%0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e21855 %T Health Care Providers’ Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study %A Cutumisu,Maria %A Ghoman,Simran K %A Lu,Chang %A Patel,Siddhi D %A Garcia-Hidalgo,Catalina %A Fray,Caroline %A Brown,Matthew R G %A Greiner,Russell %A Schmölzer,Georg M %+ Department of Educational Psychology, Faculty of Education, University of Alberta, 6-102 Education North, Edmonton, AB, T6G2G5, Canada, 1 7804925211, cutumisu@ualberta.ca %K infant %K newborn %K delivery room %K neonatal resuscitation %K performance %K neonatal resuscitation program %K serious games %K computer-based game simulation %K mindset %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Neonatal resuscitation involves a complex sequence of actions to establish an infant’s cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners’ attitudes toward computer-based learning and assessment environments influence their performance. Objective: This study explores the relation between HCPs’ attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation. Methods: Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants’ survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN. Results: The results revealed that mindset moderated the relation between participants’ perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=–1.19, SE=0.38, t44=–3.12, 95% CI –1.96 to –0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=–1.21, SE=0.38, t44=−3.16, 95% CI –1.99 to –0.44; P=.003). Conclusions: Mindset moderates the strength of the relationship between HCPs’ perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks. %M 33346741 %R 10.2196/21855 %U http://games.jmir.org/2020/4/e21855/ %U https://doi.org/10.2196/21855 %U http://www.ncbi.nlm.nih.gov/pubmed/33346741 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20913 %T Trends in Web Searches About the Causes and Treatments of Autism Over the Past 15 Years: Exploratory Infodemiology Study %A Saposnik,Florencia E %A Huber,Joelene F %+ Paediatric Medicine, The Hospital for Sick Children, Rm 10214, 10th floor Black Wing, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, 1 416 813 8422 ext 208422, joelene.huber@sickkids.ca %K autism %K infodemiology %K infoveillance %K informatics %K Google Trends %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Ninety percent of adults in the United States use the internet, and the majority of internet users report looking on the web for health information using search engines. The rising prevalence of autism spectrum disorder (ASD), uncertainty surrounding its etiology, and variety of intervention approaches contribute to questions about its causes and treatments. It is not known which terms people search most frequently about ASD and whether web search queries have changed over time. Infodemiology is an area of health informatics research using big data analytics to understand web search behavior. Objective: The objectives were to (1) use infodemiological data to analyze trends in web-based searches about the causes and treatments of ASD over time and (2) inform clinicians and ASD organizations about web queries regarding ASD. Methods: Google Trends was used to analyze web searches about the causes and treatments of ASD in the United States from 2004 to 2019. The search terms analyzed for queries about causes of ASD included vaccines, genetics, environmental factors, and microbiome and those for therapies included applied behavior analysis (ABA), gluten-free diet, chelation therapy, marijuana, probiotics, and stem cell therapy. Results: Google Trends results are normalized on a scale ranging from 0 to 100 to represent the frequency and relative interest of search topics. For searches about ASD causes, vaccines had the greatest frequency compared to other terms, with an initial search peak observed in 2008 (scaled score of 81), reaching the highest frequency in 2015 (scaled score of 100), and a current upward trend. In comparison, searches about genetics, environmental factors, and microbiome occurred less frequently. For web searches about ASD therapies, ABA consistently had a high frequency of search interest since 2004, reaching a maximum scaled score of 100 in 2019. The analyses of chelation therapy and gluten-free diet showed trending interest in 2005 (scaled score of 68) and 2007 (scaled score of 100), respectively, followed by a steady decline since (scaled scores of only 10 and 16, respectively, in 2019). Searches related to ASD and marijuana showed a rise in 2009 (scaled score of 35), and they continue to trend upward. Searches about probiotics and stem cell therapy have been relatively low (scaled scores of 22 and 18, respectively), but are gradually gaining interest. Web search volumes for stem cell therapy in 2019 surpassed both gluten-free diet and chelation therapy as web-searched interventions for ASD. Conclusions: Google Trends is an effective infodemiology tool to analyze large-scale web search trends about ASD. The results showed informative variation in search trends over 15 years. These data are useful to inform clinicians and organizations about web queries on topics related to ASD, identify knowledge gaps, and target web-based education and knowledge translation strategies. %M 33284128 %R 10.2196/20913 %U http://pediatrics.jmir.org/2020/2/e20913/ %U https://doi.org/10.2196/20913 %U http://www.ncbi.nlm.nih.gov/pubmed/33284128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23496 %T Perspectives of Child Life Specialists After Many Years of Working With a Humanoid Robot in a Pediatric Hospital: Narrative Design %A Beran,Tanya %A Pearson,Jacqueline Reynolds %A Lashewicz,Bonnie %A Baggott,Sandy %+ Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 5667, tnaberan@ucalgary.ca %K child life %K support %K pediatric %K distraction %K robotics %K human-robot interaction %D 2020 %7 19.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Child life specialists (CLSs) play an important role in supporting patients and their families during their visits to a children’s hospital. Although CLSs are equipped with considerable expertise to support families during some of the most difficult moments of their lives, we introduced an additional resource to them in the form of a humanoid robot named MEDi. Objective: The aim of this study is to explore the experiences of CLSs using a robot to support children. Methods: We interviewed 7 CLSs who had worked with this robot for several years. The transcribed interviews were analyzed using open and axial coding. Results: The first main theme that emerged was the process of navigating from fear to friendship in learning to use a humanoid robot for therapeutic support. The second major theme was MEDi as a source of connection and support to children. CLSs’ perceptions of MEDi as an adaptable resource and working with the limits of MEDi constituted the last 2 themes. Conclusions: These descriptions show how CLSs can incorporate a robot into their practice. %M 33211014 %R 10.2196/23496 %U http://www.jmir.org/2020/11/e23496/ %U https://doi.org/10.2196/23496 %U http://www.ncbi.nlm.nih.gov/pubmed/33211014 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19070 %T Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study %A Corazza,Francesco %A Snijders,Deborah %A Arpone,Marta %A Stritoni,Valentina %A Martinolli,Francesco %A Daverio,Marco %A Losi,Maria Giulia %A Soldi,Luca %A Tesauri,Francesco %A Da Dalt,Liviana %A Bressan,Silvia %+ Division of Pediatric Emergency Medicine, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy, 39 0498218015, francesco.corazza@unipd.it %K cardiac arrest %K resuscitation %K mobile app %K high-fidelity simulation training %K cognitive aid %K pediatrics %K emergency medicine %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective: To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods: A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results: Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions: The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial. %M 32788142 %R 10.2196/19070 %U https://mhealth.jmir.org/2020/10/e19070 %U https://doi.org/10.2196/19070 %U http://www.ncbi.nlm.nih.gov/pubmed/32788142 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18519 %T Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination %A Baggett,Kathleen M %A Davis,Betsy %A Landry,Susan H %A Feil,Edward G %A Whaley,Anna %A Schnitz,Alana %A Leve,Craig %+ Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State Universtiy, 14th Marietta Street NW, Suite 100&200, GA 30303, Atlanta, GA, 30303, United States, 1 4044131571, kbaggett@gsu.edu %K early intervention %K equity %K NICU %K low birthweight %K transition %K mobile internet intervention %K infants %K mothers %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective: This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods: Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results: NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions: The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions. %M 32960178 %R 10.2196/18519 %U http://www.jmir.org/2020/9/e18519/ %U https://doi.org/10.2196/18519 %U http://www.ncbi.nlm.nih.gov/pubmed/32960178 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e18427 %T Applying a Human-Centered Design to Develop a Patient Prioritization Tool for a Pediatric Emergency Department: Detailed Case Study of First Iterations %A Schiro,Jessica %A Pelayo,Sylvia %A Martinot,Alain %A Dubos,François %A Beuscart-Zéphir,Marie-Catherine %A Marcilly,Romaric %+ Inserm, CIC-IT 1403/Evalab, F-59000, Institut Coeur-Poumon, 3ème étage est, Boulevard du Pr Jules Leclerc, CS70001, Lille, 59037, France, 33 0362943935, romaric.marcilly@univ-lille.fr %K emergency department %K triage systems %K ergonomics %K design %K human-centered design %K patients %D 2020 %7 4.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patients’ waiting time. However, electronic patient triage systems are not developed so that they comply with clinicians’ workflow. Objective: This case study presents the development of a patient prioritization tool (PPT) and of the related patient prioritization algorithm (PPA) for a pediatric emergency department (PED), relying on a human-centered design process. Methods: We followed a human-centered design process, wherein we (1) performed a work system analysis through observations and interviews in an academic hospital’s PED; (2) deduced design specifications; (3) designed a mock PPT and the related PPA; and (4) performed user testing to assess the intuitiveness of the icons, the effectiveness in communicating patient priority, the fit between the prioritization model implemented and the participants’ prioritization rules, and the participants’ satisfaction. Results: The workflow analysis identified that the PPT interface should meet the needs of physicians and nurses, represent the stages of patient care, and contain patient information such as waiting time, test status (eg, prescribed, in progress), age, and a suggestion for prioritization. The mock-up developed gives the status of patients progressing through the PED; a strip represents the patient and the patient’s characteristics, including a delay indicator that compares the patient’s waiting time to the average waiting time of patients with a comparable reason for emergency. User tests revealed issues with icon intuitiveness, information gaps, and possible refinements in the prioritization algorithm. Conclusions: The results of the user tests have led to modifications to improve the usability and usefulness of the PPT and its PPA. We discuss the value of integrating human factors into the design process for a PPT for PED. The PPT/PPA has been developed and installed in Lille University Hospital's PED. Studies are carried out to evaluate the use and impact of this tool on clinicians’ situation awareness and prioritization-related cognitive load, prioritization of patients, waiting time, and patients’ experience. %M 32886071 %R 10.2196/18427 %U http://humanfactors.jmir.org/2020/3/e18427/ %U https://doi.org/10.2196/18427 %U http://www.ncbi.nlm.nih.gov/pubmed/32886071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19752 %T Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study %A Ahmadpour,Naseem %A Weatherall,Andrew David %A Menezes,Minal %A Yoo,Soojeong %A Hong,Hanyang %A Wong,Gail %+ Design Lab, School of Architecture, Design and Planning, The University of Sydney, 148 City Road, Darlington, NSW, 2006, Australia, 61 286275649, naseem.ahmadpour@sydney.edu.au %K virtual reality %K periprocedural anxiety %K children %K adolescents %K stakeholder perspective %K design %K VR %K pediatrics %K patient experience %K app %K eHealth %D 2020 %7 17.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in health care can contribute to better outcomes and meaningful experiences for patients. Objective: We used a multiperspective approach to investigate how VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxiety. Methods: This study included a focus group (n=4) and a survey (n=56) of clinicians. Semistructured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in an immunization clinic (n=3) and perioperative setting (n=35). Results: Qualitative data were examined to determine the experience and psychological needs and intervention and design strategies that may contribute to better experiences for children in three age groups (4-7, 8-11, and 12-17 years). Quantitative data were used to identify areas of priority for future VR interventions. Conclusions: We propose a set of ten design considerations for the creation of future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient’s experience. These situations require personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of preprocedure solutions, while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety. %M 32706671 %R 10.2196/19752 %U http://www.jmir.org/2020/7/e19752/ %U https://doi.org/10.2196/19752 %U http://www.ncbi.nlm.nih.gov/pubmed/32706671 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15896 %T Users’ Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study %A Floch,Jacqueline %A Vilarinho,Thomas %A Zettl,Annabel %A Ibanez-Sanchez,Gema %A Calvo-Lerma,Joaquim %A Stav,Erlend %A Haro,Peter Halland %A Aalberg,Asbjørn Lein %A Fides-Valero,Alvaro %A Bayo Montón,José Luis %+ SINTEF, Strindveien 4, Trondheim, 7465, Norway, 47 93008536, jacqueline.floch@sintef.no %K mobile health %K mHealth %K self-management %K user experience %K user acceptance %K mixed methods study %K cystic fibrosis %K pediatrics %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective: This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods: A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results: Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions: Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF. %M 32673237 %R 10.2196/15896 %U https://mhealth.jmir.org/2020/7/e15896 %U https://doi.org/10.2196/15896 %U http://www.ncbi.nlm.nih.gov/pubmed/32673237 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17943 %T Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial %A Bustamante Loyola,Jorge %A Perez Retamal,Marcela %A Morgues Nudman,Monica Isabel %A Maturana,Andres %A Salinas Gonzalez,Ricardo %A Cox,Horacio %A González Mas,José Miguel %A Muñoz,Lucia %A Lopez,Lilian %A Mendiburo-Seguel,Andrés %A Simó,Sandra %A Palau Subiela,Pascual %A Guedeney,Antoine %+ Neonatology Unit, Clinica Alemana de Santiago, Av Manquehue Norte 1499, 5th Fl, Santiago, Chile, 56 999691389, jorbuslo@alumni.uv.es %K social withdrawal %K preterm %K early detection %K interactive guidance %K emotional stress %K social development %K postnatal depression %K posttraumatic stress %D 2020 %7 26.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. Objective: The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. Methods: This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale–revised. Results: Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. Conclusions: This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. Trial Registration: ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. International Registered Report Identifier (IRRID): DERR1-10.2196/17943 %M 32589156 %R 10.2196/17943 %U http://www.researchprotocols.org/2020/6/e17943/ %U https://doi.org/10.2196/17943 %U http://www.ncbi.nlm.nih.gov/pubmed/32589156 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e17517 %T Families’ Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia %A López Seguí,Francesc %A Batlle Boada,Astrid %A García García,Juan José %A López Ulldemolins,Ana %A Achotegui del Arco,Ane %A Adroher Mas,Cristina %A García Cuyàs,Francesc %+ Sant Joan de Déu Hospital, Catalan Ministry of Health, Passeig de Sant Joan de Déu, 2, Barcelona, 08950, Spain, 34 932 53 21 00, fgarciac@sjdhospitalbarcelona.org %K home health monitoring %K pediatrics %K telehomecare %K videoconferencing %K satisfaction with care %K remote sensing technology %K telemedicine %K telehealth %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children’s care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. Objective: This study aimed to assess families’ degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. Methods: A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children’s characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. Results: A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. Conclusions: Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents. %M 32213471 %R 10.2196/17517 %U http://pediatrics.jmir.org/2020/1/e17517/ %U https://doi.org/10.2196/17517 %U http://www.ncbi.nlm.nih.gov/pubmed/32213471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16248 %T Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review %A Holmen,Heidi %A Riiser,Kirsti %A Winger,Anette %+ Oslo Metropolitan University, Postboks 4 St. Olavs plass, Oslo, N-0130, Norway, 47 67236241, heidiho@oslomet.no %K eHealth %K home-based %K pediatric palliative care %K pediatric %K children %K family %K communication %K palliative care %D 2020 %7 28.2.2020 %9 Review %J J Med Internet Res %G English %X Background: Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. Objective: This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. Methods: We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ≤18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results: We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. Conclusions: The strengths of the conclusions are limited by the studies’ methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals. Trial Registration: PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky %M 32130127 %R 10.2196/16248 %U http://www.jmir.org/2020/2/e16248/ %U https://doi.org/10.2196/16248 %U http://www.ncbi.nlm.nih.gov/pubmed/32130127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16426 %T Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study %A Matin,Shababa B %A Wallingford,Allison %A Xu,Shicheng %A Ng,Natalie %A Ho,Anthony %A Vanosdoll,Madison %A Waiswa,Peter %A Labrique,Alain B %A Acharya,Soumyadipta %+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, , Baltimore, MD, , United States, 1 4105167074, acharya@jhu.edu %K newborn %K neonatal health %K community health workers %K maternal behavior %K Uganda %K World Health Organization %K mobile apps %K telemedicine %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective: The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant’s life. We also assessed mothers’ responses to the device’s recommendation to seek care. Methods: A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers’ usage of NeMo, and the study team visited twice to observe mothers’ ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results: In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. Three days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions: NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant’s health. %M 32130174 %R 10.2196/16426 %U https://mhealth.jmir.org/2020/2/e16426 %U https://doi.org/10.2196/16426 %U http://www.ncbi.nlm.nih.gov/pubmed/32130174 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16208 %T Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store %A Fernandez-Luque,Luis %A Labarta,José I %A Palmer,Ella %A Koledova,Ekaterina %+ Merck KGaA, Frankfurter Str. 250, Darmstadt, 64293, Germany, 49 6151 72 20915, ekaterina.koledova@merckgroup.com %K growth hormone %K telemedicine %K growth monitoring %K mobile app %K mobile health %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile apps for health is growing. This rapid growth in the number of health apps can make it hard to assess their quality and features. The increased demand for and availability of mobile health apps highlights the importance of regular publication of reviews to identify potential areas of unmet needs and concern. The focus of this review is mobile apps for monitoring growth for health care professionals, caregivers, and patients. Monitoring growth as a part of healthy physical development is important across different periods of childhood and adolescence. Objective: The goal of this content analysis is to map and understand the types of apps that currently exist that are related to growth monitoring and growth hormone treatment. Methods: A semiautomated search was undertaken using the app search engine 42Matters, complemented by a manual search for growth apps using the web search tool of Google Play (Android App Store). Apps were rated on their relevance to growth monitoring and categorized by independent raters. Results: In total, 76 apps were rated relevant to growth monitoring or growth hormone treatment. The level of agreement was measured for the semiautomated search and was very high (Κ=0.97). The target audience for 87% of the apps (66/76) was patients and relatives, followed by health care professionals (11%; 8/76) and both (3%; 2/76). Apps in the category “growth tracking tools for children and babies” were retrieved most often (46%; 35/76) followed by “general baby care apps” (32%; 24/76), “nonpharmacological solutions for growth” (12%; 9/76) and “growth hormone–related” (11%; 8/76). Overall, 19/76 apps (25%) tracked a precise location. Conclusions: This study mapped the type of apps currently available for growth monitoring or growth hormone treatment that can be used as a foundation for more detailed evaluations of app quality. The popularity of care apps for children and growth monitoring apps should provide a great channel for potential intervention in childhood health in the future. %M 32130162 %R 10.2196/16208 %U http://mhealth.jmir.org/2020/2/e16208/ %U https://doi.org/10.2196/16208 %U http://www.ncbi.nlm.nih.gov/pubmed/32130162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16204 %T PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement %A Chou,Joseph H %A Roumiantsev,Sergei %A Singh,Rachana %+ Massachusetts General Hospital, 55 Fruit Street, Founders 526E, Boston, MA, 02114-2696, United States, 1 6177249040, jchou2@mgh.harvard.edu %K growth charts %K pediatrics %K infant, newborn %K infant, premature %K failure to thrive %K internet %K software %D 2020 %7 30.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Parameterization of pediatric growth charts allows precise quantitation of growth metrics that would be difficult or impossible with traditional paper charts. However, limited availability of growth chart calculators for use by clinicians and clinical researchers currently restricts broader application. Objective: The aim of this study was to assess the deployment of electronic calculators for growth charts using the lambda-mu-sigma (LMS) parameterization method, with examples of their utilization for patient care delivery, clinical research, and quality improvement projects. Methods: The publicly accessible PediTools website of clinical calculators was developed to allow LMS-based calculations on anthropometric measurements of individual patients. Similar calculations were applied in a retrospective study of a population of patients from 7 Massachusetts neonatal intensive care units (NICUs) to compare interhospital growth outcomes (change in weight Z-score from birth to discharge [∆Z weight]) and their association with gestational age at birth. At 1 hospital, a bundle of quality improvement interventions targeting improved growth was implemented, and the outcomes were assessed prospectively via monitoring of ∆Z weight pre- and postintervention. Results: The PediTools website was launched in January 2012, and as of June 2019, it received over 500,000 page views per month, with users from over 21 countries. A retrospective analysis of 7975 patients at 7 Massachusetts NICUs, born between 2006 and 2011, at 23 to 34 completed weeks gestation identified an overall ∆Z weight from birth to discharge of –0.81 (P<.001). However, the degree of ∆Z weight differed significantly by hospital, ranging from –0.56 to –1.05 (P<.001). Also identified was the association between inferior growth outcomes and lower gestational age at birth, as well as that the degree of association between ∆Z weight and gestation at birth also differed by hospital. At 1 hospital, implementing a bundle of interventions targeting growth resulted in a significant and sustained reduction in loss of weight Z-score from birth to discharge. Conclusions: LMS-based anthropometric measurement calculation tools on a public website have been widely utilized. Application in a retrospective clinical study on a large dataset demonstrated inferior growth at lower gestational age and interhospital variation in growth outcomes. Change in weight Z-score has potential utility as an outcome measure for monitoring clinical quality improvement. We also announce the release of open-source computer code written in R to allow other clinicians and clinical researchers to easily perform similar analyses. %M 32012066 %R 10.2196/16204 %U https://www.jmir.org/2020/1/e16204 %U https://doi.org/10.2196/16204 %U http://www.ncbi.nlm.nih.gov/pubmed/32012066 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e15093 %T Web-Based Technology to Improve Disease Knowledge Among Adolescents With Sickle Cell Disease: Pilot Study %A Saulsberry,Anjelica C %A Hodges,Jason R %A Cole,Audrey %A Porter,Jerlym S %A Hankins,Jane %+ Department of Hematology, St Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, , United States, 1 9015954153, jane.hankins@stjude.org %K sickle cell anemia %K eHealth %K transition to adult care %D 2020 %7 7.1.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Advancements in treatment have contributed to increased survivorship among children with sickle cell disease (SCD). Increased transition readiness, encompassing disease knowledge and self-management skills before transfer to adult care, is necessary to ensure optimal health outcomes. The Sickle Cell Transition E-Learning Program (STEP) is a public, Web-based, 6-module tool designed to increase transition readiness for youth with SCD. Objective: The objective of our study was to investigate the participation rate of youth with SCD in STEP and its association with transition readiness. Methods: This was a single-center, Institution Review Board–approved, retrospective cohort review. A total of 183 youths with SCD, aged between 12 and 15 years, were offered STEP as an adjunct to in-clinic disease education sessions. Participation rate (number of patients who used at least one STEP module divided by those approached) was calculated. The association among the number of STEP modules completed, disease knowledge, and self-management was explored. Results: Overall, 53 of the 183 approached adolescents completed at least one STEP module, yielding a participation rate in STEP of 29.0%. Of the 53 participants, 37 and 39 adolescents had disease knowledge and self-management confidence rating available, respectively. A positive correlation (r=0.47) was found between the number of STEP modules completed and disease knowledge scores (P=.003). No association was found between the number of modules completed and self-management confidence ratings. Disease knowledge scores were significantly higher among participants who completed ≥3 STEP modules compared with those who completed <3 STEP modules (U=149.00; P=.007). Conclusions: Improvement in disease knowledge in adolescence is critical to ensure the youth’s ability to self-care during the period of transition to adult care. Despite low participation, the cumulative exposure to the STEP program suggested greater promotion of disease knowledge among adolescents with SCD before transfer to adult care. %M 31909718 %R 10.2196/15093 %U https://pediatrics.jmir.org/2020/1/e15093 %U https://doi.org/10.2196/15093 %U http://www.ncbi.nlm.nih.gov/pubmed/31909718 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e15106 %T Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review %A Bird,Marissa %A Li,Lin %A Ouellette,Carley %A Hopkins,Kylie %A McGillion,Michael H %A Carter,Nancy %+ School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 9055259140 ext 22407, birdm3@mcmaster.ca %K pediatrics %K scoping review %K digital health %K children with special health care needs %K asthma %K congenital heart disease %K palliative care %K co-design %D 2019 %7 21.11.2019 %9 Review %J JMIR Pediatr Parent %G English %X Background: Use of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. Objective: We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. Methods: A systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. Results: A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. Conclusions: The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs. %M 31750840 %R 10.2196/15106 %U http://pediatrics.jmir.org/2019/2/e15106/ %U https://doi.org/10.2196/15106 %U http://www.ncbi.nlm.nih.gov/pubmed/31750840 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14247 %T An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial %A Borrelli,Belinda %A Henshaw,Michelle %A Endrighi,Romano %A Adams,William G %A Heeren,Timothy %A Rosen,Rochelle K %A Bock,Beth %A Werntz,Scott %+ Center for Behavioral Science Research, Boston University Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K oral health %K mHealth %K text message %K dental caries %K health behavior %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. Objective: This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. Methods: Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models. Results: A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively). Conclusions: The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy. %M 31710306 %R 10.2196/14247 %U https://mhealth.jmir.org/2019/11/e14247 %U https://doi.org/10.2196/14247 %U http://www.ncbi.nlm.nih.gov/pubmed/31710306 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 2 %P e13966 %T Pediatric Speech-Language Pathologists’ Use of Mobile Health Technology: Qualitative Questionnaire Study %A Thompson,Kelsey %A Zimmerman,Emily %+ Communication Sciences & Disorders, Northeastern University, 525E Behrakis Building, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 5140, e.zimmerman@neu.edu %K mHealth %K speech-language pathology %K surveys %K assessment %K pediatric %K treatment %K technology %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: While technology use in pediatric therapies is increasing, there is so far no research available focusing on how pediatric speech-language pathologists (SLPs) in the United States use technology. Objective: This paper sought to determine if, and to what extent, pediatric SLPs are using mobile apps, to determine what purpose they are using them for, and to identify gaps in available technology to provide guidance for future technological development. Methods: Pediatric SLPs completed an online survey containing five sections: demographics, overall use, use in assessment, use in intervention, barriers, and future directions. Results: Mobile app use by 485 pediatric SLPs in the clinical setting was analyzed. Most (364/438; 83.1%) pediatric SLPs reported using technology ≤50% of the time in their clinical work, with no differences evident by age group (<35 years and ≥35 years; P=.97). Pediatric SLPs are currently using apps for intervention (399/1105; 36.1%), clinical information (241/1105; 21.8%), parent education (151/1105; 13.7%), assessment (132/1105; 12%), client education (108/1105; 9.8%), and other uses (55/1105; 5.0%). Cost (46/135; 34.1%) and lack of an evidence base (36/135; 26.7%) were the most frequently reported barriers. Most SLPs (268/380; 70.7%) desired more technology use, with no difference evident by age group (P=.81). Conclusions: A majority of pediatric SLPs are using mobile apps less than 50% of the time in a pediatric setting and they use them more during intervention compared to assessment. While pediatric SLPs are hesitant to add to their client’s screen time, they would like more apps to be developed that are supported by research and are less expensive. Implications for future research and app development are also discussed. %M 31573922 %R 10.2196/13966 %U https://rehab.jmir.org/2019/2/e13966 %U https://doi.org/10.2196/13966 %U http://www.ncbi.nlm.nih.gov/pubmed/31573922 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e13400 %T Noncontact Heart and Respiratory Rate Monitoring of Preterm Infants Based on a Computer Vision System: Protocol for a Method Comparison Study %A Gibson,Kim %A Al-Naji,Ali %A Fleet,Julie-Anne %A Steen,Mary %A Chahl,Javaan %A Huynh,Jasmine %A Morris,Scott %+ School of Nursing and Midwifery, University of South Australia, North Terrace, City East, Adelaide, 5000, Australia, 61 83022706, kim.gibson@unisa.edu.au %K heart rate %K respiratory rate %K infant %K electrocardiography %K computers %D 2019 %7 29.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Biomedical research in the application of noncontact methods to measure heart rate (HR) and respiratory rate (RR) in the neonatal population has produced mixed results. This paper describes and discusses a protocol for conducting a method comparison study, which aims to determine the accuracy of a proposed noncontact computer vision system to detect HR and RR relative to the HR and RR obtained by 3-lead electrocardiogram (ECG) in preterm infants in the neonatal unit. Objective: The aim of this preliminary study is to determine the accuracy of a proposed noncontact computer vision system to detect HR and RR relative to the HR and RR obtained by 3-lead ECG in preterm infants in the neonatal unit. Methods: A single-center cross-sectional study was planned to be conducted in the neonatal unit at Flinders Medical Centre, South Australia, in May 2018. A total of 10 neonates and their ECG monitors will be filmed concurrently for 10 min using digital cameras. Advanced image processing techniques are to be applied later to determine their physiological data at 3 intervals. These data will then be compared with the ECG readings at the same points in time. Results: Study enrolment began in May 2018. Results of this study were published in July 2019. Conclusions: The study will analyze the data obtained by the noncontact system in comparison to data obtained by ECG, identify factors that may influence data extraction and accuracy when filming infants, and provide recommendations for how this noncontact system may be implemented into clinical applications. International Registered Report Identifier (IRRID): RR1-10.2196/13400 %M 31469077 %R 10.2196/13400 %U https://www.researchprotocols.org/2019/8/e13400 %U https://doi.org/10.2196/13400 %U http://www.ncbi.nlm.nih.gov/pubmed/31469077 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14540 %T A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study %A Vanosdoll,Madison %A Ng,Natalie %A Ho,Anthony %A Wallingford,Allison %A Xu,Shicheng %A Matin,Shababa Binte %A Verma,Neha %A Farzin,Azadeh %A Golden,W Christopher %A Yazdi,Youseph %A Waiswa,Peter %A Labrique,Alain %A Acharya,Soumyadipta %+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, 21218, United States, 1 4105167074, acharya@jhu.edu %K neonatal %K community health workers %K maternal %K Uganda %K World Health Organization %K smartphone app %K digital health %K mobile health %K telemedicine %D 2019 %7 15.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective: This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods: Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results: A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions: The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda. %M 31418428 %R 10.2196/14540 %U http://mhealth.jmir.org/2019/8/e14540/ %U https://doi.org/10.2196/14540 %U http://www.ncbi.nlm.nih.gov/pubmed/31418428 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e11684 %T A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study %A Ashmore,Jonathan %A Di Pietro,Jerome %A Williams,Kelly %A Stokes,Euan %A Symons,Anna %A Smith,Martina %A Clegg,Louise %A McGrath,Cormac %+ Department of Medical Physics and Bioengineering, NHS Highland, Old Perth Road, Inverness,, United Kingdom, 44 07760712289, jonathan.ashmore@nhs.net %K virtual reality %K MRI %K anxiety %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. Objective: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. Methods: A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. Results: The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. Conclusions: Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process. %M 31518319 %R 10.2196/11684 %U http://pediatrics.jmir.org/2019/1/e11684/ %U https://doi.org/10.2196/11684 %U http://www.ncbi.nlm.nih.gov/pubmed/31518319 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e11653 %T Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study %A Khader,Yousef %A Alyahya,Mohammad %A Batieha,Anwar %+ Department of Public Health and Community Medicine, Jordan University of Science and Technology, Al-Ramtha-Amman Street, Irbid, 22110, Jordan, 962 0796802040, yskhader@just.edu.jo %K perinatal death %K quality of health care %K cause of death %K Jordan %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Perinatal death audit is a feasible and cost-effective quality improvement tool that helps to improve the quality of health care and reduce perinatal deaths. Perinatal death audit is not implemented in almost all hospitals in Jordan. Objective: This study aimed to assess health professionals’ attitude toward perinatal death auditing and determine the main barriers for effective implementation of perinatal death auditing as perceived by health professionals in Jordanian hospitals. Methods: A cross-sectional study was conducted among health professionals in 4 hospitals in Jordan. All physicians (pediatricians and obstetricians) and nurses working in these hospitals were invited to participate in the study. The study questionnaire assessed the attitude of health professionals toward perinatal death audit and assessed barriers for implementation of perinatal death audit in their hospitals. Results: This study included a total of 84 physicians and 218 nurses working in the 4 selected maternity hospitals. Only 35% (29/84) of physicians and 36.2% (79/218) of nurses reported that perinatal death audit would help to improve the quality of prenatal health care services to a great or very great extent. Lack of time was the first-mentioned barrier for implementing perinatal death audit by both physicians (35/84, 42%) and nurses (80/218, 36.7%). Almost the same proportions of health professionals reported inadequate patient information being documented in hospital records as a barrier. Lack of a health information system was the third-mentioned barrier by health professionals. Fear of having conflicts with the family of the dead baby was reported by almost one-third of physicians and nurses. Only 28% (23/83) of physicians and 16.9% (36/213) of nurses reported that they would like to be involved in perinatal death audit in their health facilities. Conclusions: Health professionals in Jordan had poor attitude toward perinatal death audit. The main barriers for implementing perinatal death audit in Jordanian hospitals were lack of time, inadequate patient information being documented in hospital records, and lack of health information systems. %M 30839277 %R 10.2196/11653 %U http://publichealth.jmir.org/2019/1/e11653/ %U https://doi.org/10.2196/11653 %U http://www.ncbi.nlm.nih.gov/pubmed/30839277 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10804 %T Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study %A Kakarmath,Sujay S %A de Redon,Emily %A Centi,Amanda Jayne %A Palacholla,Ramya %A Kvedar,Joseph %A Jethwani,Kamal %A Agboola,Stephen %+ Partners Connected Health, 25 New Chardon Street, 3rd Floor, Suite 300, Boston, MA, 02114, United States, 1 6177242158, acenti@partners.org %K connected health %K continuous monitoring %K mobile phone %K pediatric %K temperature %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Fever is an important vital sign and often the first one to be assessed in a sick child. In acutely ill children, caregivers are expected to monitor a child’s body temperature at home after an initial medical consult. Fever literacy of many caregivers is known to be poor, leading to fever phobia. In children with a serious illness, the responsibility of periodically monitoring temperature can add substantially to the already stressful experience of caring for a sick child. Objective: The objective of this pilot study was to assess the feasibility of using the iThermonitor, an automated temperature measurement device, for continuous temperature monitoring in postoperative and postchemotherapy pediatric patients. Methods: We recruited 25 patient-caregiver dyads from the Pediatric Surgery Department at the Massachusetts General Hospital (MGH) and the Pediatric Cancer Centers at the MGH and the Dana Farber Cancer Institute. Enrolled dyads were asked to use the iThermonitor device for continuous temperature monitoring over a 2-week period. Surveys were administered to caregivers at enrollment and at study closeout. Caregivers were also asked to complete a daily event-monitoring log. The Generalized Anxiety Disorder-7 item questionnaire was also used to assess caregiver anxiety at enrollment and closeout. Results: Overall, 19 participant dyads completed the study. All 19 caregivers reported to have viewed temperature data on the study-provided iPad tablet at least once per day, and more than a third caregivers did so six or more times per day. Of all participants, 74% (14/19) reported experiencing an out-of-range temperature alert at least once during the study. Majority of caregivers reported that it was easy to learn how to use the device and that they felt confident about monitoring their child’s temperature with it. Only 21% (4/9) of caregivers reported concurrently using a device other than the iThermonitor to monitor their child’s temperature during the study. Continuous temperature monitoring was not associated with an increase in caregiver anxiety. Conclusions: The study results reveal that the iThermonitor is a highly feasible and easy-to-use device for continuous temperature monitoring in pediatric oncology and surgery patients. Trial Registration: ClinicalTrials.gov NCT02410252; https://clinicaltrials.gov/ct2/show/NCT02410252 (Archived by WebCite at http://www.webcitation.org/73LnO7hel) %M 31518304 %R 10.2196/10804 %U http://pediatrics.jmir.org/2018/2/e10804/ %U https://doi.org/10.2196/10804 %U http://www.ncbi.nlm.nih.gov/pubmed/31518304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10647 %T How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study %A Weitzman,Elissa R %A Magane,Kara M %A Wisk,Lauren E %+ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, BCH 3187, Boston, MA, 02115, United States, 1 617 355 3538, elissa.weitzman@childrens.harvard.edu %K aggregate research results %K decision making %K juvenile idiopathic arthritis %K patient engagement %K patient-reported outcome measures %K rheumatic disease %D 2018 %7 21.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Collection of patient-reported outcomes measures (PROs) may augment clinical data and inform health research, improving care, yet approaches to sustaining interest among patient cohorts in research participation are needed. One approach may involve returning aggregate research results (ARRs), which may help patients contextualize personal experiences, prompt conversations with providers or family, and encourage information seeking. This model has been demonstrated for Web-based patient-centered registries. Studies with clinical cohorts may further elucidate the model, its impacts on interest in research participation and planned actions, and potential for participants to experience this as helpful or harmful—gap areas. Objective: We sought to investigate the impacts of returning ARRs comprising summaries of PROs and clinical metrics to parents of children with rheumatic disease, assessing interest in future research participation among parents who viewed ARRs and plans for acting on returned information. Further, we sought to investigate reactions to viewing ARRs and how these reactions impacted planned actions. Methods: Clinical and PRO data were obtained about children in a national clinical disease registry, summarized, and processed into annotated infographics, comprising ARRs for children’s parents. Parents who viewed ARRs (n=111) were surveyed about the information’s perceived value and their reactions. Reaction patterns were summarized using principal components analysis (PCA), and associations among reaction patterns and interest in research participation and planned actions were estimated using multivariate logistic regression. Results: Parental endorsement of the value of ARRs for understanding their child’s condition and making care decisions was high (across 10 topics for which ARRs were shared, 42.2%-77.3% of the parents reported information was “very valuable”). Most (58/111, 52.3%) parents reported being more interested in participating in research after viewing ARRs, with the remainder reporting that their interest levels were unchanged. Reactions to viewing ARRs reflected experiencing validation/affirmation and information burden based on PCA. Reactions were not associated with child demographic or clinical characteristics and PROs, except that parents from households with less education reported greater information burden than those from more educated households (P=.007). In adjusted models, parents with higher validation/affirmation scores had increased odds of reporting heightened interest in research participation (adjusted odds ratio [AOR] 1.97, 95% CI 1.18-3.30), while higher information burden scores were associated with decreased odds of planned discussions with their child (AOR 0.59, 95% CI 0.36-0.95) and increased odds of planned discussions with providers (AOR 1.75, 95% CI 1.02-3.00). Conclusions: Returning ARRs may foster a “virtuous cycle” of research engagement, especially where ARRs are experienced favorably and affect plans to share and discuss ARRs in support of a child’s chronic disease care and treatment. Reactions to ARRs vary with education level, underscoring the need for attention to equity for this model. %M 30578228 %R 10.2196/10647 %U http://www.jmir.org/2018/12/e10647/ %U https://doi.org/10.2196/10647 %U http://www.ncbi.nlm.nih.gov/pubmed/30578228 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e10363 %T A Novel Smartphone App to Support Learning and Maintaining Competency With Bier Blocks for Pediatric Forearm Fracture Reductions: Protocol for a Mixed-Methods Study %A Burstein,Brett %A Bretholz,Adam %+ Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada, 1 514 412 4400 ext 24757, adambretholzmd@gmail.com %K intravenous regional anesthesia %K lidocaine %K procedural sedation %K mobile phone %D 2018 %7 21.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Distal forearm fractures are among the most common injuries presenting to the pediatric emergency department (PED). Bier block (BB), or intravenous regional anesthesia, is a safe and effective alternative to procedural sedation for closed reduction of forearm fractures; it is associated with fewer adverse events, a shorter length of stay, and reduced costs. BB has long remained relatively underutilized; however, with an increasing emphasis on efficient resource use and patient-centered care, there is renewed interest in this technique. Objective: Our tertiary PED recently became the first in Canada to successfully implement an active BB program. Subsequently, we developed a mobile BB smartphone app designed to support the sustained departmental use of BB. The app can be used for training and maintenance of competency and incorporates instructional material, as well as our institutional BB protocol, printable medication order sheets, and monitoring forms. The present report describes the development and functionality of the BB smartphone app. Methods: We have described app development and content. App dissemination metrics will be tracked, and user feedback will be analyzed using a self-administered electronic survey. Additionally, app utilization in our PED will be compared with real-world clinical use of BB for fracture reductions. Results: The first iteration of the BB app was launched in 2015, with the most recent update in September 2018. App metric tracking is planned for January 2020 until December 2021. Conclusions: We have highlighted how the BB app serves as a paradigm of an educational tool designed not only for individual users but also for supporting the department-wide implementation and dissemination of a new technique. App dissemination and use metrics will be tracked and correlated with clinical use of BB in the PED. International Registered Report Identifier (IRRID): PRR1-10.2196/10363 %M 30578214 %R 10.2196/10363 %U http://www.researchprotocols.org/2018/12/e10363/ %U https://doi.org/10.2196/10363 %U http://www.ncbi.nlm.nih.gov/pubmed/30578214 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11447 %T An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation %A Pham,Quynh %A Graham,Gary %A Lalloo,Chitra %A Morita,Plinio P %A Seto,Emily %A Stinson,Jennifer N %A Cafazzo,Joseph A %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, Suite 425, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 (416) 340 4800 ext 4765, q.pham@mail.utoronto.ca %K analytics %K engagement %K log data %K mobile health %K mobile apps %K chronic disease %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions. Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions. Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain. Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented. Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care. %M 30578179 %R 10.2196/11447 %U http://mhealth.jmir.org/2018/12/e11447/ %U https://doi.org/10.2196/11447 %U http://www.ncbi.nlm.nih.gov/pubmed/30578179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e295 %T Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review %A Sasangohar,Farzan %A Davis,Elise %A Kash,Bita A %A Shah,Sohail R %+ Industrial and Systems Engineering, Department of Environmental and Occupational Health, Texas A&M University, 101 Bizzell Street, College Station, TX, 77843, United States, 1 979 458 2337, sasangohar@tamu.edu %K neonatal %K pediatric %K remote patient monitoring %K telehealth %K telemedicine %D 2018 %7 20.12.2018 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine and telehealth solutions are emerging rapidly in health care and have the potential to decrease costs for insurers, providers, and patients in various settings. Pediatric populations that require specialty care are disadvantaged socially or economically or have chronic health conditions that will greatly benefit from results of studies utilizing telemedicine technologies. This paper examines the emerging trends in pediatric populations as part of a systematic literature review and provides a scoping review of the type, extent, and quantity of research available. Objective: This paper aims to examine the role of remote patient monitoring (RPM) and telemedicine in neonatal and pediatric settings. Findings can be used to identify strengths, weaknesses, and gaps in the field. The identification of gaps will allow for interventions or research to improve health care quality and costs. Methods: A systematic literature review is being conducted to gather an adequate amount of relevant research for telehealth in pediatric populations. The fields of RPM and telemedicine are not yet very well established by the health care services sector, and definitions vary across health care systems; thus, the terms are not always defined similarly throughout the literature. Three databases were scoped for information for this specific review, and 56 papers were included for review. Results: Three major telemedicine trends emerged from the review of 45 relevant papers—RPM, teleconsultation, and monitoring patients within the hospital, but without contact—thus, decreasing the likelihood of infection or other adverse health effects. Conclusions: While the current telemedicine approaches show promise, limited studied conditions and small sample sizes affect generalizability, therefore, warranting further research. The information presented can inform health care providers of the most widely implemented, studied, and effective forms of telemedicine for patients and their families and the telemedicine initiatives that are most cost efficient for health systems. While the focus of this review is to summarize some telehealth applications in pediatrics, we have also presented research studies that can inform providers about the importance of data sharing of remote monitoring data between hospitals. Further reports will be developed to inform health systems as the systematic literature review continues. %M 30573451 %R 10.2196/jmir.9403 %U http://www.jmir.org/2018/12/e295/ %U https://doi.org/10.2196/jmir.9403 %U http://www.ncbi.nlm.nih.gov/pubmed/30573451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10165 %T Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study %A Kaskinen,Anu %A Ayeboa-Sallah,Benjamin %A Teivaanmäki,Tiina %A Wärnhjelm,Elina %A Korhonen,Liisa %A Helve,Otto %+ Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PB 347, Helsinki, 00029 HUS, Finland, 358 94711, anu.kaskinen@helsinki.fi %K chat service %K health information %K internet %K Web-based resources %K pediatrics %K social media %D 2018 %7 14.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Pediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians. Objective: Our aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers’ questions, and whether further face-to-face medical contact was needed. Methods: In September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later. Results: The age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers’ questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians’ answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers’ main concern was infection was not found to be associated with whether caregivers considered physicians’ answers helpful or not. However, physicians felt more capable of answering caregivers’ questions when the main concern was infection. Conclusions: Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child’s health or illness. %M 30552087 %R 10.2196/10165 %U https://www.jmir.org/2018/12/e10165/ %U https://doi.org/10.2196/10165 %U http://www.ncbi.nlm.nih.gov/pubmed/30552087 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10463 %T Fertility Preservation in Children and Adolescents With Cancer: Pilot of a Decision Aid for Parents of Children and Adolescents With Cancer %A Allingham,Catherine %A Gillam,Lynn %A McCarthy,Maria %A Zacharin,Margaret %A Jayasuriya,Sadunee %A Heloury,Yves %A Orme,Lisa %A Sullivan,Michael %A Peate,Michelle %A Jayasinghe,Yasmin %+ Department of Obstetrics & Gynaecology, The Royal Women’s Hospital, University of Melbourne, 20 Flemington Road, Parkville, 3152, Australia, 61 38345 3721, yasmin.jayasinghe@unimelb.edu.au %K adolescent %K cancer %K decision aid %K fertility preservation %K pediatric %K shared decision making %K Values Clarification Exercise %D 2018 %7 28.11.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Future infertility is a significant concern for survivors of childhood and adolescent cancer. Children and adolescents may have the opportunity to undergo fertility preservation (FP) procedures (which preserve gonadal tissue or gametes for future use) prior to the cancer treatment. However, the decision is very complex, as it is often made by parents as proxy decision makers at the time of cancer diagnosis, and is time-sensitive (needing to occur before the cancer treatment begins). Furthermore, FP procedures in children and adolescents are experimental and cannot guarantee future fertility. An uninformed decision may result in future decision regret. Objective: This study aimed to assess the acceptability, usability, and feasibility of a Web-based FP decision aid (DA) in parents of children and adolescents with cancer and clinicians. Fertility knowledge and decision regret were compared in families who reviewed the DA compared with those who did not. Methods: The Web-based DA was developed according to the International Patient Decision Aid Standards. A cross-sectional study of parents of patients with cancer, who discussed fertility, and clinicians at a tertiary children’s hospital was undertaken. The acceptability, usability, and feasibility of the DA were assessed using a pre-post survey design. Measures included the validated Decision Regret Scale, a purpose-designed fertility-related knowledge scale, questions regarding satisfaction with the DA, and open-ended responses for additional feedback. Furthermore, clinicians involved in FP were also invited to review the DA. Results: We enrolled 34 parents and 11 clinicians in this study. Participants who reviewed the DA (15 parents and 11 clinicians) expressed satisfaction with its content and functionality. Parents reported an improved understanding of cancer treatments, infertility, and FP procedures and did not report greater decision regret after DA review. Most parents (13/15, 86%) would recommend the DA to other parents. All clinicians had a consensus that this was a valid and relevant information source for all involved in fertility care. Conclusions: It is an international standard of care to discuss the impact of cancer treatment on fertility before cancer treatment. This is the first fertility DA for parents of children and adolescents with cancer and is found to be relevant and acceptable by parents and clinicians. This DA has the potential to help support parents to make informed fertility-related decisions for their children and adolescents. However, future research is needed to assess the impact of the DA on prospective decision making. %M 31518288 %R 10.2196/10463 %U http://pediatrics.jmir.org/2018/2/e10463/ %U https://doi.org/10.2196/10463 %U http://www.ncbi.nlm.nih.gov/pubmed/31518288 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 2 %P e10307 %T A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation %A Levac,Danielle %A Dumas,Helene M %A Meleis,Waleed %+ Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States, 1 6173735198, d.levac@northeastern.edu %K equipment design %K rehabilitation %K pediatrics %K tablets %K software %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. %M 30478025 %R 10.2196/10307 %U http://rehab.jmir.org/2018/2/e10307/ %U https://doi.org/10.2196/10307 %U http://www.ncbi.nlm.nih.gov/pubmed/30478025 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11402 %T Telehealth Services for Children With Autism Spectrum Disorders in Rural Areas of the Kingdom of Saudi Arabia: Overview and Recommendations %A Alkhalifah,Shahad %A Aldhalaan,Hesham %+ Centre for Autism Research, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia, 966 14647272 ext 70723, shahad.alkh@gmail.com %K autism spectrum disorders %K intervention %K Saudi Arabia %K telehealth %D 2018 %7 15.11.2018 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Autism spectrum disorders (ASD) are the most-prevalent neurodevelopmental disorders. However, each child diagnosed with ASD presents with a unique range of behavioral and communication problems and issues with social skills. Many studies have highlighted the importance of early interventions for children with ASD to improve their skills and provide their families with the necessary support. However, in the Kingdom of Saudi Arabia (KSA), the earliest that a child with ASD in the major cities receives an intervention is at the age of 4 years, owing to limited services and a lack of awareness of the importance and benefits of early interventions. Families who live in rural areas of KSA arguably have a greater need for these services, as they have to travel to cities such as Riyadh for help. The use of telehealth services may be effective for ASD intervention among children living in rural areas, since such services use technology to provide consultations, interventions, diagnosis, training, and education. Research indicates that telehealth services are as valuable as traditional face-to-face treatment, allow families to obtain support from their homes, and help them improve their quality of life. This review will discuss the application of telehealth services to support families in rural areas of KSA who are dealing with issues of ASD, considering the cultural and religious contexts. In addition, it will examine ways in which technology can be employed to suit KSA’s culture and needs. %M 31518306 %R 10.2196/11402 %U http://pediatrics.jmir.org/2018/2/e11402/ %U https://doi.org/10.2196/11402 %U http://www.ncbi.nlm.nih.gov/pubmed/31518306 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e10498 %T Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis %A Luo,Gang %A Johnson,Michael D %A Nkoy,Flory L %A He,Shan %A Stone,Bryan L %+ Department of Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K appropriate hospital admission %K bronchiolitis %K emergency department %K operational definition %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Bronchiolitis is the leading cause of hospitalization in children under 2 years of age. Each year in the United States, bronchiolitis results in 287,000 emergency department visits, 32%-40% of which end in hospitalization. Frequently, emergency department disposition decisions (to discharge or hospitalize) are made subjectively because of the lack of evidence and objective criteria for bronchiolitis management, leading to significant practice variation, wasted health care use, and suboptimal outcomes. At present, no operational definition of appropriate hospital admission for emergency department patients with bronchiolitis exists. Yet, such a definition is essential for assessing care quality and building a predictive model to guide and standardize disposition decisions. Our prior work provided a framework of such a definition using 2 concepts, one on safe versus unsafe discharge and another on necessary versus unnecessary hospitalization. Objective: The goal of this study was to determine the 2 threshold values used in the 2 concepts, with 1 value per concept. Methods: Using Intermountain Healthcare data from 2005-2014, we examined distributions of several relevant attributes of emergency department visits by children under 2 years of age for bronchiolitis. Via a data-driven approach, we determined the 2 threshold values. Results: We completed the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis. Appropriate hospital admissions include actual admissions with exposure to major medical interventions for more than 6 hours, as well as actual emergency department discharges, followed by an emergency department return within 12 hours ending in admission for bronchiolitis. Based on the definition, 0.96% (221/23,125) of the emergency department discharges were deemed unsafe. Moreover, 14.36% (432/3008) of the hospital admissions from the emergency department were deemed unnecessary. Conclusions: Our operational definition can define the prediction target for building a predictive model to guide and improve emergency department disposition decisions for bronchiolitis in the future. %M 30401659 %R 10.2196/10498 %U http://medinform.jmir.org/2018/4/e10498/ %U https://doi.org/10.2196/10498 %U http://www.ncbi.nlm.nih.gov/pubmed/30401659 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e186 %T A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study %A Yimtae,Kwanchanok %A Israsena,Pasin %A Thanawirattananit,Panida %A Seesutas,Sangvorn %A Saibua,Siwat %A Kasemsiri,Pornthep %A Noymai,Anukool %A Soonrach,Tharapong %+ National Electronics and Computer Technology Center, National Science and Technology Development Agency, 112 Thailand Science Park, Klong Luang, Pathumthani, Thailand, 66 5646900, pasin.israsena@nectec.or.th %K hearing screening %K mobile health %K speech audiometry %K hearing loss %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective: This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods: An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results: For screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes). Conclusions: This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages. %M 30355558 %R 10.2196/mhealth.9560 %U http://mhealth.jmir.org/2018/10/e186/ %U https://doi.org/10.2196/mhealth.9560 %U http://www.ncbi.nlm.nih.gov/pubmed/30355558 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 3 %P e10655 %T Phase I of the Detecting and Evaluating Childhood Anxiety and Depression Effectively in Subspecialties (DECADES) Study: Development of an Integrated Mental Health Care Model for Pediatric Gastroenterology %A Hullmann,Stephanie E %A Keller,Stacy A %A Lynch,Dustin O %A Jenkins,Kelli %A Moore,Courtney %A Cockrum,Brandon %A Wiehe,Sarah E %A Carroll,Aaron E %A Bennett Jr,William E %+ Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, HITS Building, Indianapolis, IN, 46202, United States, 1 3172786928, webjr@iu.edu %K qualitative research %K patient-reported outcomes %K depression %K anxiety %D 2018 %7 10.09.2018 %9 Original Paper %J J Participat Med %G English %X Background: Children with gastrointestinal symptoms have a very high rate of anxiety and depression. Rapid identification of comorbid anxiety and depression is essential for effective treatment of a wide variety of functional gastrointestinal disorders. Objective: The objective of our study was to determine patient and parent attitudes toward depression, anxiety, and mental health screening during gastroenterology (GI) visits and to determine patient and parent preferences for communication of results and referral to mental health providers after a positive screen. Methods: We augmented standard qualitative group session methods with patient-centered design methods to assess patient and parent preferences. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: Overall, 11 families (11 patients and 14 parents) participated in 2 group sessions. Overall, patients and their parents found integrated mental health care to be acceptable in the subspecialty setting. Patients’ primary concerns were for the privacy and confidentiality of their screening results. Patients and their parents emphasized the importance of mental health services not interfering with the GI visit and collaboration between the GI physician, psychologist, and primary care provider. Conclusions: Patients and their families are open to integrated mental health care in the pediatric subspecialty clinic. The next phase of the DECADES study will translate patient and parent preferences into an integrated mental health care system and test its efficacy in the pediatric GI office. %R 10.2196/10655 %U http://jopm.jmir.org/2018/3/e10655/ %U https://doi.org/10.2196/10655 %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 %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e169 %T Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences %A Wexler,Catherine %A Brown,Melinda %A Hurley,Emily A %A Ochieng,Martin %A Goggin,Kathy %A Gautney,Brad %A Maloba,May %A Lwembe,Raphael %A Khamadi,Samoel %A Finocchario-Kessler,Sarah %+ Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS,, United States, 1 913 945 7077, cwexler@kumc.edu %K early infant diagnosis (EID) %K HIV/AIDS %K eHealth %K mHealth %K implementation science %K Kenya %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) %M 30135052 %R 10.2196/mhealth.9725 %U http://mhealth.jmir.org/2018/8/e169/ %U https://doi.org/10.2196/mhealth.9725 %U http://www.ncbi.nlm.nih.gov/pubmed/30135052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e239 %T Creating Low-Cost 360-Degree Virtual Reality Videos for Hospitals: A Technical Paper on the Dos and Don’ts %A O’Sullivan,Benjamin %A Alam,Fahad %A Matava,Clyde %+ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, 555 University Ave, Toronto, ON,, Canada, 1 8137445, clyde.matava@sickkids.ca %K 360-degree video %K VR %K virtual reality %K video production %K anesthetic preparation %K preoperative anxiety %K preoperative preparation %D 2018 %7 16.07.2018 %9 Tutorial %J J Med Internet Res %G English %X This article will provide a framework for producing immersive 360-degree videos for pediatric and adult patients in hospitals. This information may be useful to hospitals across the globe who may wish to produce similar videos for their patients. Advancements in immersive 360-degree technologies have allowed us to produce our own “virtual experience” where our children can prepare for anesthesia by “experiencing” all the sights and sounds of receiving and recovering from an anesthetic. We have shown that health care professionals, children, and their parents find this form of preparation valid, acceptable and fun. Perhaps more importantly, children and parents have self-reported that undertaking our virtual experience has led to a reduction in their anxiety when they go to the operating room. We provide definitions, and technical aspects to assist other health care professionals in the development of low-cost 360-degree videos. %M 30012545 %R 10.2196/jmir.9596 %U http://www.jmir.org/2018/7/e239/ %U https://doi.org/10.2196/jmir.9596 %U http://www.ncbi.nlm.nih.gov/pubmed/30012545 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10958 %T Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment %A Breakey,Vicky R %A Bouskill,Vanessa %A Nguyen,Cynthia %A Luca,Stephanie %A Stinson,Jennifer N %A Ahola Kohut,Sara %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children’s Hospital, HSC 3N27a, 1280 Main Street W, Hamilton, ON, L8S 4K1, Canada, 1 905 521 2100 ext 73080, breakev@mcmaster.ca %K hemophilia %K adolescents %K transition %K self-management %K education %K internet %K mentoring %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia. %M 31518296 %R 10.2196/10958 %U http://pediatrics.jmir.org/2018/2/e10958/ %U https://doi.org/10.2196/10958 %U http://www.ncbi.nlm.nih.gov/pubmed/31518296 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e68 %T Patient and Family Engagement in the Design of a Mobile Health Solution for Pediatric Asthma: Development and Feasibility Study %A McWilliams,Andrew %A Reeves,Kelly %A Shade,Lindsay %A Burton,Elizabeth %A Tapp,Hazel %A Courtlandt,Cheryl %A Gunter,Andrew %A Dulin,Michael F %+ Center for Outcomes Research and Evaluation, Carolinas HealthCare System, Research Office Building, 1540 Garden Terrace, Suite 406, Charlotte, NC, 28203, United States, 1 704 351 6835, andrew.mcwilliams@carolinas.org %K engagement %K pediatric asthma %K shared decision-making %K health information technology %D 2018 %7 22.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Asthma is a highly prevalent, chronic disease with significant morbidity, cost, and disparities in health outcomes. While adherence to asthma treatment guidelines can improve symptoms and decrease exacerbations, most patients receive care that is not guideline-based. New approaches that incorporate shared decision-making (SDM) and health information technology (IT) are needed to positively impact asthma management. Despite the promise of health IT to improve efficiency and outcomes in health care, new IT solutions frequently suffer from a lack of widespread adoption and do not achieve desired results, as a consequence of not involving end-users in design. Objective: To describe a case study of a pediatric asthma SDM health IT solution’s development and demonstrate a methodology for engaging actual patients and families in IT development. Perspectives are shared from the vantage point of the research team and a parent of a child with asthma, who participated on the development team. Methods: We adapted user-centric design principles to engage actual users across three main development phases: project initiation, ideation, and usability testing. To facilitate the necessary level of user engagement, our approach included: (1) a Development Workgroup consisting of patients, caregivers, and providers who met regularly with the research team; and (2) “real-world users” consisting of patients, caregivers, and providers recruited from a variety of care locations, including safety-net clinics. Results: Using this methodology, we successful partnered with asthma patients and families to create an interactive, digital solution called Carolinas Asthma Coach. Carolinas Asthma Coach incorporates SDM principles to elicit patient information, including goals and preferences, and provides health-literate, tailored education with specific guideline-based recommendations for patients and their providers. Of the patients, caregivers, and providers surveyed, 100% (n=60) said they would recommend Carolinas Asthma Coach to a friend or colleague. Qualitative feedback from users provided support for the usability and engaging nature of the app. Conclusions: This project demonstrates the feasibility and benefits of deploying user-centric design methods that engage real patients and caregivers throughout the health IT design process. %M 29567637 %R 10.2196/mhealth.8849 %U http://mhealth.jmir.org/2018/3/e68/ %U https://doi.org/10.2196/mhealth.8849 %U http://www.ncbi.nlm.nih.gov/pubmed/29567637