screen time exposure. A variety of statistical procedures were used to explore associations between caregiver awareness of and adherence to AAP guidelines for screen time exposure, motivations related to screen time for infants, and the duration of infant screen time exposure. Results: The results indicated that 62.2% (111/178) of mothers were aware of the AAP screen time recommendations, but only 46.1% (82/178) could cite them accurately, and most mothers learned of them via the internet or from a medical professional. Mothers who were aware of the guidelines allowed significantly less screen time for infants than those who were unaware (P=.03). In addition, parents who adhered to the AAP guidelines reported significantly less infant screen time per day than those who did not adhere (P<.001). Among mothers who reported not adhering to the guidelines, the greatest motivation for allowing screen time was perceived educational benefits. Less educated mothers rated an infant’s relaxation as a motivational factor in allowing screen time significantly higher than more highly educated mothers (P=.048). The regression analysis indicated that none of the parental motivation factors predicted daily infant screen time. Conclusions: These results indicate 2 key approaches to improving adherence to screen time recommendations. First, the awareness of the AAP recommendations needs to be increased, which tends to improve adherence. Second, the myth that screen time can be educational for infants needs to be dispelled. %M 35380541 %R 10.2196/29102 %U https://pediatrics.jmir.org/2022/2/e29102 %U https://doi.org/10.2196/29102 %U http://www.ncbi.nlm.nih.gov/pubmed/35380541 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34425 %T Use of a Paid Digital Marketing Campaign to Promote a Mobile Health App to Encourage Parent-Engaged Developmental Monitoring: Implementation Study %A Arshanapally,Suraj %A Green,Katie %A Slaughter,Karnesha %A Muller,Robert %A Wheaton,Demeika %+ National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop S106-4, Atlanta, GA, United States, 1 404 498 1007, otv1@cdc.gov %K health communication %K health promotion %K internet %K social media %K child development %K mobile health %K pediatrics %K parenting %K early child development %K developmental disability %K mobile phone %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The internet has become an increasingly popular medium for parents to obtain health information. More studies investigating the impact of paid digital marketing campaigns for parents on promoting children’s healthy development are needed. Objective: This study aims to explore the outcomes of a paid digital marketing campaign, which occurred from 2018 to 2020, to promote messages about parent-engaged developmental monitoring and ultimately direct parents to the Centers for Disease Control and Prevention’s (CDC’s) Milestone Tracker app, a mobile health (mHealth) app developed by the CDC. Methods: The paid digital marketing campaign occurred in 3 phases from 2018 to 2020. In each phase, 24 to 36 marketing messages, in English and Spanish, were created and disseminated using Google’s Universal App Campaigns and Facebook Ads Manager. Outcomes were measured using impressions, clicks, and install data. Return on investment was measured using click-through rate (CTR), cost per click, and cost per install metrics. Results: The Google-driven marketing messages garnered a total of 4,879,722 impressions (n=1,991,250, 40.81% for English and n=2,888,472, 59.19% for Spanish). The messages resulted in a total of 73,956 clicks (n=44,328, 59.94% for English and n=29,628, 40.06% for Spanish), with a total average CTR of 1.52% (2.22% for English and 1.03% for Spanish). From these clicks, there were 13,707 installs (n=9765, 71.24% for English and n=3942, 28.76% for Spanish) of the CDC’s Milestone Tracker app on Google Play Store. The total average cost per install was US $0.93 across all phases. The phase 3 headline “Track your child’s development” generated the highest CTR of 3.23% for both English and Spanish audiences. The Facebook-driven marketing messages garnered 2,434,320 impressions (n=1,612,934, 66.26% for English and n=821,386, 33.74% for Spanish). The messages resulted in 44,698 clicks (n=33,353, 74.62% for English and n=11,345, 25.38% for Spanish), with an average CTR of 1.84% (2.07% for English and 1.38% for Spanish). In all 3 phases, animated graphics generated the greatest number of clicks among both English and Spanish audiences on Facebook when compared with other types of images. Conclusions: These paid digital marketing campaigns can increase targeted message exposure about parent-engaged developmental monitoring and direct a parent audience to an mHealth app. Digital marketing platforms provide helpful metrics that can be used to assess the reach, engagement, and cost-effectiveness of this effort. The results from this study suggest that paid digital marketing can be an effective strategy and can inform future digital marketing activities to promote mHealth apps targeting parents of young children. %M 35380545 %R 10.2196/34425 %U https://pediatrics.jmir.org/2022/2/e34425 %U https://doi.org/10.2196/34425 %U http://www.ncbi.nlm.nih.gov/pubmed/35380545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e27900 %T Effectiveness of an Internet-Based and Telephone-Assisted Training for Parents of 4-Year-Old Children With Disruptive Behavior: Implementation Research %A Sourander,Andre %A Ristkari,Terja %A Kurki,Marjo %A Gilbert,Sonja %A Hinkka-Yli-Salomäki,Susanna %A Kinnunen,Malin %A Pulkki-Råback,Laura %A McGrath,Patrick J %+ Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd floor, Turku, 20014, Finland, 358 40 5571633, andre.sourander@utu.fi %K parent training %K early intervention %K implementation %K disruptive behavior %K behavior problems %K preschool children %K internet-assisted %K child mental health %K mental health %K behavior %K intervention %K children %K parents %D 2022 %7 4.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a lack of effectiveness studies when digital parent training programs are implemented in real-world practice. The efficacy of the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention on the disruptive behavior of 4-year-old children was studied in a randomized controlled trial setting in Southwest Finland between 2011 and 2013. After that, the intervention was implemented nationwide in child health clinics from 2015 onwards. Objective: The main aim of this study was to compare the treatment characteristics and effectiveness of the SFSW parent training intervention between the families who received the intervention when it was implemented as a normal practice in child health clinics and the families who received the same intervention during the randomized controlled trial. Methods: The implementation group comprised 600 families who were recruited in the SFSW intervention between January 2015 and May 2017 in real-world implementation. The RCT intervention group comprised 232 families who were recruited between October 2011 and November 2013. The same demographic and child and parent measures were collected from both study groups and were compared using linear mixed-effect models for repeated measurements. The child psychopathology and functioning level were measured using the Child Behavior Checklist (CBCL) version 1.5-5 for preschool children, the Inventory of Callous-Unemotional Traits (ICU), and a modified version of the Barkley Home Situations Questionnaire. Parenting skills were measured using the 31-item Parenting Scale and the shorter 21-item Depression, Anxiety and Stress Scale (DASS-21). The estimated child and parent outcomes were adjusted for CBCL externalizing scores at baseline, maternal education, duration of the behavior problems, and paternal age. The baseline measurements of each outcome were used as covariates. Results: The implementation group was more likely to complete the intervention than the RCT intervention group (514/600, 85.7% vs 176/232, 75.9%, respectively; P<.001). There were no significant differences between the implementation and RCT intervention groups with regard to child measures, including CBCL externalizing score (–0.2, 95% CI –1.3 to 1.6; P=.83), total score (–0.7, 95% CI –3.0 to 4.5; P=.70), internalizing score (–0.3, 95% CI –1.0 to 1.6; P=.64), and ICU total score (–0.4, 95% Cl –1.9 to 1.2; P=.64). No significant difference was detected in the Parenting Scale total score (0.0, 95% Cl –0.1 to 0.1; P=.50), while DASS-21 total score differed nearly significantly (2.5, 95% Cl 0.0-5.1; P=.05), indicating better improvement in the implementation group. Conclusions: The internet-based and telephone-assisted SFSW parent training intervention was effectively implemented in real-world settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems. Our initiative could also provide a quick socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT01750996; https://clinicaltrials.gov/ct2/show/NCT01750996 International Registered Report Identifier (IRRID): RR2-10.1186/1471-2458-13-985 %M 35377332 %R 10.2196/27900 %U https://www.jmir.org/2022/4/e27900 %U https://doi.org/10.2196/27900 %U http://www.ncbi.nlm.nih.gov/pubmed/35377332 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e33569 %T An Objective System for Quantitative Assessment of Television Viewing Among Children (Family Level Assessment of Screen Use in the Home-Television): System Development Study %A Vadathya,Anil Kumar %A Musaad,Salma %A Beltran,Alicia %A Perez,Oriana %A Meister,Leo %A Baranowski,Tom %A Hughes,Sheryl O %A Mendoza,Jason A %A Sabharwal,Ashutosh %A Veeraraghavan,Ashok %A O'Connor,Teresia %+ Agricultural Research Service, US Department of Agriculture, Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, United States, 1 7137986782, teresiao@bcm.edu %K television %K screen media %K digital media %K measurement %K child %K gaze %K machine learning %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Television viewing among children is associated with developmental and health outcomes, yet measurement techniques for television viewing are prone to errors, biases, or both. Objective: This study aims to develop a system to objectively and passively measure children’s television viewing time. Methods: The Family Level Assessment of Screen Use in the Home-Television (FLASH-TV) system includes three sequential algorithms applied to video data collected in front of a television screen: face detection, face verification, and gaze estimation. A total of 21 families of diverse race and ethnicity were enrolled in 1 of 4 design studies to train the algorithms and provide proof of concept testing for the integrated FLASH-TV system. Video data were collected from each family in a laboratory mimicking a living room or in the child’s home. Staff coded the video data for the target child as the gold standard. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each algorithm, as compared with the gold standard. Prevalence and biased adjusted κ scores and an intraclass correlation using a generalized linear mixed model compared FLASH-TV’s estimation of television viewing duration to the gold standard. Results: FLASH-TV demonstrated high sensitivity for detecting faces (95.5%-97.9%) and performed well on face verification when the child’s gaze was on the television. Each of the metrics for estimating the child’s gaze on the screen was moderate to good (range: 55.1% negative predictive value to 91.2% specificity). When combining the 3 sequential steps, FLASH-TV estimation of the child’s screen viewing was overall good, with an intraclass correlation for an overall time watching television of 0.725 across conditions. Conclusions: FLASH-TV offers a critical step forward in improving the assessment of children’s television viewing. %M 35323113 %R 10.2196/33569 %U https://pediatrics.jmir.org/2022/1/e33569 %U https://doi.org/10.2196/33569 %U http://www.ncbi.nlm.nih.gov/pubmed/35323113 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e34166 %T Multimedia Knowledge Translation Tools for Parents About Childhood Heart Failure: Environmental Scan %A Cunningham,Chentel %A Sung,Hyelin %A Benoit,James %A Conway,Jennifer %A Scott,Shannon D %+ Faculty of Nursing, University of Alberta, 5-187 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 1037, shannon.scott@ualberta.ca %K environmental scan %K pediatrics heart failure %K parent audience %K knowledge translation %K web-based educational tools %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Childhood heart failure is a factor in many hospital admissions each year. It can impose a steep learning curve for parents who need to learn the key information to care for their child at home. In this study, we conducted an environmental scan to identify and assess web-based knowledge translation tools about childhood heart failure for parent audiences developed within North America. Objective: The aim of this study is to inventory tools publicly available to parents about childhood heart failure from popular web-based venues, assess how each tool communicates health information, and explore how they were developed. Methods: Our search strategy included two commonly used multimedia-based platforms: two app stores (Google Play and Apple App Store) and one search engine (Advanced Google Search). Common search terms were used, and results were uploaded to Microsoft Excel for screening between 2 reviewers. The inclusion criteria for the tools were as follows: content focused on educating parents about their child’s heart failure, developed in the English language, and originating within Canada and the United States. A total of 2 reviewers screened the app store and internet search results for relevant tools. Each tool was assessed using the Suitability Assessment of Materials (SAM), a validated tool that objectively assesses the suitability of how health information is communicated to a particular audience. Key informants who were involved in tool development were identified and invited for a qualitative interview using a semistructured format to provide data about the development process. Key themes were identified in the semistructured interview process. Results: Frequencies and SAM percent ratings of eligible tools were reported. No apps exist for parents relating to pediatric heart failure. Overall, 17 relevant internet tools were identified, and their suitability was assessed for the parent audience. Most tools scored well in layout and type, but they scored lower in readability and graphics. Qualitative interviews with key informants revealed three key themes: timely and introductory knowledge, credible and trustworthy knowledge, and challenges and evolution in knowledge. Conclusions: This is the first environmental scan looking for parent tools relating to childhood heart failure in Canada and the United States. Findings from this study reveal that there are no apps on this topic and there is a small number of tools for parents on the internet (n=17). Using the SAM, no tools scored in the superior range, and further work in knowledge translation strategies needs to be done in this area to improve more effective education to parents and caregivers who have a child with heart failure. These findings will inform the development of a new resource on children’s heart failure that targets parents and caregiver audiences. %M 35311676 %R 10.2196/34166 %U https://pediatrics.jmir.org/2022/1/e34166 %U https://doi.org/10.2196/34166 %U http://www.ncbi.nlm.nih.gov/pubmed/35311676 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e33614 %T Locating Youth Exposed to Parental Justice Involvement in the Electronic Health Record: Development of a Natural Language Processing Model %A Boch,Samantha %A Hussain,Syed-Amad %A Bambach,Sven %A DeShetler,Cameron %A Chisolm,Deena %A Linwood,Simon %+ College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH, 45221, United States, 1 513 558 5280, bochsj@ucmail.uc.edu %K parental incarceration %K machine learning %K natural language processing %K parental justice involvement %K adverse childhood experiences %K pediatrics %K pediatric health %K parenting %K digital health %K electronic health record %K eHealth %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parental justice involvement (eg, prison, jail, parole, or probation) is an unfortunately common and disruptive household adversity for many US youths, disproportionately affecting families of color and rural families. Data on this adversity has not been captured routinely in pediatric health care settings, and if it is, it is not discrete nor able to be readily analyzed for purposes of research. Objective: In this study, we outline our process training a state-of-the-art natural language processing model using unstructured clinician notes of one large pediatric health system to identify patients who have experienced a justice-involved parent. Methods: Using the electronic health record database of a large Midwestern pediatric hospital-based institution from 2011-2019, we located clinician notes (of any type and written by any type of provider) that were likely to contain such evidence of family justice involvement via a justice-keyword search (eg, prison and jail). To train and validate the model, we used a labeled data set of 7500 clinician notes identifying whether the patient was ever exposed to parental justice involvement. We calculated the precision and recall of the model and compared those rates to the keyword search. Results: The development of the machine learning model increased the precision (positive predictive value) of locating children affected by parental justice involvement in the electronic health record from 61% (a simple keyword search) to 92%. Conclusions: The use of machine learning may be a feasible approach to addressing the gaps in our understanding of the health and health services of underrepresented youth who encounter childhood adversities not routinely captured—particularly for children of justice-involved parents. %M 35311681 %R 10.2196/33614 %U https://pediatrics.jmir.org/2022/1/e33614 %U https://doi.org/10.2196/33614 %U http://www.ncbi.nlm.nih.gov/pubmed/35311681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27760 %T An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children’s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial %A Pearson,Nicole %A Finch,Meghan %A Sutherland,Rachel %A Kingsland,Melanie %A Wolfenden,Luke %A Wedesweiler,Taya %A Herrmann,Vanessa %A Yoong,Sze Lin %+ Hunter New England Population Health, Longworth Avenue, Wallsend, 2308, Australia, 61 02 49246031 ext 46031, Nicole.Pearson@health.nsw.gov.au %K nutrition %K mHealth %K child %K preschool %K parents %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 %M 35297768 %R 10.2196/27760 %U https://www.jmir.org/2022/3/e27760 %U https://doi.org/10.2196/27760 %U http://www.ncbi.nlm.nih.gov/pubmed/35297768 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30795 %T Online-Delivered Over Staff-Delivered Parenting Intervention for Young Children With Disruptive Behavior Problems: Cost-Minimization Analysis %A Ingels,Justin B %A Corso,Phaedra S %A Prinz,Ronald J %A Metzler,Carol W %A Sanders,Matthew R %+ Department of Health Policy and Management, College of Public Health, University of Georgia, 105 Spear Road, Athens, GA, 30602, United States, 1 706 713 2738, ingels@uga.edu %K online parenting intervention %K child disruptive behavior problems %K cost-minimization analysis %K online versus staff delivery %K evidence-based parenting support %K population reach %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. Objective: This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. Methods: A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. Results: For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P<.001), family costs (t185=9.2; P<.001), and total costs (t171=19.1; P<.001) compared to the staff-delivered intervention. The mean incremental cost difference between the interventions was $1164 total costs per case. The same pattern of significant differences was confirmed in the per-protocol analysis based on the families who completed their respective intervention, with a mean incremental cost difference of $1483 per case. All costs were valued or adjusted in 2017 US dollars. Conclusions: The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. Trial Registration: ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431 %M 35275084 %R 10.2196/30795 %U https://pediatrics.jmir.org/2022/1/e30795 %U https://doi.org/10.2196/30795 %U http://www.ncbi.nlm.nih.gov/pubmed/35275084 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30364 %T The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach %A Wiljén,Angelica %A Chaplin,John Eric %A Crine,Vanessa %A Jobe,William %A Johnson,Ensa %A Karlsson,Katarina %A Lindroth,Tomas %A Schwarz,Anneli %A Stenmarker,Margaretha %A Thunberg,Gunilla %A Öhlén,Joakim %A Nilsson,Stefan %+ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden, 46 738538951, stefan.nilsson.4@gu.se %K children %K communication %K long-term illness %K mHealth %K pediatric care %K person-centered care %K symptom assessment %K universal design %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents’ views and health care professionals’ expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non–clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child’s voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings. %M 35258466 %R 10.2196/30364 %U https://pediatrics.jmir.org/2022/1/e30364 %U https://doi.org/10.2196/30364 %U http://www.ncbi.nlm.nih.gov/pubmed/35258466 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32406 %T Proxy Information Seeking by Users of a Parenting Information Website: Quantitative Observational Study %A El Sherif,Reem %A Pluye,Pierre %A Schuster,Tibor %A Grad,Roland %+ Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada, 1 5143987375, reem.elsherif@mail.mcgill.ca %K consumer health information %K information seeking behavior %K child development %K child health %K information outcomes %K health information %K digital health %K parenting %K online information %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: One of the largest groups of consumers who seek health information on the internet are parents of young children, as well as people in their social circle. The concept of proxy seeking (on behalf of others) has been explored in the literature, yet little is known about the outcomes. Objective: The main aim of this study was to describe consumer health information outcomes reported by proxy seekers using a parenting website. Methods: We conducted a 2-year quantitative observational study. Participants were parents of 0- to 8-year-old children and members of their entourage in Canada who had accessed Naître et Grandir through the website or through a weekly newsletter. For each Naître et Grandir webpage, participants’ perceptions regarding the outcomes of seeking and using specific webpages were gathered using a content-validated Information Assessment Method questionnaire. We compared the outcomes reported by parents with those reported by members of their entourage after consulting a parenting information website and explored if the method of accessing the information by the proxy seekers (website or weekly newsletter) changed the outcomes reported. For key primary survey items, the chi-square test was conducted, and differences in relative frequencies of responses were computed along with confidence intervals. Results: A total of 51,325 completed questionnaires were included in the analysis, pertaining to 1079 Naître et Grandir webpages (mean 48; range 1-637). Compared to parents, individuals in the entourage are more likely to report using the information in discussion with others (mean difference 0.166, 95% CI 0.155-0.176). Parents, on the other hand, were more likely than the entourage to report using the information to better understand (mean difference 0.084, 95% CI 0.073-0.094), to decide to do something (mean difference 0.156, 95% CI 0.146-0.166), or to do something in a different manner (mean difference 0.052, 95% CI 0.042-0.061). In addition, results suggest that the differences in perceived benefits of parenting information by the entourage depend on how they access the information. Respondents who were actively seeking the information (through the website) were more likely to report that the information would help them be less worried (mean difference 0.047; 95% CI 0.024-0.069), handle a problem (mean difference 0.083; 95% CI 0.062-0.104), and decide what to do with someone else (mean difference 0.040, 95% CI 0.020-0.058). Respondents who passively acquired the information (through the newsletter) were more likely to report that the information would help improve the health or well-being of a child (mean difference 0.090; 95% CI 0.067-0.112). Conclusions: By better understanding how consumers and their entourages use information, information providers can adapt information to meet both individual and group needs, and health care practitioners can target patients’ entourages with web-based health information resources for dissemination and use. %M 35254283 %R 10.2196/32406 %U https://pediatrics.jmir.org/2022/1/e32406 %U https://doi.org/10.2196/32406 %U http://www.ncbi.nlm.nih.gov/pubmed/35254283 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32129 %T Evidence-Based Behavioral Strategies in Smartphone Apps for Children’s Sleep: Content Analysis %A Simon,Stacey L %A Kaar,Jill L %A Talker,Ishaah %A Reich,Jennifer %+ Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Box B395, Aurora, CO, 80045, United States, 1 720 777 5681, stacey.simon@childrenscolorado.org %K pediatrics %K technology %K smartphones %K health behavior %K sleep applications %K children %K mobile health %K mHealth %K smartphone applications %K health applications %K sleep disorders %K sleep problems %K developer descriptions %K apps %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Empirically supported treatments for pediatric sleep problems exist, but many families turn to other sources for help with their children’s sleep, such as smartphone apps. Sleep apps are easy for families to access, but little evidence exists regarding the validity of the services and information provided in the developer descriptions of the apps. Objective: The goal of this study was to examine the features and claims of developer descriptions of sleep apps for children. Methods: A search of the Apple iTunes store and Google Play was conducted using the terms “kids sleep,” “child sleep,” and “baby sleep.” Data on the type of app, price, user rating, and number of users were collected. Apps were analyzed in comparison with evidence-based behavioral strategies and were thematically coded on the basis of claims provided in developer descriptions. Results: A total of 83 app descriptions were examined, of which only 2 (2.4%) offered sleep improvement strategies. The majority were sound and light apps (78%) and 19% were bedtime games or stories. Only 18 of 83 (21.6%) apps were identified as containing empirically supported behavioral sleep strategies. Despite this, many apps asserted claims that they will help children “fall asleep instantly,” “cry less and sleep better,” or improve child development. Conclusions: A large variety of sleep apps exist for use among children, but few include evidence-based behavioral strategies according to the developer descriptions of the apps. Addressing sleep difficulties in children is important to promote physical, cognitive, and emotional development. Collaboration between sleep researchers and technology developers may be beneficial for creating evidence-supported apps to help with children’s sleep in the future. %M 35238787 %R 10.2196/32129 %U https://pediatrics.jmir.org/2022/1/e32129 %U https://doi.org/10.2196/32129 %U http://www.ncbi.nlm.nih.gov/pubmed/35238787 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e35934 %T Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-Assisted Parenting Intervention %A Becker,Sara J %A Helseth,Sarah A %A Kelly,Lourah M %A Janssen,Tim %A Wolff,Jennifer C %A Spirito,Anthony %A Wright,Thomas %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903-2905, United States, 1 4018636604, sara_becker@brown.edu %K adolescent %K residential %K technology-assisted %K substance use %K parent %K randomized controlled trial %K RCT %K intervention %K eHealth %K problem behaviour %K problem behavior %D 2022 %7 28.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment)—a technology-assisted parenting intervention informed by extensive formative research—as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. Objective: This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. Methods: Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART+TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multimethod follow-up assessments consisting of self-reported parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6, 12, and 24 weeks postdischarge from residential care. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. Results: The trial was funded in August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021, with recruitment beginning in February 2022. Conclusions: The proposed research has the potential to advance the field by serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. Trial Registration: ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385 International Registered Report Identifier (IRRID): PRR1-10.2196/35934 %M 35225821 %R 10.2196/35934 %U https://www.researchprotocols.org/2022/2/e35934 %U https://doi.org/10.2196/35934 %U http://www.ncbi.nlm.nih.gov/pubmed/35225821 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32274 %T Changes in Use of a Leisure Activity Mobile App for Children With Disabilities During the COVID-19 Pandemic: Retrospective Study %A Yoo,Paul Yejong %A Movahed,Mehrnoosh %A Rue,Ishana %A Santos,Carlos Denner Dos %A Majnemer,Annette %A Shikako,Keiko %+ Faculty of Medicine and Health Sciences, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400 ext 0802, keiko.thomas@mcgill.ca %K COVID-19 %K participation %K childhood disability %K online leisure %K app engagement %K mHealth %K children %K parents %K mobile apps %K mobile health %K digital health %K pandemic %K online leisure activities %K user engagement %K app usability %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Participation in leisure activities is essential for child development and a human right as per the United Nations Convention on the Rights of the Child. Children with disabilities face several restrictions when participating in leisure activities as compared to same age peers without disabilities. Access to information about accessible, inclusive leisure activities is one of the barriers limiting participation, and one potential health promotion strategy is to provide access to information to increase participation. The Jooay App is a mobile app listing such activities in Canada and Australia. With the COVID-19 global pandemic and subsequent public health measures, most community-based facilities providing the activities listed on Jooay were closed. The app therefore started listing online activities offered with the expectation of continuing to provide information for families and understanding the extent to which users relied on the mobile app as a tool to identify new safe leisure opportunities. Objective: This study aims to describe the engagement of the Jooay app before and during COVID-19, and to estimate the extent to which the listing of online activities was related to the engagement of the Jooay app. Methods: We conducted a retrospective study comparing Jooay app use between March 2020 and February 2021 to the engagement between March 2019 and February 2020 by Jooay users. Spearman rank correlations were carried out to identify associations between the activities listed and the users’ engagement from May 2020 to February 2021. Results: Active engagement with the Jooay app from March 2020 to February 2021 dropped by an average of 135 engagements (64.2%) compared to engagements in 2019-2020. The largest monthly drop in engagement was observed in May 2020 by 239 engagements (88.8%). There was a strong positive correlation between the number of active users and the number of online activities listed on the app (rs=0.900). Conclusions: The engagement with the Jooay App presented an expected decrease during the first wave of the COVID-19 pandemic. The addition of online adapted leisure activities to the app’s listings during the pandemic increased app use. Access to information about inclusive activities is a barrier for children with disabilities to engage in leisure. Mobile health solutions can be responsive to contextual factors and consider the social determinants of health such as socioeconomic and public health emergency issues that can impact the participation of vulnerable populations such as children with disabilities and help eliminate barriers to participation. The provision of online leisure opportunities during the pandemic could facilitate participation in these activities during the pandemic and beyond, which is essential and beneficial for the physical and mental well-being of children with disabilities and their families. %M 35100129 %R 10.2196/32274 %U https://pediatrics.jmir.org/2022/1/e32274 %U https://doi.org/10.2196/32274 %U http://www.ncbi.nlm.nih.gov/pubmed/35100129 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e27615 %T Effectiveness of Pediatric Teleconsultation to Prevent Skin Conditions in Infants and Reduce Parenting Stress in Mothers: Randomized Controlled Trial %A Ando,Tomohisa %A Mori,Rintaro %A Takehara,Kenji %A Asukata,Mari %A Ito,Shuichi %A Oka,Akira %+ Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan, 81 334170181, ando-tm@ncchd.go.jp %K teleconsultation %K email newsletters %K eHealth %K pediatrician %K infant %K mother %K atopic dermatitis %K parenting stress %K randomized controlled trial %K stress %K dermatitis %K parenting %K pediatrics %K email %K children %K Japan %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In Japan, eHealth for infants and mothers is currently an important aspect, but its effectiveness has rarely been examined. For infants, skin problems, including atopic dermatitis (AD), which is known to lead to other allergic diseases, are one of the most common conditions. Mothers of infants are prone to experiencing parenting stress, which adversely affects mothers’ and children’s well-being. Additionally, studies have reported that AD among offspring enhances parenting stress, and postnatal maternal psychological problems can increase the risk of AD in children. Objective: This study evaluated the effectiveness of pediatric teleconsultation for preventing AD in infants and reducing parenting stress in mothers in Japan. Methods: The study was an open-label, randomized, parallel-armed controlled trial. In total, 318 pairs of infants and mothers in the Yokohama City Sakae Ward were recruited when they submitted birth cards to the ward, received the explanation about the trial, and provided informed consent on the website for this trial. Eligible pairs of infants and mothers were randomly assigned to the intervention group (n=140) or the control group (n=138). Participants in the intervention and control groups received routine postnatal care from local government services. In addition, participants in the intervention group had the option to combine routine pediatric services with teleconsultation and email newsletters without charge from the date of registration until the infant turned 4 months. Primary outcomes were (1) the prevalence of AD in infants diagnosed based on the United Kingdom Working Party criteria and (2) parenting stress and mental status of mothers assessed using the Parenting Stress Index-Short Form (PSI-SF) and General Health Questionnaire-12 (GHQ-12). Data were collected by the ward office staff and researcher during the 4-month checkup. Results: The prevalence of AD in infants was significantly lower in the intervention group than in the control group during the 4-month checkup (20% vs 33%, P=.02; relative risk ratio, 0.709 [95% CI 0.519-0.969]). No significant differences were observed in the PSI-SF and GHQ-12 scores between the 2 groups. There was a significant difference in the prevalence of AD between participants who used teleconsultation services and email newsletters, participants who did not use teleconsultation services but received email newsletters, and participants who neither received nor used either service (18% vs 22% vs 33%, P=.048). Conclusions: This is the first randomized controlled trial demonstrating that routine pediatric care combined with teleconsultation and email newsletters was effective in reducing the prevalence of AD in infants. The findings highlight the potential of pediatric eHealth to become a useful new strategy for preventing AD. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000029774; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034022 %M 34678753 %R 10.2196/27615 %U https://pediatrics.jmir.org/2022/1/e27615 %U https://doi.org/10.2196/27615 %U http://www.ncbi.nlm.nih.gov/pubmed/34678753 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e34117 %T Refinement of a Parent–Child Shared Asthma Management Mobile Health App: Human-Centered Design Study %A Sonney,Jennifer %A Cho,Emily E %A Zheng,Qiming %A Kientz,Julie A %+ Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, 1959 NE Pacific Street, Box 357262, Seattle, WA, 98195, United States, 1 206 685 2161, jsonney@uw.edu %K parent–child shared management %K school-age children %K asthma %K participatory design %K mHealth %K prototype %K usability %K family health informatics %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent–child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent–child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent–child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. %M 35175214 %R 10.2196/34117 %U https://pediatrics.jmir.org/2022/1/e34117 %U https://doi.org/10.2196/34117 %U http://www.ncbi.nlm.nih.gov/pubmed/35175214 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e21867 %T Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial %A Macam,Samantha Reyes %A Mack,Wendy %A Palinkas,Lawrence %A Kipke,Michele %A Javier,Joyce Rivera %+ Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, United States, 1 619 850 1412, smacam@g.ucla.edu %K Filipino %K mental health %K prevention %K parenting practices %K community health %D 2022 %7 17.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. Objective: The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. Methods: This study uses a randomized controlled 2-arm individually randomized group treatment pretest–posttest design for 180 parent–child dyads. Individuals are eligible if they are ≥18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics’ Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. Results: Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. Conclusions: Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. Trial Registration: ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170 International Registered Report Identifier (IRRID): DERR1-10.2196/21867 %M 35175200 %R 10.2196/21867 %U https://www.researchprotocols.org/2022/2/e21867 %U https://doi.org/10.2196/21867 %U http://www.ncbi.nlm.nih.gov/pubmed/35175200 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29857 %T Health Care Professional and Caregiver Attitudes Toward and Usage of Medical Podcasting: Questionnaire Study %A Lee,Clement %A Zhou,Melissa S %A Wang,Evelyn R %A Huber,Matthew %A Lockwood,Katie K %A Parga,Joanna %+ Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 626 660 4428, theclem@gmail.com %K podcasts %K social media %K caregiver %K parent %K parenting %K education %K pediatrics %K podcasting %K patient education %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Podcasts are used increasingly in medicine. There is growing research into the role of podcasts in medical education, but the use of podcasting as a tool for pediatric parent/caregiver health education is largely unexplored. As parents/caregivers seek medical information online, an understanding of parental preferences is needed. Objective: We sought to explore health care professional and parent/caregiver awareness and views on podcasting as a health education tool. Methods: This survey study was conducted and distributed via in-person collection from parents/caregivers (≥18 years old) in the waiting room of an academic pediatric primary care clinic, targeted social media promotion, and professional listservs for health care professionals in pediatrics. Statistical analysis included chi-square tests of independence between categorical variables. Results: In total, 125 health care professionals and 126 caregivers completed the survey. Of those surveyed, 81% (101/125) of health care professionals and 55% (69/126) of parents/caregivers listened to podcasts (P<.001). Health care professionals and parents/caregivers listed the same top 3 quality indicators for medical podcasts. Podcast listeners were more likely to have higher incomes and use professional websites for information. The survey elicited a variety of reasons for podcast nonengagement. Conclusions: Health care professionals appear to be more engaged in medical education podcasts than parents/caregivers. However, similar factors were valued when evaluating the quality of a pediatric podcast: accuracy, transparency, and credibility. Professional websites may be one avenue to increase podcast uptake. More needs to be done to explore the use of podcasts and digital media for medical information. %M 35103616 %R 10.2196/29857 %U https://pediatrics.jmir.org/2022/1/e29857 %U https://doi.org/10.2196/29857 %U http://www.ncbi.nlm.nih.gov/pubmed/35103616 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e31628 %T Pediatric Tele–Home Care Compared to Usual Care: Cost-Minimization Analysis %A Adroher Mas,Cristina %A Esposito Català,Candela %A Batlle Boada,Astrid %A Casadevall Llandrich,Ricard %A Millet Elizalde,Marta %A García García,Juan José %A del Castillo Rey,Manel %A García Cuyàs,Francesc %A Pons Serra,Miquel %A López Seguí,Francesc %+ Sant Joan de Déu Hospital, Catalan Ministry of Health, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Spain, 34 932 53 21 00 ext 73041, cristina.adroher@sjd.es %K cost analysis %K pediatric tele–home care %K home care service %K health economics %K telehealth %K economic evaluation %K telemedicine %K pediatrics %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. Objective: The aim of this study is to compare the average cost of a discharge by tele–home care with the usual care and to analyze the main drivers of the differential costs of both care models. Methods: A cost-minimization analysis is conducted under a hospital’s perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. Results: A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. Conclusions: The cost analysis conducted under a hospital perspective shows that pediatric tele–home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction. %M 35049513 %R 10.2196/31628 %U https://pediatrics.jmir.org/2022/1/e31628 %U https://doi.org/10.2196/31628 %U http://www.ncbi.nlm.nih.gov/pubmed/35049513 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e31699 %T Decision-making for Parents of Children With Medical Complexities: Activity Theory Analysis %A Buchanan,Francine %A Lai,Claudia %A Cohen,Eyal %A Milo-Manson,Golda %A Shachak,Aviv %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 4326, buchanan.fr@gmail.com %K shared decision-making %K activity theory %K parental decision-making %K parenting %K participatory medicine %K pediatric %K caregiving %D 2022 %7 17.1.2022 %9 Original Paper %J J Particip Med %G English %X Background: Shared decision-making (SDM), a collaborative approach to reach decisional agreement, has been advocated as an ideal model of decision-making in the medical encounter. Frameworks for SDM have been developed largely from the clinical context of a competent adult patient facing a single medical problem, presented with multiple treatment options informed by a solid base of evidence. It is difficult to apply this model to the pediatric setting and children with medical complexity (CMC), specifically since parents of CMC often face a myriad of interconnected decisions with minimal evidence available on the multiple complex and co-existing chronic conditions. Thus, solutions that are developed based on the traditional model of SDM may not improve SDM practices for CMCs and may be a factor contributing to the low rate of SDM practiced with CMCs. Objective: The goal of our study was to address the gaps in the current approach to SDM for CMC by better understanding the decision-making activity among parents of CMCs and exploring what comprises their decision-making activity. Methods: We interviewed 12 participants using semistructured interviews based on activity theory. Participants identified as either a parent of a CMC or a CMC over the age of 18 years. Qualitative framework analysis and an activity theory framework were employed to understand the complexity of the decision-making process in context. Results: Parents of CMCs in our study made decisions based on a mental model of their child’s illness, informed by the activities of problem-solving, seeking understanding, obtaining tests and treatment, and caregiving. These findings suggest that the basis for parental choice and values, which are used in the decision-making activity, was developed by including activities that build concrete understanding and capture evidence to support their decisions. Conclusions: Our interviews with parents of CMCs suggest that we can address both the aims of each individual activity and the related outcomes (both intended and unintended) by viewing the decision-making activity as a combination of caregiving, problem-solving, and seeking activities. Clinicians could consider using this lens to focus decision-making discussions on integrating the child’s unique situation, the insights parents gain through their decision-making activity, and their clinical knowledge to enhance the understanding between parents and health care providers, beyond the narrow concept of parental values. %M 35037890 %R 10.2196/31699 %U https://jopm.jmir.org/2022/1/e31699 %U https://doi.org/10.2196/31699 %U http://www.ncbi.nlm.nih.gov/pubmed/35037890 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e31411 %T Facebook Support Groups for Pediatric Rare Diseases: Cross-Sectional Study to Investigate Opportunities, Limitations, and Privacy Concerns %A Titgemeyer,Sarah Catrin %A Schaaf,Christian P %+ Institute of Human Genetics, Heidelberg University, Im Neuenheimer Feld 366, Heidelberg, 69120, Germany, 49 6221 56 5151, christian.schaaf@med.uni-heidelberg.de %K Facebook %K support group %K parental support %K pediatric rare diseases %K privacy paradox %K children’s privacy %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Because of the nature of rare diseases with affected individuals being widely geographically dispersed, finding an in-person/offline support group itself can be a challenge. Affected individuals therefore turn to social networking platforms such as Facebook for online support groups. Objective: We aim to put into perspective the opportunities Facebook offers as a tool for pediatric rare disease support groups by investigating its use, advantages, and limitations including privacy concerns. We analyze group accessibility and usage, advantages specific to rare diseases, perceived privacy, and views on using Facebook for communication between health professionals and parents, pharmaceutical companies, and study recruitment. Methods: We contacted 12 Facebook support groups for 12 respective rare diseases with pediatric onset and invited group members to participate in a cross-sectional online survey. Results: Of 231 respondents, 87.0% (n=201) of respondents were female, 12.6% (n=29) were male, and 0.4% reported another sex (n=1). Respondents’ mean age was 41.56 years (SD 9.375); 91.3% (n=211) of respondents were parents (183 mothers, 27 fathers, 1 other sex); 59.7% (n=138) reported a self-initiated search for the Facebook group, 24.2% (n=56) received recommendations from their health professionals, and 12.6% (n=29) recommendations from someone else affected by the disease. On average, support group members visited Facebook at least once a day, visited and passively participated (read/liked posts) several times a week, and participated actively (commented/posted) once a month. As much as 79.2% (183/231) agreed that they would like to have health professionals as members of the respective Facebook group. Group members expressed more concern about privacy issues on Facebook in general than in their respective Facebook support groups, with concerns mostly related to Facebook itself and nongroup members. Conclusions: Our study confirmed that Facebook enhances support group accessibility for parents of children with rare diseases. Group participants perceive a reduction and elimination of distance, a common challenge in rare disease, and Facebook support groups create an environment of perceived privacy. The group’s privacy setting can be a critical factor for active support group participation. Sharing personal information and pictures on Facebook is very common among group participants, which shows the importance of discussing and protecting children’s privacy rights in this context. Trial Registration: German Clinical Trials Register DRKS00016067; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016067 %M 34989690 %R 10.2196/31411 %U https://pediatrics.jmir.org/2022/1/e31411 %U https://doi.org/10.2196/31411 %U http://www.ncbi.nlm.nih.gov/pubmed/34989690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27033 %T Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study %A Shorey,Shefaly %A Tan,Thiam Chye %A , %A Mathews,Jancy %A Yu,Chun Yan %A Lim,Siew Hoon %A Shi,Luming %A Ng,Esperanza Debby %A Chan,Yiong Huak %A Law,Evelyn %A Chee,Cornelia %A Chong,Yap Seng %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K depression %K development %K education %K parent %K perinatal %K support %K telehealth %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child’s development. Given the rise in technology and parents’ preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles—the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. %M 36260376 %R 10.2196/27033 %U https://www.jmir.org/2021/12/e27033 %U https://doi.org/10.2196/27033 %U http://www.ncbi.nlm.nih.gov/pubmed/36260376 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29731 %T Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study %A Cooray,Nipuna %A Sun,Si Louise %A Ho,Catherine %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1, King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K Behaviour Change Wheel %K mobile app %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach. %M 34932004 %R 10.2196/29731 %U https://pediatrics.jmir.org/2021/4/e29731 %U https://doi.org/10.2196/29731 %U http://www.ncbi.nlm.nih.gov/pubmed/34932004 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e17723 %T Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial %A Chu,Joanna Ting Wai %A Wadham,Angela %A Jiang,Yannan %A Stasiak,Karolina %A Shepherd,Matthew %A Bullen,Christopher %+ The National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019 Victoria Street West, Auckland, 1142, New Zealand, 64 3737599, jt.chu@auckland.ac.nz %K parenting %K mHealth %K text messaging %K recruitment %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. Objective: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. Methods: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. Results: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). Conclusions: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307 %M 34932007 %R 10.2196/17723 %U https://pediatrics.jmir.org/2021/4/e17723 %U https://doi.org/10.2196/17723 %U http://www.ncbi.nlm.nih.gov/pubmed/34932007 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29687 %T Initial Feasibility of the “Families Moving Forward Connect” Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach %A Petrenko,Christie Lynn McGee %A Kautz-Turnbull,Carson Christine %A Roth,Alicia Rose %A Parr,Jennifer Elizabeth %A Tapparello,Cristiano %A Demir,Utku %A Olson,Heather Carmichael %+ Mt. Hope Family Center, University of Rochester, 187 Edinburgh St, Rochester, NY, 14608, United States, 1 585 275 2991, christie.petrenko@rochester.edu %K fetal alcohol spectrum disorders %K fetal alcohol syndrome %K intervention %K mobile health %K mHealth %K parenting %K children %K prenatal alcohol %K digital health %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers’ stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. %M 34860661 %R 10.2196/29687 %U https://formative.jmir.org/2021/12/e29687 %U https://doi.org/10.2196/29687 %U http://www.ncbi.nlm.nih.gov/pubmed/34860661 %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 %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e23659 %T The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial %A Kavanagh,David John %A Connolly,Jennifer %A Fisher,Jane %A Halford,W Kim %A Hamilton,Kyra %A Hides,Leanne %A Milgrom,Jeannette %A Rowe,Heather %A Scuffham,Paul A %A White,Katherine M %A Wittkowski,Anja %A Appleton,Shelley %A Sanders,Davina %+ Centre for Children’s Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane Qld, 4101, Australia, 61 419 479227, david.kavanagh@qut.edu.au %K perinatal %K depression %K prevention %K men %K self-guided %K internet %D 2021 %7 26.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective: This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods: The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results: Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions: Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277 %M 34842534 %R 10.2196/23659 %U https://www.jmir.org/2021/11/e23659 %U https://doi.org/10.2196/23659 %U http://www.ncbi.nlm.nih.gov/pubmed/34842534 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e27054 %T A Parent Coach–Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial %A Hurst,Rachel %A Liljenquist,Kendra %A Lowry,Sarah J %A Szilagyi,Peter G %A Fiscella,Kevin A %A Weaver,Marcia R %A Porras-Javier,Lorena %A Ortiz,Janette %A Sotelo Guerra,Laura J %A Coker,Tumaini R %+ School of Public Health, New York University, 70 Washington Square S, New York, NY, 10012, United States, 1 212 998 1212, rjh430@nyu.edu %K preventive care %K well-child care %K community health centers %D 2021 %7 25.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. Objective: This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. Methods: This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ≤12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician’s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. Results: Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. Conclusions: This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. Trial Registration: ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898 International Registered Report Identifier (IRRID): DERR1-10.2196/27054 %M 34842563 %R 10.2196/27054 %U https://www.researchprotocols.org/2021/11/e27054 %U https://doi.org/10.2196/27054 %U http://www.ncbi.nlm.nih.gov/pubmed/34842563 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31041 %T A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators’ Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Jacob,John %A Munday,Fritha %A Zeni,Megan %A Walters,Melanie %A Cheng,Tina %A Schneeberg,Amy %A Fox,Emily %A Oberle,Eva %+ Department of Pediatrics, University of British Columbia, F511-4480 Oak St, Vancouver, BC, V6H 0B3, Canada, 1 604 875 3712, mbrussoni@bcchr.ubc.ca %K early years %K risky play %K teacher %K childcare %K early learning %K risk perception %K outdoor play %D 2021 %7 18.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs’ and ELCC administrators’ perceptions and practices in support of children’s outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children’s play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041 %M 34792479 %R 10.2196/31041 %U https://www.researchprotocols.org/2021/11/e31041 %U https://doi.org/10.2196/31041 %U http://www.ncbi.nlm.nih.gov/pubmed/34792479 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e28608 %T Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study %A Borloz,Sylvie %A Bucher Della Torre,Sophie %A Collet,Tinh-Hai %A Jotterand Chaparro,Corinne %+ Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Montetan 14, Lausanne, 1004, Switzerland, 41 795568409, sylvie.borloz@chuv.ch %K adolescent %K obesity %K ultraprocessed foods %K qualitative food intake %K food educational style %K smartphone application %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. Objective: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. Methods: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent’s food educational style using the Kids’ Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. Results: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3±SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). Conclusions: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. Trial Registration: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121 %M 34779776 %R 10.2196/28608 %U https://pediatrics.jmir.org/2021/4/e28608 %U https://doi.org/10.2196/28608 %U http://www.ncbi.nlm.nih.gov/pubmed/34779776 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27297 %T Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study %A Chin,Samuel %A Carlin,Rebecca %A Mathews,Anita %A Moon,Rachel %+ Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, United States, 1 4349245521, rym4z@virginia.edu %K sleep position %K bed-sharing %K social norms %K social media %K safe sleep %K bedding %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of “likes” for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of “likes” for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of “likes” was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. %M 34779783 %R 10.2196/27297 %U https://pediatrics.jmir.org/2021/4/e27297 %U https://doi.org/10.2196/27297 %U http://www.ncbi.nlm.nih.gov/pubmed/34779783 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e18483 %T Using Social Media as a Research Tool for a Bespoke Web-Based Platform for Stakeholders of Children With Congenital Anomalies: Development Study %A Sinclair,Marlene %A McCullough,Julie E M %A Elliott,David %A Braz,Paula %A Cavero-Carbonell,Clara %A Dornan,Lesley %A Jamry-Dziurla,Anna %A João Santos,Ana %A Latos-Bieleńska,Anna %A Machado,Ausenda %A Páramo-Rodríguez,Lucía %+ Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Northern Ireland, BT37 0QB, United Kingdom, 44 02890368118, m.sinclair1@ulster.ac.uk %K Facebook %K YouTube %K Twitter %K social media %K metrics %K e-forum %K congenital anomalies %K coproduction %K COVID-19 %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Limited research evidence exists on the development of web-based platforms for reciprocal communication, coproduction research, and dissemination of information among parents, professionals, and researchers. This paper provides learning and the outcomes of setting up a bespoke web-based platform using social media. Objective: This study aims to explore the establishment of a web-based, multicontextual research communication platform for parents and stakeholders of children with congenital anomalies using social media and to identify associated research and ethical and technical challenges. Methods: The ConnectEpeople e-forum was developed using social media platforms with a stakeholder engagement process. A multilevel approach was implemented for reciprocal engagement between parents of children with congenital anomalies, researchers, health care professionals, and other stakeholders using private and invisible and public Facebook groups, closed Twitter groups, and YouTube. Ethical approval was obtained from Ulster University. Results: Nonprofit organizations (N=128) were invited to engage with an initial response rate of 16.4% (21/128). Of the 105 parents contacted, 32 entered the private and invisible Facebook groups to participate in the coproduction research. Public Facebook page followers rose to 215, a total of 22 posts had an engagement of >10%, and 34 posts had a reach of over 100. Webinars included requested information on childhood milestones and behavior. YouTube coverage included 106 ConnectEpeople videos with 28,708 impressions. Project information was obtained from 35 countries. The highest Facebook activity occurred during the early morning hours. Achievement of these results required dedicated time management, social media expertise, creativity, and sharing knowledge to curate valuable content. Conclusions: Building and maintaining a multilayered online forum for coproduction and information sharing is challenging. Technical considerations include understanding the functionality and versatility of social media metrics. Social media offers valuable, easily accessible, quantitative, and qualitative data that can drive the reciprocal process of forum development. The identification and integration of the needs of the ConnectEpeople e-forum was a key driver in the dissemination of useful, meaningful, and accessible information. The necessary dedicated administration to respond to requests and posts and collate data required significant time and effort. Participant safety, the development of trust, and the maintenance of confidentiality were major ethical considerations. Discussions on social media platforms enabled parents to support each other and their children. Social media platforms are particularly useful in identifying common family needs related to early childhood development. This research approach was challenging but resulted in valuable outputs requiring further application and testing. This may be of particular importance in response to COVID-19 or future pandemics. Incorporating flexible, adaptable social media strategies into research projects is recommended to develop effective platforms for collaborative and impactful research and dissemination. %M 34779778 %R 10.2196/18483 %U https://pediatrics.jmir.org/2021/4/e18483 %U https://doi.org/10.2196/18483 %U http://www.ncbi.nlm.nih.gov/pubmed/34779778 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30350 %T Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study %A Malamsha,Maria Proches %A Sauli,Elingarami %A Luhanga,Edith Talina %+ School of Computation and Communication Science and Engineering, Nelson Mandela African Institution of Science and Technology, PO Box 447, Nelson Mandela Rd, Arusha, United Republic of Tanzania, 255 715261702, selestinapro@gmail.com %K child sexual abuse %K social cultural belief %K ecological setting %K prevention %K parents %K caretakers %K child experts %K mobile game %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods:  HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. %M 34747703 %R 10.2196/30350 %U https://games.jmir.org/2021/4/e30350 %U https://doi.org/10.2196/30350 %U http://www.ncbi.nlm.nih.gov/pubmed/34747703 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30242 %T US Parents’ Acceptance of Learning About Mindfulness Practices for Parents and Children: National Cross-sectional Survey %A Mathur,Mala %A Kerr,Bradley R %A Babal,Jessica C %A Eickhoff,Jens C %A Coller,Ryan J %A Moreno,Megan A %+ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082655835, mmathur@wisc.edu %K mindfulness %K mental health %K general pediatrics %K pediatrics %K children %K parents %K acceptability %K well-being %K parenting %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents’ acceptance of learning about mindfulness practices. Objective: This study aims to assess parents’ beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds. Methods: We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds. Results: Participants (N=3000) were 87% (n=2621) female and 82.5% (n=2466) Caucasian. Most (n=1913, 64.2%) reported beliefs that mindfulness can be beneficial when parenting, 56.4% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1% (n=768; P<.001). Parents interested in learning about mindfulness were more likely to be male 62.6% (n=223; P<.001). There was no significant difference in interest in learning about mindfulness from a health care provider based on race. Conclusions: This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices. %M 34726605 %R 10.2196/30242 %U https://pediatrics.jmir.org/2021/4/e30242 %U https://doi.org/10.2196/30242 %U http://www.ncbi.nlm.nih.gov/pubmed/34726605 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e26842 %T Youths’ and Parents’ Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study %A Lilja,Josefine Lotten %A Rupcic Ljustina,Mirna %A Nissling,Linnea %A Larsson,Anna Caroline %A Weineland,Sandra %+ Research, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, Kungsgatan 12, Göteborg, 411 19, Sweden, 46 769402969, josefine.lilja@vgregion.se %K internet %K CBT %K cognitive behavioral therapy %K adolescents %K parents %K anxiety %K primary care %K mixed methods %K experiences %K youths %K digital health %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people’s interest in internet treatment or the attitudes they and their parents have toward it. Objective: This study aims to investigate adolescents’ and parents’ attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects. Methods: The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment. Results: The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms (χ22=8.333; P=.02) and that adolescents’ motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths’ need for autonomy while also engaging with them in the treatment work. Conclusions: Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist’s role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment. %M 34723830 %R 10.2196/26842 %U https://pediatrics.jmir.org/2021/4/e26842 %U https://doi.org/10.2196/26842 %U http://www.ncbi.nlm.nih.gov/pubmed/34723830 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30169 %T A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study %A Wong,Jill %A Foussat,Agathe C %A Ting,Steven %A Acerbi,Enzo %A van Elburg,Ruurd M %A Mei Chien,Chua %+ Department of Neonatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore, 65 6394 1240, chua.mei.chien@singhealth.com.sg %K chatbot %K parental stress %K parental sleep %K infant feeding %K preterm infants %K term infants %K sleep %K stress %K eHealth %K support %K anxiety %K usability %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as “easy” to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were “satisfied” (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to “discomfort” and “tiredness” were more prevalent in preterm group conversations, whereas the topic of “positive feelings” occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents’ ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 %M 34544679 %R 10.2196/30169 %U https://pediatrics.jmir.org/2021/4/e30169 %U https://doi.org/10.2196/30169 %U http://www.ncbi.nlm.nih.gov/pubmed/34544679 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30695 %T The Content and Quality of Publicly Available Information About Congenital Diaphragmatic Hernia: Descriptive Study %A Soltys,Frank Coyle %A Spilo,Kimi %A Politi,Mary C %+ Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, United States, 1 3176750010, fsoltys@wustl.edu %K congenital diaphragmatic hernia %K prenatal counseling %K fetal care %K online information %K parental decision making %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making. Objective: We aimed to examine the content and quality of publicly available, internet-based CDH information. Methods: We conducted internet searches across 2 popular search engines (Google and Bing). Websites were included if they contained CDH information and were publicly available. We developed a coding instrument to evaluate websites. Two coders (FS and KS) were trained, achieved interrater reliability, and rated remaining websites independently. Descriptive statistics were performed. Results: Searches yielded 520 websites; 91 met inclusion criteria and were analyzed. Most websites provided basic CDH information including describing the defect (86/91, 95%), need for neonatal intensive care (77/91, 85%), and surgical correction (79/91, 87%). Few mentioned palliative care, decisions about pregnancy termination (13/91, 14%), or support resources (21/91, 23%). Conclusions: Findings highlight the variability of information about CDH on the internet. Clinicians should work to develop or identify reliable, comprehensive information about CDH to support parents. %M 34665147 %R 10.2196/30695 %U https://pediatrics.jmir.org/2021/4/e30695 %U https://doi.org/10.2196/30695 %U http://www.ncbi.nlm.nih.gov/pubmed/34665147 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27551 %T Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study %A O'Dell,Sean M %A Fisher,Heidi R %A Schlieder,Victoria %A Klinger,Tracey %A Kininger,Rachel L %A Cosottile,McKenna %A Cummings,Stacey %A DeHart,Kathy %+ Department of Psychiatry and Behavioral Health, Geisinger, 100 N. Academy Ave, Danville, PA, United States, 1 570 214 5236, sodell@geisinger.edu %K primary care %K parenting %K targeted prevention %K behavioral intervention technology %K behavioral health %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. Objective: The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. Methods: We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. Results: Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child’s age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. Conclusions: These findings provide a rich understanding of the complexity involved in meeting parents’ needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children. %M 34609324 %R 10.2196/27551 %U https://pediatrics.jmir.org/2021/4/e27551 %U https://doi.org/10.2196/27551 %U http://www.ncbi.nlm.nih.gov/pubmed/34609324 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e30240 %T Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study %A Levey,Elizabeth J %A Onyeaka,Henry %A Bartles,Sophia M %A Sanchez Calderon,Elena %A Sanchez,Sixto E %A Prom,Maria C %A Fesseha,Eden M %A Gelaye,Bizu %+ Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 726 2000, elevey@mgh.harvard.edu %K access to care %K adolescent motherhood %K LMICs %K mobile phone %K perinatal mental health %K telehealth %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. %M 34533473 %R 10.2196/30240 %U https://pediatrics.jmir.org/2021/3/e30240 %U https://doi.org/10.2196/30240 %U http://www.ncbi.nlm.nih.gov/pubmed/34533473 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26273 %T Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample %A Hamilton,Jessica Leigh %A Lee,Woanjun %+ Department of Psychology, Rutgers University, 50 Joyce Kilmer Ave, Piscataway, NJ, 08854, United States, 1 (848) 445 2576, jessica.hamilton@rutgers.edu %K adolescents %K social media %K daytime sleepiness %K parenting %K bedtime %K mental health %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents’ mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45% (1929/4153) identified as female, and 67.93% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=−0.34, SE 0.09; P<.001) and importance (B=−0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth’s perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. %M 34524967 %R 10.2196/26273 %U https://mental.jmir.org/2021/9/e26273 %U https://doi.org/10.2196/26273 %U http://www.ncbi.nlm.nih.gov/pubmed/34524967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26203 %T The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents’ Problematic Internet Use: Moderation Analysis %A Hwang,Juwon %A Toma,Catalina L %+ School of Media and Strategic Communication, Oklahoma State University, 317-A Paul Miller Building, Stillwater, OK, 74078, United States, 1 6083324571, juwon.hwang.23@gmail.com %K problematic internet use %K PIU %K subjective mental well-being %K perceived parental supportiveness %K adolescents %K well-being %K young adult %K internet %K mental health %K support %K parent %K engagement %K social media %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents’ subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents’ engagement in PIU. Objective: This paper aimed to examine the role played by adolescents’ perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology & Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4% (2130/4592) female and 66.9% (3370/4592) White. Findings revealed that, controlling for adolescents’ demographics and social media use, higher levels of perceived parental supportiveness (β=–.285, P<.001) and higher levels of subjective mental well-being (β=–.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being (β=–.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents’ mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents’ mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. %M 34524093 %R 10.2196/26203 %U https://mental.jmir.org/2021/9/e26203 %U https://doi.org/10.2196/26203 %U http://www.ncbi.nlm.nih.gov/pubmed/34524093 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e25387 %T Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel %A Khodyakov,Dmitry %A Jilani,Shahla M %A Dellva,Stephanie %A Faherty,Laura J %+ RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, United States, 1 310 393 0411 ext 6159, dmitry_khodyakov@rand.org %K Delphi %K ExpertLens %K expert panel %K neonatal abstinence syndrome %K neonatal opioid withdrawal syndrome %K neonatal withdrawal %K neonatal %K neonates %K opioid %K opioids %K withdrawal %K infants %K clinical %K newborn %K newborns %K perinatal %K postnatal %D 2021 %7 7.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants. Objective: The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS. Methods: We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings. Results: The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021. Conclusions: A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads. International Registered Report Identifier (IRRID): DERR1-10.2196/25387 %M 34491203 %R 10.2196/25387 %U https://www.researchprotocols.org/2021/9/e25387 %U https://doi.org/10.2196/25387 %U http://www.ncbi.nlm.nih.gov/pubmed/34491203 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e27049 %T Exploring Mothers’ Experience of a Linguistic Feedback Technology for Children at Risk of Poor Language Development: Qualitative Pilot Study %A So,Lydia %A Miller,Erin %A Eastwood,John %+ Department of Community Paediatrics, South Western Sydney Local Health District, Health Services Building Level 3, Cnr Campbell & Goulburn Street, Liverpool, NSW 2170, Australia, 61 2 4634 3553, lydia.so@health.nsw.gov.au %K language development %K technology %K feedback %K socioeconomic factors %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The early language environment is important for language development and a child’s life-course trajectory. Risk factors associated with poor language development outcomes in children include maternal anxiety and depression, low educational attainment, substance misuse, and low socioeconomic status. Language Environment Analysis (LENA) is a wearable technology designed to promote caregivers’ engagement in supporting their children’s language development. LENA provides quantitative linguistic feedback, which has been shown to improve caregiver language output, thus enhancing a child’s language environment. There is limited research on the uptake of this technology by families with developmentally at-risk children. Objective: This qualitative study aims to explore the conditions under which mothers with children at risk of poor developmental outcomes are willing to adopt the use of LENA to monitor and improve caregiver language output. Methods: Using a qualitative interpretive design, semistructured, in-depth interviews were conducted with 8 mothers. Participants were recruited purposively to select the maximal variation of socioeconomic and ethnodemographic backgrounds. The transcribed interview data were analyzed thematically and interpretatively. Themes were mapped abductively to an extended Unified Theory of Acceptance and Use of Technology, which included contextual factors for LENA acceptance. Results: Factors that influenced the intention to use LENA included both technology-specific acceptance factors and contextual factors. Technology acceptance themes included reassurance, feeling overwhelmed, and trust. These themes were mapped to performance expectancy, effort expectancy, and social influence. Contextual themes included emergent success and the intrusion of past difficulties. These were mapped to parenting self-efficacy and perceived risk. The theme of building on success described behavioral intention. Mothers were more likely to adopt LENA when the technology was viewed as acceptable, and this was influenced by parenting self-efficacy and perceived risk. Conclusions: LENA is a technology that is acceptable to mothers with children who are at risk of poor language development outcomes. Further studies are needed to establish LENA’s effectiveness as an adjunct to strategies to enrich a child’s early language environment. %M 34463633 %R 10.2196/27049 %U https://pediatrics.jmir.org/2021/3/e27049 %U https://doi.org/10.2196/27049 %U http://www.ncbi.nlm.nih.gov/pubmed/34463633 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e31072 %T Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting %A Baggett,Kathleen M %A Davis,Betsy %A Sheeber,Lisa %A Miller,Katy %A Leve,Craig %A Mosley,Elizabeth A %A Landry,Susan H %A Feil,Edward G %+ Georgia State University, 14 Marietta St NW, Atlanta, GA, 30303, United States, 1 404 413 1571, kbaggett@gsu.edu %K maternal depression %K parenting %K infant social-emotional and social-communication development %K mobile intervention %K remote coaching %K trial protocol %K mobile phone %D 2021 %7 18.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 %M 34406122 %R 10.2196/31072 %U https://www.researchprotocols.org/2021/8/e31072 %U https://doi.org/10.2196/31072 %U http://www.ncbi.nlm.nih.gov/pubmed/34406122 %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 %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28855 %T Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study %A Artieta-Pinedo,Isabel %A Paz-Pascual,Carmen %A Bully,Paola %A Espinosa,Maite %A , %+ Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, Osi Barakaldo-Sestao, Lurkizaga S/N, Barakaldo, 48901, Spain, 34 946006667, misabel.artieta@ehu.eus %K prenatal education %K women %K patient decision aid %K decision-making %K clinical decision support systems %K action research and pregnancy %K implementation science %K health service needs and demands %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. %M 34383670 %R 10.2196/28855 %U https://formative.jmir.org/2021/8/e28855 %U https://doi.org/10.2196/28855 %U http://www.ncbi.nlm.nih.gov/pubmed/34383670 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e31013 %T Practitioners’ and Policymakers’ Successes, Challenges, Innovations, and Learning in Promoting Children’s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey %A Davidson,Jennifer C %A Karadzhov,Dimitar %A Wilson,Graham %+ Institute for Inspiring Children's Futures, School of Social Work and Social Policy, University of Strathclyde, Curran Building, Level 6, 94 Cathedral Street, Glasgow, G4 0LG, United Kingdom, 44 141 444 8513, jennifer.davidson@strath.ac.uk %K mobile phones %K smartphone app %K qualitative %K mixed method %K international %K survey %K service providers %K policy %K practice %K children’s rights %K well-being %K COVID-19 %K pandemic %K app %K mHealth %K children %D 2021 %7 29.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children’s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children’s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children’s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners’, managers’, and policymakers’ efforts to support children’s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies—the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents’ sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 %M 34323850 %R 10.2196/31013 %U https://www.researchprotocols.org/2021/7/e31013 %U https://doi.org/10.2196/31013 %U http://www.ncbi.nlm.nih.gov/pubmed/34323850 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e24791 %T A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review %A Monzani,Alice %A Tagliaferri,Francesco %A Bellone,Simonetta %A Genoni,Giulia %A Rabbone,Ivana %+ Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy, 39 03213733868, alice.monzani@med.uniupo.it %K COVID-19 %K SARS-CoV-2 %K children %K pediatrics %K bibliometric review %K publications %K research %K literature %K review %D 2021 %7 23.7.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective: We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods: The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results: A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9%) were research articles, 436 (18.9%) were reviews, 363 (15.8%) were letters, 186 (8.1%) were editorials, 7 (0.3%) were conference papers, and 231 (10%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions: In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease. %M 34081597 %R 10.2196/24791 %U https://pediatrics.jmir.org/2021/3/e24791 %U https://doi.org/10.2196/24791 %U http://www.ncbi.nlm.nih.gov/pubmed/34081597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22709 %T Internet-Administered Cognitive Behavioral Therapy for Common Mental Health Difficulties in Parents of Children Treated for Cancer: Intervention Development and Description Study %A Woodford,Joanne %A Farrand,Paul %A Hagström,Josefin %A Hedenmalm,Li %A von Essen,Louise %+ Uppsala University, Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, MTC-huset: Dag Hammarskjölds väg 14B, 1 tr, Uppsala, 751 85, Sweden, 46 070 4250714, louise-von.essen@kbh.uu.se %K parents %K eMental health %K internet-administered cognitive behavioral therapy %K ICBT %K TIDieR %K CBT self-help %K low-intensity CBT %K mobile phone %D 2021 %7 22.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Following the end of a child’s treatment for cancer, parents may report psychological distress. However, there is a lack of evidence-based interventions that are tailored to the population, and psychological support needs are commonly unmet. An internet-administered low-intensity cognitive behavioral therapy (LICBT)–based intervention (EJDeR [internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer]) may provide a solution. Objective: The first objective is to provide an overview of a multimethod approach that was used to inform the development of the EJDeR intervention. The second objective is to provide a detailed description of the EJDeR intervention in accordance with the Template for Intervention Description and Replication (TIDieR) checklist. Methods: EJDeR was developed through a multimethod approach, which included the use of existing evidence, the conceptualization of distress, participatory action research, a cross-sectional survey, and professional and public involvement. Depending on the main presenting difficulty identified during assessment, LICBT behavioral activation or worry management treatment protocols are adopted for the treatment of depression or generalized anxiety disorder when experienced individually or when comorbid. EJDeR is delivered via the Uppsala University Psychosocial Care Programme (U-CARE) portal, a web-based platform that is designed to deliver internet-administered LICBT interventions and includes secure videoconferencing. To guide parents in the use of EJDeR, weekly written messages via the portal are provided by e-therapists comprising final year psychology program students with training in cognitive behavioral therapy. Results: An overview of the development process and a description of EJDeR, which was informed by the TIDieR checklist, are presented. Adaptations that were made in response to public involvement are highlighted. Conclusions: EJDeR represents a novel, guided, internet-administered LICBT intervention for supporting parents of children treated for cancer. Adopting the TIDieR checklist offers the potential to enhance fidelity to the intervention protocol and facilitate later implementation. The intervention is currently being tested in a feasibility study (the ENGAGE study). International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-023708 %M 34142662 %R 10.2196/22709 %U https://formative.jmir.org/2021/7/e22709 %U https://doi.org/10.2196/22709 %U http://www.ncbi.nlm.nih.gov/pubmed/34142662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26600 %T Support Seeking in the Postpartum Period: Content Analysis of Posts in Web-Based Parenting Discussion Groups %A Chivers,Bonnie R %A Garad,Rhonda M %A Moran,Lisa J %A Lim,Siew %A Harrison,Cheryce L %+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, 3168, Australia, 61 3 8572 2600, cheryce.harrison@monash.edu %K pregnancy %K perinatal %K maternal %K postpartum %K infant %K social support %K qualitative %K health %K online %D 2021 %7 15.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time. Objective: This study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed. Methods: A leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines. Results: In total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes. Conclusions: Engagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices. %M 34264198 %R 10.2196/26600 %U https://www.jmir.org/2021/7/e26600 %U https://doi.org/10.2196/26600 %U http://www.ncbi.nlm.nih.gov/pubmed/34264198 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e27974 %T Internet Searches for Terms Related to Child Maltreatment During COVID-19: Infodemiology Approach %A Riem,Madelon M E %A De Carli,Pietro %A Guo,Jing %A Bakermans-Kranenburg,Marian J %A van IJzendoorn,Marinus H %A Lodder,Paul %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, Netherlands, 31 0243612142, m.riem@psych.ru.nl %K child %K maltreatment %K COVID-19 %K pandemic %K internet searches %K information-seeking %K internet %K abuse %K trend %K Google trends %K infodemiology %D 2021 %7 13.7.2021 %9 Viewpoint %J JMIR Pediatr Parent %G English %X We examined internet searches indicative of abusive parental behaviors before and after the World Health Organization’s declaration of COVID-19 as a pandemic (March 11, 2020) and subsequent lockdown measures in many countries worldwide. Using Google Trends, we inferred search trends between December 28, 2018, and December 27, 2020, for queries consisting of “mother,” “father,” or “parents” combined with each of the 11 maltreatment-related verbs used in the Conflict Tactics Scales, Parent-Child version. Raw search counts from the Google Trends data were estimated using Comscore. Of all 33 search terms, 28 terms showed increases in counts after the lockdowns began. These findings indicate a strong increase in internet searches relating to occurrence, causes, or consequences of emotional and physical maltreatment since the lockdowns began and call for the use of maltreatment-related queries to direct parents or children to online information and support. %M 34174779 %R 10.2196/27974 %U https://pediatrics.jmir.org/2021/3/e27974 %U https://doi.org/10.2196/27974 %U http://www.ncbi.nlm.nih.gov/pubmed/34174779 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e29538 %T Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation %A Sung,Jenna Y %A Mumper,Emma %A Schleider,Jessica Lee %+ Department of Psychology, Stony Brook University, Psychology-B 340, Stony Brook, NY, 11794-2500, United States, 1 631 632 4131, jessica.schleider@stonybrook.edu %K acceptability %K adolescent mental health %K adolescent %K anxiety %K avoidance %K behavior %K child mental health %K children %K digital mental health %K intervention %K mental health %K parent %K prevention %K young adult %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions—particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children—for instance, by mitigating known anxiety risk factors—remains unexplored. Objective: This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods: In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results: Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions: Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration: ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9 %M 34255718 %R 10.2196/29538 %U https://mental.jmir.org/2021/7/e29538 %U https://doi.org/10.2196/29538 %U http://www.ncbi.nlm.nih.gov/pubmed/34255718 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27504 %T Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review %A Milne-Ives,Madison %A Neill,Sarah %A Bayes,Natasha %A Blair,Mitch %A Blewitt,Jane %A Bray,Lucy %A Carrol,Enitan D %A Carter,Bernie %A Dawson,Rob %A Dimitri,Paul %A Lakhanpaul,Monica %A Roland,Damian %A Tavare,Alison %A Meinert,Edward %A , %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DT, United Kingdom, 44 1752600600, edward.meinert@plymouth.ac.uk %K acute disease %K telemedicine %K child %K pediatrics %K childhood disease %K childhood illness %K health education %K health literacy %K help-seeking behavior %K child health %K digital intervention %K mHealth %K primary care %K sick child %D 2021 %7 30.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child’s symptoms is one of many factors that play a role in parents’ decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents’ knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. Objective: The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home. Methods: The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references’ titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported. Results: The systematic review will commence during 2021. Conclusions: This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/27504 %M 34228628 %R 10.2196/27504 %U https://www.researchprotocols.org/2021/6/e27504 %U https://doi.org/10.2196/27504 %U http://www.ncbi.nlm.nih.gov/pubmed/34228628 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e26571 %T A Data-Free Digital Platform to Reach Families With Young Children During the COVID-19 Pandemic: Online Survey Study %A Richter,Linda Marleine %A Naicker,Sara Naomi %+ DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Office 154 First Floor East Wing, Wits School of Public Health, Education Campus, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa, 27 117172382, linda.richter@wits.ac.za %K families %K parenting %K children %K COVID-19 %K digital %K survey %K data-free %D 2021 %7 28.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries. Objective: The study objectives were two-fold. The first objective was to gather data on the impact of the COVID-19 pandemic on families of young children using an online survey. The second objective was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa. Methods: We used a data-free mobile messenger platform to conduct a short digital survey of the impact of the COVID-19 pandemic on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey. Results: More than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of its launch. Respondents were predominantly from lower classes and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns and some underrepresentation of rural households. Mothers comprised 70.2% (11,178/15,912) of respondents and fathers comprised 29.8% (4734/15,912), representing 18,672 children 5 years of age and younger. Response rates per survey item ranged from 74.8% (11,907/15,912) at the start of the survey to 50.3% (8007/15,912) at completion. A total of 82.0% (12,729/15,912) of parents experienced at least one challenge during the pandemic, and 32.4% (2737/8441) did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost. Conclusions: Data-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated, or no-cost, services could provide a feasible, sustainable, and equitable basis for ongoing interactions with families of young children. %M 33852414 %R 10.2196/26571 %U https://pediatrics.jmir.org/2021/2/e26571 %U https://doi.org/10.2196/26571 %U http://www.ncbi.nlm.nih.gov/pubmed/33852414 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e27542 %T Self-Care Needs and Technology Preferences Among Parents in Marginalized Communities: Participatory Design Study %A Yuwen,Weichao %A Duran,Miriana %A Tan,Minghui %A Ward,Teresa M %A Cheng,Sunny Chieh %A Ramirez,Magaly %+ School of Nursing & Healthcare Leadership, University of Washington Tacoma, 1900 Commerce Street, Box 358421, Tacoma, WA, 98402, United States, 1 2536924478, wyuwen@uw.edu %K asthma %K caregiving %K self-care %K parents %K qualitative research %K culturally appropriate technology %K minority groups %K marginalization %D 2021 %7 22.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Ten million parents provide unpaid care to children living with chronic conditions, such as asthma, and a high percentage of these parents are in marginalized communities, including racial and ethnic minority and low-income families. There is an urgent need to develop technology-enabled tailored solutions to support the self-care needs of these parents. Objective: This study aimed to use a participatory design approach to describe and compare Latino and non-Latino parents’ current self-care practices, needs, and technology preferences when caring for children with asthma in marginalized communities. Methods: The participatory design approach was used to actively engage intended users in the design process and empower them to identify needs and generate design ideas to meet those needs. Results: Thirteen stakeholders participated in three design sessions. We described Latino and non-Latino parents’ similarities in self-care practices and cultural-specific preferences. When coming up with ideas of technologies for self-care, non-Latino parents focused on improving caregiving stress through journaling, daily affirmations, and tracking feelings, while Latino parents focused more on relaxation and entertainment. Conclusions: Considerations need to be taken beyond language differences when developing technology-enabled interventions for diverse populations. The community partnership approach strengthened the study’s inclusive design. %M 34156343 %R 10.2196/27542 %U https://pediatrics.jmir.org/2021/2/e27542 %U https://doi.org/10.2196/27542 %U http://www.ncbi.nlm.nih.gov/pubmed/34156343 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e18830 %T Implementation of iPads to Increase Compliance With Delivery of New Parent Education in the Mother–Baby Unit: Retrospective Study %A Pavuluri,Haritha %A Grant,Alicia %A Hartman,Alexander %A Fowler,Lauren %A Hudson,Jennifer %A Springhart,Patrick %A Kennedy,Ann Blair %+ University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, United States, 1 864 455 8374, kenneda5@greenvillemed.sc.edu %K technology %K handheld computers %K workflow %K education %K newborn %K head trauma %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting. Objective: The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother–baby unit resulted in improved rates of parents’ acceptance of the opportunity to view an educational video about AHT. Methods: We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother–baby unit. Results: Compliance increased overall (P<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (φ=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance. Conclusions: Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother–baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother–baby unit. %M 34128809 %R 10.2196/18830 %U https://pediatrics.jmir.org/2021/2/e18830 %U https://doi.org/10.2196/18830 %U http://www.ncbi.nlm.nih.gov/pubmed/34128809 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e19114 %T Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial %A Bourdeau,Beth %A Miller,Brenda A %A Byrnes,Hilary F %A Woodall,W Gill %A Buller,David B %A Grube,Joel W %+ Division of Prevention Science, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143, United States, 1 4155021000, Beth.Bourdeau@ucsf.edu %K adolescent %K sexual behavior %K parenting %K intervention %K randomized controlled trial %K mobile phone %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation. Objective: This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time. Methods: A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents. Results: Less than half (88/206, 42.7%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations. Conclusions: Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term. Trial Registration: ClinicalTrials.gov NCT03521115; https://clinicaltrials.gov/ct2/show/NCT03521115 %M 34128818 %R 10.2196/19114 %U https://pediatrics.jmir.org/2021/2/e19114 %U https://doi.org/10.2196/19114 %U http://www.ncbi.nlm.nih.gov/pubmed/34128818 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29770 %T Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study %A Stoodley,Cathy %A McKellar,Lois %A Ziaian,Tahereh %A Steen,Mary %A Gwilt,Ian %A Fereday,Jenny %+ UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Corner of North Terrace and, Frome Rd,, Adelaide, 5001, Australia, 61 430346633, cathy.stoodley@unisa.edu.au %K mother-infant relationship %K mother-infant relations %K mother-infant bonding %K infant development %K midwife %K early postnatal %K co-design %K mixed methods %D 2021 %7 10.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship. Objective: The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period. Methods: This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys. Results: Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023. Conclusions: The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period. %M 34110301 %R 10.2196/29770 %U https://www.researchprotocols.org/2021/6/e29770 %U https://doi.org/10.2196/29770 %U http://www.ncbi.nlm.nih.gov/pubmed/34110301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26867 %T Medical Insights from Posts About Irritable Bowel Syndrome by Adolescent Patients and Their Parents: Topic Modeling and Social Network Analysis %A Zhong,Bu %A Liu,Qian %+ School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, 601 Huangpu West Ave, Tianhe District, Guangzhou, Guangdong Province, 510632, China, 86 13302292599, tsusanliu@jnu.edu.cn %K irritable bowel syndrome %K health care forum %K adolescent %K parents %K topic modeling %K social network analysis %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents with irritable bowel syndrome (IBS) are increasingly seeking and sharing information about their symptoms in web-based health care forums. Their posts and those from their parents contain critical insights that can be used by patients, physicians, and caregivers to manage IBS symptoms. Objective: The aim of this study is to examine the posts from adolescent patients and their parents in a health forum, IBS Group, to better understand the key challenges, concerns, and issues of interest to young patients with IBS and their caregivers. Methods: Using topic modeling and social network analysis, in this study, we analyzed all the messages (over 750 topics and 3400 replies) posted on the IBS Group forum from 2010-2019 by adolescents with IBS aged 13-17 years and parents having children with IBS. We first detected 6 major topics in the posts by adolescent patients and parents on teenagers’ IBS symptoms and the interaction between the topics. Social network analysis was then performed to gain insights into the nature of web-based interaction patterns among patients and caregivers. Results: Using the Latent Dirichlet Allocation algorithm and a latent Dirichlet allocation visualization tool, this study revealed 6 leading topics of concern in adolescents with IBS: school life, treatment or diet, symptoms, boys’ ties to doctors, social or friend issues, and girls’ ties to doctors. The top 6 topics in the parents’ discussions were school life, girls’ issues, boys’ issues, diet choice, symptoms, and stress. The analyses show that the adolescent patients themselves are most concerned about the effect of IBS on their everyday activities and social lives. For parents having daughters with IBS, their top concerns were related to the girls’ school performance and how much help they received at school. For their sons, the parents were more concerned about the pain and suffering that their sons had to endure. Both parents and adolescents gained social support from the web-based platform. Topic modeling shows that IBS affects teenagers the most in the areas of pain and school life. Furthermore, the issues raised by parents suggest that girls are bothered more by school performance over pain, whereas boys show exactly the opposite: pain is of greater concern than school performance. Conclusions: This study represents the first attempt to leverage both machine learning approaches and social network analysis to identify top IBS concerns from the perspectives of adolescent patients and caregivers in the same health forum. Young patients with IBS must face the challenges of social influences and anxiety associated with this health disorder in addition to physical pain and other symptoms. Boys and girls are affected differently by pain and school performance and view the IBS impacts differently from the parents. %M 34106078 %R 10.2196/26867 %U https://www.jmir.org/2021/6/e26867 %U https://doi.org/10.2196/26867 %U http://www.ncbi.nlm.nih.gov/pubmed/34106078 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e29411 %T “It's Been Negative for Us Just All the Way Across the Board”: Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic %A Hammons,Amber J %A Villegas,Elizabeth %A Robart,Ryan %+ Department of Child and Family Science, California State University, Fresno, 5241 North Maple Avenue, Fresno, CA, 93740, United States, 1 559 278 1158, ahammons@csufresno.edu %K children %K COVID-19 %K experiences %K family %K outcomes %K pandemic %K parenting %K parents %K screen time %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families’ experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children’s ST habits as the country attempts to establish a new normal. %M 34081606 %R 10.2196/29411 %U https://pediatrics.jmir.org/2021/2/e29411 %U https://doi.org/10.2196/29411 %U http://www.ncbi.nlm.nih.gov/pubmed/34081606 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24156 %T Perceptions and Acceptability of a Smartphone App Intervention (ChildSafe) in Malaysia: Qualitative Exploratory Study %A Yong,Teresa Sui Mien %A Perialathan,Komathi %A Ahmad,Masitah %A Juatan,Nurashma %A Abdul Majid,Liana %A Johari,Mohammad Zabri %+ Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, No 1, Jalan Setia Murni U13/52, Section U13, Shah Alam, 40170, Malaysia, 60 333627600 ext 8612, teresa_yong@yahoo.co.uk %K child safety %K unintentional injuries %K consolidated framework for implementation research (CFIR) %K characteristics of individuals %K Mobile App Rating Scale (MARS) %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective: This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods: This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results: The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions: Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians. %M 34061039 %R 10.2196/24156 %U https://pediatrics.jmir.org/2021/2/e24156 %U https://doi.org/10.2196/24156 %U http://www.ncbi.nlm.nih.gov/pubmed/34061039 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e26372 %T The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study %A Hou,Zhiyuan %A Song,Suhang %A Du,Fanxing %A Shi,Lu %A Zhang,Donglan %A Lin,Leesa %A Yu,Hongjie %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 %K prevention %K vaccination %K behavior %K children %K China %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. Objective: The goal of this study was to assess the change in children’s and adolescents’ prevention and vaccination behaviors amid China’s COVID-19 epidemic. Methods: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children’s and adolescents’ prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents’ characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. Results: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2% (638/776) of children or adolescents always wore masks when going out compared with 31.5% (521/1655) before the epidemic; in addition, 25.0% (414/1655) and 79.8% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9% (776/1655) went out during the epidemic. Meanwhile, 56.1% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8% (468/626) delaying scheduled vaccinations and 80.9% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. Conclusions: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders. %M 33882450 %R 10.2196/26372 %U https://publichealth.jmir.org/2021/5/e26372 %U https://doi.org/10.2196/26372 %U http://www.ncbi.nlm.nih.gov/pubmed/33882450 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e16145 %T Indigenous Mothers’ Use of Web- and App-Based Information Sources to Support Healthy Parenting and Infant Health in Canada: Interpretive Description %A Wright,Amy Lynn %A VanEvery,Rachel %A Miller,Vicky %+ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Suite 130, 155 College Street, Toronto, ON, M5T 1P8, Canada, 1 416 946 8183, amyl.wright@utoronto.ca %K Indigenous health %K infant health %K mothers %K parenting %K qualitative research %K health education %K health services accessibility %K mobile phone %D 2021 %7 21.5.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based sources of health information are widely used by parents to support healthy parenting and aid in decision making about their infants’ health. Although fraught with challenges such as misinformation, if used appropriately, web-based resources can improve access to health education and promote healthy choices. How Indigenous mothers use web-based information to support their parenting and infants’ health has not yet been investigated; however, web-based modalities may be important methods for mitigating the reduced access to health care and negative health care interactions that many Indigenous people are known to experience. Objective: This study aims to understand the experience of Indigenous mothers who use web-based information to support the health of their infants. Methods: This interpretive description qualitative study used semistructured interviews and a discussion group to understand how Indigenous mothers living in Hamilton, Ontario and caring for an infant aged <2 years experienced meeting the health needs of their infants. The data presented reflect their experiences of using web-based sources of health information to support their infants’ health. The Two-Eyed Seeing approach was applied to the study design, which ensured that both western and Indigenous worldviews were considered throughout. Results: A total of 19 Indigenous mothers participated in this study. The resulting 4 themes included distrusting information, staying anonymous, using visual information to support decision making, and accessing a world of experiences. Although fewer Indigenous mothers used web-based sources of information compared to mothers in the general population in other studies, tailoring web-based modalities to meet the unique needs of Indigenous mothers is an important opportunity for supporting the health and wellness of both mothers and infants. Conclusions: Web-based information sources are commonly used among parents, and ever-evolving web-based technologies make this information increasingly available and accessible. Tailoring web-based modalities to meet the unique preferences and needs of Indigenous mothers is an important method for improving their access to reliable and accurate health care information, thereby supporting healthy parenting and promoting infant health. %M 34018489 %R 10.2196/16145 %U https://pediatrics.jmir.org/2021/2/e16145 %U https://doi.org/10.2196/16145 %U http://www.ncbi.nlm.nih.gov/pubmed/34018489 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e23115 %T Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial %A Manjong,Florence Titu %A Verla,Vincent Siysi %A Egbe,Thomas Obinchemti %A Nsagha,Dickson Shey %+ Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, 237, Cameroon, 237 677 499 429, nsaghads@hotmail.com %K nutrition education %K caregivers %K nutrition outcomes %K indigenous children %D 2021 %7 20.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce. Objective: This study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers’ knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon. Methods: A two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child–caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers’ peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers’ knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea. Results: Baseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child–caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript. Conclusions: The findings of this study will provide evidence on the impact of culturally tailored and health belief model–based nutrition education on behavior change as a complementary strategy for strengthening health facility–based approaches in the reduction of malnutrition burden among the study population International Registered Report Identifier (IRRID): DERR1-10.2196/23115 %M 34014173 %R 10.2196/23115 %U https://www.researchprotocols.org/2021/5/e23115 %U https://doi.org/10.2196/23115 %U http://www.ncbi.nlm.nih.gov/pubmed/34014173 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24196 %T Parents’ Attitudes Toward School Students’ Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study %A Buabbas,Ali %A Hasan,Huda %A Shehab,Abrar Abdulmohsen %+ Department of Community Medicine and Bahavioural Sciences, Faculty of Medicine, Kuwait University, Jabriya, 320 St, Hawally Governorate, 13110, Kuwait, 965 246 36559, ali.buabbas@hsc.edu.kw %K smartphones %K overuse impact %K school students %K parents’ attitudes %D 2021 %7 20.5.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents’ awareness of the risks of the overuse of smartphones (SPs) among their children and parents’ attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue. Objective: This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it. Methods: The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait. Results: A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5%) than male (45/120, 37.5%) respondents. Almost all of the participants (118/120, 98.3%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children’s health (117/120, 97.5%). Although the participants, mostly the mothers, supervised their children’s use of SPs closely (106/120, 88.3%), the majority could not control their children’s length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children. Conclusions: Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested. %M 33878024 %R 10.2196/24196 %U https://pediatrics.jmir.org/2021/2/e24196 %U https://doi.org/10.2196/24196 %U http://www.ncbi.nlm.nih.gov/pubmed/33878024 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e28991 %T Use of the Instagram Hashtags #winemom and #momjuice Among Mothers During the COVID-19 Pandemic: Descriptive, Cross-sectional Study %A Basch,Corey H %A Meleo-Erwin,Zoe C %A Mohlman,Jan %A Fera,Joseph %A Quinones,Nasia %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, United States, 1 973 720 2603, baschc@wpunj.edu %K Instagram %K alcohol consumption %K COVID-19 %K social media %K communication %K parenting %D 2021 %7 18.5.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The tendency of parents to consume alcohol during the COVID-19 pandemic is likely to be moderated by pandemic-related stress combined with the ongoing demands of childcare and home-based education, which are reported to be more burdensome for females than males. Objective: The purpose of this study was to describe alcohol-related content posted by mothers on Instagram during the COVID-19 pandemic. Methods: Using two popular hashtags, #momjuice and #winemom, 50 Instagram posts on each were collected from the “top posts” tab. The coding categories were created inductively and were as follows: displays alcohol (drinking/holding alcohol or alcohol itself), person is making alcoholic beverages, type of alcohol featured or discussed, highlights anxiety and/or depression/mental state, highlights struggling (in general), highlights parenting challenges, encourages alcohol consumption, discourages alcohol consumption, features a person wearing clothing or shows products promoting alcohol, promotes alcohol rehabilitation, highlights caffeine to alcohol daily transition throughout the day, and highlights other drugs besides caffeine and alcohol. Results: Overall, the 100 selected posts had a total of 5108 comments and 94,671 likes. The respective averages were 51.08 (SD 77.94) and 946.71 (SD 1731.72). A majority (>50%) of the posts reviewed encouraged alcohol consumption (n=66) and/or displayed alcohol (n=56). Of the 66 that encouraged and/or displayed alcohol, the common type of alcohol discussed or featured was wine (n=55). Only 6 posts discouraged alcohol use and only 4 provided the audience with a disclaimer. None of the videos promoted or endorsed alcohol rehabilitation in any way. Only 37 posts highlighted struggle. However, these posts garnered more than a majority of the likes (n=50,034, 52.3%). Posts that showed struggle received an average of 1359.57 (SD 2108.02) likes. Those that did not show struggle had an average of 704.24 (SD 1447.46) likes. An independent one-tailed t test demonstrated this difference to be statistically significant (P=.0499). Conclusions: The findings of this investigation suggest that though these hashtags ostensibly exist to valorize excess alcohol consumption, they may be serving as a support system for mothers who are experiencing increased burdens and role stress during the pandemic. Given the strains placed on mothers overall and especially during the COVID-19 pandemic, efforts must be taken to increase access to and affordability of telehealth-based mental health care. %M 33848257 %R 10.2196/28991 %U https://pediatrics.jmir.org/2021/2/e28991 %U https://doi.org/10.2196/28991 %U http://www.ncbi.nlm.nih.gov/pubmed/33848257 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24802 %T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework %A Karssen,Levie T %A Vink,Jacqueline M %A de Weerth,Carolina %A Hermans,Roel C J %A de Kort,Carina P M %A Kremers,Stef PJ %A Ruiter,Emilie L M %A Larsen,Junilla K %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl %K childhood obesity %K preventive intervention %K parenting practices %K energy-balance related behavior %K socio-economic position %K mHealth %K behavior change %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Form Res %G English %X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. %M 33988510 %R 10.2196/24802 %U https://formative.jmir.org/2021/5/e24802 %U https://doi.org/10.2196/24802 %U http://www.ncbi.nlm.nih.gov/pubmed/33988510 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25047 %T Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial %A Al Azdi,Zunayed %A Islam,Khaleda %A Khan,Muhammad Amir %A Khan,Nida %A Ejaz,Amna %A Khan,Muhammad Ahmar %A Warraitch,Azza %A Jahan,Ishrat %A Huque,Rumana %+ ARK Foundation, Suite C-4, House No. 6, Road No. 109, Gulshan-2, Dhaka, 1212, Bangladesh, 880 1711455670, azdi1627@gmail.com %K mental health %K refugee health %K early childhood development %K Rohingya %K Bangladesh %K community health care %K community health worker %D 2021 %7 4.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Thousands of Rohingya refugee mothers at the world’s largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. Objective: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers’ mental health status. Methods: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox’s Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention’s acceptability and feasibility. Results: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. Conclusions: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention’s sustainability. Trial Registration: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553 International Registered Report Identifier (IRRID): DERR1-10.2196/25047 %M 33944793 %R 10.2196/25047 %U https://www.researchprotocols.org/2021/5/e25047 %U https://doi.org/10.2196/25047 %U http://www.ncbi.nlm.nih.gov/pubmed/33944793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24861 %T A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers’ Tolerance for, and Parenting Practices Associated With, Children’s Outdoor Risky Play: Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Lin,Yingyi %A Jacob,John %A Pike,Ian %A Bundy,Anita %A Faulkner,Guy %A Gardy,Jennifer %A Fisher,Brian %A Mâsse,Louise %+ Department of Pediatrics, Faculty of Medicine, University of British Columbia, F508 – 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada, 1 6048753712, mbrussoni@bcchr.ubc.ca %K outdoor play %K mothering %K independent mobility %K physical activity %K risk perception %K risky play %K risk reframing %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. Objective: The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. Methods: The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. Results: A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. Conclusions: The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial Registration: ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2552-4 %M 33904820 %R 10.2196/24861 %U https://www.jmir.org/2021/4/e24861 %U https://doi.org/10.2196/24861 %U http://www.ncbi.nlm.nih.gov/pubmed/33904820 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e25811 %T Parent Experiences With Electronic Medication Monitoring in Pediatric Asthma Management: Qualitative Study %A Kan,Kristin %A Shaunfield,Sara %A Kanaley,Madeleine %A Chadha,Avneet %A Boon,Kathy %A Foster,Carolyn C %A Morales,Luis %A Labellarte,Patricia %A Vojta,Deneen %A Gupta,Ruchi S %+ Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, United States, 1 3122276785, kkan@luriechildrens.org %K pediatric asthma %K digital health %K outpatient care %K asthma management %K pediatric %K asthma %K parents %K caregivers %K Bluetooth sensors %K inhaler %D 2021 %7 23.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Electronic medication monitoring (EMM) is a digital tool that can be used for tracking daily medication use. Previous studies of EMM in asthma management have been conducted in adults or have examined pediatric interventions that use EMM for less than 1 year. To understand how to improve EMM-enhanced interventions, it is necessary to explore the experiences of parents of children with asthma, recruited from outpatient practices, who completed a 12-month intervention trial. Objective: The objective of our study was to use qualitative inquiry to answer the following questions: (1) how did using an EMM-enhanced intervention change parents'/caregivers’ experiences of managing their child’s asthma, and (2) what do parents recommend for improving the intervention in the future? Methods: Parents were recruited from the intervention arm of a multicomponent health intervention enhanced by Bluetooth-enabled sensors placed on inhaler medications. Semistructured interviews were conducted with 20 parents of children aged 4-12 years with asthma. Interviews were audio-recorded, transcribed, and inductively analyzed using a constant comparative approach. Results: Interview participants reflected an even mix of publicly and privately insured children and a diverse racial-ethnic demographic. Parents discussed 6 key themes related to their experience with the EMM-enhanced intervention for the management of their child's asthma: (1) compatibility with the family's lifestyle, (2) impact on asthma management, (3) impact on the child’s health, (4) emotional impact of the intervention, (5) child’s engagement in asthma management with the intervention, and (6) recommendations for future intervention design. Overall, parents reported that the 12-month EMM intervention was compatible with their daily lives, positively influenced their preventive and acute asthma management, and promoted their child's engagement in their own asthma management. While parents found the intervention acceptable and generally favorable, some parents identified compatibility issues for families with multiple caregivers and frustration when the technology malfunctioned. Conclusions: Parents generally viewed the intervention as a positive influence on the management of their child's asthma. However, our study also highlighted technology challenges related to having multiple caregivers, which will need to be addressed in future iterations for families. Attention must be paid to the needs of parents from low socioeconomic households, who may have more limited access to reliable internet or depend on other relatives for childcare. Understanding these family factors will help refine how a digital tool can be adopted into daily disease management of pediatric asthma. %M 33890861 %R 10.2196/25811 %U https://pediatrics.jmir.org/2021/2/e25811 %U https://doi.org/10.2196/25811 %U http://www.ncbi.nlm.nih.gov/pubmed/33890861 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e29048 %T Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study %A Taylor,Rachael W %A Conlon,Cathryn A %A Beck,Kathryn L %A von Hurst,Pamela R %A Te Morenga,Lisa A %A Daniels,Lisa %A Haszard,Jill J %A Meldrum,Alison M %A McLean,Neve H %A Cox,Alice M %A Tukuafu,Lesieli %A Casale,Maria %A Brown,Kimberley J %A Jones,Emily A %A Katiforis,Ioanna %A Rowan,Madeleine %A McArthur,Jenny %A Fleming,Elizabeth A %A Wheeler,Ben J %A Houghton,Lisa A %A Diana,Aly %A Heath,Anne-Louise M %+ Department of Human Nutrition, University of Otago, 70 Union St West, Dunedin, 9054, New Zealand, 64 34798379, anne-louise.heath@otago.ac.nz %K infant %K diet %K complementary feeding %K food pouch %K baby-led weaning %K iron %K growth %K eating behavior %K feeding behavior %K dental health %K choking %K breast milk %D 2021 %7 21.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food “pouches” and “baby-led weaning” (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. Objective: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. Methods: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide “dose-to-mother” technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. Results: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. Conclusions: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. International Registered Report Identifier (IRRID): DERR1-10.2196/29048 %M 33881411 %R 10.2196/29048 %U https://www.researchprotocols.org/2021/4/e29048 %U https://doi.org/10.2196/29048 %U http://www.ncbi.nlm.nih.gov/pubmed/33881411 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25219 %T Predictors of Parental Barriers to Reduce Excessive Child Screen Time Among Parents of Under-Five Children in Selangor, Malaysia: Cross-sectional Study %A Mansor,Elliza %A Ahmad,Norliza %A Raj,Diana %A Mohd Zulkefli,Nor Afiah %A Mohd Shariff,Zalilah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia, 60 019 271 0577, lizaahmad@upm.edu.my %K child %K self-efficacy %K screen time %K Malaysia %K parent-child relations %K public sector %K children %K screen %K parental %D 2021 %7 13.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, there is an increasing prevalence of excessive screen time exposure among young children, including in Malaysia. Parents are advised to limit this exposure, but there are barriers for many of them to follow this recommendation. To date, there is a lack of research on the factors that cause these parental barriers. Objective: This study aimed to determine the parental barrier toward the reduction of excessive child screen time and its predictors among parents of children aged younger than 5 years in the Petaling District, Selangor, Malaysia. Methods: A cross-sectional study was conducted from April 2019 to June 2020 among 789 parent-child dyads attending child health clinics in the Petaling District. Validated self-administered questionnaires were used to capture information on sociodemographic, parental, child-related, and environmental factors and parental barriers. Stratified sampling with probability proportionate to size was employed. Data were analyzed using SPSS Statistics version 25 (IBM Corp). Descriptive analysis and bivariable analysis were performed before multiple linear regression was used to identify predictors of parental barriers. Results: The overall mean score of parental barriers was 3.51 (SD 0.83), indicating that the average numbers of barriers experienced by parents were more than 3. The multivariable analysis showed that the predictors of parental barriers included monthly household income (adjusted β=–.03, 95% CI –0.05 to –0.02), parents who worked in public sectors (adjusted β=.18, 95% CI 0.06 to 0.29), positive parental attitude on screens (adjusted β=.68, 95% CI 0.58 to 0.79), low parent self-efficacy to influence child’s physical activity (adjusted β=–.32, 95% CI –0.43 to –0.20), and child screen time (adjusted β=.04, 95% CI 0.02 to 0.06). Conclusions: The strongest predictor of parental barriers to reduce excessive child screen time was the positive parental attitude on screen time which could contribute to their abilities to limit child screen time. Thus, future intervention strategies should aim to foster correct parental attitudes toward screen time activities among young children. %M 33847590 %R 10.2196/25219 %U https://www.jmir.org/2021/4/e25219 %U https://doi.org/10.2196/25219 %U http://www.ncbi.nlm.nih.gov/pubmed/33847590 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24579 %T Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial %A Scott,Jane Anne %A Burns,Sharyn K %A Hauck,Yvonne L %A Giglia,Roslyn C %A Jorgensen,Anita M %A White,Becky Kate %A Martin,Annegret %A Robinson,Suzanne %A Dhaliwal,Satvinder S %A Binns,Colin W %A Maycock,Bruce R %+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, Australia, 61 040 413 0489, jane.scott@curtin.edu.au %K breastfeeding %K fathers %K peer support %K mHealth, smartphone app %K infants %K social support %K feeding %K smartphone %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. Objective: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-015-0601-5 %M 33843604 %R 10.2196/24579 %U https://pediatrics.jmir.org/2021/2/e24579 %U https://doi.org/10.2196/24579 %U http://www.ncbi.nlm.nih.gov/pubmed/33843604 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e28089 %T Autonomic Nervous System Maturation and Emotional Coordination in Interactions of Preterm and Full-Term Infants With Their Parents: Protocol for a Multimethod Study %A Koumarela,Christina %A Kokkinaki,Theano %A Giannakakis,Giorgos %A Koutra,Katerina %A Hatzidaki,Eleftheria %+ Laboratory of Applied Psychology, Department of Psychology, University of Crete, Gallos, Rethymnon, 74 100, Greece, 30 2831077536, kokkinaki@uoc.gr %K preterm infants %K heart rate variability %K emotional coordination %K developmental outcomes %D 2021 %7 12.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is limited knowledge on the physiological and behavioral pathways that may affect the developmental outcomes of preterm infants and particularly on the link between autonomic nervous system maturation and early social human behavior. Thus, this study attempts to investigate the way heart rate variability (HRV) parameters are related to emotional coordination in interactions of preterm and full-term infants with their parents in the first year of life and the possible correlation with the developmental outcomes of infants at 18 months. Objective: The first objective is to investigate the relationship between emotional coordination and HRV in dyadic full-term infant–parent (group 1) and preterm infant–parent (group 2) interactions during the first postpartum year. The second objective is to examine the relationship of emotional coordination and HRV in groups 1 and 2 in the first postpartum year with the developmental outcomes of infants at 18 months. The third objective is to investigate the effect of maternal and paternal postnatal depression on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. The fourth objective is to examine the effect of family cohesion and coping on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. Methods: This is an observational, naturalistic, and longitudinal study applying a mixed method design that includes the following: (1) video recordings of mother-infant and father-infant interactions at the hospital, in the neonatal period, and at home at 2, 4, 6, 9, and 12 months of the infants’ life; (2) self-report questionnaires of parents on depressive symptoms, family cohesion, and dyadic coping of stress; (3) infants’ HRV parameters in the neonatal period and at each of the above age points during and after infant-parent video recordings; and (4) assessment of toddlers’ social and cognitive development at 18 months through an observational instrument. Results: The study protocol has been approved by the Research Ethics Committee of the University of Crete (number/date: 170/September 18, 2020). This work is supported by the Special Account for Research Funds of the University of Crete (grant number: 10792-668/08.02.2021). All mothers (with their partners) of full-term and preterm infants who give birth between March 2021 and January 2022 at the General University Hospital of Crete (northern Crete, Greece) will be invited to participate. The researcher will invite the parents of infants to participate in the study 1 to 2 days after birth. Data collection is expected to be completed by March 2023, and the first results will be published by the end of 2023. Conclusions: Investigating the regulatory role of HRV and social reciprocity in preterm infants may have implications for both medicine and psychology. International Registered Report Identifier (IRRID): PRR1-10.2196/28089 %M 33843606 %R 10.2196/28089 %U https://www.researchprotocols.org/2021/4/e28089 %U https://doi.org/10.2196/28089 %U http://www.ncbi.nlm.nih.gov/pubmed/33843606 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e22541 %T Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study %A Tate,Allan %A Trofholz,Amanda %A Miner,Michael %A Berge,Jerica %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 202 BS Miller Hall, 101 Buck Rd, Health Sciences Campus, Athens, GA, 30602, United States, 1 706 542 6317, allan.tate@uga.edu %K meal healthfulness %K direct observation %K family meals %K well-being %K diet %K food %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis–St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). Conclusions: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment. %M 33759788 %R 10.2196/22541 %U https://pediatrics.jmir.org/2021/1/e22541 %U https://doi.org/10.2196/22541 %U http://www.ncbi.nlm.nih.gov/pubmed/33759788 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19461 %T Parents’ Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey %A Glassman,Jill %A Humphreys,Kathryn %A Yeung,Serena %A Smith,Michelle %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center, School of Medicine, Stanford University, 365 Lasuen Street, #308, Stanford, CA, 94305, United States, 1 8314195302, jill.r.glassman@stanford.edu %K parenting %K digital technology %K mobile phone %K child development %K artificial intelligence %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents’ use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)–based tools that help with mitigating technoference. Objective: This study aims to assess parents’ awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors. Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents’ perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income). Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements “I am worried about the impact of my mobile electronic device use on my child” and “Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving” (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents’ perceived technoference and sociodemographic factors, parents’ perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools. Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful. %M 33720026 %R 10.2196/19461 %U https://www.jmir.org/2021/3/e19461 %U https://doi.org/10.2196/19461 %U http://www.ncbi.nlm.nih.gov/pubmed/33720026 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e23842 %T Perspectives of Pregnant and Breastfeeding Women on Participating in Longitudinal Mother-Baby Studies Involving Electronic Health Records: Qualitative Study %A Hentschel,Austen %A Hsiao,Chu J %A Chen,Lynn Y %A Wright,Lauren %A Shaw,Jennifer %A Du,Xinsong %A Flood-Grady,Elizabeth %A Harle,Christopher A %A Reeder,Callie F %A Francois,Magda %A Louis-Jacques,Adetola %A Shenkman,Elizabeth %A Krieger,Janice L %A Lemas,Dominick J %+ Clinical Translational Science Institute, University of Florida, 2004 Mowry Road, Suite 2234, PO Box 100177, Gainesville, FL, United States, 1 3522945971, djlemas@ufl.edu %K electronic health records %K pregnancy %K breastfeeding %K maternal-child health %K research engagement %K mother-infant medical record linkage %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Electronic health records (EHRs) hold great potential for longitudinal mother-baby studies, ranging from assessing study feasibility to facilitating patient recruitment to streamlining study visits and data collection. Existing studies on the perspectives of pregnant and breastfeeding women on EHR use have been limited to the use of EHRs to engage in health care rather than to participate in research. Objective: The aim of this study is to explore the perspectives of pregnant and breastfeeding women on releasing their own and their infants’ EHR data for longitudinal research to identify factors affecting their willingness to participate in research. Methods: We conducted semistructured interviews with pregnant or breastfeeding women from Alachua County, Florida. Participants were asked about their familiarity with EHRs and EHR patient portals, their comfort with releasing maternal and infant EHR data to researchers, the length of time of the data release, and whether individual research test results should be included in the EHR. The interviews were transcribed verbatim. Transcripts were organized and coded using the NVivo 12 software (QSR International), and coded data were thematically analyzed using constant comparison. Results: Participants included 29 pregnant or breastfeeding women aged between 22 and 39 years. More than half of the sample had at least an associate degree or higher. Nearly all participants (27/29, 93%) were familiar with EHRs and had experience accessing an EHR patient portal. Less than half of the participants (12/29, 41%) were willing to make EHR data available to researchers for the duration of a study or longer. Participants’ concerns about sharing EHRs for research purposes emerged in 3 thematic domains: privacy and confidentiality, transparency by the research team, and surrogate decision-making on behalf of infants. The potential release of sensitive or stigmatizing information, such as mental or sexual health history, was considered in the decisions to release EHRs. Some participants viewed the simultaneous use of their EHRs for both health care and research as potentially beneficial, whereas others expressed concerns about mixing their health care with research. Conclusions: This exploratory study indicates that pregnant and breastfeeding women may be willing to release EHR data to researchers if researchers adequately address their concerns regarding the study design, communication, and data management. Pregnant and breastfeeding women should be included in EHR-based research as long as researchers are prepared to address their concerns. %M 33666558 %R 10.2196/23842 %U https://pediatrics.jmir.org/2021/1/e23842 %U https://doi.org/10.2196/23842 %U http://www.ncbi.nlm.nih.gov/pubmed/33666558 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e25388 %T Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study %A Donelle,Lorie %A Hall,Jodi %A Hiebert,Bradley %A Jackson,Kimberley %A Stoyanovich,Ewelina %A LaChance,Jessica %A Facca,Danica %+ Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, FNB Rm. 2356, 1115 Richmond St., London, ON, N6A 5B9, Canada, 1 5196612111 ext 86565, ldonelle@uwo.ca %K parenting %K digital health %K technology %K health literacy %K information seeking %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The transition to parenting—that is, the journey from preconception through pregnancy and postpartum periods—is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents’ experiences with and uses of digital technology during 4 stages—prenatal, pregnancy, labor, and postpartum—of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents’ type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: “Is this normal; is this happening to you?!”, “Am I having a heart attack; what is this?”, and “Anyone can put anything on Wikipedia”: Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers’ perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents. %M 33595440 %R 10.2196/25388 %U https://pediatrics.jmir.org/2021/1/e25388 %U https://doi.org/10.2196/25388 %U http://www.ncbi.nlm.nih.gov/pubmed/33595440 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e24106 %T A Multicomponent Intervention to Reduce Screen Time Among Children Aged 2-5 Years in Chandigarh, North India: Protocol for a Randomized Controlled Trial %A Kaur,Nimran %A Gupta,Madhu %A Malhi,Prahbhjot %A Grover,Sandeep %+ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India, 91 7087008223, madhugupta21@gmail.com %K multimedia %K digital-media %K preschooler %K sedentary behaviors %K toddler %K sedentary %K screen %K children %K youth %D 2021 %7 11.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Excessive digital screen exposure (≥1 hour per day) is associated with limited growth and development in children. Objective: This study aims to develop and assess a multicomponent intervention program's effectiveness in reducing excessive screen time among children aged 2-5 years. Methods: A theory-based multicomponent intervention known as Program to Lower Unwanted Media Screens (PLUMS) at the household level has been developed. It is based on the social cognitive theory for children and self-determination theory for caregivers. After pretesting, a randomized control trial will be conducted to assess this intervention's effectiveness among healthy children aged 2-5 (±3 months) years and their primary caregivers who have at least one digital media gadget at home in zone three of Chandigarh (population of 2,730,035). A sample size of 428 children is estimated per arm. PLUMS includes disseminating specific information, education, communication in the form of videos and posters to the primary caregivers, and conducting motivational interviewing as and when needed. Children will be provided suggestions for playful activities as alternatives to digital media gadgets. The primary outcome is the mean change in the duration of screen time, and secondary outcomes are sleep duration and patterns, emotional-behavioral problems, and level of physical activity of the children. Per-protocol and intention-to-treat analyses will be conducted using SPSS for Macintosh, Version 25.0. Results: The intervention package will be disseminated once a week for 8 weeks to the participants via the caregivers' preferred means of communication. The endline assessment will be done immediately postintervention and after the 6 months of follow-up. The Institute's ethics committee, Postgraduate Institute of Medical Education and Research, Chandigarh, India, has approved this study (INT/IEC/2019/000711). The Indian Council of Medical Research, New Delhi (3/1/3/Next-100/JRF-2015/HRD), and PGIMER, Chandigarh (71/2-Edu-16/92, Dated 08/01/2018) funded this study. Conclusions: PLUMS might be effective in reducing excessive screen time among children aged 2-5 years in a North Indian Union Territory. Trial Registration: Clinical Trial Registry India CTRI/2017/09/009761; https://tinyurl.com/53q6dpjs International Registered Report Identifier (IRRID): DERR1-10.2196/24106 %M 33570499 %R 10.2196/24106 %U http://www.researchprotocols.org/2021/2/e24106/ %U https://doi.org/10.2196/24106 %U http://www.ncbi.nlm.nih.gov/pubmed/33570499 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23917 %T The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study %A Liu,Guihua %A Wang,Shuo %A Liao,Jinhua %A Ou,Ping %A Huang,Longsheng %A Xie,Namei %A He,Yingshuang %A Lin,Jinling %A He,Hong-Gu %A Hu,Rongfang %+ The School of Nursing, Fujian Medical University, 1 Xuefu Road, Shangjie Zhen, Minhou County, Fuzhou, 350000, China, 86 13509366729, hulu2886@sina.com %K coronavirus disease 2019 %K autism spectrum disorder %K parenting training %K psychological well-being %K social media %K WeChat %K COVID-19 %K autism %K parenting %K mental health %K well-being %K anxiety %K depression %K stress %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 %M 33481751 %R 10.2196/23917 %U https://mental.jmir.org/2021/2/e23917 %U https://doi.org/10.2196/23917 %U http://www.ncbi.nlm.nih.gov/pubmed/33481751 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e23886 %T Adolescent Problem Gaming and Loot Box Purchasing in Video Games: Cross-sectional Observational Study Using Population-Based Cohort Data %A Ide,Soichiro %A Nakanishi,Miharu %A Yamasaki,Syudo %A Ikeda,Kazutaka %A Ando,Shuntaro %A Hiraiwa-Hasegawa,Mariko %A Kasai,Kiyoto %A Nishida,Atsushi %+ Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan, 81 3 5316 2298, nishida-at@igakuken.or.jp %K loot box purchasing %K gambling %K adolescents %K primary caregivers %D 2021 %7 9.2.2021 %9 Short Paper %J JMIR Serious Games %G English %X Background: Video game loot boxes, which can typically be purchased by players or are given as reward, contain random virtual items, or loot, ranging from simple customization options for a player's avatar or character, to game-changing equipment such as weapons and armor. Loot boxes have drawn concern, as purchasing loot boxes might lead to the development of problematic gambling for adolescents. Although parental problem gambling is associated with adolescent problem gambling, no studies have evaluated the prevalence of loot box purchases in adolescents’ parents. Objective: This study investigated the association between loot box purchasing among adolescents and parents, and problem online gaming in population-based samples. Methods: In total, 1615 adolescent (aged 14 years) gamers from Japan responded to a questionnaire regarding their loot box purchasing and problem online gaming behaviors. Problem online gaming was defined as four or more of the nine addictive behaviors from the Diagnostic and Statistical Manual of Mental Disorders. The adolescents’ primary caregivers were asked about their loot box purchasing. Results: Of the 1615 participants, 57 (3.5%) reported loot box purchasing. This prevalence did not differ according to primary caregivers’ loot box purchasing, but adolescents who purchased loot boxes were significantly more likely to exhibit problem online gaming (odds ratio 3.75, 95% CI 2.17-6.48). Conclusions: Adolescent loot box purchasing is linked to problem online gaming, but not with parents’ loot box purchasing. Measures to reduce these behaviors should target reducing addictive symptoms in young video gamers. %M 33560241 %R 10.2196/23886 %U http://games.jmir.org/2021/1/e23886/ %U https://doi.org/10.2196/23886 %U http://www.ncbi.nlm.nih.gov/pubmed/33560241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22440 %T Outcomes of Equity-Oriented, Web-Based Parenting Information in Mothers of Low Socioeconomic Status Compared to Other Mothers: Participatory Mixed Methods Study %A Pluye,Pierre %A El Sherif,Reem %A Gonzalez-Reyes,Araceli %A Turcotte,Emmanuelle %A Schuster,Tibor %A Bartlett,Gillian %A Grad,Roland M %A Granikov,Vera %A Barwick,Melanie %A Doray,Geneviève %A Lagarde,François %A Loignon,Christine %+ Department of Family Medicine, McGill University, 5858 Cote des neiges, Rm 300, Montreal, QC, H3S 1Z1, Canada, 1 514 398 8483, pierre.pluye@mcgill.ca %K consumer health information %K child development %K child health %K literacy %K information outcomes %D 2020 %7 10.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Typically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy). Objective: This study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes. Methods: A participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants’ perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants’ characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate’s perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes. Results: QUAN—a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL—the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings. Conclusions: This is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch. %M 33170125 %R 10.2196/22440 %U https://www.jmir.org/2020/11/e22440 %U https://doi.org/10.2196/22440 %U http://www.ncbi.nlm.nih.gov/pubmed/33170125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20002 %T Parental Online Information Access and Childhood Vaccination Decisions in North America: Scoping Review %A Ashfield,Sarah %A Donelle,Lorie %+ Western University, FNB Room 2356 Faculty of Health Science, 1115 Richmond Street, London, ON, N6A 5B9, Canada, 1 519 661 2111 ext 86565, ldonelle@uwo.ca %K childhood vaccination %K parental vaccine decisions %K online vaccine information %K social media %K vaccine hesitancy %K digital health literacy %D 2020 %7 13.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Immunizing children throughout their early years prevents the spread of communicable disease and decreases the morbidity and mortality associated with many vaccine-preventable diseases. Searching online allows individuals rapid access to health information. Objective: The purpose of this review was to develop an understanding of the existing literature of parents’ online health information-seeking behaviors to inform their vaccination choices for their children and to identify gaps in the literature around parents’ use of online health information and their vaccination choices. Methods: A scoping review of peer-reviewed literature from Canada and the United States was performed. The following databases were utilized to perform the search: PubMed, CINAHL, Nursing & Allied Health Database, Scopus, and PsycINFO. The purpose of this review was to examine parents’ use of online information seeking related to vaccine information and to understand how parents utilize this information to inform decisions about vaccinating their children. Of the 34 papers included in the review, 4 relevant themes and subthemes were identified: information seeking, online information resources, online vaccine content, and trust in health care providers. Results: Examination of the literature revealed conflicting information regarding parents’ use of social media and online resources to inform decisions around vaccinating their children. There is evidence of significant misinformation regarding vaccine risks online. Parents’ digital health literacy levels are unknown and may affect their ability to appraise online vaccination information. Conclusions: Parents are seeking vaccine information from online sources. However, the influence of online vaccine information on parental vaccine practices remains uncertain. %M 33048055 %R 10.2196/20002 %U http://www.jmir.org/2020/10/e20002/ %U https://doi.org/10.2196/20002 %U http://www.ncbi.nlm.nih.gov/pubmed/33048055 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19378 %T Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study %A van der Windt,Melissa %A van der Kleij,Rianne Maria %A Snoek,Katinka Marianne %A Willemsen,Sten Paul %A Dykgraaf,Ramon Henny Maria %A Laven,Joop Stephanus Elisabeth %A Schoenmakers,Sam %A Steegers-Theunissen,Régine Patricia Maria %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, +31 107038255, r.steegers@erasmusmc.nl %K eHealth %K periconception period %K lifestyle intervention %D 2020 %7 30.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors. Objective: We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods: A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service “Healthy Pregnancy” with the eHealth platform “Smarter Pregnancy” (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ≥30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results: A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further. %M 32996885 %R 10.2196/19378 %U http://www.jmir.org/2020/9/e19378/ %U https://doi.org/10.2196/19378 %U http://www.ncbi.nlm.nih.gov/pubmed/32996885 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e14920 %T Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study %A McMichael,Lucy %A Farič,Nuša %A Newby,Katie %A Potts,Henry W W %A Hon,Adrian %A Smith,Lee %A Steptoe,Andrew %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, United Kingdom, 44 020776794466 ext 41914, nfaric@gmail.com %K exercise %K obesity %K video games %K adolescent %K adolescence %K sports %K health %K leisure activities %K virtual reality %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity. Since parental support is a consistent determinant of physical activity in adolescents, it is crucial to gather the views of parents of adolescents about this type of intervention. Objective: This study aimed to interview parents of younger adolescents (13-17 years old) about physical activity, gaming, and VR as part of the larger vEngage study. Methods: Semistructured interviews were conducted with 18 parents of adolescents. Data were synthesized using framework analysis. Results: Parents believed that encouraging physical activity in adolescents was important, particularly for mental health. Most parents felt that their children were not active enough. Parents reported their adolescents regularly gamed, with mostly negative perceptions of gaming due to violent content and becoming addicted. Parents discussed an inability to relate to gaming due to “generational differences,” but an exception was exergaming, which they had played with their children in the past (eg, Wii Fit). Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. Conclusions: The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that addresses parental concerns, particularly around addiction, violence, and safety, without actively involving their participation. While parents would rather their children performed “real-world” physical activity, they believed the key to engagement was through technology. Overall, there was the perception that harnessing gaming and sedentary screen time for a positive purpose would be strongly supported. %M 32840487 %R 10.2196/14920 %U http://games.jmir.org/2020/3/e14920/ %U https://doi.org/10.2196/14920 %U http://www.ncbi.nlm.nih.gov/pubmed/32840487 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e18992 %T The Parenting Education Needs of Women Experiencing Incarceration in South Australia: Proposal for a Mixed Methods Study %A Lovell,Belinda %A Steen,Mary %A Esterman,Adrian %A Brown,Angela %+ University of South Australia, City East Campus, Adelaide, Australia, 61 883021164, lovbj005@mymail.unisa.edu.au %K prison %K parenting programs %K education %K women %K mothers. %D 2020 %7 13.8.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated. Objective: This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal; the authors acknowledge the diversity within Aboriginal cultures. Methods: This study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed. Results: A scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government. Conclusions: The scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women’s voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study. International Registered Report Identifier (IRRID): PRR1-10.2196/18992 %M 32673211 %R 10.2196/18992 %U http://www.researchprotocols.org/2020/8/e18992/ %U https://doi.org/10.2196/18992 %U http://www.ncbi.nlm.nih.gov/pubmed/32673211 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e18292 %T The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers %A Hammons,Amber Jean %A Villegas,Elizabeth %A Olvera,Norma %A Greder,Kimberly %A Fiese,Barbara %A Teran-Garcia,Margarita %A , %+ California State University, 5241 N Maple Ave, Fresno, CA, , United States, 1 5592781158 ext 1158, ahammons@csufresno.edu %K family mealtimes %K healthy eating %K technology at the table %K parenting and mealtimes %K Hispanic culture %K obesity prevention %D 2020 %7 10.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. Objective: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. Methods: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. Results: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. Conclusions: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone’s tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives. %M 32576547 %R 10.2196/18292 %U http://pediatrics.jmir.org/2020/2/e18292/ %U https://doi.org/10.2196/18292 %U http://www.ncbi.nlm.nih.gov/pubmed/32576547 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e13686 %T Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial %A Fatori,Daniel %A Argeu,Adriana %A Brentani,Helena %A Chiesa,Anna %A Fracolli,Lislaine %A Matijasevich,Alicia %A Miguel,Euripedes C %A Polanczyk,Guilherme %+ Department of Psychiatry, University of Sao Paulo Medical School, 785 R Dr Ovídio Pires de Campos, Sao Paulo, Brazil, 55 11961626183, daniel.fatori@gmail.com %K mHealth %K early childhood development %K maternal care %K randomized clinical trial %K daily diary %K ambulatory assessment %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 %M 32720906 %R 10.2196/13686 %U https://mhealth.jmir.org/2020/7/e13686 %U https://doi.org/10.2196/13686 %U http://www.ncbi.nlm.nih.gov/pubmed/32720906 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e15777 %T Smartphone Self-Monitoring by Young Adolescents and Parents to Assess and Improve Family Functioning: Qualitative Feasibility Study %A Swendeman,Dallas %A Sumstine,Stephanie %A Brink,Amber %A Mindry,Deborah %A Medich,Melissa %A Russell,Michael %+ Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948158, dswendeman@mednet.ucla.edu %K adolescents %K parenting %K conflict %K self-monitoring %K smartphones %K mHealth %K ecological momentary assessment %K mobile phone %D 2020 %7 23.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. Objective: This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. Methods: Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. Results: The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families’ daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. Conclusions: The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs. %M 32574148 %R 10.2196/15777 %U http://formative.jmir.org/2020/6/e15777/ %U https://doi.org/10.2196/15777 %U http://www.ncbi.nlm.nih.gov/pubmed/32574148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e18279 %T Detecting Screams From Home Audio Recordings to Identify Tantrums: Exploratory Study Using Transfer Machine Learning %A O'Donovan,Rebecca %A Sezgin,Emre %A Bambach,Sven %A Butter,Eric %A Lin,Simon %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143556814, emre.sezgin@nationwidechildrens.org %K machine learning %K scream detection %K audio event detection %K tantrum identification %K autism %K behavioral disorder %K data-driven approach %D 2020 %7 16.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Qualitative self- or parent-reports used in assessing children’s behavioral disorders are often inconvenient to collect and can be misleading due to missing information, rater biases, and limited validity. A data-driven approach to quantify behavioral disorders could alleviate these concerns. This study proposes a machine learning approach to identify screams in voice recordings that avoids the need to gather large amounts of clinical data for model training. Objective: The goal of this study is to evaluate if a machine learning model trained only on publicly available audio data sets could be used to detect screaming sounds in audio streams captured in an at-home setting. Methods: Two sets of audio samples were prepared to evaluate the model: a subset of the publicly available AudioSet data set and a set of audio data extracted from the TV show Supernanny, which was chosen for its similarity to clinical data. Scream events were manually annotated for the Supernanny data, and existing annotations were refined for the AudioSet data. Audio feature extraction was performed with a convolutional neural network pretrained on AudioSet. A gradient-boosted tree model was trained and cross-validated for scream classification on the AudioSet data and then validated independently on the Supernanny audio. Results: On the held-out AudioSet clips, the model achieved a receiver operating characteristic (ROC)–area under the curve (AUC) of 0.86. The same model applied to three full episodes of Supernanny audio achieved an ROC-AUC of 0.95 and an average precision (positive predictive value) of 42% despite screams only making up 1.3% (n=92/7166 seconds) of the total run time. Conclusions: These results suggest that a scream-detection model trained with publicly available data could be valuable for monitoring clinical recordings and identifying tantrums as opposed to depending on collecting costly privacy-protected clinical data for model training. %M 32459656 %R 10.2196/18279 %U http://formative.jmir.org/2020/6/e18279/ %U https://doi.org/10.2196/18279 %U http://www.ncbi.nlm.nih.gov/pubmed/32459656 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e15647 %T Gamifying Parenting Education Using an App Developed for Pacific and Other New Zealand Families (Play Kindly): Qualitative Study %A Mairs,Rebecca A %A Bekker,Marthinus J %A Patolo,Tony %A Hopkins,Sarah A %A Cowley-Malcolm,Esther T %A Perese,Lana M %A Sundborn,Gerhard B %A Merry,Sally N %+ Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 373 7599 ext 92019, marthinus.bekker@auckland.ac.nz %K parenting %K mHealth %K Pacific peoples %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Play Kindly is a gamified animated app designed to address common behavioral problems in childhood. The interface is designed to appeal to Pacific people, a population group with a higher risk of developing clinically significant behavioral problems than most other ethnic groups in New Zealand. Objective: The aim of this study is to explore the opinions of parents and professionals about the acceptability, usability, and content of Play Kindly. Methods: We used qualitative and Pacific and Māori research methodologies. A total of five focus groups with 45 parents and 12 individual interviews with professionals were conducted. The five focus groups consisted of 2 pan-Pacific groups, 1 Māori group, 1 open group, and 1 group of young Pacific adults or prospective parents. The professionals were from a range of disciplines, and the majority had expertise in early childhood, parenting interventions, or research in this field. Results: Play Kindly appealed to both parents and professionals. Participants related to the scenarios, which were created in collaboration with a playwright and animator. Although most participants liked the Pacific feel, there was some disagreement about how culturally specific the app should be. A range of issues with usability and gamification techniques were highlighted, likely attributed to the low budget and lack of initial co-design with parents as well as professionals with specific expertise in parenting. A number of parents and professionals felt that the parenting strategies were overly simplified and did not take into account the context in which the behavior occurred. Professionals suggested narrowing the focus of the app to deliver two important parenting messages: playing with your child and positively reinforcing desired behaviors. Conclusions: Play Kindly is the first culturally adapted parenting app of its kind designed for Pacific parents and other New Zealanders with children 2-5 years of age. This app has potential in Pacific communities where there are limited culturally specific parenting resources. The results of this study will guide improvements of the app prior to testing it in an open trial. %M 32519973 %R 10.2196/15647 %U http://games.jmir.org/2020/2/e15647/ %U https://doi.org/10.2196/15647 %U http://www.ncbi.nlm.nih.gov/pubmed/32519973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16148 %T Development of an Instrument to Assess Parents’ Excessive Web-Based Searches for Information Pertaining to Their Children’s Health: The “Children’s Health Internet Research, Parental Inventory” (CHIRPI) %A Barke,Antonia %A Doering,Bettina K %+ Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstrasse 25, Eichstaett, 85072, Germany, 49 842193 ext 21842, abarke@gwdg.de %K hypochondriasis %K internet %K health behavior %K health knowledge, attitudes, practice %K questionnaire %K children %K parents %D 2020 %7 15.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children’s health. Objective: This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children’s Health Internet Research, Parental Inventory (CHIRPI). Methods: A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents’ perception of their children’s health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child’s Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS−). Results: CHIRPI’s internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as rtt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one’s child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η2=0.053) and each subscale (Symptom Focus η2=0.012; Distress η2=0.113; and Implementing Advice η2=0.018). Conclusions: The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child’s health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children. %M 32293571 %R 10.2196/16148 %U https://www.jmir.org/2020/4/e16148 %U https://doi.org/10.2196/16148 %U http://www.ncbi.nlm.nih.gov/pubmed/32293571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16954 %T Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study %A Verma,Rhea %A Krishnamurti,Tamar %A Ray,Kristin N %+ Department of Pediatrics, University of Pittsburgh School of Medicine, 3414 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 4126926000, kristin.ray@chp.edu %K consultation %K referral %K telemedicine %K telehealth %K child health %K child health services %D 2020 %7 9.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic consultations, which use store-and-forward transfer of clinical information between a primary care physician and a specialist, improve access to specialty care. Adoption of electronic consultations is beginning in pediatric health care systems, but little is known about parent perspectives, informational needs, and preferences for interaction with this new model of care. Objective: This study aimed to examine parent perspectives about electronic consultations, including perceived benefits and risks, anticipated informational needs, and preferences for parent engagement with electronic consultations. Methods: We recruited caregivers of pediatric patients (aged 0-21 years) attending visits at an academic primary care center. Caregivers were eligible if their child had ever been referred for in-person specialty care. Caregivers participated in a semistructured interview about electronic consultations, including general perspectives, desired information, and preferences for parental engagement. Interviews were transcribed and qualitatively analyzed to identify parent perspectives on electronic consultations in general, information parents would like to receive about electronic consultations, and perspectives on opportunities to enhance parent engagement with electronic consultations. Results: Interviewees (n=20) anticipated that electronic consultations would reduce the time burden of specialty care on families and that these had the potential to improve the integrity and availability of clinical information, but interviewees also expressed concern about data confidentiality. The most detailed information desired by interviewees about electronic consultations related to data security, including data confidentiality, availability, and integrity. Interviewees expressed concern that electronic consultations could exclude parents from their child’s health care decisions. Interviewees saw value in the potential ability to track the consultation status or to participate in the consultation dialogue, but they were more ambivalent about the idea of read-only access to consultation documentation. Conclusions: Parents identified the potential risks and benefits of pediatric electronic consultations, with implications for communication with families about electronic consultations and for incorporation of features to enhance parent engagement. %M 32084626 %R 10.2196/16954 %U https://www.jmir.org/2020/4/e16954 %U https://doi.org/10.2196/16954 %U http://www.ncbi.nlm.nih.gov/pubmed/32084626 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12618 %T Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach %A Doty,Jennifer L %A Brady,Sonya S %A Monardez Popelka,Javiera %A Rietveld,Laura %A Garcia-Huidobro,Diego %A Doty,Matthew J %A Linares,Roxana %A Svetaz,Maria Veronica %A Allen,Michele L %+ Department of Family, Youth and Community Sciences, University of Florida, 3038D McCarty Hall D, PO Box, Gainesville, FL, 32611-0001, United States, 1 3522733543, jennifer.doty@ufl.edu %K mobile application %K eHealth %K community-based participatory research %K Hispanic Americans, family %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent’s intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents’ technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. %M 32012034 %R 10.2196/12618 %U https://formative.jmir.org/2020/1/e12618 %U https://doi.org/10.2196/12618 %U http://www.ncbi.nlm.nih.gov/pubmed/32012034 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e14518 %T A Pragmatic Internet Intervention to Promote Positive Parenting and School Readiness in Early Childhood: Initial Evidence of Program Use and Satisfaction %A McGoron,Lucy %A Ratner,Hilary Horn %A Knoff,Kathryn AG %A Hvizdos,Erica %A Ondersma,Steven J %+ Wayne State University, The Merrill Palmer Skillman Institute for Child and Family Development, 71 E Ferry St, Detroit, MI, 48202, United States, 1 3136642553, Lucy.K.McGoron@wayne.edu %K child rearing %K child development %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them. Objective: This study aimed to evaluate engagement in the 5-a-Day Parenting program, a technology-based program designed with low-income families in mind, to promote daily use of 5 specific parenting activities conducive to children’s school readiness. Following earlier pilot data, the program was enhanced with an initial motivational e-intervention and tailored text messages designed to promote engagement. Methods: Parents were recruited from local childcare centers and through a participant registry. We examined rates of receipt of program text messages and use of video-based content on the program website, 3 factors that may affect website use, and satisfaction with key program elements. Results: A total of 360 parents of young children learned about the study and had the opportunity to use the 5-a-Day Parenting website. Of these, 94 parents participated in the study, and 33% (31/94) accessed the video-based content on the website at least once. No association was found between website use and program recruitment approach, program-affiliation message, sociocontextual risk, and baseline use of the five parenting activities. Satisfaction with text messages and video-based content was high. Conclusions: For some parents, technology-based programs appear useful; however, engagement could still be enhanced. Additional research should seek innovative strategies for promoting engagement in Web-based parenting programs. %M 31782739 %R 10.2196/14518 %U http://pediatrics.jmir.org/2019/2/e14518/ %U https://doi.org/10.2196/14518 %U http://www.ncbi.nlm.nih.gov/pubmed/31782739 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e13023 %T Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables %A Grace,Rebekah %A Baird,Kelly %A Elcombe,Emma %A Webster,Vana %A Barnes,Jacqueline %A Kemp,Lynn %+ Translational Research and Social Innovation, Western Sydney University, 1 Campbell St, Level 3, Liverpool, 2170, Australia, 61 87389362, r.grace2@westernsydney.edu.au %K volunteer home visiting %K randomized controlled trial %K families %K support services %K social relationships %K community %K Volunteer Family Connect %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Volunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children. Objective: This paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills. Methods: The RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group). Results: The intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the “Guidance” subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable “parenting sense of competence” and largely neutral findings for the primary outcome variable “community connectedness,” the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving. Conclusions: The Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 %M 31750834 %R 10.2196/13023 %U http://pediatrics.jmir.org/2019/2/e13023/ %U https://doi.org/10.2196/13023 %U http://www.ncbi.nlm.nih.gov/pubmed/31750834 %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 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14906 %T Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study %A Scheier,Lawrence Matthew %A Kumpfer,Karol L %A Brown,Jaynie Litster %A Hu,QingQing %+ LARS Research Institute, 15029 North Thompson Peak Blvd, Suite B111-443, Scottsdale, AZ, 85260, United States, 1 702 630 7584, scheier@larsri.org %K formative evaluation %K parenting skills %K drug prevention %K focus groups %K key stakeholders %K consumer preference survey %K internet intervention %D 2019 %7 5.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format. Objective: The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program. Methods: We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program. Results: Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=−3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=−1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=−1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01). Conclusions: Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention. %M 31687934 %R 10.2196/14906 %U http://formative.jmir.org/2019/4/e14906/ %U https://doi.org/10.2196/14906 %U http://www.ncbi.nlm.nih.gov/pubmed/31687934 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12666 %T Tracker-Based Personal Advice to Support the Baby’s Healthy Development in a Novel Parenting App: Data-Driven Innovation %A Otte,Renée A %A van Beukering,Alice J E %A Boelens-Brockhuis,Lili-Marjan %+ Philips Research, Family Care Solutions, High Tech Campus 34, Room 3 065, Eindhoven, 5656AE, Netherlands, 31 402748877, renee.otte@philips.com %K data analytics %K data-driven science %K mHealth %K mobile apps %K infant development %K infant health %K parenting %D 2019 %7 24.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The current generation of millennial parents prefers digital communications and makes use of apps on a daily basis to find information about child-rearing topics. Given this, an increasing amount of parenting apps have become available. These apps also allow parents to track their baby’s development with increasing completeness and precision. The large amounts of data collected in this process provide ample opportunity for data-driven innovation (DDI). Subsequently, apps are increasingly personalized by offering information that is based on the data tracked in the app. In line with this, Philips Avent has developed the uGrow app, a medical-grade app dedicated to new parents for tracking their baby’s development. Through so-called insights, the uGrow app seeks to provide a data-driven solution by offering parents personal advice that is sourced from user-tracked behavioral and contextual data. Objective: The aim of this study was twofold. First, it aimed to give a description of the development process of the insights for the uGrow app. Second, it aimed to present results from a study about parents’ experiences with the insights. Methods: The development process comprised 3 phases: a formative phase, development phase, and summative phase. In the formative phase, 3 substudies were executed in series to understand and identify parents’ and health care professionals’ (HCPs) needs for insights, using qualitative and quantitative methods. After the formative phase, insights were created during the development phase. Subsequently, in the summative phase, these insights were validated against parents’ experience using a quantitative approach. Results: As part of the formative phase, parents indicated having a need for smart information based on a data analysis of the data they track in an app. HCPs supported the general concept of insights for the uGrow app, although specific types of insights were considered irrelevant or even risky. After implementing a preliminary set of insights in a prototype version of the uGrow app and testing it with parents, the majority of parents (87%) reported being satisfied with the insights. From these outcomes, a total of 89 insights were implemented in a final version of the uGrow app. In the summative phase, the majority of parents reported experiencing these insights as reassuring and useful (94%), as adding enjoyment (85%), and as motivating for continuing tracking for a longer period of time (77%). Conclusions: Parents experienced the insights in the uGrow app as useful and reassuring and as adding enjoyment to their use of the uGrow app and tracking their baby’s development. The insights development process we followed showed how the quality of insights can be guaranteed by ensuring that insights are relevant, appropriate, and evidence based. In this way, insights are an example of meaningful DDI. %M 31342901 %R 10.2196/12666 %U https://mhealth.jmir.org/2019/7/e12666/ %U https://doi.org/10.2196/12666 %U http://www.ncbi.nlm.nih.gov/pubmed/31342901 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14289 %T Mothers’ Perceptions of the Internet and Social Media as Sources of Parenting and Health Information: Qualitative Study %A Moon,Rachel Y %A Mathews,Anita %A Oden,Rosalind %A Carlin,Rebecca %+ University of Virginia, PO Box 800386, Charlottesville, VA, 22908, United States, 1 4349245521, rym4z@virginia.edu %K internet %K parenting %K social media %K focus groups %D 2019 %7 09.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditionally, guidance and support to new parents have come from family, friends, and health care providers. However, the internet and social media are growing sources of guidance and support for parents. Little is known about how the internet and social media are used by parents of young infants and specifically about parental perceptions of the internet and social media as sources of parenting and infant health information. Objective: The aim of this study was to explore, using qualitative methods, parental perceptions of the advantages and disadvantages of the internet and social media as sources of parenting and health information regarding their infant. Methods: A total of 28 mothers participated in focus groups or individual interviews. Probing questions concerning parenting and health information sources were asked. Themes were developed in an iterative manner from coded data. Results: The central themes were (1) reasons that mothers turn to the internet for parenting and health information, (2) cautionary advice about the internet, and (3) reasons that mothers turn to social media for parenting and health information. Mothers appreciated the ability to gather unlimited information and multiple opinions quickly and anonymously, but recognized the need to use reputable sources of information. Mothers also appreciated the immediacy of affirmation, support, and tailored information available through social media. Conclusions: The internet and social media are rapidly becoming important and trusted sources of parenting and health information that mothers turn to when making infant care decisions. %M 31290403 %R 10.2196/14289 %U https://www.jmir.org/2019/7/e14289/ %U https://doi.org/10.2196/14289 %U http://www.ncbi.nlm.nih.gov/pubmed/31290403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13689 %T The Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Pragmatic Randomized Controlled Trial %A Sawyer,Alyssa %A Kaim,Amy %A Le,Huynh-Nhu %A McDonald,Denise %A Mittinty,Murthy %A Lynch,John %A Sawyer,Michael %+ School of Public Health, University of Adelaide, Adelaide Health & Medical Sciences Building, 57 North Terrace, Mail Drop DX 650 550, Adelaide, 5005, Australia, 61 8 81617207, alyssa.sawyer@adelaide.edu.au %K mobile phone %K infant %K mother-child relations %K postnatal depression %K randomized controlled trial %D 2019 %7 04.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Postnatal depression and caregiving difficulties adversely affect mothers, infants, and later childhood development. In many countries, resources to help mothers and infants are limited. Online group–based nurse-led interventions have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period. Objective: This study tested the effectiveness of a 4-month online group–based nurse-led intervention delivered when infants were aged 2 to 6 months as compared with standard care outcomes. Methods: The study was a block randomized control trial. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Those who agreed to participate were randomly assigned to the intervention or standard care. The overall response rate was 63.3% (133/210). Primary outcomes were the level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and quality of maternal caregiving assessed using the Parenting Stress Index (PSI; competence and attachment subscales), the Parenting Sense of Competence Scale (PSCS), and the Nursing Child Assessment Satellite Training Scale. Assessments were completed at baseline (mean child age 4.9 weeks [SD 1.4]) and again when infants were aged 8 and 12 months. Results: Outcomes were evaluated using linear generalized estimating equations adjusting for postrandomization group differences in demographic characteristics and the outcome score at baseline. There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale (P=.69) nor in the PSCS (P=.11). Although the group by time interaction suggested there were differences over time between the EPDS and PSI attachment subscale scores in the intervention and standard care groups (P=.001 and P=.04, respectively), these arose largely because the intervention group had stable scores over time whereas the standard care group showed some improvements between baseline and 12 months. Mothers engaged well with the intervention with at least 60% (43/72) of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly. Conclusions: Mothers reported that the intervention was helpful, and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the 2 groups in this study are the failure of many mothers to use key components of the intervention and residual differences between the intervention and standard care groups post randomization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001732471; http://www.ANZCTR.org.au/ACTRN12616001732471.aspx (archived on WebCite as http://www.webcitation.org/77zo30GDw) %M 31165715 %R 10.2196/13689 %U https://www.jmir.org/2019/6/e13689/ %U https://doi.org/10.2196/13689 %U http://www.ncbi.nlm.nih.gov/pubmed/31165715 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12794 %T Using Smartphone-Based Psychoeducation to Reduce Postnatal Depression Among First-Time Mothers: Randomized Controlled Trial %A Chan,Ko Ling %A Leung,Wing Cheong %A Tiwari,Agnes %A Or,Ka Lun %A Ip,Patrick %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong,, China (Hong Kong), 852 2766 5709, koling.chan@polyu.edu.hk %K smartphone technology %K postnatal depression %K psychoeducation %K randomized controlled trial %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers. Objective: This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life. Methods: A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as “intervention” or “control” by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. Results: The final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was −0.65 (95% CI −1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels. Conclusions: The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers. Trial Registration: HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384 %M 31094354 %R 10.2196/12794 %U http://mhealth.jmir.org/2019/5/e12794/ %U https://doi.org/10.2196/12794 %U http://www.ncbi.nlm.nih.gov/pubmed/31094354 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12664 %T EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases %A Ponum,Mahvish %A Hasan,Osman %A Khan,Saadia %+ School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad, Pakistan, Islamabad, 440000, Pakistan, 92 3067826262, mponum.msit15seecs@seecs.edu.pk %K infectious diseases %K mHealth %K causes of death %D 2019 %7 14.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. %M 31094329 %R 10.2196/12664 %U http://www.i-jmr.org/2019/2/e12664/ %U https://doi.org/10.2196/12664 %U http://www.ncbi.nlm.nih.gov/pubmed/31094329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11446 %T Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study %A Ristkari,Terja %A Kurki,Marjo %A Suominen,Auli %A Gilbert,Sonja %A Sinokki,Atte %A Kinnunen,Malin %A Huttunen,Jukka %A McGrath,Patrick %A Sourander,Andre %+ Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, Turku, 20014, Finland, 358 504643141, terjaris@utu.fi %K child mental health %K early intervention %K parenting education %K disruptive behavior %K preschool children %D 2019 %7 11.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Parent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. However, no studies exist on how well Web-based training programs work when they make the transition from the research setting to implementation in primary health care. Objective: The study aimed to examine how the randomized controlled trial (RCT) and implementation study groups of the Strongest Families Smart Website (SFSW) intervention differed in child psychopathology, family demographics and treatment-related factors, such as therapeutic alliance and parents’ satisfaction rates. The intervention was conducted in the pediatric primary health care in Finland. Methods: The study focused on 232 parents who had taken part in the SFSW intervention, which formed part of a 2-arm RCT study, and 882 families that would participate in the subsequent SFSW implementation study group. Both groups comprised parents whose children displayed high levels of parent-reported disruptive behavioral problems when they were screened in child health clinics at 4 years of age. Parents in both groups were provided with the SFSW intervention, which consisted of a Web-based training program with 11 weekly themes and associated telephone sessions. Results: Demographic factors or duration of behavioral problems did not differ statistically or clinically between the RCT and implementation groups. Overall, 42.0% (362/862) of children in the implementation group and 35.4% (80/226) in the RCT intervention group had suffered from behavioral difficulties more than 1 year before the screening phase (χ12=3.2; P=.07). The mean duration of telephone coaching calls was very similar in the implementation and RCT intervention groups, that is, 38 and 37 min per call, respectively (t279.5=0.26; P=.79). The total time spent on the website of the program was 451 min in the implementation group and 431 min in the RCT intervention group (t318.8=1.38; P=.17). In the RCT intervention group, 52 of the 232 participants (22.4%) discontinued the program before the tenth week, whereas in the implementation group, 109 of the 882 participants (12.4%; odds ratio 2.05, 95% CI 1.4-3.0; P<.001) discontinued. Parents in both the implementation (77.1% to 98.5%, 498/742 to 731/742, respectively) and the RCT (64.8% to 98.2%, N=105/162- to 159/162, respectively) groups reported qualitatively similar and high level of posttreatment satisfaction rates in improved parenting skills, expectations, and stress relief. Parents in both groups reported a high level of satisfaction in skills and professionalism of the telephone coaches. Conclusions: The implementation of population-based screening of Web-based parent training intervention with telephone coaching resulted in good feasibility, fidelity, accessibility, and similar satisfaction level post treatment when compared with intervention in RCT research setting. The discontinuation of treatment in the implementation group was exceptionally low. %M 30973337 %R 10.2196/11446 %U https://www.jmir.org/2019/4/e11446/ %U https://doi.org/10.2196/11446 %U http://www.ncbi.nlm.nih.gov/pubmed/30973337 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12355 %T What Women With Disabilities Write in Personal Blogs About Pregnancy and Early Motherhood: Qualitative Analysis of Blogs %A Litchman,Michelle L %A Tran,MJ %A Dearden,Susan E %A Guo,Jia-Wen %A Simonsen,Sara E %A Clark,Lauren %+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 801 585 9612, Michelle.Litchman@nurs.utah.edu %K disabled persons %K pregnancy %K blog %K women’s health %K parenting %K mothers %K spinal cord injury %K autism %K traumatic brain injury %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: More than 1 in 10 women of reproductive age identify as having some type of disability. Most of these women are able to become pregnant and have similar desires for motherhood as women without disability. Women with disability, however, face greater stigma and stereotyping, additional risk factors, and may be less likely to receive adequate reproductive health care compared with their peers without disability. More and more individuals, including those with disability, are utilizing the internet to seek information and peer support. Blogs are one source of peer-to-peer social media engagement that may provide a forum for women with disability to both share and obtain peer-to-peer information and support. Nevertheless, it is not clear what content about reproductive health and pregnancy and/or motherhood is featured in personal blogs authored by women with spinal cord injury (SCI), traumatic brain injury (TBI), spina bifida, and autism. Objective: The objective of this study was twofold: (1) to examine the information being shared in blogs by women with 4 types of disabilities, namely, SCI, TBI, spina bifida, and autism, about reproductive health, disability, health care, pregnancy, and motherhood; and (2) to classify the content of reproductive health experiences addressed by bloggers to better understand what they viewed as important. Methods: Personal blogs were identified by searching Google with keywords related to disabilities, SCI, TBI, spina bifida, and autism, and a variety of keywords related to reproductive health. The first 10 pages of each database search in Google, based on the relevance of the search terms, were reviewed and all blogs in these pages were included. Blog inclusion criteria were as follows: (1) written by a woman or care partner (ie, parent or spouse) of a woman with a self-identified diagnosis of SCI, TBI, spina bifida, or autism; (2) focused on the personal experience of health and health care during the prepregnancy, prenatal, antepartum, intrapartum, and/or postpartum periods; (3) written in English; and (4) published between 2013 and 2017. A descriptive and thematic qualitative analysis of blogs and corresponding comments was facilitated with NVivo software and matrix analysis. Results: Our search strategy identified 125 blogs that met all the inclusion criteria; no blogs written by women with spina bifida were identified. We identified 4 reproductive health themes featured in the blog of women with disabilities: (1) (in)accessible motherhood, (2) (un)supportive others, (3) different, but not different, and (4) society questioning motherhood. Conclusions: This analysis of personal blogs about pregnancy and health care written by women with SCI, TBI, and autism provides a glimpse into their experiences. The challenges faced by these women and the adaptations they made to successfully navigate pregnancy and early motherhood provide insights that can be used to shape future research. %M 31518332 %R 10.2196/12355 %U http://pediatrics.jmir.org/2019/1/e12355/ %U https://doi.org/10.2196/12355 %U http://www.ncbi.nlm.nih.gov/pubmed/31518332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11065 %T Evaluation of Mothers’ Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study %A Shorey,Shefaly %A Ng,Esperanza Debby %+ National University of Singapore, Level 2 Clinical Research Centre, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K education %K mothers %K parenting %K technology %D 2019 %7 13.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Transitioning into parenthood can be stressful as parents struggle to cope with new parenting responsibilities. Although perinatal care in hospitals aims to improve parental outcomes, there is a general consensus that it is suboptimal and insufficient. Therefore, many studies have designed intervention methods to supplement support for parents during this stressful period. However, studies often focus on parental outcomes as indicators of their interventions’ success and effectiveness. Studies evaluating participants’ experiences and feedback are limited. Objective: This study aimed to examine the experiences and perceptions of participants who participated in a supportive education parenting program intervention study. Methods: A qualitative semistructured interview was conducted with 16 mothers (6 control and 10 intervention) from a randomized controlled trial. The supportive education parenting program received by the intervention group included 2 phone-based perinatal educational sessions, a phone-based educational session after childbirth, and a 1-month postpartum access to a mobile health app. The interviews were approximately 30- to 60-min long, audiotaped and transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. Results: The 3 main themes evaluating mothers’ experiences and perceptions were generated: (1) changed perspective toward parenthood, (2) journey from pregnancy to after birth, and (3) a way forward. Mothers from the intervention group mostly had good perinatal experiences with sufficient support received, which elevated their emotional well-being and increased parenting involvement. Mothers in the control group, although satisfied with the hospital care received, were more stressed and shared a need for professional advice and extra support. Apart from technical enhancements, mothers also requested extended social support during early pregnancy up to 1 year postpartum, taking into consideration Asian cultural practices. Conclusions: Mothers who received the intervention were overall satisfied with the support provided by the technology-based supportive educational parenting program. The success of the educational program in this study highlights the need to supplement standard care in hospitals with technology-based educational programs. Future research should include fathers’ perceptions to attain an in-depth understanding of overall participants’ experiences and needs in the future development of supportive and educational programs. %M 30758295 %R 10.2196/11065 %U https://www.jmir.org/2019/2/e11065/ %U https://doi.org/10.2196/11065 %U http://www.ncbi.nlm.nih.gov/pubmed/30758295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10816 %T Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial %A Shorey,Shefaly %A Ng,Yvonne Peng Mei %A Ng,Esperanza Debby %A Siew,An Ling %A Mörelius,Evalotte %A Yoong,Joanne %A Gandhi,Mihir %+ Clinical Research Centre, Alice Lee Centre for Nursing Studies, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K parents %K social support %D 2019 %7 13.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child’s development. For the family’s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period. Objective: This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples. Methods: A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura’s self-efficacy theory and Bowlby’s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables. Results: The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD −1.32; 95% CI −1.89 to −0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD −0.91; 95% CI −1.34 to −0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD −0.82; 95% CI −1.15 to −0.49; P<.001). Conclusions: The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents’ needs and create positive childbirth experiences, which may in turn encourage parents to have more children. Trial Registration: ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO). %M 30758289 %R 10.2196/10816 %U http://www.jmir.org/2019/2/e10816/ %U https://doi.org/10.2196/10816 %U http://www.ncbi.nlm.nih.gov/pubmed/30758289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11454 %T Differences Between Mothers and Fathers of Young Children in Their Use of the Internet to Support Healthy Family Lifestyle Behaviors: Cross-Sectional Study %A Laws,Rachel %A Walsh,Adam D %A Hesketh,Kylie D %A Downing,Katherine L %A Kuswara,Konsita %A Campbell,Karen J %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, Geelong, 3125, Australia, 61 432388593, r.laws@deakin.edu.au %K child %K family %K healthy lifestyle %K infant %K internet %K obesity %K parents %D 2019 %7 23.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In early life, both mothers and fathers are important influences on their children’s diet, active play, and obesity risk. Parents are increasingly relying on the internet and social media as a source of information on all aspects of parenting. However, little is known about the use of Web-based sources of information relevant to family lifestyle behaviors and, in particular, differences between mothers’ and fathers’ use and sociodemographic predictors. Objective: The objective of this study was to examine if mothers and fathers differ in their use of the internet for information on their own health and their child’s health, feeding, and playing and to examine sociodemographic predictors of the use of the internet for information on these topics. Methods: We conducted a secondary analysis on data collected from mothers (n=297) and fathers (n=207) participating in the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) when their children were 36 months of age. The main outcome variables were the use of the internet for information gathering for parents’ own health and child health, feeding, and playing. Binary logistic regression was used to examine the sociodemographic predictors of outcomes. Results: Compared with fathers (n=296), a higher proportion of mothers (n=198) used the internet for information on their own health (230, 78.5% vs 93, 46.5%), child health (226, 77.1% vs 84, 42.4%), child feeding (136, 46.3% vs 35, 17.5%), and child play (123, 42.1% vs 28, 14.0%) and intended to use Facebook to connect with other parents (200, 74.9% vs 43, 30.5%). Despite the high use of the internet to support family health behaviors, only 15.9% (47/296) of mothers reported consulting health practitioners for advice and help for their own or their child’s weight, diet, or physical activity. Sociodemographic predictors of internet use differed between mothers and fathers and explained only a small proportion of the variance in internet use to support healthy family lifestyle behaviors. Conclusions: Our findings support the use of the internet and Facebook as an important potential avenue for reaching mothers with information relevant to their own health, child health, child diet, and active play. However, further research is required to understand the best avenues for engaging fathers with information on healthy family lifestyle behaviors to support this important role in their child’s life. Trial Registration: ISRCTN Registry ISRCTN81847050; http://www.isrctn.com/ISRCTN81847050 %M 30674450 %R 10.2196/11454 %U http://www.jmir.org/2019/1/e11454/ %U https://doi.org/10.2196/11454 %U http://www.ncbi.nlm.nih.gov/pubmed/30674450 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e11791 %T “If You Let Them, They Will Be on It 24 Hours a Day”: Qualitative Study Conducted in the United States Exploring Brazilian Immigrant Mothers’ Beliefs, Attitudes, and Practices Related to Screen Time Behaviors of Their Preschool-Age Children %A Lindsay,Ana Cristina %A Moura Arruda,Carlos André %A Machado,Márcia MT %A Greaney,Mary L %+ Department of Exercise and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, United States, 1 6172877579, Ana.Lindsay@umb.edu %K Brazil %K immigrants %K mothers %K child, preschool %K screen time %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children. Objective: This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children’s ST behaviors. Methods: A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis. Results: In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their preschool-age children’s ST, nearly all viewed ST as an acceptable part of their children’s daily lives. Furthermore, mothers perceived that ST has more benefits than disadvantages. The mothers’ positive beliefs about (eg, educational purposes and entertainment) and perceived functional benefits of ST (eg, ability to keep children occupied so tasks can be completed and facilitation of communication with family outside the United States) contributed to their acceptance of ST for their preschool-age children. Nevertheless, most mothers spoke of needing to balance their preschool-age children’s ST with other activities. Mothers reported using several parenting practices including monitoring time and content, setting limits and having rules, and prompting their children to participate in other activities to manage their preschool-age children’s ST. Conclusions: This study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children’s ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at limiting preschool-age children’s ST. %M 31518308 %R 10.2196/11791 %U http://pediatrics.jmir.org/2019/1/e11791/ %U https://doi.org/10.2196/11791 %U http://www.ncbi.nlm.nih.gov/pubmed/31518308 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e192 %T Parents’ Perspectives on the Theoretical Domains Framework Elements Needed in a Pediatric Health Behavior App: A Crowdsourced Social Validity Study %A Cushing,Christopher C %A Fedele,David A %A Brannon,Erin E %A Kichline,Tiffany %+ Clinical Child Psychology Program, University of Kansas, Dole Human Development Center, 1000 Sunnyside Avenue, Room 2011, Lawrence, KS, 66049, United States, 1 7858640713, christopher.cushing@ku.edu %K mHealth %K adolescent %K children %K parent %K stakeholder %K consumer preference %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial products that are not based in theory or evidence and may not take stakeholder preferences into account. Objective: The aim was to assess parent preference for mobile app features that map onto specific Theoretical Domains Framework (TDF) elements. Methods: This study was a crowdsourced social validity study of 183 parents who were asked to rate their preferences for mobile app features that correspond to elements of the TDF. The TDF organizes a large number of theoretical models and constructs into three components: (1) capability, (2) motivation, and (3) opportunity. Parents of children were recruited through Amazon Mechanical Turk. Results: The majority of participants were Caucasian and mean age was 36.9 (SD 8.0) years. Results revealed broad acceptability of communication, motivation, and opportunity domains. However, the degree to which each domain was valued varied within behavioral category. Parents demonstrated a preference for increasing procedural knowledge for physical activity and diet behaviors over sleep (F2,545=5.18, P=.006). Similarly, parents valued self-monitoring as more important for physical activity than sleep (F2,546=4.04, P=.02). When asked about the value of features to help children develop skills, parents preferred those features for dietary behavior over sleep (F2,546=3.57, P=.03). Parents perceived that goal-setting features would be most useful for physical activity over sleep and diet (F2,545=5.30, P=.005). Incentive features within the app were seen as most useful for physical activity over sleep (F2,546=4.34, P=.01). Conclusions: This study presents a low-cost strategy for involving a large number of stakeholders in the discussion of how health behavior theory should be applied in a mHealth intervention. Our approach is innovative in that it took a scientific framework (ie, TDF) and made it digestible to parents so that they could then provide their opinions about features that might appear in a future app. Our survey items discriminated between various health behaviors allowing stakeholders to communicate the different health behaviors that they would like a TDF feature to change. Moreover, we were able to develop a set of consumer opinions about features that were directly linked to elements of the TDF. %M 30578173 %R 10.2196/mhealth.9808 %U https://mhealth.jmir.org/2018/12/e192/ %U https://doi.org/10.2196/mhealth.9808 %U http://www.ncbi.nlm.nih.gov/pubmed/30578173 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e13 %T Use of Electronic Entertainment and Communication Devices Among a Saudi Pediatric Population: Cross-Sectional Study %A Amawi,Sami Omar %A Subki,Ahmed Hussein %A Khatib,Hazim Abdulkarim %A Alkhateeb,Omer Sameer %A Fida,Rida Hashim %A Saggaf,Omar Mohammed %A Jan,Mohammed Mohammed %+ Department of Pediatrics, College of Medicine, King Abdulaziz University, , Jeddah,, Saudi Arabia, 966 560662735, ahs.subki@gmail.com %K television %K tablet %K mobile phone %K computers %K devices %K entertainment %K use %K Saudi Arabia %K children %K population %K behavior %K parental impression %D 2018 %7 06.09.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Excessive use of various electronic entertainment and communication devices, particularly among children, has been associated with increased behavioral problems. Despite children’s escalating use of these devices, parents’ awareness about the impact thereof is still lacking. Objective: The objective of this study was to assess the use of electronic entertainment and communication devices among children attending a health care facility in Jeddah, Saudi Arabia, as well as the parental impression regarding the impact of electronic devices use on the behavior of their child. Methods: A focused 15-item questionnaire was designed for this cross-sectional study involving mothers of children attending the Well Baby Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from July 1, 2016 to November 30, 2016. Results: This study included 190 mothers. The mean ages of the children, mothers, and fathers were 7.3 (SD 3.5), 35 (SD 6.5), and 43 (SD 8.3) years, respectively. Most children were of Saudi Arabian nationality (106/190, 55.8%). The most used device in this study was television (154/190, 81.0%), followed by mobile phones (134/190, 70.5%), and tablets (116/190, 61.0%). Computers were the least used device in this study (59/190, 31.0%). In total, 24.7% (47/190) of children in this study used electronic entertainment and communication devices for more than 4 hours per day. Most mothers (129/190, 67.9%) felt that their child spends too much time on electronic devices. Hyperactivity or behavioral problems were reported by 20.0% (38/190) of mothers in this study. Children spending longer hours on electronic devices were much more likely to be perceived to suffer from hyperactivity or behavioral problems (P=.01). Conclusions: Parental awareness is necessary to counteract the harmful effects of using electronic devices for a prolonged period. Parents require help to cope with this problem effectively. %M 30190254 %R 10.2196/ijmr.9103 %U http://www.i-jmr.org/2018/2/e13/ %U https://doi.org/10.2196/ijmr.9103 %U http://www.ncbi.nlm.nih.gov/pubmed/30190254 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e7 %T Engaging Men in Prenatal Health via eHealth: Findings From a National Survey %A Mackert,Michael %A Guadagno,Marie %A Lazard,Allison %A Donovan,Erin %A Rochlen,Aaron %A Garcia,Alexandra %A Damásio,Manuel José %A Crook,Brittani %+ Center for Health Communication, The University of Texas at Austin, 1 University Station A1200, Austin, TX, 78712, United States, 1 5172143200, mariea@utexas.edu %K health communication %K fathering %K expectant fathers %K prenatal health %D 2018 %7 09.08.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors. Objective: The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers. Methods: A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey. Results: Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger. Conclusions: We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early “teachable moment”—where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States. %M 31518311 %R 10.2196/pediatrics.9513 %U http://pediatrics.jmir.org/2018/2/e7/ %U https://doi.org/10.2196/pediatrics.9513 %U http://www.ncbi.nlm.nih.gov/pubmed/31518311 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e144 %T How New and Expecting Fathers Engage With an App-Based Online Forum: Qualitative Analysis %A White,Becky K %A Giglia,Roslyn C %A Scott,Jane A %A Burns,Sharyn K %+ Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 4123, s.burns@curtin.edu.au %K mHealth %K mobile app %K breastfeeding %K fathers %K online communities %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is important for infants, and fathers are influential in supporting their partner in their decision to breastfeed and how long they breastfeed for. Fathers can feel excluded from traditional antenatal education and support opportunities but highly value social support from peers. Online health forums can be a useful source of social support, yet little is known about how fathers would use a conversation forum embedded in a breastfeeding-focused app. Milk Man is a mobile app that aimed to increase paternal support for breastfeeding using a range of strategies, including a conversation forum. Objective: The aim of this study was to examine how fathers used a breastfeeding-focused conversation forum contained within a mobile app throughout the perinatal period. Methods: A qualitative analysis of comments posted by users in the online forum contained within the Milk Man app was conducted. The app contained a library of information for fathers, as well as a conversation forum. Thematic analysis was used to organize and understand the data. The NVivo 11 software package was used to code comments into common nodes, which were then organized into key themes. Results: In all, 208 contributors (35.5% [208/586] of those who had access to the app) posted at least once within the forum. In total, 1497 comments were included for analysis. These comments were coded to 3799 individual nodes and then summarized to 54 tree nodes from which four themes emerged to describe how fathers used the app. Themes included seek and offer support, social connection, informational support provision, and sharing experiences. Posting in the forum was concentrated in the antenatal period and up to approximately 6 weeks postpartum. Conclusions: These data show that fathers are prepared to use a breastfeeding-focused online forum in a variety of ways to facilitate social support. Fathers can be difficult to reach in the perinatal period, yet engaging them and increasing social support is important. This research demonstrates the acceptability of an innovative way of engaging new and expecting fathers. %M 29914862 %R 10.2196/mhealth.9999 %U http://mhealth.jmir.org/2018/6/e144/ %U https://doi.org/10.2196/mhealth.9999 %U http://www.ncbi.nlm.nih.gov/pubmed/29914862 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e155 %T Parents’ Experiences of Caring for Their Child at the Time of Discharge After Cardiac Surgery and During the Postdischarge Period: Qualitative Study Using an Online Forum %A Wray,Jo %A Brown,Katherine %A Tregay,Jenifer %A Crowe,Sonya %A Knowles,Rachel %A Bull,Kate %A Gibson,Faith %+ Charles West Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom, 44 207405 ext 9200, jo.wray@gosh.nhs.uk %K congenital heart disease %K parents %K online forum %K isolation %D 2018 %7 09.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Congenital heart disease (CHD) is the most common class of birth defects, which encompasses a broad spectrum of severity ranging from relatively minor to extremely complex. Improvements in surgery and intensive care have resulted in an increasing number of infants with the most complex lesions surviving after surgery until the time of discharge from the hospital, but there remain concerns about out-of-hospital mortality, variability in how services are provided at the time of discharge and beyond, and difficulties experienced by some families in accessing care. Objective: As part of a mixed-methods program of research, this study aimed to elicit parental experiences of caring for a child with CHD after hospital discharge following a cardiac surgery and collect information to inform interviews for a subsequent stage of the project. Methods: A closed online discussion group was set up via the main Facebook page of the Children’s Heart Federation (CHF), a national charity offering support to children with heart disease and their families. The discussion group was advertised through the charity’s webpage, and interested participants were directed to the charity’s Facebook page from where they could access the closed Facebook group and respond to questions posted. The CHF moderated the forum, and the research team provided questions to be posted on the forum. Responses were collated into a single transcript and subjected to thematic analysis. Results: The forum was open for 4 months, and 91 participants (mean age 35 years, range 23-58 years, 89 females, 89 parents, and 2 grandparents) submitted demographic information and were given access to the closed forum group. A common experience of isolation emerged from the data, with descriptions of how that isolation was experienced (physical, social, knowledge) and its psychological impact, together with the factors that made it worse or better. Woven through this theme was the notion that parents developed expertise over time. Conclusions: The use of an online forum provided a means for eliciting data from a large number of parents regarding their experiences of caring for their child after hospital discharge following cardiac surgery. Parents engaged with the forum and were able to articulate what went well and what went less well, together with sharing their stories and supporting each other through doing so. Some parents clearly found participating in the forum a positive experience in itself, demonstrating the potential of social media as a mechanism for providing support and reducing isolation. Information gained from the forum was used to shape questions for interviews with parents in a subsequent phase of the study. Furthermore, the themes identified in the online forum have contributed to identifying ways of improving the provision of care and support for parents of high-risk babies following discharge after cardiac surgery. %M 29743157 %R 10.2196/jmir.9104 %U http://www.jmir.org/2018/5/e155/ %U https://doi.org/10.2196/jmir.9104 %U http://www.ncbi.nlm.nih.gov/pubmed/29743157 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e4 %T The Rise of New Alcoholic Games Among Adolescents and the Consequences in the Emergency Department: Observational Retrospective Study %A Barbieri,Stefania %A Omizzolo,Luca %A Tredese,Alberto %A Vettore,Gianna %A Calaon,Alberto %A Behr,Astrid Ursula %A Snenghi,Rossella %A Montisci,Massimo %A Gaudio,Rosa Maria %A Paoli,Andrea %A Pietrantonio,Vincenzo %A Santi,Jacopo %A Donato,Daniele %A Carretta,Giovanni %A Dolcet,Annalisa %A Feltracco,Paolo %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani, 2, Padova,, Italy, 39 04 98074414, stefibarbieri118@gmail.com %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The links between the internet and teenager behavior are difficult situations to control and may lead to the development of new and excessive methods of drinking alcohol during alcoholic games. Findings indicate that reported cases are very useful sources for better understanding of alcoholic games, yielding successful measures promoting health among adolescents. Admittance of adolescents to hospital emergency departments (EDs) after consumption of excessive amounts of alcohol has become the norm in developed countries. The harmful effects of acute alcohol abuse are reported in this paper. Objective: The aim of this work was to investigate the close connections between new drinking behaviors among adolescents and study the increase in new alcoholic games, together with the challenges that cause acute alcohol intoxication, the influence of the internet and social networks, and their consequences for public health services. Methods: Data came from prehospital and intrahospital admissions attributable to alcohol consumption. From 2013 to 2015, 3742 patients were admitted to EDs due to acute alcohol intoxication: 830 of them were aged 15 to 30 years, and 225 were adolescents and young adults between 15 and 20 years who had been playing alcoholic games. Retrospectively, diagnostic data associated with extrahospital anamneses were selected by one of the hospital management information systems, Qlik. As a result of our previous experience, questionnaires and face-to-face interviews were performed at a later stage, when a clinical audit for intoxicated adolescent patients was described, with the overall goal of establishing a potential methodological workflow and adding important information to research carried out so far. Results: Between 2013 and 2015, 830 young patients aged 15 to 30 years were admitted to EDs for acute alcohol intoxication. About 20% (166/830) of the sample confirmed that they had drunk more than 5 alcoholic units within 2 hours twice during the past 30 days as a result of binge drinking. Referring to new alcoholic games, 41% of the sample stated that they knew what neknomination is and also that at least one of their friends had accepted this challenge, describing symptoms such as vomiting, headache, altered behavior, increased talkativeness, and sociability. The median value of the weighted average cost of the diagnosis-related group relating to interventions provided by hospitals was the same for both genders, €46,091 (US $56,497; minimum €17,349 and maximum €46,091). Conclusions: Drinking games encourage young people to consume large quantities of alcohol within a short period of time putting them at risk of alcohol poisoning, which can potentially lead to accidental injuries, unsafe sex, suicide, sexual assault, and traffic accidents. The spread of these games through the internet and social networks is becoming a serious health problem facing physicians and medical professionals every day, especially in the ED; for this reason, it is necessary to be aware of the risks represented by such behaviors in order to recognize and identify preliminary symptoms and develop useful prevention programs. The strategic role of emergency services is to monitor and define the problem right from the start in order to control the epidemic, support planning, coordinate the delivery of assistance in the emergency phase, and provide medical education. Hospital-based interdisciplinary health care researchers collected specific data on hazardous drinking practices linked to evaluation of increased alcohol-related consequences and cases admitted to the ED. %M 31518328 %R 10.2196/pediatrics.6578 %U http://pediatrics.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/pediatrics.6578 %U http://www.ncbi.nlm.nih.gov/pubmed/31518328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e116 %T Perceptions About Disseminating Health Information Among Mommy Bloggers: Quantitative Study %A Burke-Garcia,Amelia %A Kreps,Gary L %A Wright,Kevin B %+ Department of Communication, George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA, 22030, United States, 1 2023205060, ameliaburke-garcia@westat.com %K mommy bloggers %K social media %K health messages %K health information dissemination %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Social media are potentially powerful channels for communicating relevant health information in culturally sensitive and influential ways to key audiences. Moreover, these channels hold promise for promoting awareness and knowledge of health risks, prevention, and treatment by utilizing opinion leaders for message dissemination. Despite limited empirical evidence to-date, early promising results suggest that blogs are a form of social media that should be examined as worthy channels for health communication. Objectives: This formative study explored mommy bloggers’ perceptions about sharing health-related information on their blogs with their readers. It also sought to analyze which topics would be of most interest to mommy bloggers, what motivates them to write about health issues, and how they perceive interest in these topics among their readers. Methods: This study employed survey methodology, including the use of open-ended questions, the responses to which were coded for analysis. Specifically, a 14-item survey was fielded with mommy bloggers between October 1 and October 28, 2016. Bloggers were recruited through The Motherhood network. A total of 461 mommy bloggers responded to the survey; 163 were removed for low quality responses and incomplete data. As a result, 298 eligible participants completed the survey. For open-ended questions in the survey, a sample of responses were coded and analyzed. Results: The majority of the respondents (87.2%, 260/298) reported that they have written about health issues in the past; 97.3% (290/298) of the respondents reported that they would consider writing about health issues sometime in the future, and 96.3% (287/298) of the respondents reported that their readers like to read about health issues on their blogs. In terms of content priorities for this sample of bloggers, Nutrition and Physical Activity dominate the current conversation and similarly, Physical Activity and Nutrition remain top content priorities for these bloggers for the future. Moreover, 21.3% of the respondents reported that their readers would be interested in these topics. Finally, having a personal connection with a health issue was found to be positively associated with likeliness to write about health issues on their blog (P<.001). Conclusions: This study illustrates that there are potentially rich opportunities for working with mommy bloggers to communicate with key health decision makers (moms) on important health issues. There is a great support among mommy bloggers for health information dissemination as well as interest for accessing relevant health information from their readers. This presents an opportunity for public health research and communication campaigns to more broadly promote their messages, thereby contributing to their behavior change objectives. Limitations included overrepresentation of white, higher-educated, and younger women. It suggests a need for more targeted engagement of a diverse sample for future work. %M 29691204 %R 10.2196/resprot.7764 %U http://www.researchprotocols.org/2018/4/e116/ %U https://doi.org/10.2196/resprot.7764 %U http://www.ncbi.nlm.nih.gov/pubmed/29691204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e25 %T Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in School-Aged Children, Adolescents, and Young Adults With Autism via a Digital Smartglasses-Based Socioemotional Coaching Aid: Short-Term, Uncontrolled Pilot Study %A Vahabzadeh,Arshya %A Keshav,Neha U %A Salisbury,Joseph P %A Sahin,Ned T %+ Brain Power, 1 Broadway, 14th Floor, Cambridge, MA,, United States, 1 404 857 7179, sahin@post.harvard.edu %K autism spectrum disorder %K Asperger syndrome %K augmented reality %K virtual reality %K artificial intelligence %K affective computing %K patient education as a topic %K ADHD %K attention deficit disorder with hyperactivity %K attention %K smartglasses %D 2018 %7 02.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: People with autism spectrum disorder (ASD) commonly experience symptoms related to attention-deficit/hyperactivity disorder (ADHD), including hyperactivity, inattention, and impulsivity. One-third of ASD cases may be complicated by the presence of ADHD. Individuals with dual diagnoses face greater barriers to accessing treatment for ADHD and respond less positively to primary pharmacologic interventions. Nonpharmacologic technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. Objective: The objective of this preliminary study was to describe the changes in ADHD-related symptoms in children, adolescents, and young adults with ASD immediately after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. Methods: We recruited 8 children, adolescents, and young adults with ASD (male to female ratio of 7:1, mean age 15 years, range 11.7-20.5 years) through a Web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n=4, ABC-H≥13) and a low ADHD-related symptom group (n=4, ABC-H<13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. We then calculated caregiver-reported ABC-H scores at 24 and 48 hours after the session. Results: All 8 participants were able to complete the intervention session. Postintervention ABC-H scores were lower for most participants at 24 hours (n=6, 75%) and for all participants at 48 hours (n=8, 100%). At 24 hours after the session, average participant ABC-H scores decreased by 54.9% in the high ADHD symptom group and by 20% in the low ADHD symptom group. At 48 hours after the session, ABC-H scores compared with baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusions: This study provides initial evidence for the possible potential of the Empowered Brain system to reduce ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children, adolescents, and young adults with ASD. This digital smartglasses intervention can potentially be targeted at a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand the clinical importance of these observed changes and to conduct longitudinal studies on this intervention with control groups and larger sample sizes. %M 29610109 %R 10.2196/mental.9631 %U http://mental.jmir.org/2018/2/e25/ %U https://doi.org/10.2196/mental.9631 %U http://www.ncbi.nlm.nih.gov/pubmed/29610109 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e115 %T Pregnant Women Sharing Pregnancy-Related Information on Facebook: Web-Based Survey Study %A Harpel,Tammy %+ Department of Family & Consumer Sciences, Illinois State University, Campus Box 5060, Turner Hall, Normal, IL, 61790-5060, United States, 1 3094382680, tsharpe@ilstu.edu %K pregnancy %K social media %K Facebook %D 2018 %7 22.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Research indicates expectant and new mothers use the Internet, specifically social media, to gain information and support during the transition to parenthood. Although parents regularly share information about and photos of their child or children on Facebook, researchers have neither explored the use of Facebook to share pregnancy-related information nor investigated factors that influence such sharing. Objective: The aim of this study was to address a gap in the literature by exploring the use of Facebook by pregnant women. Specifically, the study examined the use of Facebook to share pregnancy-related information, as well as any association between prenatal attachment and the aforementioned aspects of sharing pregnancy-related information on Facebook. Methods: Pregnant women who were at least 18 years of age were recruited for participation in the study through posts and paid advertisements on Facebook and posts to professional organization listservs. Individuals interested in participating were directed to a secure Web-based survey system where they completed the consent form and the survey that focused on their current pregnancy. Participants completed the Maternal Antenatal Attachment Scale and answered questions that assessed how often they shared pregnancy-related information on Facebook, who they shared it with, why they shared it, and what they shared. Results: A total of 117 pregnant women completed the survey. Descriptive statistics indicated that the pregnancy announcement was most commonly shared (75/108, 69.4%), with most women sharing pregnancy-related information on Facebook less than monthly (52/117, 44.4%) with only family and friends (90/116, 77.6% and 91/116, 78.4%, respectively) and for the purpose of involving others or sharing the experience (62/107, 57.9%). Correlation and regression analyses showed that prenatal attachment, in general, was positively and significantly related to all aspects of sharing pregnancy-related information at the P<.05 level, with the exception of sharing because of expectations. Quality of attachment, which involves the positive feelings the woman has about her unborn child, was significantly associated with sharing to involve others or share the pregnancy (t8,93=2.654 , P=.009). In contrast, after controlling for other variables, the strength or preoccupation component of prenatal attachment was significantly associated with frequency of sharing (t8,100=2.554 , P=.01), number to types of information shared (t8,97=2.605 , P=.01), number of groups with whom shared (t8,99=3.467, P=.001), and sharing to get advice (χ28=5.339 , P=.02). Conclusions: Pregnant women in this study used Facebook for a variety of reasons, demonstrating the use of the social media platform during pregnancy for supportive and informational purposes. Overall, the results of this study are likely to be useful to professionals who are seeking alternative methods for providing intervention, information, and support to pregnant women via social media in our technology-driven society. %M 29567636 %R 10.2196/jmir.7753 %U http://www.jmir.org/2018/3/e115/ %U https://doi.org/10.2196/jmir.7753 %U http://www.ncbi.nlm.nih.gov/pubmed/29567636 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e77 %T Strengths-Based Behavioral Intervention for Parents of Adolescents With Type 1 Diabetes Using an mHealth App (Type 1 Doing Well): Protocol for a Pilot Randomized Controlled Trial %A Hilliard,Marisa E %A Eshtehardi,Sahar S %A Minard,Charles G %A Saber,Rana %A Thompson,Debbe %A Karaviti,Lefkothea P %A Rojas,Yuliana %A Anderson,Barbara J %+ Section of Psychology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX, 770030, United States, 1 832 824 7209, marisa.hilliard@bcm.edu %K adolescence %K type 1 diabetes %K parenting %D 2018 %7 13.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Supportive parent involvement for adolescents’ type 1 diabetes (T1D) self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative family teamwork. Few interventions have used explicitly strengths-based approaches to help reinforce desired management behaviors and promote positive family interactions around diabetes care. Objective: The aim of this protocol was to describe the development of a new, strengths-based behavioral intervention for parents of adolescents with T1D delivered via a mobile-friendly Web app called Type 1 Doing Well. Methods: Ten adolescent-parent dyads and 5 diabetes care providers participated in a series of qualitative interviews to inform the design of the app. The 3- to 4-month pilot intervention will involve 82 parents receiving daily prompts to use the app, in which they will mark the diabetes-related strength behaviors (ie, positive attitudes or behaviors related to living with or managing T1D) their teen engaged in that day. Parents will also receive training on how to observe diabetes strengths and how to offer teen-friendly praise via the app. Each week, the app will generate a summary of the teen’s most frequent strengths from the previous week based on parent reports, and parents will be encouraged to praise their teen either in person or from a library of reinforcing text messages (short message service, SMS). Results: The major outcomes of this pilot study will include intervention feasibility and satisfaction data. Clinical and behavioral outcomes will include glycemic control, regimen adherence, family relationships and conflict, diabetes burden, and health-related quality of life. Conclusions: This strengths-based, mobile health (mHealth) intervention aims to help parents increase their awareness of and efforts to support their adolescents’ engagement in positive diabetes-related behaviors. If efficacious, this intervention has the potential to reduce the risk of family conflict, enhance collaborative family teamwork, and ultimately improve diabetes outcomes. Trial Registration: ClinicalTrials.gov NCT02877680; https://clinicaltrials.gov/ct2/show/NCT02877680 (Archived by WebCite at http://www.webcitation.org/6xTAMN5k2) %M 29535081 %R 10.2196/resprot.9147 %U http://www.researchprotocols.org/2018/3/e77/ %U https://doi.org/10.2196/resprot.9147 %U http://www.ncbi.nlm.nih.gov/pubmed/29535081 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e20 %T Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial %A Kazi,Abdul Momin %A Ali,Murtaza %A Zubair,Khurram %A Kalimuddin,Hussain %A Kazi,Abdul Nafey %A Iqbal,Saleem Perwaiz %A Collet,Jean-Paul %A Ali,Syed Asad %+ Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 34864232, momin.kazi@aku.edu %K SMS %K mobile phone %K reminders %K low- and middle-income countries %K routine immunization %K children %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results: Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant. Conclusions: Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration: ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc) %M 29514773 %R 10.2196/publichealth.7026 %U http://publichealth.jmir.org/2018/1/e20/ %U https://doi.org/10.2196/publichealth.7026 %U http://www.ncbi.nlm.nih.gov/pubmed/29514773 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e59 %T Evaluation of a Mobile Phone–Based Intervention to Increase Parents’ Knowledge About the Measles-Mumps-Rubella Vaccination and Their Psychological Empowerment: Mixed-Method Approach %A Fadda,Marta %A Galimberti,Elisa %A Fiordelli,Maddalena %A Schulz,Peter Johannes %+ Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Auf der Mauer 17, Zurich, 8092, Switzerland, 41 4463 ext 24187, marta.fadda@hest.ethz.ch %K qualitative research %K measles-mumps-rubella vaccine %K surveys and questionnaires %K mobile applications %K knowledge %K patient participation %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most intervention studies is that they do not apply randomized controlled trials (RCTs), the method that, over the last 2 decades, has increasingly been considered as the only method to provide proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. This study, however, holds that methods other than RCTs also can produce meaningful results. Objective: The aim of this study was to evaluate 2 mobile phone–based interventions aimed at increasing parents’ knowledge of the measles-mumps-rubella (MMR) vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The 2 interventions were part of an RCT. Methods: We conducted 2 studies with the RCT participants: a Web-based survey aimed at assessing their rating of the tool regarding a number of qualities such as usability and usefulness (N=140), and qualitative telephonic interviews to explore participants’ experiences with the app (N=60). Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment intervention) liked the app significantly better compared with the group that only received the empowerment intervention (F2,137=15.335; P<.001). Parents who were exposed to the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that efforts to empower patients should always be accompanied by the provision of factual information. Using a narrative format that promotes parents’ identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time. Trial Registration: International Standard Randomized Controlled Trial Number 30768813; http://www.isrctn.com/ ISRCTN30768813 (Archived by WebCite at http://www.webcitation.org/6xOQSJ3w8) %M 29514772 %R 10.2196/mhealth.8263 %U http://mhealth.jmir.org/2018/3/e59/ %U https://doi.org/10.2196/mhealth.8263 %U http://www.ncbi.nlm.nih.gov/pubmed/29514772 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e1 %T Theoretically-Based Emotion Regulation Strategies Using a Mobile App and Wearable Sensor Among Homeless Adolescent Mothers: Acceptability and Feasibility Study %A Leonard,Noelle R %A Casarjian,Bethany %A Fletcher,Richard R %A Prata,Cathleen %A Sherpa,Dawa %A Kelemen,Anna %A Rajan,Sonali %A Salaam,Rasheeda %A Cleland,Charles M %A Gwadz,Marya Viorst %+ Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 1st Avenue, 7th Floor, New York, NY, 10010, United States, 1 212 992 7167, nrl4@nyu.edu %K electrodermal response %K adolescence %K mothers %K emotion %K parenting %D 2018 %7 01.03.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Many adolescent mothers are parenting young children under highly stressful conditions as they are managing first-time parenthood, poverty, lack of housing, school and work, and challenging peer and familial relationships. Mobile health (mHealth) technology has the potential to intervene at various points in the emotion regulation process of adolescent mothers to provide them support for more adaptive emotional and behavioral regulation in the course of their daily life. Objective: The goal of this study was to examine the acceptability, feasibility, use patterns, and mechanisms by which a mobile technology used as an adjunct to in-person, provider-delivered sessions fostered adolescent mothers’ adaptive emotion regulation strategies under real-life conditions. Methods: Participants (N=49) were enrolled in the intervention condition of a larger pilot study of homeless adolescent mothers living in group-based shelters. The mHealth technology, Calm Mom, consisted of a mobile app and a wrist-worn sensorband for the ambulatory measurement and alerting of increased electrodermal activity (EDA), a physiological measurement of stress. We examined logs of mobile app activity and conducted semistructured qualitative interviews with a subsample (N=10) of participants. Qualitative data analysis was guided by the theoretical frames of the intervention and a technology acceptance model and included an analysis of emerging themes and concepts. Results: Overall, participants indicated that one or more of the elements of Calm Mom supported their ability to effectively regulate their emotions in the course of their daily life in ways that were consonant with the intervention’s theoretical model. For many adolescent mothers, the app became an integral tool for managing stress. Due to technical challenges, fewer participants received sensorband alerts; however, those who received alerts reported high levels of acceptability as the technology helped them to identify their emotions and supported them in engaging in more adaptive behaviors during real-life stressful situations with their children, peers, and family members. Conclusions: Calm Mom is a promising technology for providing theoretically driven behavioral intervention strategies during real-life stressful moments among a highly vulnerable population. Future research efforts will involve addressing technology challenges and refining tailoring algorithms for implementation in larger-scale studies. %M 30637376 %R 10.2196/pediatrics.9037 %U http://pediatrics.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/pediatrics.9037 %U http://www.ncbi.nlm.nih.gov/pubmed/30637376 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e39 %T Feasibility and Efficacy of a Parent-Focused, Text Message–Delivered Intervention to Reduce Sedentary Behavior in 2- to 4-Year-Old Children (Mini Movers): Pilot Randomized Controlled Trial %A Downing,Katherine L %A Salmon,Jo %A Hinkley,Trina %A Hnatiuk,Jill A %A Hesketh,Kylie D %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia, 61 392446088, k.downing@deakin.edu.au %K child behavior %K children %K mHealth %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite public health guidelines to limit sedentary behavior, many young children spend large amounts of time sedentary (eg, screen and sitting time) during waking hours. Objective: The objective of this study was to test the feasibility and efficacy of a parent-focused, predominantly text message–delivered intervention to support parents to reduce the amount of time their children spend in sedentary behavior. Methods: Mini Movers was a pilot randomized controlled trial delivered to parents of 2- to 4-year-old children in Melbourne, Australia. Participants were recruited through playgroups, social media, and snowball sampling. Eligibility criteria were having an ambulatory child (2-4 years), English literacy, and smartphone ownership. Participants were randomized to intervention or wait-list control on a 1:1 ratio after baseline data collection. The 6-week intervention was predominantly delivered via text messages, using a Web-based bulk text message platform managed by the interventionist. Intervention strategies focused on increasing parental knowledge, building self-efficacy, setting goals, and providing reinforcement, and were underpinned by the Coventry, Aberdeen & London-Refined taxonomy of behavior change techniques and social cognitive theory. The primary outcome was intervention feasibility, measured by recruitment, retention, intervention delivery, and fidelity; process evaluation questionnaires; and qualitative interviews with a subsample of participants. Secondary outcomes were children’s screen and restraint time (parent report), sitting time (parent report, activPAL), and potential mediators (parent report). Linear regression models were used to determine intervention effects on secondary outcomes, controlling for the child’s sex and age and clustering by playgroup; effect sizes (Cohen's d) were calculated. Results: A total of 57 participants (30 intervention; 27 wait-list control) were recruited, and retention was high (93%). Process evaluation results showed that the intervention was highly acceptable to parents. The majority of intervention components were reported to be useful and relevant. Compared with children in the control group, children in the intervention group had significantly less screen time postintervention (adjusted difference [95% CI]=−35.0 [−64.1 to −5.9] min/day; Cohen's d=0.82). All other measures of sedentary behavior were in the expected direction, with small to moderate effect sizes. Conclusions: Mini Movers was shown to be a feasible, acceptable, and efficacious pilot intervention for parents of young children, warranting a larger-scale randomized control trial. Trial Registration: Australian New Zealand Clinical Trials registry: ACTRN12616000628448; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?ACTRN=12616000628448p (Archived by WebCite at http://www.webcitation.org/ 6wZcA3cYM) %M 29426816 %R 10.2196/mhealth.8573 %U http://mhealth.jmir.org/2018/2/e39/ %U https://doi.org/10.2196/mhealth.8573 %U http://www.ncbi.nlm.nih.gov/pubmed/29426816 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e35 %T The Effectiveness and Cost-Effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-Time Mothers: Randomized Controlled Trial Protocol %A He,Honggu %A Zhu,Lixia %A Chan,Sally Wai Chi %A Chong,Yap-Seng %A Jiao,Nana %A Chan,Yiong Huak %A Luo,Nan %A Shorey,Shefaly %+ Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2 Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294 ext 1294, nurssh@nus.edu.sg %K mothers %K education %K postpartum period %K Internet %D 2018 %7 31.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: In addition to recuperating from the physical and emotional demands of childbirth, first-time mothers are met with demands of adapting to their social roles while picking up new skills to take care of their newborn. Mothers may not feel adequately prepared for parenthood if they are situated in an unsupported environment. Postnatal psychoeducational interventions have been shown to be useful and can offer a cost-effective solution for improving maternal outcomes. Objective: The objective of this study was to examine the effectiveness and cost-effectiveness of Web-based and home-based postnatal psychoeducational programs for first-time mothers on maternal outcomes. Methods: A randomized controlled three-group pre- and posttests experimental design is proposed. This study plans to recruit 204 first-time mothers on their day of discharge from a public tertiary hospital in Singapore. Eligible first-time mothers will be randomly allocated to either a Web-based psychoeducation group, a home-based psychoeducation group, or a control group receiving standard care. The outcomes include maternal parental self-efficacy, social support, psychological well-being (anxiety and postnatal depression), and cost evaluation. Data will be collected at baseline, 1 month, 3 months, and 6 months post-delivery. Results: The recruitment (n=204) commenced in October 2016 and was completed in February 2017, with 68 mothers in each group. The 6-month follow-up data collection was completed in August 2017. Conclusions: This study may identify an effective and cost-effective Web-based postnatal psychoeducational program to improve first-time mothers’ health outcomes. The provision of a widely-accessed Web-based postnatal psychoeducational program will eventually lead to more positive postnatal experiences for first-time mothers and positively influence their future birth plans. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 45202278; http://www.isrctn.com/ISRCTN45202278 (Archived by WebCite at http://www.webcitation.org/6whx0pQ2F). %M 29386175 %R 10.2196/resprot.9042 %U http://www.researchprotocols.org/2018/1/e35/ %U https://doi.org/10.2196/resprot.9042 %U http://www.ncbi.nlm.nih.gov/pubmed/29386175 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e14 %T Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review %A Lindsay,Ana Cristina %A Wasserman,Minerva %A Muñoz,Mario A %A Wallington,Sherrie F %A Greaney,Mary L %+ Department of Exercise and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, United States, 1 6172877579, ana.lindsay@umb.edu %K parenting %K styles %K practices %K physical activity %K children %K Hispanic %K Latino %D 2018 %7 30.01.2018 %9 Review %J JMIR Public Health Surveill %G English %X Background: Research indicates that parents influence their children’s physical activity (PA) and sedentary behaviors (SB) through their parenting styles and practices. Objective: The objectives of this paper were to evaluate existing research examining the associations between parenting styles, parenting practices, and PA and SB among Latino children aged between 2 and 12 years, highlight limitations of the existing research, and generate suggestions for future research. Methods: The method of this integrative review was informed by methods developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed-methods studies. Using the Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines, five electronic academic databases (PubMed, SPORTDiscus, PsycINFO, PsycARTICLES, and CINAHL) were searched for peer-reviewed, full-text papers published in English. Of the 641 unique citations identified, 67 full-text papers were retrieved, and 16 were selected for review. Results: The majority of the 16 reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, and only 1 study examined the association between parenting styles and Latino children’s PA and SB. Most (n=15) reviewed studies assessed the influence of parenting practices on children’s PA and SB, and they provide good evidence that parenting practices such as offering verbal encouragement, prompting the child to be physically active, providing logistic support, engaging and being involved in PA, monitoring, and offering reinforcement and rewards encourage, facilitate, or increase children’s PA. The examined studies also provide evidence that parenting practices, such as setting rules and implementing PA restrictions due to safety concerns, weather, and using psychological control discourage, hinder, or decrease children’s PA. Conclusions: Because this review found a very small number of studies examining the relationship between parenting styles and Latino children’s PA and SB, additional research is needed. Given that the majority of reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, additional research examining parenting styles, parenting practices, and PA and SB among multiethnic Latino groups is needed to design interventions tailored to the needs of this ethnically diverse population group. %M 29382629 %R 10.2196/publichealth.8159 %U http://publichealth.jmir.org/2018/1/e14/ %U https://doi.org/10.2196/publichealth.8159 %U http://www.ncbi.nlm.nih.gov/pubmed/29382629 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e17 %T A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial %A Yap,Marie Bee Hui %A Mahtani,Shireen %A Rapee,Ronald M %A Nicolas,Claire %A Lawrence,Katherine A %A Mackinnon,Andrew %A Jorm,Anthony F %+ Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, 3800, Australia, 61 399050723, marie.yap@monash.edu %K family %K anxiety %K parenting %K depression %K adolescent %K Internet %K mental health %K preventive health services %D 2018 %7 19.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. Objective: This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. Methods: A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms). Results: Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions. Conclusions: The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health. Trial Registration: Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj) %M 29351895 %R 10.2196/jmir.9139 %U http://www.jmir.org/2018/1/e17/ %U https://doi.org/10.2196/jmir.9139 %U http://www.ncbi.nlm.nih.gov/pubmed/29351895 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e59 %T Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety %A Yap,Marie BH %A Lawrence,Katherine A %A Rapee,Ronald M %A Cardamone-Breen,Mairead C %A Green,Jacqueline %A Jorm,Anthony F %+ Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton, 3800, Australia, 61 399050723, marie.yap@monash.edu %K family %K tailored %K internet %K mental health %K preventive health services %D 2017 %7 19.12.2017 %9 Viewpoint %J JMIR Ment Health %G English %X Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents’ mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents’ needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes. %M 29258974 %R 10.2196/mental.8492 %U http://mental.jmir.org/2017/4/e59/ %U https://doi.org/10.2196/mental.8492 %U http://www.ncbi.nlm.nih.gov/pubmed/29258974 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e166 %T “Mommy Blogs” and the Vaccination Exemption Narrative: Results From A Machine-Learning Approach for Story Aggregation on Parenting Social Media Sites %A Tangherlini,Timothy R %A Roychowdhury,Vwani %A Glenn,Beth %A Crespi,Catherine M %A Bandari,Roja %A Wadia,Akshay %A Falahi,Misagh %A Ebrahimzadeh,Ehsan %A Bastani,Roshan %+ Department of Electrical Engineering, University of California, Los Angeles, 56-125B Engineering IV Building, 420 Westwood Plaza (Box 951594), Los Angeles, CA, 90095-1594, United States, 1 310 206 4975, vwani@ee.ucla.edu %K vaccination %K social media %K machine learning %K personal narratives %K Internet %K health knowledge %K attitudes %K practice %D 2016 %7 22.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media offer an unprecedented opportunity to explore how people talk about health care at a very large scale. Numerous studies have shown the importance of websites with user forums for people seeking information related to health. Parents turn to some of these sites, colloquially referred to as “mommy blogs,” to share concerns about children’s health care, including vaccination. Although substantial work has considered the role of social media, particularly Twitter, in discussions of vaccination and other health care–related issues, there has been little work on describing the underlying structure of these discussions and the role of persuasive storytelling, particularly on sites with no limits on post length. Understanding the role of persuasive storytelling at Internet scale provides useful insight into how people discuss vaccinations, including exemption-seeking behavior, which has been tied to a recent diminution of herd immunity in some communities. Objective: To develop an automated and scalable machine-learning method for story aggregation on social media sites dedicated to discussions of parenting. We wanted to discover the aggregate narrative frameworks to which individuals, through their exchange of experiences and commentary, contribute over time in a particular topic domain. We also wanted to characterize temporal trends in these narrative frameworks on the sites over the study period. Methods: To ensure that our data capture long-term discussions and not short-term reactions to recent events, we developed a dataset of 1.99 million posts contributed by 40,056 users and viewed 20.12 million times indexed from 2 parenting sites over a period of 105 months. Using probabilistic methods, we determined the topics of discussion on these parenting sites. We developed a generative statistical-mechanical narrative model to automatically extract the underlying stories and story fragments from millions of posts. We aggregated the stories into an overarching narrative framework graph. In our model, stories were represented as network graphs with actants as nodes and their various relationships as edges. We estimated the latent stories circulating on these sites by modeling the posts as a sampling of the hidden narrative framework graph. Temporal trends were examined based on monthly user-poststatistics. Results: We discovered that discussions of exemption from vaccination requirements are highly represented. We found a strong narrative framework related to exemption seeking and a culture of distrust of government and medical institutions. Various posts reinforced part of the narrative framework graph in which parents, medical professionals, and religious institutions emerged as key nodes, and exemption seeking emerged as an important edge. In the aggregate story, parents used religion or belief to acquire exemptions to protect their children from vaccines that are required by schools or government institutions, but (allegedly) cause adverse reactions such as autism, pain, compromised immunity, and even death. Although parents joined and left the discussion forums over time, discussions and stories about exemptions were persistent and robust to these membership changes. Conclusions: Analyzing parent forums about health care using an automated analytic approach, such as the one presented here, allows the detection of widespread narrative frameworks that structure and inform discussions. In most vaccination stories from the sites we analyzed, it is taken for granted that vaccines and not vaccine preventable diseases (VPDs) pose a threat to children. Because vaccines are seen as a threat, parents focus on sharing successful strategies for avoiding them, with exemption being the foremost among these strategies. When new parents join such sites, they may be exposed to this endemic narrative framework in the threads they read and to which they contribute, which may influence their health care decision making. %M 27876690 %R 10.2196/publichealth.6586 %U http://publichealth.jmir.org/2016/2/e166/ %U https://doi.org/10.2196/publichealth.6586 %U http://www.ncbi.nlm.nih.gov/pubmed/27876690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e169 %T If You Build It, Will They Come? Patterns of Internet-Based and Face-To-Face Participation in a Parenting Program for Military Families %A Doty,Jennifer L %A Rudi,Jessie H %A Pinna,Keri L M %A Hanson,Sheila K %A Gewirtz,Abigail H %+ University of Minnesota, Family Social Science, Room 294 McNH, 1985 Buford Ave, St. Paul, MN, 55108, United States, 1 612 624 1475, agewirtz@umn.edu %K parenting %K evidence-based practice %K military %K prevention %K Internet %K interactive media %D 2016 %7 22.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Some evidence suggests parents are drawn to media-based interventions over face-to-face interventions, but little is known about the factors associated with parents’ use of Internet-based or Internet-enhanced programs, especially among military families. Research is needed to understand characteristics of parents who may be most likely to use online components or attend face-to-face meetings in order to ensure maximum engagement. Objective: In this study, we examined characteristics that predict various patterns of Internet use and face-to-face attendance in a parenting program designed for military families. Methods: An ecological framework guided analysis of differences in patterns of Internet-based use and face-to-face attendance by parents’ demographic characteristics (gender, education, employment, and child age), incentives offered, and number of months the parent was deployed. We reported differences in the total number of online components completed over the 14 modules, total number of face-to-face sessions attended, and the use of different types of online components accessed (videos, downloadable handouts, mindfulness exercises, knowledge checks, and downloadable summaries). Then, we computed multinomial logistic regression accounting for nestedness (parents within families) to examine associations between demographic, programmatic, and military-related characteristics and patterns of engagement (use of online components and attendance at face-to-face sessions). Results: Just over half (52.2%, 193/370) of the participants used the online components at least once, and the majority of participants (73.2%, 271/370) attended at least 1 face-to-face session. An examination of different patterns of participation revealed that compared with those who participated primarily in face-to-face sessions, parents who participated online but had little face-to-face participation were more likely to have received incentives than those who did not (95% CI 1.9-129.7). Among participants who had been deployed, those who had earned a 4-year degree (95% CI 1.0-2.2) and those who had been offered incentives to participate online (95% CI 2.1-58.6) were more likely to be highly engaged in online components and attend face-to-face compared with those who attended primarily face-to-face. However, those with a high number of months of deployment (95% CI 0.6-1.0) were less likely to be in the pattern of highly engaged in online components and face-to-face attendance. Compared with those who participated primarily face-to-face, deployed mothers were about 4 times more likely to engage in moderate online use with face-to-face attendance than deployed fathers (95% CI 1.21-11.83) and participate primarily online (95% CI 0.77-25.20). Conclusions: Results imply that parents may be drawn to different delivery options of a parenting program (online components vs face-to-face sessions) depending on their education level, incentives to engage in online components, and their military-related experience. Results suggest potential directions for tailoring Internet-based interventions. %M 27334833 %R 10.2196/jmir.4445 %U http://www.jmir.org/2016/6/e169/ %U https://doi.org/10.2196/jmir.4445 %U http://www.ncbi.nlm.nih.gov/pubmed/27334833 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e51 %T The Effectiveness of Parent Training as a Treatment for Preschool Attention-Deficit/Hyperactivity Disorder: Study Protocol for a Randomized Controlled, Multicenter Trial of the New Forest Parenting Program in Everyday Clinical Practice %A Lange,Anne-Mette %A Daley,David %A Frydenberg,Morten %A Rask,Charlotte U %A Sonuga-Barke,Edmund %A Thomsen,Per H %+ Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Skovagervej 2, Risskov, 8240, Denmark, 45 28771566, annelang@rm.dk %K ADHD %K preschool %K child %K treatment %K parents %K parent training %K psycho-social %K RCT, clinical %K psychological %K multi-centre %K TAU %K non-pharmacological %D 2016 %7 13.04.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parent training is recommended as the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. Objective: The objective of this trial is to investigate whether the NFPP can be effectively delivered for children referred through official community pathways in everyday clinical practice. Methods: A multicenter randomized controlled parallel arm trial design is employed. There are two treatment arms, NFPP and treatment as usual. NFPP consists of eight individually delivered parenting sessions, where the child attends during three of the sessions. Outcomes are examined at three time points (T1, T2, T3): T1 (baseline), T2 (week 12, post intervention), and T3 (6 month follow/up). 140 children between the ages of 3-7, with a clinical diagnosis of ADHD, informed by the Development and Well Being Assessment, and recruited from three child and adolescent psychiatry departments in Denmark will take part. Randomization is on a 1:1 basis, stratified for age and gender. Results: The primary endpoint is change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (ADHD-RS) by T2. Secondary outcome measures include: effects on this measure at T3 and T2 and T3 measures of teacher reported Preschool ADHD-RS scores, parent and teacher rated scores on the Strength & Difficulties Questionnaire, direct observation of ADHD behaviors during Child’s Solo Play, observation of parent-child interaction, parent sense of competence, and family stress. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of nonpharmacological treatments. Conclusions: The trial will provide evidence as to whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice. Trial Registration: ClinicalTrials.gov NCT01684644; https://clinicaltrials.gov/ct2/show/NCT01684644?term= NCT01684644&rank=1 (Archived by WebCite at http://www.webcitation/6eOOAe8Qe) %M 27076496 %R 10.2196/resprot.5319 %U http://www.researchprotocols.org/2016/2/e51/ %U https://doi.org/10.2196/resprot.5319 %U http://www.ncbi.nlm.nih.gov/pubmed/27076496 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 3 %N 2 %P e6 %T Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test %A Brand,Leah %A Beltran,Alicia %A Buday,Richard %A Hughes,Sheryl %A O'Connor,Teresia %A Baranowski,Janice %A Dadabhoy,Hafza R %A Diep,Cassandra S %A Baranowski,Tom %+ Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, United States, 1 713 798 9319, lbrand@bcm.edu %K mobile games %K games for health %K serious games %K pediatric nutrition %K parenting %D 2015 %7 24.07.2015 %9 Original Paper %J JMIR Serious Games %G English %X Background: Vegetable consumption protects against chronic diseases, but many young children do not eat vegetables. One quest within the mobile application Mommio was developed to train mothers of preschoolers in effective vegetable parenting practices, or ways to approach getting their child to eat and enjoy vegetables. A much earlier version of the game, then called Kiddio, was alpha tested previously, but the game has since evolved in key ways. Objective: The purpose of this research was to alpha test the first quest, substantiate earlier findings and obtain feedback on new game features to develop an effective, compelling parenting game. Methods: Mothers of preschool children (n=20) played a single quest of Mommio 2 to 4 times, immediately after which a semi-structured interview about their experience was completed. Interviews were transcribed and double coded using thematic analysis methods. Results: Mothers generally liked the game, finding it realistic and engaging. Some participants had difficulties with mechanics for moving around the 3-D environment. Tips and hints were well received, and further expansion and customization were desired. Conclusions: Earlier findings were supported, though Mommio players reported more enjoyment than Kiddio players. Continued development will include more user-friendly mechanics, customization, opportunities for environment interaction, and food parenting scenarios. %M 26208899 %R 10.2196/games.4081 %U http://games.jmir.org/2015/2/e6/ %U https://doi.org/10.2196/games.4081 %U http://www.ncbi.nlm.nih.gov/pubmed/26208899 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e14 %T Readability of Information Related to the Parenting of a Child With a Cleft %A De Felippe,Nanci %A Kar,Farnaz %+ School of Dentistry, Division of Orthodontics, University of Minnesota, Rm 6-320A, Moos Tower, 515 Delaware St SE, Minneapolis, MN, 55455, United States, 1 612 625 3652, farah049@umn.edu %K cleft lip %K cleft palate %K parenting %K readability %K literacy %D 2015 %7 08.07.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Many parents look to various sources for information about parenting when their child has a cleft lip and/or palate. More than 8 million Americans perform health-related searches every day on the World Wide Web. Furthermore, a significant number of them report feeling “overwhelmed” by the language and content of the information. Objective: The purpose of this study is to determine the readability of information related to parenting a child with cleft lip and/or palate. It was hypothesized that the readability of such materials would be at a level higher than 6th grade. Methods: In February of 2012, a Web-based search was conducted using the search engine Google for the terms “parenting cleft lip and palate.” Results: A total of 15 websites, 7 books, and 8 booklets/factsheets (N=30) entered the readability analysis. Flesch-Kincaid Grade Level, Fog Scale Level, and Simple Measure of Gobbledygook (SMOG) index scores were calculated. The reading level of the websites and books ranged from 8th to 9th and 9th to10th grade, respectively. The average reading level of the booklets/factsheets was 10th grade. Overall, the mean readability of the media resources analyzed was considered “hard to read.” No statistically significant mean difference was found for the readability level across websites, books, and booklets/factsheets (Kruskal-Wallis test, significance level .05). Conclusions: When considering websites, books, booklets, and factsheets analyzed, the average readability level was between 8th and 10th grade. With the US national reading level average at 8th grade and the general recommendation that health-related information be written at a 6th grade level, many parents may find the text they are reading too difficult to comprehend. Therefore, many families might be missing out on the opportunity to learn parenting practices that foster optimal psychosocial development of their children. %M 26155814 %R 10.2196/ijmr.4210 %U http://www.i-jmr.org/2015/3/e14/ %U https://doi.org/10.2196/ijmr.4210 %U http://www.ncbi.nlm.nih.gov/pubmed/26155814