%0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67877 %T Evidence of Interventions for the Prevention of Unintentional Injuries: Scoping Review %A Shetty,Sheela %A Nayak,Baby S %A George,Anice %A Shetty,Avinash %A Guddattu,Vasudeva %K prevention %K injury %K education %K health %K child %K children %K unintentional injury %K disability %K youth %K surveillance %K surveillance data %K risk factor %K injury intervention %K literature search %K scoping review %K scoping literature review %K policymaker %K preventative measure %K preventive measure %D 2025 %7 28.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Unintentional injuries are the leading cause of death and disability among young children. Preventive strategies for unintentional injuries are mainly based on surveillance data and identifying risk factors. Objective: This study aimed to review and synthesize published literature that determined the effectiveness of interventions for preventing unintentional injuries among children. Methods: The methodological framework was supported by The Joanna Briggs Institute Reviewer’s Manual – Methodology for JBI Scoping Reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The inclusion criteria to include the studies in the review were unintentional injuries in children, interventions to prevent injuries, a brief description of the intervention and the outcome of the intervention, and articles published in a peer-reviewed journal and written in the English language. Results: In total, 21 articles were included in the review following the systematic search of key databases such as Web of Science, PubMed/MEDLINE, Scopus, ScienceDirect, and gray literature for studies published between July 2013 and May 2023. Of the 21 articles, 16 were randomized controlled trials, 4 were nonrandomized controlled trials, and 1 was a mixed method study. The findings of the review showed that interventions, either as a single measure (video-based teaching, testimonial story-based teaching, health education, storybook reading) or in combination (knowledge quiz and simulation test, module-based teaching along with personal counseling, and teaching with the help of video and poster), have shown a considerable decline in the number and severity of injuries. The studies included various target populations, including children and adolescents between 0 and 19 years old. Conclusions: The review results indicate the need to plan, implement, and reinforce preventive measures and techniques to reduce unintentional injuries among children. They can also serve as a useful indicator for policymakers. %R 10.2196/67877 %U https://pediatrics.jmir.org/2025/1/e67877 %U https://doi.org/10.2196/67877 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57325 %T Fact or Fiction—Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study %A DeMatteo,Carol %A Randall,Sarah %A Jakubowski,Josephine %A Stazyk,Kathy %A Obeid,Joyce %A Noseworthy,Michael %A Mazurek,Michael %A Timmons,Brian W %A Connolly,John %A Giglia,Lucia %A Hall,Geoffrey %A Lin,Chia-Yu %A Perrotta,Samantha %K pediatric concussion %K guidelines %K adherence %K return to school %K return to sport %K actigraphy %D 2024 %7 9.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1‐17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population. Objective: This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury. Methods: Children and youth (N=139) aged 5‐18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution. Results: For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3). Conclusions: Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols. %R 10.2196/57325 %U https://pediatrics.jmir.org/2024/1/e57325 %U https://doi.org/10.2196/57325 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e54623 %T Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial %A Li,Yun %A Xiao,Qiuli %A Chen,Min %A Jiang,Chunhua %A Kang,Shurong %A Zhang,Ying %A Huang,Jun %A Yang,Yulin %A Li,Mu %A Jiang,Hong %K health literacy %K WeChat %K cluster randomized controlled trial %K RCT %K randomized %K controlled trial %K controlled trials %K parental %K parenting %K parents %K parent %K China %K Chinese %K mHealth %K mobile health %K app %K apps %K applications %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K toddler %K toddlers %D 2024 %7 4.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Parental health literacy is important to children’s health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)–based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children’s health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention’s effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children’s health outcomes. Furthermore, despite slight subgroup differences in the intervention’s effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model–based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740 %R 10.2196/54623 %U https://publichealth.jmir.org/2024/1/e54623 %U https://doi.org/10.2196/54623 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55280 %T Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation %A McGrane Minton,Heather %A Murray,Linda %A Allan,Marjorie J %A Perry,Roslyn %A Bettencourt,Amie F %A Gross,Deborah %A Strano,Lauri %A Breitenstein,Susan M %+ College of Nursing, The Ohio State University, 1577 Neil Ave., Columbus, OH, 43210, United States, 1 6146884614, breitenstein.5@osu.edu %K COVID-19 %K implementation %K internet-based intervention %K parenting %K community dissemination %K hybrid delivery %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. Objective: This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. Methods: This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. Results: In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child’s behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Conclusions: Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed. %M 38959504 %R 10.2196/55280 %U https://pediatrics.jmir.org/2024/1/e55280 %U https://doi.org/10.2196/55280 %U http://www.ncbi.nlm.nih.gov/pubmed/38959504 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e47361 %T Exploring the Potential of a Behavior Theory–Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study %A Cooray,Nipuna %A Ho,Catherine %A Bestman,Amy %A Adams,Susan %A Nassar,Natasha %A Keay,Lisa %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, 2000, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K digital behavior change interventions %K user experience %K falls %K infant fall %K injury %K mobile app %K digital intervention %K users %K mixed methods longitudinal study %K behavior %K development %K fall risk %K fall prevention %K acceptability %K app %K children %K internet %K parents %K maternal, paternal %K accidents %K infancy %K infant %K accidental fall %K accidental falls %K infant behavior %K longitudinal design %K mixed methods %K parent %K mobile phone %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. Objective: This study aims to evaluate a behavior theory–informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. Methods: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. Results: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. Conclusions: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app. %M 38170580 %R 10.2196/47361 %U https://pediatrics.jmir.org/2024/1/e47361 %U https://doi.org/10.2196/47361 %U http://www.ncbi.nlm.nih.gov/pubmed/38170580 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34413 %T Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study %A Cooray,Nipuna %A Sun,Si Louise %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1 King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K falls %K child injury %K online discussion forums %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. Objective: The objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. Methods: Online parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. Results: We identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. Conclusions: The findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior. %M 35536607 %R 10.2196/34413 %U https://pediatrics.jmir.org/2022/2/e34413 %U https://doi.org/10.2196/34413 %U http://www.ncbi.nlm.nih.gov/pubmed/35536607 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29731 %T Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study %A Cooray,Nipuna %A Sun,Si Louise %A Ho,Catherine %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1, King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K Behaviour Change Wheel %K mobile app %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach. %M 34932004 %R 10.2196/29731 %U https://pediatrics.jmir.org/2021/4/e29731 %U https://doi.org/10.2196/29731 %U http://www.ncbi.nlm.nih.gov/pubmed/34932004 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28931 %T Perceptions of Alerts Issued by Social Media Platforms in Response to Self-injury Posts Among Latinx Adolescents: Qualitative Analysis %A Laestadius,Linnea I %A Craig,Katherine A %A Campos-Castillo,Celeste %+ Zilber School of Public Health, University of Wisconsin-Milwaukee, P O Box 413, Milwaukee, WI, 53201, United States, 1 414 251 5607, llaestad@uwm.edu %K adolescents %K social media %K mental health %K NSSI %K race and ethnicity %K mobile phone %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing interest in using social media data to detect and address nonsuicidal self-injury (NSSI) among adolescents. Adolescents often do not seek clinical help for NSSI and may adopt strategies to obscure detection; therefore, social media platforms may be able to facilitate early detection and treatment by using machine learning models to screen posts for harmful content and subsequently alert adults. However, such efforts have raised privacy and ethical concerns among health researchers. Little is currently known about how adolescents perceive these efforts. Objective: The aim of this study is to examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents, who are at risk for NSSI yet are underrepresented in both NSSI and health informatics research. In addition, we considered their perspectives on preferred recipients of automated alerts. Methods: We conducted semistructured, qualitative interviews with 42 Latinx adolescents between the ages of 13 and 17 years who were recruited from a nonprofit organization serving the Latinx community in Milwaukee, Wisconsin. The Latinx population in Milwaukee is largely of Mexican descent. All interviews were conducted between June and July 2019. Transcripts were analyzed using framework analysis to discern their perceptions of automated alerts sent by social media platforms and potential alert recipients. Results: Participants felt that automated alerts would make adolescents safer and expedite aid before the situation escalated. However, some worried that hyperbolic statements would generate false alerts and instigate conflicts. Interviews revealed strong opinions about ideal alert recipients. Parents were most commonly endorsed, but support was conditional on perceptions that the parent would respond appropriately. Emergency services were judged as safer but inappropriate for situations considered lower risk. Alerts sent to school staff generated the strongest privacy concerns. Altogether, the preferred alert recipients varied by individual adolescents and perceived risks in the situation. None raised ethical concerns about the collection, analysis, or storage of personal information regarding their mental health status. Conclusions: Overall, Latinx adolescents expressed broad support for automated alerts for NSSI on social media, which indicates opportunities to address NSSI. However, these efforts should be co-constructed with adolescents to ensure that preferences and needs are met, as well as embedded within broader approaches for addressing structural and cultural barriers to care. %M 34383683 %R 10.2196/28931 %U https://www.jmir.org/2021/8/e28931 %U https://doi.org/10.2196/28931 %U http://www.ncbi.nlm.nih.gov/pubmed/34383683 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24156 %T Perceptions and Acceptability of a Smartphone App Intervention (ChildSafe) in Malaysia: Qualitative Exploratory Study %A Yong,Teresa Sui Mien %A Perialathan,Komathi %A Ahmad,Masitah %A Juatan,Nurashma %A Abdul Majid,Liana %A Johari,Mohammad Zabri %+ Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, No 1, Jalan Setia Murni U13/52, Section U13, Shah Alam, 40170, Malaysia, 60 333627600 ext 8612, teresa_yong@yahoo.co.uk %K child safety %K unintentional injuries %K consolidated framework for implementation research (CFIR) %K characteristics of individuals %K Mobile App Rating Scale (MARS) %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective: This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods: This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results: The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions: Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians. %M 34061039 %R 10.2196/24156 %U https://pediatrics.jmir.org/2021/2/e24156 %U https://doi.org/10.2196/24156 %U http://www.ncbi.nlm.nih.gov/pubmed/34061039 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24861 %T A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers’ Tolerance for, and Parenting Practices Associated With, Children’s Outdoor Risky Play: Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Lin,Yingyi %A Jacob,John %A Pike,Ian %A Bundy,Anita %A Faulkner,Guy %A Gardy,Jennifer %A Fisher,Brian %A Mâsse,Louise %+ Department of Pediatrics, Faculty of Medicine, University of British Columbia, F508 – 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada, 1 6048753712, mbrussoni@bcchr.ubc.ca %K outdoor play %K mothering %K independent mobility %K physical activity %K risk perception %K risky play %K risk reframing %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. Objective: The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. Methods: The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. Results: A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. Conclusions: The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial Registration: ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2552-4 %M 33904820 %R 10.2196/24861 %U https://www.jmir.org/2021/4/e24861 %U https://doi.org/10.2196/24861 %U http://www.ncbi.nlm.nih.gov/pubmed/33904820 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25805 %T Food Allergy Symptom Self-Management With Technology (FASST) mHealth Intervention to Address Psychosocial Outcomes in Caregivers of Children With Newly Diagnosed Food Allergy: Protocol for a Pilot Randomized Controlled Trial %A Broome,Brantlee %A Madisetti,Mohan %A Prentice,Margaret %A Williams,Kelli Wong %A Kelechi,Teresa %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, United States, 1 843 792 3370, broomeb@musc.edu %K caregiver well-being %K food allergy %K self-management %K mhealth, randomizes mixed trial %K caregiver %K well-being %K emergency room %K smartphone app %K smartphone %K children %D 2021 %7 3.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 2.4 million children in the United States suffer from food-induced anaphylaxis, a condition that is annually responsible for over 200 deaths and 200,000 emergency room visits. As a result, caregivers of children newly diagnosed with severe and life-threatening food allergic reactions experience clinically significant symptoms of psychological distress, including fatigue, anxiety, depressed mood, social isolation, and substantially reduced quality of life. Despite this recognition, there is a lack of caregiver-centered self-management interventions to address these concerns. Objective: In this protocol, we propose to develop and conduct feasibility testing of a technology-enhanced, self-management, mobile health, smartphone app intervention called Food Allergy Symptom Self-Management with Technology for Caregivers (FASST) designed to meet the psychosocial health needs of caregivers of children with a new diagnosis of food allergy. Methods: This pilot study uses qualitative work (Phase I) to inform a 4-week longitudinal randomized controlled trial (Phase II). In Phase I, 10 caregivers of children (≤18 years old) with established food allergy (≥1 year from diagnosis) will participate in semistructured interviews to inform the development of the FASST app. In Phase II, 30 caregivers of children (≤18 years old) with a newly diagnosed food allergy (≤90 days from diagnosis) will be randomized 2:1 to receive the FASST intervention (n=20) or control condition (basic app with educational resources; n=10). Process measures include feasibility, caregiver acceptability, adherence, and satisfaction. Outcome measures include caregiver fatigue, anxiety, depression, sleep, self-efficacy, and quality of life measured at baseline, week 4, and 3 months post study completion. Results: Phase I study activities have been completed, and Phase II participant enrollment into the randomized controlled trial is expected to commence in 2021. Conclusions: With limited readily available resources at their disposal, the results from this study have the potential to provide caregivers of children with a newly diagnosed food allergy a tool to help them self-manage and mitigate negative psychosocial factors during a critical time period in the caregiving/condition trajectory. Trial Registration: ClinicalTrials.gov Identifier NCT04512924: https://clinicaltrials.gov/ct2/show/NCT04512924 International Registered Report Identifier (IRRID): DERR1-10.2196/25805 %M 33656448 %R 10.2196/25805 %U https://www.researchprotocols.org/2021/3/e25805 %U https://doi.org/10.2196/25805 %U http://www.ncbi.nlm.nih.gov/pubmed/33656448 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25443 %T mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial %A Desrosiers,Alethea %A Schafer,Carolyn %A Esliker,Rebecca %A Jambai,Musu %A Betancourt,Theresa S %+ Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 01778, United States, 1 617 552 8398, alethea.desrosiers@bc.edu %K mHealth %K caregiver mental health %K family functioning %K early childhood development %K community health workers %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective: This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods: We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results: Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions: This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration: ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID): PRR1-10.2196/25443 %M 33528371 %R 10.2196/25443 %U https://www.researchprotocols.org/2021/2/e25443 %U https://doi.org/10.2196/25443 %U http://www.ncbi.nlm.nih.gov/pubmed/33528371 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25474 %T Awareness, Information-Seeking Behavior, and Information Preferences About Early Childhood Allergy Prevention Among Different Parent Groups: Protocol for a Mixed Methods Study %A Lander,Jonas %A Curbach,Janina %A von Sommoggy,Julia %A Bitzer,Eva Maria %A Dierks,Marie-Luise %+ Hanover Medical School, Carl-Neuberg-Str 1, Hanover, 30625, Germany, 49 5115324450, lander.jonas@mh-hannover.de %K health literacy %K allergy prevention %K children %K health information %K parents %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: In early childhood allergy prevention (ECAP), parents act on behalf of their children. Parental health literacy and the availability of high-quality information, both online and offline, are crucial for effective ECAP. Recent research highlights three main points. First, parents need sufficient health literacy to discriminate between high-quality and low-quality information. Second, ECAP information behaviors may vary between phases of childhood development and according to individual circumstances. Third, to strengthen user-centeredness of available services, a better overview of parents’ information practices and needs and how they handle uncertainties is required. Objective: This study aims to explore why, how, and when parents search for and apply ECAP-specific health information and which individual (eg, understanding of advice) and organizational challenges (eg, information services, information complexity, and changing recommendations) they perceive and how they handle them. This study also aims to assess the needs and preferences that parents express for future information formats and contents. The findings should inform the practical design of ECAP information as well as formats and channels specific to different parent groups. Methods: The above-named issues will be explored with parents in four German cities as one element in our efforts to cover the spectrum of perspectives. Based on a mixed methods design, including qualitative and quantitative assessments, the first year serves to prepare focus groups, a piloted focus group guide, a short standardized survey adapted from the European Health Literacy Project, recruitment channels, and the recruitment of participants. After conducting 20 focus groups in the second year, data will be analyzed via a constant comparison method in the third year. Based on this, practice implications on channels (ie, Where?), formats (ie, How?), and contents (ie, What?) of ECAP-specific information will be derived and discussed with parents and associated project partners before its dissemination to relevant ECAP actors (eg, childcare institutions and pediatricians). Results: The study began with preselection of recruitment channels, drafting of recruitment and study information for potential participants, and agreement on a first full version of the guideline. Then, a detailed contact list was compiled of health professionals, administrative and social institutions, and relevant social media channels (N=386) to be approached for assistance in contacting parents. The recruitment was postponed due to COVID-19 and will start in January 2021. Conclusions: ECAP is a relevant example for assessing how users (ie, parents) handle not only health information but the various and continuous changes, uncertainties, and controversies attached to it. So far, it is unclear how parents implement the respective scientific recommendations and expert advice, which is why this study aims to inform those who communicate with parents about ECAP information. International Registered Report Identifier (IRRID): PRR1-10.2196/25474 %M 33470948 %R 10.2196/25474 %U http://www.researchprotocols.org/2021/1/e25474/ %U https://doi.org/10.2196/25474 %U http://www.ncbi.nlm.nih.gov/pubmed/33470948 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e16958 %T SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study %A Hossain,Md Mosharaf %A Mani,Kulanthayan %A Mat Min,Ruhani %+ Safe Kids Malaysia and Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 0397692398, kulan@upm.edu.my %K acceptability %K SMS %K drowning %K parents %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In many cases, greater use is being made of mobile phone text messages as a means of communication between patients and health care providers in countries around the world. Objective: We studied the use of mobile phones and the factors related to the acceptability of text messages for parents for the prevention of child drowning in Bangladesh. Methods: From a randomized controlled trial involving 800 parents, 10% (80/800) were selected, and socioeconomic status, mobile phone use, and acceptability of SMS text messages for drowning prevention were measured. Participants with at least one child under 5 years of age were selected from rural areas in Rajshahi District in Bangladesh. Mobile phone–based SMS text messages were sent to the participants. Multivariate regression was used to determine the factors related to the acceptability of text messages for the prevention of child drowning in Bangladesh. Results: The acceptability of SMS text messages for the prevention of child drowning in Bangladesh was significantly lower among women (odds ratio [OR] 0.50, 95% CI 0.12-1.96, P=.02) than among men, lower for parents older than 30 years (OR 0.17, 95% CI 0.14-1.70, P=.01) compared to parents younger than 30 years, higher among parents who had an education (OR 1.63, 95% CI 1.11-5.80, P=.04) than among illiterate parents, and higher among parents with a monthly household income over 7000 Bangladeshi Taka (approximately US $82.54; OR 1.27, 95% CI 1.06-1.96, P=.05) than among parents whose monthly income was less than 7000 Bangladeshi Taka. Conclusions: The high percentage of mobile phone use and the acceptability of SMS text messages for parents for the prevention of child drowning are encouraging, in terms of identifying the best strategy for using such technologies, and deserve further evaluation. %M 32965224 %R 10.2196/16958 %U http://mhealth.jmir.org/2020/9/e16958/ %U https://doi.org/10.2196/16958 %U http://www.ncbi.nlm.nih.gov/pubmed/32965224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17756 %T A Mobile Game (Safe City) Designed to Promote Children’s Safety Knowledge and Behaviors: Protocol for a Randomized Controlled Trial %A Wong,Rosa S %A Tung,Keith TS %A Wong,Hiu Tung %A Ho,Frederick KW %A Wong,Hing Sang %A Fu,King-Wa %A Pong,Ting Chuen %A Chan,Ko Ling %A Chow,Chun Bong %A Ip,Patrick %+ Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China (Hong Kong), 852 2255 4090, patricip@hku.hk %K serious game %K safety training %K mobile game %K mobile phone %K injury prevention %K randomized controlled trial %K game-based intervention %D 2020 %7 12.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children have high levels of curiosity and eagerness to explore. This makes them more vulnerable to danger and hazards, and they thus have a higher risk of injury. Safety education such as teaching safety rules and tips is vital to prevent children from injuries. Although game-based approaches have the potential to capture children’s attention and sustain their interest in learning, whether these new instructional approaches are more effective than traditional approaches in delivering safety messages to children remains uncertain. Objective: The aim of this study is to test the effectiveness of a game-based intervention in promoting safety knowledge and behaviors among Hong Kong school children in Grades 4-6. It will also examine the potential effect of the game-based intervention on these children’s functioning and psychosocial difficulties. Methods: This study comprises the development of a city-based role-playing game Safe City, where players are immersed as safety inspectors to prevent dangerous situations and promote safety behavior in a virtual city environment. The usability and acceptability tests will be conducted with children in Grades 4-6 who will trial the gameplay on a mobile phone. Adjustments will be made based on their feedback. A 4-week randomized controlled trial with children studying in Grades 4-6 in Hong Kong elementary schools will be conducted to assess the effectiveness of the Safe City game–based intervention. In this trial, 504 children will play Safe City, and 504 children will receive traditional instructional materials (electronic and printed safety information). The evaluation will be conducted using both child self-report and parent proxy-report data. Specifically, child safety knowledge and behaviors will be assessed by a questionnaire involving items on knowledge and behaviors, respectively, for home safety, road safety, and sport-related safety; child functioning will be assessed by PedsQL Generic Core Scales; and psychosocial difficulties will be assessed by the Strength and Difficulties Questionnaire. These questionnaires will be administered at 3 time points: before, 1 month, and 3 months after the intervention. Game usage statistics will also be reviewed. Results: This project was funded in September 2019. The design and development of the Safe City game are currently under way. Recruitment and data collection will begin from September 2020 and will continue up to March 1, 2021. Full analysis will be conducted after the end of the data collection period. Conclusions: If the Safe City game is found to be an effective tool to deliver safety education, it could be used to promote safety in children in the community and upgraded to incorporate more health-related topics to support education and empowerment for the larger public. Trial Registration: ClinicalTrials.gov NCT04096196; https://clinicaltrials.gov/ct2/show/NCT04096196 International Registered Report Identifier (IRRID): PRR1-10.2196/17756 %M 32530436 %R 10.2196/17756 %U http://www.researchprotocols.org/2020/6/e17756/ %U https://doi.org/10.2196/17756 %U http://www.ncbi.nlm.nih.gov/pubmed/32530436 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13519 %T An App-Based Intervention for Caregivers to Prevent Unintentional Injury Among Preschoolers: Cluster Randomized Controlled Trial %A Ning,Peishan %A Cheng,Peixia %A Schwebel,David C %A Yang,Yang %A Yu,Renhe %A Deng,Jing %A Li,Shukun %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K unintentional injury %K preschoolers %K cluster randomized controlled trial %K app %K mobile health %K intervention %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: App-based interventions have the potential to reduce child injury in countries with limited prevention resources, but their effectiveness has not been rigorously examined. Objective: This study aimed to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers. Methods: A 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. Recruitment was conducted through preschools, which were randomly allocated to either the control group (ie, app-based parenting education excluding unintentional injury prevention) or the intervention group (ie, app-based parenting education including unintentional injury prevention). A total of 2920 caregivers of preschoolers aged 3-6 years from 20 preschools in Changsha, China, were recruited offline through the schools. The primary outcome was unintentional injury incidences among preschoolers in the past 3 months; this measure was assessed through an online caregiver-report at the baseline visit and at 3-month and 6-month follow-up visits. Secondary outcome measures included caregivers’ self-reported attitudes and behaviors concerning child supervision during the last week. Generalized estimating equations (GEEs) were used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for sociodemographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat. A per-protocol sensitivity analysis was also conducted. Results: In total, 1980 of the 2920 caregivers completed the study. The mean age of participants was 32.0 years (SD 5.5) and 68.99% (1366/1980) of them were female. During the 6-month follow-up visit, unintentional injury incidence did not change significantly in either group: incidence in the intervention group went from 8.76% (94/1073) to 8.11% (87/1073), P=.59; incidence in the control group went from 9.4% (85/907) to 7.5% (69/907), P=.15. The changes did not differ between the groups (odds ratio [OR] 1.14, 95% CI 0.80-1.62). Changes in the average score in attitude concerning unintentional injury prevention were also similar between the groups (B .05, 95% CI -0.03 to 0.13). Changes in unintentional injury prevention behaviors were greater in the intervention group than in the control group after the intervention (B .87, 95% CI 0.33-1.42). Analyses of individual injury prevention behaviors showed that the intervention reduced three risky behaviors: unsafe feeding of children (OR 0.73, 95% CI 0.60-0.89); incorrectly placing children in cars (OR 0.73, 95% CI 0.57-0.93); and allowing children to ride bicycles, electric bicycles, or motorcycles unsupervised (OR 0.80, 95% CI 0.64-0.99). The intervention also improved scores on three safety-focused behaviors: testing water temperature before giving children a bath (OR 1.26, 95% CI 1.05-1.52); properly storing sharp objects (OR 1.24, 95% CI 1.01-1.52); and safely storing medicines, detergents, and pesticides (OR 1.24, 95% CI 1.02-1.51). Conclusions: The app-based intervention did not reduce unintentional injury incidence among preschoolers but significantly improved caregivers’ safety behaviors. This app-based intervention approach to improve caregiver behaviors surrounding child injury risk offers promise to be modified and ultimately disseminated broadly. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84) International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 %M 31400105 %R 10.2196/13519 %U https://mhealth.jmir.org/2019/8/e13519/ %U https://doi.org/10.2196/13519 %U http://www.ncbi.nlm.nih.gov/pubmed/31400105 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12135 %T A Mobile Phone App for the Self-Management of Pediatric Concussion: Development and Usability Testing %A Sandhu,Harminder %A Wilson,Katherine %A Reed,Nick %A Mihailidis,Alex %+ Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3861, nreed@hollandbloorview.ca %K brain concussion %K safety %K pediatrics %K youth %K children %K self-management %K mild traumatic brain injury %K mobile apps %K mobile health %D 2019 %7 31.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Concussion is a common injury among Canadian children and adolescents that leads to a range of neurobehavioral deficits. However, noticeable gaps continue to exist in the management of pediatric concussion, with poor health outcomes associated with the inadequate application of best practice guidelines. Objective: The aim of this study was to describe the development and assess the usability of a mobile phone app to aid youth in the self-management of concussion. A secondary objective was to assess the usefulness of the app. Methods: An agile user-centered design approach was used to develop the technology, followed by a formative lab-based usability study for assessment and improvement proposals. Youths aged 10 to 18 years with a history of concussion and health care professionals involved in concussion management were recruited. This study included participants performing 12 tasks with the mobile phone app while using the think aloud protocol and the administration of the System Usability Scale (SUS), posttest questionnaire, and a semistructured interview. Results: A mobile phone app prototype called NeuroCare, an easily accessible pediatric concussion management intervention that provides easy access to expert-informed concussion management strategies and helps guide youth in self-managing and tracking their concussion recovery, was developed. A total of 7 youths aged between 10 and 18 years with a history of concussion and 7 health care professionals were recruited. The mean SUS score was 81.9, mean task success rates were greater than 90% for 92% (11/12) of the tasks, 92% (11/12) of tasks had a total error frequency of less than 11 errors, and mean task completion times were less than 2 min for 100% of the tasks. Conclusions: Results suggest that participants rated this app as highly usable, acceptable to users, and that it may be useful in helping youth self-manage concussion. %M 31152527 %R 10.2196/12135 %U http://humanfactors.jmir.org/2019/2/e12135/ %U https://doi.org/10.2196/12135 %U http://www.ncbi.nlm.nih.gov/pubmed/31152527 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12022 %T Qualitative and Quantitative Evaluation of the Make Safe Happen App: Mobile Technology–Based Safety Behavior Change Intervention for Parents %A Roberts,Kristin J %A McAdams,Rebecca J %A Kristel,Orie V %A Szymanski,Alison M %A McKenzie,Lara B %+ Center for Injury Research and Policy, The Research Institute, Nationwide Children’s Hospital, Research Building III, 5th Floor, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 355 5858, kristin.roberts@nationwidechildrens.org %K smartphone %K mobile phone %K mobile app %K parents %K focus groups %K technology %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with proper injury prevention information that is easily accessible may help them make their homes safer for children. Objective: The aim of this study was to evaluate parental injury prevention awareness and home safety behaviors, motivations for and challenges to taking injury prevention and safety actions for parents as well as user experience following the use of the Make Safe Happen mobile app. Methods: A total of 40 parents with children aged 0-12 years living in Columbus, Ohio, participated in 1 of 5 focus group discussions following the completion of (1) a pretest survey, (2) use of the Make Safe Happen app, and (3) a posttest survey. Results: Following the use of the Make Safe Happen app, parents reported a significant increase in injury prevention awareness and completed 45% more home safety behaviors in and around their homes. Nearly all of the parents felt the app provided them with the information needed to make their home safer for their children; the great majority of parents intended to make such changes in the future. Conclusions: The combination of qualitative and quantitative data collection allowed for rich data capture and provided a deeper understanding of parents’ safety knowledge, behaviors, app use, and decision making regarding child injury prevention in and around the home. The Make Safe Happen app provides the information and motivation parents and caregivers need to help them take steps to prevent child injuries that may occur in and around their homes. %M 31518322 %R 10.2196/12022 %U http://pediatrics.jmir.org/2019/1/e12022/ %U https://doi.org/10.2196/12022 %U http://www.ncbi.nlm.nih.gov/pubmed/31518322