%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69425 %T Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial %A Seiterö,Anna %A Henriksson,Pontus %A Thomas,Kristin %A Henriksson,Hanna %A Löf,Marie %A Bendtsen,Marcus %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Linköping, SE-58183, Sweden, 46 700895376, anna.seitero@liu.se %K mHealth %K multiple behavior %K high school students %K digital behavior change intervention %K public health %K telemedicine %K randomized controlled trial %D 2025 %7 22.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI –0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 %M 40262133 %R 10.2196/69425 %U https://www.jmir.org/2025/1/e69425 %U https://doi.org/10.2196/69425 %U http://www.ncbi.nlm.nih.gov/pubmed/40262133 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63378 %T Evaluating a Web-Based Application to Facilitate Family-School-Health Care Collaboration for Children With Neurodevelopmental Disorders in Inclusive Settings: Protocol for a Nonrandomized Trial %A Meyer,Eric %A Sauzéon,Hélène %A Saint-Supery,Isabeau %A Mazon,Cecile %+ Flowers team-project, Inria Research Center of the University of Bordeaux, 200 Avenue de la Vieille Tour, Talence Cedex, 33405, France, 33 0524574000, cecile.mazon@inria.fr %K neurodevelopmental disorders %K coeducation %K whole-school approach %K family-professional partnership %K web application %K inclusive education %K family-school-health care %D 2025 %7 17.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: An individual education plan (IEP) is a key element in the support of the schooling of children with special educational needs or disabilities. The IEP process requires effective communication and strong partnership between families, school staff, and health care practitioners. However, these stakeholders often report their collaboration as limited and difficult to maintain, leading to difficulties in implementing and monitoring the child’s IEP. Objective: This paper aims to describe the study protocol used to evaluate a technological tool (CoEd application) aiming at fostering communication and collaboration between family, school, and health care in the context of inclusive education. Methods: This protocol describes a longitudinal, nonrandomized controlled trial, with baseline, 3 month, and 6-month follow-up assessments. The intervention consisted of using the web-based CoEd application for 3 months to 6 months. This application is composed of a child’s file in which stakeholders of the support team can share information about the child’s profile, skills, aids and adaptations, and daily events. The control group is asked to function as usual to support the child in inclusive settings. To be eligible, a support team must be composed of at least two stakeholders, including at least one of the parents. Additionally, the pupil had to be aged between 10 years and 16 years, enrolled in secondary school, be taught in mainstream settings, and have an established or ongoing diagnosis of autism spectrum disorder, attention-deficit/hyperactivity disorder, or intellectual disability (IQ<70). Primary outcome measures cover stakeholders’ relationships, self-efficacy, and attitudes toward inclusive education, while secondary outcome measures are related to stakeholders’ burden and quality of life, as well as children’s school well-being and quality of life. We plan to analyze data using ANCOVA to investigate pre-post and group effects, with a technological skills questionnaire as the covariate. Results: After screening for eligibility, 157 participants were recruited in 37 support teams, composed of at least one parent and one professional (school, health care). In September 2023, after the baseline assessment, the remaining 127 participants were allocated to the CoEd intervention (13 teams; n=82) or control condition (11 teams; n=45). Conclusions: We expect that the CoEd application will improve the quality of interpersonal relationships in children’s IEP teams (research question [RQ]1), will show benefits for the child (RQ2), and improve the well-being of the child and the stakeholders (RQ3). Thanks to the participatory design, we also expect that the CoEd application will elicit a good user experience (RQ4). The results from this study could have several implications for educational technology research, as it is the first to investigate the impacts of a technological tool on co-educational processes. International Registered Report Identifier (IRRID): DERR1-10.2196/63378 %M 40245385 %R 10.2196/63378 %U https://www.researchprotocols.org/2025/1/e63378 %U https://doi.org/10.2196/63378 %U http://www.ncbi.nlm.nih.gov/pubmed/40245385 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60092 %T Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up %A Wang,Naibo %A Wang,Chen %A Zhang,Puhong %A Li,Yinghua %A He,Feng J %A Li,Li %A Li,Yuan %A Luo,Rong %A Wan,Dezhi %A Xu,Lewei %A Deng,Lifang %A Wu,Lei %+ School of Public Health, Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Jiangxi Medical College, Nanchang University, No. 461 Ba Yi Avenue, Donghu District, Jiangxi Province, Nanchang, 330006, China, 86 18970813850, leiwu@ncu.edu.cn %K school-based health education %K EduSaltS %K mobile health %K salt reduction %K cluster randomized trial %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)– and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention’s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren’s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were –0.24 g/day (95% CI –0.82 to 0.33), –0.68 mm Hg (95% CI –2.32 to 0.95), and –1.37 mm Hg (95% CI –2.79 to 0.06), respectively. For adults, the intervention group’s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were –1.06 g/day (95% CI –1.81 to –0.30), –2.26 mm Hg (95% CI –4.26 to –0.26), and –2.33 mm Hg (95% CI –3.84 to –0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 %M 40017342 %R 10.2196/60092 %U https://www.jmir.org/2025/1/e60092 %U https://doi.org/10.2196/60092 %U http://www.ncbi.nlm.nih.gov/pubmed/40017342 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 10 %N %P e64096 %T School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners %A March,Christine A %A Naame,Elissa %A Libman,Ingrid %A Proulx,Chelsea N %A Siminerio,Linda %A Miller,Elizabeth %A Lyon,Aaron R %+ , Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, United States, 1 4126929156, christine.eklund@chp.edu %K type 1 diabetes %K user-centered design %K school health %K collaborative care model %K implementation research %K pediatric %K usability testing %K virtual intervention %K multisystem community partners %K children %K youth %K diabetes management support %K health system partners %K psychosocial interventions %K quantitative assessments %K qualitative assessments %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Diabetes %G English %X Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation. Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams. Methods: We recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA. Results: In the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10%-60% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue (ρ=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings. Conclusions: Cross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing. %M 40138695 %R 10.2196/64096 %U https://diabetes.jmir.org/2025/1/e64096 %U https://doi.org/10.2196/64096 %U http://www.ncbi.nlm.nih.gov/pubmed/40138695 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60424 %T Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform %A Dolón-Poza,María %A Gabaldón-Pérez,Ana-Marta %A Berrezueta-Guzman,Santiago %A López Gracia,David %A Martín-Ruiz,María-Luisa %A Pau De La Cruz,Iván %+ , Technical University of Munich, BildungsCampus 2, Heilbronn, 74076, Germany, 49 15159184710, s.berrezueta@tum.de %K developmental language disorder %K simple language delay %K adaptive screening system %K early childhood education %K pervasive therapy %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform’s utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 %M 40086469 %R 10.2196/60424 %U https://humanfactors.jmir.org/2025/1/e60424 %U https://doi.org/10.2196/60424 %U http://www.ncbi.nlm.nih.gov/pubmed/40086469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65169 %T A Classroom-Based Intervention for Reducing Sedentary Behavior and Improving Spinal Health: Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial %A Fisher,Dominic %A Maart,Rentia %A Thabane,Lehana %A Louw,Quinette %+ School of Health Professions, Faculty of Health, University of Plymouth, North Road East, InterCity Place, Plymouth, PL4 6AB, United Kingdom, 44 01752587580, dominic.fisher@plymouth.ac.uk %K sedentary behavior %K spinal health %K classroom-based intervention %K sit-stand desks %K spinal %K African %K Africa %K primary school %K child %K youth %K randomized controlled trial %K RCT %K infectious disease %K acceptability %K data collection %K teacher %K classroom-based interventions %K primary school learners %K physical activity %K closed-cohort %K interview %K quantitative data %K wearable %K wearable sensor %K spine %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable diseases (NCDs) resulting from sedentary behavior (SB) are adding a further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture, allowing learners to interrupt prolonged bouts of sitting with standing without interrupting their school work. Alternating between sitting and standing also benefits spinal health by interrupting prolonged periods of high spinal loading, but no such intervention has been trialed in South Africa. The potential to reduce strain on the health system by reducing the incidence of NCDs and improving spinal health requires further consideration. Before embarking on a large classroom-based trial, it is essential to determine the acceptability of the intervention, its impact on teachers’ practices, and the logistical and pragmatic considerations of data collection. Objective: This study aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners, to assess the pragmatics of delivering and adherence to the intervention, and assess the pragmatics of measuring physical activity and postural dynamism data with wearable sensors. Methods: We used a stratified, closed-cohort, randomized, 2-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and grade 6 class each was recruited from contrasting socioeconomically categorized, state-funded primary schools in the Western Cape province, South Africa. Classroom furniture was substituted with sit-stand desks, and health education and movement videos (HEMVs) were shown during class time. Skin-mounted activPAL physical activity monitors were used to measure SB and postural topography and Noraxon myoMOTION inertial measurement units (IMUs) to measure spinal movement. The study was evaluated for feasibility by tracking school retention, successful delivery of the HEMVs, the use of sit-stand desks, compliance with the wearable sensors, and data accuracy. We deductively analyzed teachers’ interviews and learners’ focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was performed using Microsoft Excel. Results: Cluster 1 withdrew from the study before follow-up SB, postural topography, and spinal movements were measured. All feasibility outcomes, namely (1) classroom retention, (2) delivery of HEMVs, (3) learner and teacher acceptance and usage of sit-stand classroom furniture, (4) 100% compliance with wearing skin-mounted sensors for the duration of the intended measurement period, and (5) minimum 80% eligibility of sensor data gathered included in data analysis, were met in cluster 2. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology. Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualized teacher training on how sit-stand desks and HEMVs can be used as classroom management tools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR2-10.2196/18522 %M 39993285 %R 10.2196/65169 %U https://formative.jmir.org/2025/1/e65169 %U https://doi.org/10.2196/65169 %U http://www.ncbi.nlm.nih.gov/pubmed/39993285 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68667 %T Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study %A Prochnow,Tyler %A Dunton,Genevieve F %A de la Haye,Kayla %A Pollack Porter,Keshia M %A Lee,Chanam %+ Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab, College Station, TX, 77843, United States, 1 2629450275, tprochnow@tamu.edu %K physical activity %K youth %K social environment %K built environment %K ecological momentary assessment %K social network analysis %K phenotypes %K accelerometry %K GPS %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study’s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 %M 39984166 %R 10.2196/68667 %U https://www.researchprotocols.org/2025/1/e68667 %U https://doi.org/10.2196/68667 %U http://www.ncbi.nlm.nih.gov/pubmed/39984166 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67962 %T Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study %A Midgett,Aida %A Doumas,Diana M %A Peralta,Claudia %A Peck,Matt %A Reilly,Blaine %A Buller,Mary K %+ Boise State University, 301 University Drive, Boise, ID, 83706, United States, 1 426 1214, AidaMidgett@boisestate.edu %K technology-based bullying intervention %K STAC-T %K usability testing %K middle school %K rural %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. %M 39984169 %R 10.2196/67962 %U https://humanfactors.jmir.org/2025/1/e67962 %U https://doi.org/10.2196/67962 %U http://www.ncbi.nlm.nih.gov/pubmed/39984169 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68840 %T Effect of the Reassured Self-Compassion–Based School Program on Anxiety, Video Game Addiction, and Body Image Among Rural Female Adolescents: Retrospective Study %A Zuair,Areeg %+ Community Health Nursing Department, College of Nursing, Taibah University, Prince Naif Ibn Abdulaziz Rd, Medina, 42351, Saudi Arabia, 966 594800400, Azuair@taibahu.edu.sa %K adolescents %K rural %K compassion-focused therapy %K mental health %K Saudi Arabia %K school %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported. Objective: This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia. Methods: A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children's Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models. Results: Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference –4.11, 95% CI –6.98 to –1.24; P=.005) and video game addiction (mean difference –1.62, 95% CI –2.83 to –0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI –0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention. Conclusions: The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions. %M 39970430 %R 10.2196/68840 %U https://formative.jmir.org/2025/1/e68840 %U https://doi.org/10.2196/68840 %U http://www.ncbi.nlm.nih.gov/pubmed/39970430 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52713 %T SARS-CoV-2 Infections in a Triad of Primary School Learners (Grades 1-7), Their Parents, and Teachers in KwaZulu-Natal, South Africa: Protocol for a Cross-Sectional and Nested Case-Cohort Study %A Dassaye,Reshmi %A Chetty,Terusha %A Daniels,Brodie %A Gaffoor,Zakir %A Spooner,Elizabeth %A Ramraj,Trisha %A Mthethwa,Ncengani %A Nsibande,Duduzile Faith %A Pillay,Saresha %A Bhana,Arvin %A Magasana,Vuyolwethu %A Reddy,Tarylee %A Mohlabi,Khanya %A Moore,Penelope Linda %A Burgers,Wendy A %A de Oliveira,Tulio %A Msomi,Nokukhanya %A Goga,Ameena %+ HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa, 27 312604486, Reshmi.Dassaye@mrc.ac.za %K COVID-19 %K SARS-CoV-2 %K learners %K seroprevalence %K long COVID %K transmission dynamics %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics. Objective: This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings. Methods: Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques. Results: A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024. Conclusions: This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers. International Registered Report Identifier (IRRID): DERR1-10.2196/52713 %M 39700491 %R 10.2196/52713 %U https://www.researchprotocols.org/2024/1/e52713 %U https://doi.org/10.2196/52713 %U http://www.ncbi.nlm.nih.gov/pubmed/39700491 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56567 %T Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study %A Bunnell,Brian E %A Schuler,Kaitlyn R %A Ivanova,Julia %A Flynn,Lea %A Barrera,Janelle F %A Niazi,Jasmine %A Turner,Dylan %A Welch,Brandon M %+ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613-4706, United States, 1 8139748607, bbunnell@usf.edu %K mental health %K mental illness %K mental disease %K mental disorder %K homework %K homework challenge %K therapy %K therapist %K barriers %K adult client %K adult %K technology-based solution %K health technology %K digital health %K digital technology %K digital intervention %K mobile phone %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act–compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. %M 39665475 %R 10.2196/56567 %U https://humanfactors.jmir.org/2024/1/e56567 %U https://doi.org/10.2196/56567 %U http://www.ncbi.nlm.nih.gov/pubmed/39665475 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60692 %T Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City %A Gerchow,Lauren %A Lanier,Yzette %A Fayard,Anne-Laure %A Squires,Allison %+ Rory Meyers College of Nursing, New York University, 433 1st Ave, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, lmg490@nyu.edu %K adolescent %K reproductive health %K sexual health %K cocreation %K co-design %K human-centered design %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. %M 39560978 %R 10.2196/60692 %U https://pediatrics.jmir.org/2024/1/e60692 %U https://doi.org/10.2196/60692 %U http://www.ncbi.nlm.nih.gov/pubmed/39560978 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57509 %T Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle (LIVELY) for Childhood Obesity Prevention: Study Protocol %A Basilico,Sara %A Conti,Maria Vittoria %A Ardoino,Ilaria %A Breda,Chiara %A Loperfido,Federica %A Klaic,Elena %A Spialtini,Linda %A Foresta,Andreana %A Orsini,Francesca %A Ojeda Fernandez,Maria Luisa %A Conca Bonizzoni,Stefano %A Modena,Elisabetta %A Tootoonchi Hamedani,Yasamin %A Villa,Federica %A Cena,Hellas %A Baviera,Marta %A Franchi,Carlotta %+ Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi 21, Pavia, 27100, Italy, 39 0382987536, sara.basilico01@universitadipavia.it %K childhood obesity %K school education %K family education %K healthy lifestyle %K sustainability %K primary prevention %K nutritional intervention %K physical activity %K community engagement %K lifestyle habits %K socio-economic status %K LIVELY study %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity has become a significant public health concern over the past 2 decades, posing multifactorial challenges, including modifiable factors like dietary habits, physical activity, screen time, and sleeping habits. Prevention efforts require a comprehensive approach comprising educational interventions, collaboration among multidisciplinary teams, and community engagement. Since schools play a central role in children's lives, they are the ideal setting for promoting healthy habits. Objective: The LIVELY (Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle) study will assess the prevalence of overweight and obesity in primary school children and identify contributing factors within families. Additionally, it aims to implement and evaluate a multidimensional, multidisciplinary intervention to foster a sustainable and healthy lifestyle, ultimately working toward preventing obesity in school-aged children. Methods: During the school year, each class will be individually involved in a multidimensional educational intervention covering the topics of healthy, sustainable nutrition and lifestyle. Children will also participate in a multimedia lab where they will create an animated cartoon. The lectures will engage them through various methods, including direct instructions, games, and drawing activities, to stimulate and enhance their learning and involvement. Results: Data collection began in October 2023 and will last until the end of October 2024. A sample of 227 children from 14 classes was included in the study. The mean age was 8.9 (SD 1.2) years, and 48% (n=110) were males. Among the overall sample, 18.1% (n=41; 95% CI 13.7%-23.7%) were overweight, while 5.3% (n=12; 95% CI 3%-9%) had obesity. Males had a higher prevalence of obesity than females (9.1%, n=10 vs 1.7%, n=3, P=.03, respectively). Otherwise, the prevalence of central obesity was similar between the two (P=.329). Data analysis and the presentation of the complete results will be available after the end of 2024. Conclusions: The study could lead to the structuring of an educational intervention model in school settings aimed at preventing childhood obesity. Moreover, it could help raise awareness of childhood obesity and help prevent this public health issue. Trial Registration: ClinicalTrials.gov NCT05966051; https://clinicaltrials.gov/study/NCT05966051 International Registered Report Identifier (IRRID): DERR1-10.2196/57509 %M 39475855 %R 10.2196/57509 %U https://www.researchprotocols.org/2024/1/e57509 %U https://doi.org/10.2196/57509 %U http://www.ncbi.nlm.nih.gov/pubmed/39475855 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60626 %T Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial %A Kvestad,Ingrid %A Adolfsen,Frode %A Angeles,Renira Corinne %A Brandseth,Oda Lekve %A Breivik,Kyrre %A Evertsen,Janne Grete %A Foer,Irene Kvåle %A Haaland,Morten %A Homola,Birgit Millerjord %A Hoseth,Gro Elisabeth %A Jonsson,Josefine %A Kjerstad,Egil %A Kyrrestad,Henriette %A Martinussen,Monica %A Moberg,Annelene %A Moberg,Karianne %A Skogstrand,Anita %A Solberg,Line Remme %A Aasheim,Merete %+ NORCE Norwegian Research Center, 5838 Bergen, Bergen, Norway, 47 99400431, inkv@norceresearch.no %K peer bullying in early childhood education and care %K The Bernese Program %K cluster randomized controlled trial %K bullying %K child %K preschool %K program evaluation %D 2024 %7 24.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A new and growing body of research has studied bullying among children in early childhood education and care centers (ECECs). The Bernese Program (Be-Prox) is designed to systematically prevent and handle bullying between children in Swiss ECECs. However, the effectiveness of the Be-Prox intervention has not yet been explored in a Norwegian ECEC setting. Objective: This study aims to evaluate the effectiveness of Be-Prox in preventing and handling bullying among peers in Norwegian ECECs. Methods: ECECs from 2 Norwegian municipalities were invited to participate in a cluster randomized controlled trial (RCT) to evaluate the effectiveness of the Be-Prox intervention on peer bullying in Norwegian ECECs. After baseline measures were taken, project ECECs were randomized to either an intervention or a control arm. The Be-Prox intervention was introduced to ECECs in the intervention arm through 6 modules over a 9-month period immediately after the randomization. ECECs in the control arm participated in the data collection and were offered the Be-Prox intervention the following year. The primary outcome of the effect evaluation is the mean sum of negative behavior between peers after the Be-Prox training is completed in the intervention arm. Secondary outcomes include child bystander behavior, teacher self-efficacy, and ECEC’s authoritative climate. An extensive implementation and process evaluation, as well as cost-effectiveness analyses, will be conducted alongside the RCT. Results: Baseline data collection was conducted in September 2023, and the postintervention data collection started in May 2024. At baseline, we collected data on 708 children and 413 personnel from 38 project ECECs in the 2 Norwegian municipalities. The results from the study will be available in late 2024 at the earliest. Conclusions: The proposed project includes a comprehensive evaluation of the effectiveness of Be-Prox in Norwegian ECECs directly targeting the prevention and handling of bullying, including implementation and cost-effectiveness evaluations. The results from the project have the potential to fill in identified knowledge gaps in the understanding of negative behavior and bullying between peers in ECECs, and how these may be prevented. If proven efficient, our ambition is to offer Be-Prox to Norwegian ECECs as an evidence-based practice to prevent and handle bullying among preschool children. Trial Registration: ClinicalTrials.gov NCT06040437; https://clinicaltrials.gov/study/NCT06040437 International Registered Report Identifier (IRRID): DERR1-10.2196/60626 %M 39447170 %R 10.2196/60626 %U https://www.researchprotocols.org/2024/1/e60626 %U https://doi.org/10.2196/60626 %U http://www.ncbi.nlm.nih.gov/pubmed/39447170 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56355 %T Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study %A Iyer,Priya %A Iyer,Lina %A Carter,Nicole %A Iyer,Ranjani %A Stirling,Amy %A Priya,Lakshmi %A Sriraman,Ushma %+ Department of Education, Heartfulness Institute, 2200 Goldenrod Ln, San Ramon, CA, 94582, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness, anxiety, loneliness, high school, satisfaction with life %K self-care %K develop %K stress %K stress management %K effectiveness %K life satisfaction %K students %K student %K support %K web-based program %K time management %K educational %K mental health %K tool %K tools %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder—Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 %M 39047180 %R 10.2196/56355 %U https://formative.jmir.org/2024/1/e56355 %U https://doi.org/10.2196/56355 %U http://www.ncbi.nlm.nih.gov/pubmed/39047180 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55290 %T Examining the Acceptability of Helminth Education Packages “Magic Glasses Lower Mekong” and “Magic Glasses Opisthorchiasis” and Their Impact on Knowledge, Attitudes, and Practices Among Schoolchildren in the Lower Mekong Basin: Protocol for a Cluster Randomized Controlled Trial %A O'Connor,Suji Y %A Mationg,Mary Lorraine %A Kelly,Matthew J %A Williams,Gail M %A Clements,Archie CA %A Sripa,Banchob %A Sayasone,Somphou %A Khieu,Virak %A Wangdi,Kinley %A Stewart,Donald E %A Tangkawattana,Sirikachorn %A Suwannatrai,Apiporn T %A Savathdy,Vanthanom %A Khieu,Visal %A Odermatt,Peter %A Gordon,Catherine A %A Wannachart,Sangduan %A McManus,Donald P %A Gray,Darren J %+ National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Road, Acton, 2601, Australia, 61 026125 2378, suji.oconnor@anu.edu.au %K attitude %K child %K health education %K helminths %K knowledge %K practices %K Opisthorchis viverrini %K randomized controlled trial %K schools %K Ascaris lumbricoides %K Trichuris trichiura %K hookworm %K Magic Glasses %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Helminths are a major global health issue, impacting health, educational, and socioeconomic outcomes. Infections, often starting in childhood, are linked to anemia, malnutrition, cognitive deficit, and in chronic cases of Opisthorchis viverrini (OV), cholangiocarcinoma. The main control strategy for helminth infection is mass drug administration; however, this does not prevent reinfection. As such, prevention strategies are needed. The “Magic Glasses” is a school-based cartoon health education package that has demonstrated success in improving knowledge, attitudes, and practices (KAP) surrounding soil-transmitted helminths (STH) in China and the Philippines. This study is designed to assess the acceptability and impact of the 2 new versions of the Magic Glasses targeting STH and OV designed for the Lower Mekong audience in Cambodia, Lao People’s Democratic Republic (PDR), and Thailand. Objective: The objective of this study is to evaluate the acceptability of the “Magic Glasses Lower Mekong” and “Magic Glasses Opisthorchiasis” education packages among schoolchildren in the Lower Mekong Basin, and the impact of these education packages on students’ KAP surrounding STH and OV, respectively. Methods: Schoolchildren will be recruited into a cluster randomized controlled trial with intervention and control arms in rural schools in Cambodia, Lao PDR, and Thailand. Schoolchildren’s initial acceptability of the intervention will be evaluated using an adapted questionnaire. Sustained acceptability will be assessed at 9-month follow-up through focus group discussions with students and interviews with teachers. Impact will be evaluated by KAP questionnaires on STH and OV. KAP questionnaires will be administered to children at baseline and at follow-up. Indirect impact on parents' KAP of OV and STH will be assessed through focus group discussions at follow-up. Results: The trial is in progress in Lao PDR and Thailand and is expected to commence in Cambodia in January 2024. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the intervention arm of the study will have higher KAP scores for STH and OV, compared with the participants in the control arm at follow-up. We expect that students will have initial and sustained acceptability of these intervention packages. Conclusions: This trial will examine the acceptability of the “Magic Glasses Opisthorchiasis” and “Magic Glasses Lower Mekong” interventions and provide evidence on the effectiveness of the “Magic Glasses” on KAP related to OV and STH among schoolchildren in the Lower Mekong Basin. Study results will provide insight on acceptability and impact indicators and inform a scaling up protocol for the “Magic Glasses” education packages in Cambodia, Lao PDR, and Thailand. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000271606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385315&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/55290 %M 39283663 %R 10.2196/55290 %U https://www.researchprotocols.org/2024/1/e55290 %U https://doi.org/10.2196/55290 %U http://www.ncbi.nlm.nih.gov/pubmed/39283663 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48705 %T Identifying Psychosocial and Ecological Determinants of Enthusiasm In Youth: Integrative Cross-Sectional Analysis Using Machine Learning %A Dolling-Boreham,Roberta M %A Mohan,Akshay %A Abdelhack,Mohamed %A Elton-Marshall,Tara %A Hamilton,Hayley A %A Boak,Angela %A Felsky,Daniel %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada, 1 416 535 8501 ext 33587, daniel.felsky@camh.ca %K subjective well-being %K Ontario Student Drug Use and Health Survey (OSDUHS) %K machine learning %K Shapley additive explanations (SHAP) %K extreme gradient boosting (XGBoost) %K psychosocial %K ecological %K determinants %K enthusiasm %K mental health %K well-being %K youth %K public health %K student %K self-reported %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the factors contributing to mental well-being in youth is a public health priority. Self-reported enthusiasm for the future may be a useful indicator of well-being and has been shown to forecast social and educational success. Typically, cross-domain measures of ecological and health-related factors with relevance to public policy and programming are analyzed either in isolation or in targeted models assessing bivariate interactions. Here, we capitalize on a large provincial data set and machine learning to identify the sociodemographic, experiential, behavioral, and other health-related factors most strongly associated with levels of subjective enthusiasm for the future in a large sample of elementary and secondary school students. Objective: The aim of this study was to identify the sociodemographic, experiential, behavioral, and other health-related factors associated with enthusiasm for the future in elementary and secondary school students using machine learning. Methods: We analyzed data from 13,661 participants in the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (grades 7-12) with complete data for our primary outcome: self-reported levels of enthusiasm for the future. We used 50 variables as model predictors, including demographics, perception of school experience (i.e., school connectedness and academic performance), physical activity and quantity of sleep, substance use, and physical and mental health indicators. Models were built using a nonlinear decision tree–based machine learning algorithm called extreme gradient boosting to classify students as indicating either high or low levels of enthusiasm. Shapley additive explanations (SHAP) values were used to interpret the generated models, providing a ranking of feature importance and revealing any nonlinear or interactive effects of the input variables. Results: The top 3 contributors to higher self-rated enthusiasm for the future were higher self-rated physical health (SHAP value=0.62), feeling that one is able to discuss problems or feelings with their parents (SHAP value=0.49), and school belonging (SHAP value=0.32). Additionally, subjective social status at school was a top feature and showed nonlinear effects, with benefits to predicted enthusiasm present in the mid-to-high range of values. Conclusions: Using machine learning, we identified key factors related to self-reported enthusiasm for the future in a large sample of young students: perceived physical health, subjective school social status and connectedness, and quality of relationship with parents. A focus on perceptions of physical health and school connectedness should be considered central to improving the well-being of youth at the population level. %M 39264706 %R 10.2196/48705 %U https://publichealth.jmir.org/2024/1/e48705 %U https://doi.org/10.2196/48705 %U http://www.ncbi.nlm.nih.gov/pubmed/39264706 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58610 %T Establishing Priorities for Improving Data Collection and Measurement of Mental Health and Well-Being of Adolescents With Special Educational Needs Within Nonmainstream Schools: Protocol for a Delphi Study %A Jeffery,Mairi C %A Deighton,Jessica %A Lereya,Suzet Tanya %+ Evidence Based Practice Unit, University College London and Anna Freud, 4-8 Rodney St, London, N1 9JH, United Kingdom, 44 020 7443 2218, mairi.jeffery.16@ucl.ac.uk %K special educational needs %K special schools %K alternative provision %K mental health %K well-being %K school-based measurement %D 2024 %7 9.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are more than 1.5 million children and young people in England with special educational needs (SEN), with over 160,000 young people in the United Kingdom attending a special school or alternative provision (AP) setting. Young people with SEN have been found to be at risk for poorer mental health and well-being than non-SEN peers. However, there is a range of both school-related and research challenges associated with identifying difficulties in a timely manner. Objective: This Delphi study aims to determine a list of stakeholder priorities for improving school-based measurement of mental health and well-being among young people with SEN, at an aggregated level, within secondary special school or AP settings. A secondary objective is to inform the implementation of school-based well-being surveys, improve engagement in special schools or AP settings, and improve survey response rates among children and young people with SEN. Methods: A mixed methods Delphi study will be conducted, including a scoping review and preliminary focus groups with school staff members and researchers to establish key issues. This will be followed by a 2-round Delphi survey to determine a list of stakeholder priorities for improving the measurement of mental health and well-being at an aggregate level within special schools and AP settings. A final stakeholder workshop will be held to discuss the findings. A list of recommendations will be drafted as a report for special schools and AP settings. Results: The study has received ethical approval from the University College London Research Ethics Committee. The stage 1 scoping review has commenced. Recruitment for focus groups will begin in Autumn 2024. The first round of the Delphi survey will commence in early 2025, and the second round of the Delphi survey in the spring of 2025. The final workshop will commence in mid-2025 with final results expected in late 2025. Conclusions: There is a need for clear recommendations for special schools and AP settings on priorities for improving the measurement of mental health and well-being problems among young people with SEN. There is also a need for recommendations to researchers implementing school-based well-being surveys, including the #BeeWell program, to enable them to improve their engagement in special schools and AP settings and ensure surveys are accessible. International Registered Report Identifier (IRRID): PRR1-10.2196/58610 %M 39250211 %R 10.2196/58610 %U https://www.researchprotocols.org/2024/1/e58610 %U https://doi.org/10.2196/58610 %U http://www.ncbi.nlm.nih.gov/pubmed/39250211 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63220 %T Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial %A Zhu,Shimin %A Hu,Yuxi %A Wang,Ruobing %A Qi,Di %A Lee,Paul %A Ngai,So Wa %A Cheng,Qijin %A Wong,Paul Wai Ching %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom , Kowloon, Hong Kong, 999077, China (Hong Kong), 852 27665787, jasmine.zhu@polyu.edu.hk %K implicit theory %K fixed mindset %K mental health %K secondary school students %K belief in change %D 2024 %7 30.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children’s affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child’s internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Objective: Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children’s academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. Methods: A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Results: Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. Conclusions: This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/63220 %R 10.2196/63220 %U https://www.researchprotocols.org/2024/1/e63220 %U https://doi.org/10.2196/63220 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54637 %T Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process %A Grummitt,Lucinda %A Bailey,Sasha %A Kelly,Erin V %A Birrell,Louise %A Gardner,Lauren A %A Halladay,Jillian %A Chapman,Cath %A Andrews,Jack L %A Champion,Katrina E %A Hunter,Emily %A Egan,Lyra %A Conroy,Chloe %A Tiko,Raaya %A Nguyen,An %A Teesson,Maree %A Newton,Nicola C %A Barrett,Emma L %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, The University of Sydney, Sydney, 2006, Australia, 61 86279014, lucinda.grummitt@sydney.edu.au %K mental health %K prevention %K school %K depression %K anxiety %K proportionate universalism %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. Objective: This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). Methods: Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. Results: Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. Conclusions: The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools. %M 39167794 %R 10.2196/54637 %U https://pediatrics.jmir.org/2024/1/e54637 %U https://doi.org/10.2196/54637 %U http://www.ncbi.nlm.nih.gov/pubmed/39167794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58322 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research %A Rulison,Kelly %A Weaver,GracieLee %A Milroy,Jeffrey %A Beamon,Emily %A Kelly,Samantha %A Ameeni,Ali %A Juma,Amina %A Abualgasim,Fadhel %A Husain,Jaafar %A Wyrick,David %+ Prevention Strategies, 9 Provence Ct, Greensboro, NC, 27410, United States, 1 3366885770, kelly@preventionstrategies.com %K Antiextremism %K peaceful coexistence %K intervention %K evaluation %K international %K multiphase optimization strategy %K preparation phase %K extremism %K extremist %K peace %K peaceful %K resistance %K violent %K violence %K radical %K radicalism %K Bahrain %K education %K educational %K school %K schools %K student %K students %K drug %K drugs %K abuse %K substance %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. Objective: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. Methods: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. Results: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). Conclusions: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons. %M 39018090 %R 10.2196/58322 %U https://formative.jmir.org/2024/1/e58322 %U https://doi.org/10.2196/58322 %U http://www.ncbi.nlm.nih.gov/pubmed/39018090 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e52224 %T Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis %A He,Zonglin %A Zhou,Botao %A Feng,Haixiao %A Bai,Jian %A Wang,Yuechun %K flipped classroom %K flipped classroom teaching %K physiology %K scientific knowledge map %K hot topics %K frontier progress %K evolution trend %K classroom-based %K bibliometric visual analysis %K bibliometric %K visual analysis %K medical education %K teaching method %K bibliometric analysis %K visualization tool %K academic %K academic community %K inverted classroom %D 2024 %7 25.6.2024 %9 %J JMIR Med Educ %G English %X Background: Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students’ and teachers’ responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively. Objective: This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature. Methods: A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends. Results: A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013‐2014), extensive practice stage (2015‐2019), and modification and growth stage (2020‐2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others. Conclusions: This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents. %R 10.2196/52224 %U https://mededu.jmir.org/2024/1/e52224 %U https://doi.org/10.2196/52224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46764 %T Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study %A Soneson,Emma %A Howarth,Emma %A Weir,Alison %A Jones,Peter B %A Fazel,Mina %+ Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 1865 613127, emma.soneson@psych.ox.ac.uk %K mental health %K children %K schools %K teachers %K training %K digital intervention %K pupil mental health %K mental health training %K intervention %K empowerment %K student %K pupil %K support %K school staff %K web-based training %D 2024 %7 23.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. Objective: We aimed to explore the feasibility of Kognito’s At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff’s knowledge and skills in supporting pupil mental health. Methods: We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff’s self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff’s identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. Results: A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. Conclusions: The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support. %M 38652534 %R 10.2196/46764 %U https://www.jmir.org/2024/1/e46764 %U https://doi.org/10.2196/46764 %U http://www.ncbi.nlm.nih.gov/pubmed/38652534 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45508 %T Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study %A Malkin,Jennifer %A Jessiman-Perreault,Geneviève %A Alberga Machado,Amanda %A Teare,Gary %A Snider,Joanne %A Tirmizi,Syed Farhan %A Youngson,Erik %A Wang,Ting %A Law,Jessica %A Bandara,Thilina %A Rathwell,Mika %A Neudorf,Cordell %A Allen Scott,Lisa %+ Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, 2210 2 Street SW, Calgary, AB, T2S 3C3, Canada, 1 7808503104, jennifernlmalkin@gmail.com %K co-design %K geospatial %K human papillomavirus %K immunization %K population-based %K vaccine %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. Objective: The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. Methods: Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. Results: The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. Conclusions: Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions. %M 38536211 %R 10.2196/45508 %U https://publichealth.jmir.org/2024/1/e45508 %U https://doi.org/10.2196/45508 %U http://www.ncbi.nlm.nih.gov/pubmed/38536211 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e53072 %T Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study %A Goncalves,Aurelie %A Lespiau,Florence %A Briet,Gaëtan %A Vaillant-Coindard,Eugénie %A Palermo,Angèle %A Decobert,Elsa %A Allegret-Bourdon,Nathan %A Charbonnier,Elodie %+ APSY-v, University of Nîmes, Rue du docteur Georges Salan, CS13019, Nîmes, F-30021, France, 33 466364518, aurelie.goncalves@unimes.fr %K learning support %K exergaming %K physics playground %K educational games %K primary school %K children %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children’s interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant. Objective: The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration). Methods: This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills. Results: The implementation of this exergaming program was welcomed by the school’s administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; W=933.0; P=.002; rrb=−0.39, 95% CI −0.58 to −0.16) and motivation in mathematics (+0.7, +9.8%; W=381.5; P=.005; rrb=−0.44, 95% CI −0.66 to −0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups. Conclusions: The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children. %M 38393767 %R 10.2196/53072 %U https://games.jmir.org/2024/1/e53072 %U https://doi.org/10.2196/53072 %U http://www.ncbi.nlm.nih.gov/pubmed/38393767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46746 %T Attitudes Toward School-Based Surveillance of Adolescents’ Social Media Activity: Convergent Parallel Mixed Methods Survey %A Burke,Colin %A Triplett,Cynthia %A Rubanovich,Caryn Kseniya %A Karnaze,Melissa M %A Bloss,Cinnamon S %+ Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive MC0811, La Jolla, CA, 92093-0811, United States, 1 (858) 534 2230, cbloss@eng.ucsd.edu %K social media %K surveillance %K privacy %K public health %K students %K schools %K social media monitoring %K SMM %K school safety %K mental health %K adolescents %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults’ overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. %M 38319696 %R 10.2196/46746 %U https://formative.jmir.org/2024/1/e46746 %U https://doi.org/10.2196/46746 %U http://www.ncbi.nlm.nih.gov/pubmed/38319696 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e43943 %T The Effect of a Video-Assisted Health Education Program Followed by Peer Education on the Health Literacy of COVID-19 and Other Infectious Diseases Among School Children: Quasi-Randomized Controlled Trial %A Zhang,Xiaojuan %A Wen,Yingkun Justin %A Han,Ning %A Jiang,Yawen %+ School of Public Health (Shenzhen), Sun Yat-sen University, Room 533, West Wing of Medical Complex #1, Sun Yat-sen University, 66 Gongchang Road, Guangming District Shenzhen, Shenzhen, Guangdong, China, 86 13632974660, jiangyw26@mail.sysu.edu.cn %K infectious diseases %K primary school students %K quasi-randomized controlled trial %K video-assisted health education %K peer education %K item response theory %K IRT %D 2024 %7 29.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To improve the engagement and effectiveness of traditional health programs, it is necessary to explore alternative models of health education including video-assisted lectures and peer education. Objective: This study aimed to evaluate the effects of a combination of video-assisted lectures and peer education on health literacy related to infectious diseases among students. Methods: Third-grade classes from 11 pilot schools in Longgang District of Shenzhen, China, were randomized to the intervention and control groups. In the intervention group, a video-assisted interactive health education program was conducted twice over a time span of 5 months. Each of the 2 sessions included a 40-minute lecture on COVID-19 and other common infectious diseases in schools and a 5-minute science video. In addition, 5 “little health supervisors” at the end of the first session were elected in each class, who were responsible for helping class members to learn health knowledge and develop good hygiene habits. Students answered the same quiz before the first and after the second session. Models based on item response theory (IRT) were constructed to score the students’ knowledge of infectious diseases based on the quiz. Results: In total, 52 classes and 2526 students (intervention group: n=1311; control group: n=1215) were enrolled. Responses of the baseline survey were available for 2177 (86.2%; intervention group: n=1306; control group: n=871) students and those of the postintervention survey were available for 1862 (73.7%; intervention group: n=1187; control group: n=675). There were significant cross-group differences in the rates of correctly answering questions about influenza symptoms, transmission, and preventive measures; chicken pox symptoms; norovirus diarrhea symptoms; mumps symptoms; and COVID-19 symptoms. Average IRT scores of questions related to infectious diseases in the intervention and control groups were, respectively, –0.0375 (SD 0.7784) and 0.0477 (SD 0.7481) before the intervention (P=.01), suggesting better baseline knowledge in the control group. After the intervention, the average scores of the intervention and control groups were 0.0543 (SD 0.7569) and –0.1115 (SD 0.7307), respectively (P<.001), suggesting not only significantly better scores but also greater improvement in the intervention group. Conclusions: After the health education project, the correct answer rate of infectious disease questions in the intervention group was higher than that of the control group, which indicates significant effects of the combination of video-assisted lectures and peer education for the promotion of health literacy. In addition, the intervention effect of the first session persisted for at least 4 months up to the second session. As such, the proposed program was effective in improving the health literacy of school children in relation to infectious diseases and should be considered for massive health promotion campaigns during pandemics. Trial Registration: ISRCTN ISRCTN49297995; https://www.isrctn.com/ISRCTN49297995 %M 38285496 %R 10.2196/43943 %U https://humanfactors.jmir.org/2024/1/e43943 %U https://doi.org/10.2196/43943 %U http://www.ncbi.nlm.nih.gov/pubmed/38285496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46494 %T Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation %A Xu,Yi %A Yang,Hongshen %A Jin,Zhou %A Xiang,Jian %A Xu,Haiyun %A Pokay,Yili Huang %A Mao,Haibo %A Cai,Xugong %A Wu,Yili %A Wang,Deborah Baofeng %+ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, 1 Shengjin Road, Huanglong Residential District, Wenzhou, 325000, China, 86 13757707429, debbiebwang@msn.com %K adolescents %K digital mental health clinic %K emotional distress %K mental health service %K secondary school %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. Objective: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. Methods: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. Results: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. Conclusions: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended. %M 37883144 %R 10.2196/46494 %U https://formative.jmir.org/2023/1/e46494 %U https://doi.org/10.2196/46494 %U http://www.ncbi.nlm.nih.gov/pubmed/37883144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46350 %T The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study %A Hermsen,Sander %A Van Abswoude,Femke %A Steenbergen,Bert %+ Precision Health and Nutrition Group, OnePlanet Research Centre, Bronland 10, Wageningen, 6708 WH, Netherlands, 31 317 791 009, sander.hermsen@imec.nl %K active living %K adolescents %K physical activity %K digital health %K mobile phone %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Participation in organized sports and other forms of active living have important health benefits in adolescence and adulthood. Unfortunately, the transition to secondary school has been shown to be a barrier to participation. Social networks can play important roles in activating adolescents, and information and communication technology (ICT) interventions can augment this role. To date, there are few insights into what adolescents themselves think and feel about barriers to and motivators for active living, the role of their social networks in active living, and the potential of ICT for physical activity (PA). Objective: This study aimed to gather insights into the perspectives of adolescents aged 12 to 14 years on active living and sports participation, motivators and demotivators for active living, and the potential roles of their social network and of ICT. Methods: A total of 26 adolescents aged 12 to 14 years from different levels of Dutch secondary schools participated in 1 of 5 semistructured focus group interviews, in which they talked about sports and PA, their social networks, their ICT use, and the role of social networks and ICT in PA. All interviews were transcribed and analyzed using a thematic qualitative approach. Results: The study showed that all participants were physically active, although the transition to secondary school made this difficult, mostly because of time constraints. Participants saw positive physical and mental health effects as important benefits of active living. They regarded social benefits as strong motivators for active living: being together, making friends, and having fun together. However, the social network could also demotivate through negative peer judgment and negative feedback. Participants were willing to share their own positive experiences and hear about those from close peers and friends but would not share their own (and were not interested in others’) negative experiences or personal information. Participants were mainly interested in descriptive norms set by others and obtained inspiration from others for PA. With respect to using ICT for active living, participants stated a preference for social challenges among friends, personalized feedback, goals, activities, and rewards. Competition was seen as less important or even unattractive. If mentioned, participants felt that this should be with friends, or peers of a similar level, with fun being more important than the competition itself. Conclusions: This study shows that adolescents feel that their social network is and can be a strong driver of active living. They are willing to use ICT-based solutions that make use of social networks for PA as long as these solutions involve their current (close) network and use an approach based on being together and having fun together. %M 37796582 %R 10.2196/46350 %U https://formative.jmir.org/2023/1/e46350 %U https://doi.org/10.2196/46350 %U http://www.ncbi.nlm.nih.gov/pubmed/37796582 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46757 %T Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post–Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial %A Gómez-Restrepo,Carlos %A Sarmiento-Suárez,María José %A Alba-Saavedra,Magda %A Calvo-Valderrama,Maria Gabriela %A Rincón-Rodríguez,Carlos Javier %A Bird,Victoria Jane %A Priebe,Stefan %A van Loggerenberg,Francois %+ Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, Academic Centre, Newham Centre for Mental Health, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 02075404210, f.vanloggerenberg@qmul.ac.uk %K mental health %K digital intervention %K psychosocial intervention %K armed conflict %K adolescents %K school %K DIALOG+ %K DIALOG+S %K mobile phone %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post–armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 %M 37792465 %R 10.2196/46757 %U https://formative.jmir.org/2023/1/e46757 %U https://doi.org/10.2196/46757 %U http://www.ncbi.nlm.nih.gov/pubmed/37792465 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49670 %T Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project %A Kegelaers,Jolan %A Baetens,Imke %A Soyez,Veerle %A Van Heel,Martijn %A Van Hove,Lisa %A Wylleman,Paul %+ Brussels University Consultation Center, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, 1050, Belgium, 32 2 629 27 60, jolan.kegelaers@vub.be %K children %K physical activity %K psychological symptoms %K sport %K well-being %K youth %D 2023 %7 18.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people’s specific needs, challenges, and motivations when designing novel mental health promotion interventions. Objective: The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program. Methods: A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence. Results: Participant recruitment will commence in September 2023. The full project will be completed by March 2027. Conclusions: With this intervention, we aim to provide a direct contribution to the promotion of children and young people’s mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations. International Registered Report Identifier (IRRID): PRR1-10.2196/49670 %M 37594846 %R 10.2196/49670 %U https://www.researchprotocols.org/2023/1/e49670 %U https://doi.org/10.2196/49670 %U http://www.ncbi.nlm.nih.gov/pubmed/37594846 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44928 %T Supporting Children’s Social Connection and Well-Being in School-Age Care: Mixed Methods Evaluation of the Connect, Promote, and Protect Program %A Milton,Alyssa Clare %A Mengesha,Zelalem %A Ballesteros,Kristin %A McClean,Tom %A Hartog,Saskia %A Bray-Rudkin,Lucie %A Ngo,Cathy %A Hickie,Ian %+ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Level 5 Professor Marie Bashir Building, Missenden Road, Camperdown, 2050, Australia, 61 2 8627 7240, alyssa.milton@sydney.edu.au %K participatory design %K evaluation %K children %K school-age care %K after-school care %K health %K well-being %K program development %K community consultation %D 2023 %7 25.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school–age children’s social, emotional, physical, and cognitive well-being. Objective: This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. Methods: A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. Results: The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children’s well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children’s prosocial behaviors increased (mean difference=0.64; P=.04; t57=−2.06, 95% CI −1.36 to −0.02) and peer problems decreased (mean difference=−0.69; P=.01; t57=2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. Conclusions: To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them. %M 37490323 %R 10.2196/44928 %U https://pediatrics.jmir.org/2023/1/e44928 %U https://doi.org/10.2196/44928 %U http://www.ncbi.nlm.nih.gov/pubmed/37490323 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42265 %T The Effectiveness of an After-school Sport Sampling Intervention on Urban Middle School Youth in the Midwest: Posttest-Only Study %A Lightner,Joseph %A Eighmy,Katlyn %A Valleroy,Ella %A Wray,Bridget %A Grimes,Amanda %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108-2718, United States, 1 8162351703, lightnerj@umkc.edu %K physical activity %K adolescent %K sport sampling %K physical literacy %K BMI %K health intervention %K parenting %K healthy lifestyle %K youth %K health inequality %K underserved population %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. Objective: The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. Methods: Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. Results: The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). Conclusions: An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. International Registered Report Identifier (IRRID): RR2-10.2196/37126 %M 36696161 %R 10.2196/42265 %U https://pediatrics.jmir.org/2023/1/e42265 %U https://doi.org/10.2196/42265 %U http://www.ncbi.nlm.nih.gov/pubmed/36696161 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40354 %T The Relationship Between Social Integration and Physical Activity, Diet, and Sleep Among Youths: Cross-sectional Survey Study %A Wray,Bridget %A Grimes,Amanda %A Eighmy,Katlyn %A Lightner,Joseph %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108-2718, United States, 1 816 235 1703, lightnerj@umkc.edu %K social integration %K youth %K nutrition %K sleep %K physical activity %K adults %K exercise %K health %K wellness %K health behavior %K school students %K diet %K children %K health behavior intervention %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social integration has been shown to predict physical activity (PA), diet, and sleep in adults. However, these associations have not been well-studied in youth samples. Using a life course perspective, it is imperative to study this in youths as social and health behaviors are established early in life. Objective: The purpose of this study was to understand the relationship between social integration and PA, diet, and sleep for urban, middle-school youth. Methods: Cross-sectional baseline data from middle-school youths (N=73) who participated in an afterschool health behavior intervention were included in this study. Results: Time with friends significantly predicted moderate to vigorous intensity PA (β=.33, P=.02). Time spent with family was significantly related to fruit consumption (t66=1.38, P=.005) and vegetable consumption (t72=1.96, P=.01). Conclusions: Social integration appears to be related to both PA and nutrition behaviors in youths. Future research should expand on our findings to explain how different domains of social integration may impact youths’ health behaviors. International Registered Report Identifier (IRRID): RR2-10.2196/37126 %M 36416871 %R 10.2196/40354 %U https://pediatrics.jmir.org/2022/4/e40354 %U https://doi.org/10.2196/40354 %U http://www.ncbi.nlm.nih.gov/pubmed/36416871 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40451 %T Risk and Resilience Pathways, Community Adversity, Decision-making, and Alcohol Use Among Appalachian Adolescents: Protocol for the Longitudinal Young Mountaineer Health Study Cohort %A Kristjansson,Alfgeir L %A Santilli,Annette M %A Mills,Rosalina %A Layman,Hannah M %A Smith,Megan L %A Mann,Michael J %A MacKillop,James %A James,Jack E %A Lilly,Christa L %A Kogan,Steven M %+ Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, United States, 1 3042933129, alkristjansson@hsc.wvu.edu %K adolescence %K middle school %K Appalachia %K caffeine %K alcohol use %K Young Mountaineer Health Study %K prevention %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use. Objective: The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school–aged youth in resource-poor Appalachian rural communities. Methods: This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. Results: In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes. Conclusions: The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021. International Registered Report Identifier (IRRID): DERR1-10.2196/40451 %M 35930337 %R 10.2196/40451 %U https://www.researchprotocols.org/2022/8/e40451 %U https://doi.org/10.2196/40451 %U http://www.ncbi.nlm.nih.gov/pubmed/35930337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e40022 %T Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study %A Midgett,Aida %A Doumas,Diana M %A Buller,Mary K %+ Department of Counselor Education, Boise State University, 1910 University Drive, Boise, ID, 83725, United States, 1 2084261219, AidaMidgett@boisestate.edu %K teacher bullying interventions %K technology-based bullying intervention %K STAC %K middle school %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers’ attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation. %M 35921129 %R 10.2196/40022 %U https://formative.jmir.org/2022/8/e40022 %U https://doi.org/10.2196/40022 %U http://www.ncbi.nlm.nih.gov/pubmed/35921129 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e35695 %T Impact of a Papillomavirus Vaccination Promotion Program in Middle School: Study Protocol for a Cluster Controlled Trial %A Tran,Phuong Lien %A Chirpaz,Emmanuel %A Boukerrou,Malik %A Bertolotti,Antoine %+ Department of Gynecology and Obstetrics, University Hospital of St Pierre, 97 Avenue du Président Mitterrand, Saint Pierre, Réunion, 97410, France, 33 262262359135, phuong.tran@chu-reunion.fr %K HPV vaccine %K vaccination program %K middle school %K school %K student %K women's health %K sexual health %K cervical cancer %K vaccination %K papillomavirus %K vaccine %K public education %K patient education %K community education %K promotion %K program %K youth %K children %K protocol %K mortality %K uterine cervical cancer %K cancer %K HPV %K health promotion %K girls %K school %K intervention %K parent %K training %D 2022 %7 13.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: On Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for human papillomavirus (HPV) vaccination is low. Objective: The main objective of the study is to evaluate the impact of a health promotion program promoting HPV vaccination on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. Methods: This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered containing information to students and parents, training of general practitioners, and free school-based vaccination (in a “health bus”). Children who attend this program will constitute the intervention group and will be compared to children from another middle school who will not attend the program constituting the control group. Results: Recruitment began in October 2020. In the intervention school, of 780 students, 245 were randomly selected in the 12 classes. In the control school, 259 students out of 834 were randomly selected. Conclusions: In this study, we explore the impact of a health promotion program combining information toward students, parents, and general practitioners with free school-based vaccination. We expect a significantly higher HPV vaccination coverage in the intervention school as compared to the control school, whether it be among girls or boys. The final implication would be an extension of this program in all middle schools on the Island and thus an increase in HPV vaccination coverage. Trial Registration: ClinicalTrials.gov NCT04459221; https://clinicaltrials.gov/ct2/show/NCT04459221 International Registered Report Identifier (IRRID): DERR1-10.2196/35695 %M 35700023 %R 10.2196/35695 %U https://www.researchprotocols.org/2022/6/e35695 %U https://doi.org/10.2196/35695 %U http://www.ncbi.nlm.nih.gov/pubmed/35700023 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e25086 %T The Sign 4 Big Feelings Intervention to Improve Early Years Outcomes in Preschool Children: Outcome Evaluation %A Davidson,Rosemary %A Randhawa,Gurch %+ Institute for Health Research, University of Bedfordshire, University Square, Luton, LU1 3JU, United Kingdom, 44 1582 743797, rosemary.davidson@beds.ac.uk %K language development %K sign language %K early years outcomes %K well-being %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Any delays in language development may affect learning, profoundly influencing personal, social, and professional trajectories. The effectiveness of the Sign 4 Big Feelings (S4BF) intervention was investigated by measuring changes in early years outcomes (EYOs) after a 3-month period. Objective: This study aims to determine whether children’s well-being and EYOs significantly improve (beyond typical, expected development) after the S4BF intervention period and whether there are differences between boys and girls in progress achieved. Methods: An evaluation of the S4BF intervention was conducted with 111 preschool-age children in early years settings in Luton, United Kingdom. Listening, speaking, understanding, and managing feelings and behavior, in addition to the Leuven well-being scale, were assessed in a quasi-experimental study design to measure pre- and postintervention outcomes. Results: Statistically and clinically significant differences were found for each of the 7 pre- and postmeasures evaluated: words understood and spoken, well-being scores, and the 4 EYO domains. Gender differences were negligible in all analyses. Conclusions: Children of all abilities may benefit considerably from S4BF, but a language-based intervention of this nature may be transformational for children who are behind developmentally, with English as an additional language, or of lower socioeconomic status. Trial Registration: ISRCTN Registry ISRCTN42025531; https://doi.org/10.1186/ISRCTN42025531 %M 35594062 %R 10.2196/25086 %U https://pediatrics.jmir.org/2022/2/e25086 %U https://doi.org/10.2196/25086 %U http://www.ncbi.nlm.nih.gov/pubmed/35594062 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e32490 %T Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study %A Zapolski,Tamika %A Whitener,MacKenzie %A Khazvand,Shirin %A Crichlow,Queenisha %A Revilla,Rebecca %A Salgado,Eduardo F %A Aalsma,Matthew %A Cyders,Melissa %A Salyers,Michelle %A Wu,Wei %+ Department of Psychology, School of Science, Indiana University–Purdue University Indianapolis, 402 N Blackford Street, LD 126K, Indianapolis, IN, 46202, United States, 1 317 274 2934, tzapolsk@iu.edu %K dialectical behavioral therapy %K adolescents %K high school %K intervention %K high school %K teenagers %K risk-taking behavior %K impulsivity %K emotion dysregulation %K social and emotional learning %K youth %D 2022 %7 12.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school’s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions. International Registered Report Identifier (IRRID): DERR1-10.2196/32490 %M 35551054 %R 10.2196/32490 %U https://www.researchprotocols.org/2022/5/e32490 %U https://doi.org/10.2196/32490 %U http://www.ncbi.nlm.nih.gov/pubmed/35551054 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37126 %T Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study %A Grimes,Amanda %A Lightner,Joseph S %A Eighmy,Katlyn %A Wray,Bridget D %A Valleroy,Ella %A Baughn,Maya %+ School of Nursing and Health Studies, University of Missouri, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention protocol %K physical activity %K food intake %K nutrition %K healthy eating %K middle schoolers %K youth %K school %K student %K fitness %K exercise %K food consumption %K diet %K fruit consumption %K vegetable consumption %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 %M 35507392 %R 10.2196/37126 %U https://www.researchprotocols.org/2022/5/e37126 %U https://doi.org/10.2196/37126 %U http://www.ncbi.nlm.nih.gov/pubmed/35507392 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e28276 %T Adapting the Use of Digital Content to Improve the Learning of Numeracy Among Children With Autism Spectrum Disorder in Rwanda: Thematic Content Analysis Study %A Ntalindwa,Theoneste %A Nduwingoma,Mathias %A Uworwabayeho,Alphonse %A Nyirahabimana,Pascasie %A Karangwa,Evariste %A Rashid Soron,Tanjir %A Westin,Thomas %A Karunaratne,Thashmee %A Hansson,Henrik %+ Telepsychiatry Research and Innovation Network Ltd, 114, Kazi Nazrul Islam Avenue, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K autism %K learning %K ICT %K e-learning %K education %K children %K ASD %K teaching %K teachers %K communication %K communication technology %K online content %K Rwanda %K gamification %K school %K school-age children %K behavior %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many teachers consider it challenging to teach children with autism spectrum disorder (ASD) in an inclusive classroom due to their unique needs and challenges. The integration of information communication technology (ICT) in the education system allows children with ASD to improve their learning. However, these ICT tools should meet their needs to lead a productive life. Objective: This study aimed to examine the possibilities of re-creating and adapting digital content to improve the learning of numeracy among children with ASD in inclusive school settings. Methods: We conducted 7 focus group discussions (FGDs) with 56 teachers from 7 schools and 14 parents from April to November 2019. Each of the FGDs took around 1 hour. Two clustered sets of questions were used: (1) general knowledge about teaching children with ASD and (2) analysis of selected online educational video content of early math (specifically, counting numbers). The researchers used video to understand current methodologies used in teaching children with ASD, possibilities of adaptation of the content in the current teaching environment, future challenges when the content is adapted, and possible solutions to overcome those challenges. All data, including audio recordings, field notes, and participants’ comments, were transcribed, recorded, and analyzed following the steps recommended in qualitative data analysis. Results: The researchers identified ten themes from the analysis of the data: (1) awareness of the existence of ASD among children in schools and the community, (2) acceptance of children with ASD in an inclusive classroom and the community, (3) methods and models used when teaching children with ASD, (4)realia used to improve the learning of children with ASD, (5) the design of educational digital content, (6) the accessibility of online educational content, (7) quality of the content of the educational multimedia, (8) the opportunity of using the translated and re-created content inside and outside the classroom, (9) the relevance of the digital content in the Rwandan educational system, and (10) enhancement of the accessibility and quality of the digital content. We found that participants assumed that the content translation, gamification, and re-creation would help teach children with ASD. Moreover, they recommended contextualizing the content, increasing access to digital devices, and further research in the education of different subjects. Conclusions: Although many studies have identified the possibilities of using ICT to support children with ASD, few studies have documented the possibilities of integrating the existing technologies tested in the international community. This study is charting new territory to investigate online content to suit the context of schools. This study recommends further exploration of possible methodologies, such as applied behavior analysis or verbal behavior therapy, and the development of contextualized technologies that respond to the educational needs of children with ASD. %M 35438638 %R 10.2196/28276 %U https://games.jmir.org/2022/2/e28276 %U https://doi.org/10.2196/28276 %U http://www.ncbi.nlm.nih.gov/pubmed/35438638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27760 %T An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children’s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial %A Pearson,Nicole %A Finch,Meghan %A Sutherland,Rachel %A Kingsland,Melanie %A Wolfenden,Luke %A Wedesweiler,Taya %A Herrmann,Vanessa %A Yoong,Sze Lin %+ Hunter New England Population Health, Longworth Avenue, Wallsend, 2308, Australia, 61 02 49246031 ext 46031, Nicole.Pearson@health.nsw.gov.au %K nutrition %K mHealth %K child %K preschool %K parents %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 %M 35297768 %R 10.2196/27760 %U https://www.jmir.org/2022/3/e27760 %U https://doi.org/10.2196/27760 %U http://www.ncbi.nlm.nih.gov/pubmed/35297768 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e30778 %T Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study %A Šorgo,Andrej %A Crnkovič,Nuša %A Gabrovec,Branko %A Cesar,Katarina %A Selak,Špela %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubljana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K online study %K stress %K COVID-19 %K postsecondary students %K pandemic %K epidemiology %K educational institutions %K online education %K pedagogy %K mental health %D 2022 %7 15.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students’ mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study–related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students’ negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. %M 35171098 %R 10.2196/30778 %U https://www.jmir.org/2022/3/e30778 %U https://doi.org/10.2196/30778 %U http://www.ncbi.nlm.nih.gov/pubmed/35171098 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31172 %T Exploring Middle School Students’ Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study %A Abraham,Olufunmilola %A Szela,Lisa %A Khan,Mahnoor %A Geddam,Amrita %+ Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescents %K adolescent education %K adolescent health %K older children %K middle school students %K cancer awareness %K cancer education %K cancer prevention %K health education %K serious games %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students’ preferences for the use of SGs for cancer prevention education. The study also characterized the students’ perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on “Cancer, Clear & Simple,” a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants’ gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least “some” gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters’ outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. %M 34643533 %R 10.2196/31172 %U https://games.jmir.org/2022/1/e31172 %U https://doi.org/10.2196/31172 %U http://www.ncbi.nlm.nih.gov/pubmed/34643533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30565 %T Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study %A Burn,Anne-Marie %A Ford,Tamsin J %A Stochl,Jan %A Jones,Peter B %A Perez,Jesus %A Anderson,Joanna K %+ Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, , Cambridge, CB2 0SZ, United Kingdom, 44 1223 465 192, amb278@medschl.cam.ac.uk %K mental health %K assessment %K young people %K youth %K schools %K computerized adaptive testing %K mobile apps %K user-centered design %K coproduction %K qualitative study %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles—an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. %M 35006079 %R 10.2196/30565 %U https://formative.jmir.org/2022/1/e30565 %U https://doi.org/10.2196/30565 %U http://www.ncbi.nlm.nih.gov/pubmed/35006079 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34530 %T A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial %A Stapinski,Lexine %A Routledge,Kylie %A Snijder,Mieke %A Doyle,Michael %A Champion,Katrina %A Chapman,Cath %A Ward,James %A Baumgart,Amanda %A Lee,K S Kylie %A Teesson,Maree %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Lvl 6, Jane Foss Russell Building G02, Darlington, 2006, Australia, 61 286279039, lexine.stapinski@sydney.edu.au %K Aboriginal and Torres Strait Islander %K prevention %K alcohol %K tobacco %K substance use %K universal prevention %K well-being %K harm minimization %K Indigenous %K web-based %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 %M 34994696 %R 10.2196/34530 %U https://www.researchprotocols.org/2022/1/e34530 %U https://doi.org/10.2196/34530 %U http://www.ncbi.nlm.nih.gov/pubmed/34994696 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e24792 %T Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial %A Koziol-McLain,Jane %A Wilson,Denise %A Vandal,Alain C %A Eruera,Moana %A Nada-Raja,Shyamala %A Dobbs,Terry %A Roguski,Michael %A Barbarich-Unasa,Te Wai %+ Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 211213474, jane.koziol-mclain@aut.ac.nz %K indigenous %K Māori %K young people %K relationships %K school %K mHealth %K smartphone app %K mobile phone %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori–centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 %M 34967750 %R 10.2196/24792 %U https://www.researchprotocols.org/2021/12/e24792 %U https://doi.org/10.2196/24792 %U http://www.ncbi.nlm.nih.gov/pubmed/34967750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25902 %T Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial %A Barnes,Courtney %A Yoong,Sze Lin %A Nathan,Nicole %A Wolfenden,Luke %A Wedesweiler,Taya %A Kerr,Jayde %A Ward,Dianne S %A Grady,Alice %+ Hunter New England Population Health, Locked Bag 10, Wallsend, Newcastle, 2287, Australia, 61 0249246678, courtney.barnes@health.nsw.gov.au %K childcare center %K web-based %K nutrition %K healthy eating %K randomized controlled trial %K intervention %K implementation %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w %M 34914617 %R 10.2196/25902 %U https://www.jmir.org/2021/12/e25902 %U https://doi.org/10.2196/25902 %U http://www.ncbi.nlm.nih.gov/pubmed/34914617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30668 %T Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study %A Davies,Sian M %A Jardine,Jenni %A Gutridge,Kerry %A Bernard,Zara %A Park,Stephen %A Dawson,Tom %A Abel,Kathryn M %A Whelan,Pauline %+ GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 306 7974, sian.davies-5@manchester.ac.uk %K digital mental health %K acceptability %K feasibility %K child and adolescent mental health and well-being %K school-based mental health care %K prevention %K digital assessment and monitoring %K reading screening or ability %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (≥1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. %M 34898446 %R 10.2196/30668 %U https://formative.jmir.org/2021/12/e30668 %U https://doi.org/10.2196/30668 %U http://www.ncbi.nlm.nih.gov/pubmed/34898446 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e24840 %T Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study %A Mastorci,Francesca %A Piaggi,Paolo %A Trivellini,Gabriele %A Doveri,Cristina %A Casu,Anselmo %A Bastiani,Luca %A Marinaro,Irene %A Vassalle,Cristina %A Pingitore,Alessandro %+ Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Via Moruzzi 1, Pisa, 56124, Italy, 39 050312605, pingi@ifc.cnr.it %K adolescent %K well-being management %K schools %K web tool %K health promotion %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups. %M 34860668 %R 10.2196/24840 %U https://formative.jmir.org/2021/12/e24840 %U https://doi.org/10.2196/24840 %U http://www.ncbi.nlm.nih.gov/pubmed/34860668 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31041 %T A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators’ Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Jacob,John %A Munday,Fritha %A Zeni,Megan %A Walters,Melanie %A Cheng,Tina %A Schneeberg,Amy %A Fox,Emily %A Oberle,Eva %+ Department of Pediatrics, University of British Columbia, F511-4480 Oak St, Vancouver, BC, V6H 0B3, Canada, 1 604 875 3712, mbrussoni@bcchr.ubc.ca %K early years %K risky play %K teacher %K childcare %K early learning %K risk perception %K outdoor play %D 2021 %7 18.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs’ and ELCC administrators’ perceptions and practices in support of children’s outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children’s play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041 %M 34792479 %R 10.2196/31041 %U https://www.researchprotocols.org/2021/11/e31041 %U https://doi.org/10.2196/31041 %U http://www.ncbi.nlm.nih.gov/pubmed/34792479 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31789 %T An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial %A Kaiser,Sabine %A Martinussen,Monica %A Adolfsen,Frode %A Breivik,Kyrre %A Kyrrestad,Henriette %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, UiT The Arctic University of Norway, Campus Tromsø, Breivika, Tromsø, 9019, Norway, 47 77645850, sabine.kaiser@uit.no %K cyberbullying %K intervention %K mobile app %K adolescents %K NettOpp %K mental health %K adolescents %K health care %D 2021 %7 8.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 %M 34747704 %R 10.2196/31789 %U https://www.researchprotocols.org/2021/11/e31789 %U https://doi.org/10.2196/31789 %U http://www.ncbi.nlm.nih.gov/pubmed/34747704 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29989 %T Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators’ Skills in Adolescent Mental Health) Program %A Parker,Belinda L %A Anderson,Melissa %A Batterham,Philip J %A Gayed,Aimee %A Subotic-Kerry,Mirjana %A Achilles,Melinda R %A Chakouch,Cassandra %A Werner-Seidler,Aliza %A Whitton,Alexis E %A O’Dea,Bridianne %+ Black Dog Institute, 3 Hospital Rd, Randwick, NSW, 2031, Australia, 61 29382 8509, b.odea@blackdog.org.au %K mental health %K training %K high school teachers %K youth %K mental health programs %K secondary schools %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Secondary schools are increasingly supporting adolescents’ mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators’ skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers’ knowledge and confidence in caring for students’ mental health. Objective: This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers. Methods: A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants’ perceptions of program effectiveness. Results: A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness. Conclusions: Findings indicated that a web-based training program may be beneficial for improving secondary school teachers’ abilities to care for students’ mental health; however, program modifications are required to increase training completions. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529 %M 34677134 %R 10.2196/29989 %U https://mental.jmir.org/2021/10/e29989 %U https://doi.org/10.2196/29989 %U http://www.ncbi.nlm.nih.gov/pubmed/34677134 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30339 %T A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial %A Gonsalves,Pattie P %A Sharma,Rhea %A Hodgson,Eleanor %A Bhat,Bhargav %A Jambhale,Abhijeet %A Weiss,Helen A %A Fairburn,Christopher G %A Cavanagh,Kate %A Cuijpers,Pim %A Michelson,Daniel %A Patel,Vikram %+ Sangath, E-5, Lane 1, Westend Marg, Saiyad ul ajaib, Saket, New Delhi, 110030, India, 91 9899419704, pattie.gonsalves@sangath.in %K randomized controlled trial %K internet-based intervention %K smartphone %K adolescent %K schools %K mental health %K COVID-19 %K app %K protocol %K problem-solving %K intervention %K teenager %K young adult %K India %K feasibility %K effective %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 %M 34586075 %R 10.2196/30339 %U https://www.researchprotocols.org/2021/10/e30339 %U https://doi.org/10.2196/30339 %U http://www.ncbi.nlm.nih.gov/pubmed/34586075 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30899 %T The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study %A Engler-Stringer,Rachel %A Black,Jennifer %A Muhajarine,Nazeem %A Martin,Wanda %A Gilliland,Jason %A McVittie,Janet %A Kirk,Sara %A Wittman,Hannah %A Mousavi,Amin %A Elliott,Sinikka %A Tu,Sylvana %A Hills,Brent %A Androsoff,Gordon %A Field,Debbie %A Macdonald,Brit %A Belt,Chelsea %A Vatanparast,Hassan %+ Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N5E5, Canada, 1 3069667839, rachel.engler-stringer@usask.ca %K school food programs %K Canada %K nutrition %K intervention research %K mHealth %D 2021 %7 21.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones. Objective: The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices. Methods: This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project. Results: This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention. Conclusions: The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent. International Registered Report Identifier (IRRID): DERR1-10.2196/30899 %M 34546171 %R 10.2196/30899 %U https://www.researchprotocols.org/2021/9/e30899 %U https://doi.org/10.2196/30899 %U http://www.ncbi.nlm.nih.gov/pubmed/34546171 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e29454 %T School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review %A Exner-Cortens,Deinera %A Baker,Elizabeth %A Gray,Shawna %A Fernandez Conde,Cristina %A Rivera,Rocio Ramirez %A Van Bavel,Marisa %A Vezina,Elisabeth %A Ambrose,Aleta %A Pawluk,Chris %A Schwartz,Kelly D %A Arnold,Paul D %+ Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada, 1 4032208871, deinera.exner2@ucalgary.ca %K suicide %K risk assessment %K youth %K eHealth %K school mental health %K mobile phone %D 2021 %7 21.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. %M 34546178 %R 10.2196/29454 %U https://mental.jmir.org/2021/9/e29454 %U https://doi.org/10.2196/29454 %U http://www.ncbi.nlm.nih.gov/pubmed/34546178 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30499 %T Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial %A Anderson,Pamela %A Coyle,Karin %A Guinosso,Stephanie %A Ferrand,John L %A Owora,Arthur %A Houghton,Rebecca F %A Walsh-Buhi,Eric %+ Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, Room 116, Bloomington, IN, 47405, United States, 1 8128554867, erwals@iu.edu %K adolescents %K youth %K teens %K healthy relationships %K unintended pregnancy %K teen pregnancy %K sexually transmitted infections %K sexually transmitted diseases %K sexual health education %K school-based health center %K randomized controlled trial %D 2021 %7 1.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study—the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. Trial Registration: ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876 International Registered Report Identifier (IRRID): DERR1-10.2196/30499 %M 34468330 %R 10.2196/30499 %U https://www.researchprotocols.org/2021/9/e30499 %U https://doi.org/10.2196/30499 %U http://www.ncbi.nlm.nih.gov/pubmed/34468330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26223 %T Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study %A Beames,Joanne R %A Johnston,Lara %A O'Dea,Bridianne %A Torok,Michelle %A Christensen,Helen %A Boydell,Katherine M %A Werner-Seidler,Aliza %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 ext 8776, j.beames@blackdog.org.au %K secondary school %K depression %K prevention %K digital %K barrier %K facilitator %K teacher %K counselor %K principal %K student %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective: The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods: This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results: A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions: The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types. %M 34448701 %R 10.2196/26223 %U https://www.jmir.org/2021/8/e26223 %U https://doi.org/10.2196/26223 %U http://www.ncbi.nlm.nih.gov/pubmed/34448701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28273 %T Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial %A Van de Kop,Huib %A Toussaint,Huub %A Janssen,Mirka %A Busch,Vincent %A Verhoeff,Arnoud %+ Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, Amsterdam, 1067 SM, Netherlands, 31 0 621158166, j.h.van.de.kop@hva.nl %K physical activity %K participatory %K adolescents %K protocol %K assets %K school-based %K students %K participation %K school-age children %K teenagers %K exercise %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. Objective: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. Methods: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students’ assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. Results: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10× 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). Conclusions: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. Trial Registration: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636 International Registered Report Identifier (IRRID): DERR1-10.2196/28273 %M 34121666 %R 10.2196/28273 %U https://www.researchprotocols.org/2021/7/e28273 %U https://doi.org/10.2196/28273 %U http://www.ncbi.nlm.nih.gov/pubmed/34121666 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e26690 %T Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study %A Mclaughlin,Matthew %A Duff,Jed %A McKenzie,Tom %A Campbell,Elizabeth %A Sutherland,Rachel %A Wiggers,John %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, 2308, Australia, 61 402448504, Matthew.Mclaughlin1@health.nsw.gov.au %K process evaluation %K engagement %K think-aloud methodology %K mixed methods %K physical activity %K website %K digital health intervention %K implementation support %K delivery mode %K scale-up %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective: The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods: The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the “following a thread” approach. Results: For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions: Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870 %M 34309565 %R 10.2196/26690 %U https://pediatrics.jmir.org/2021/3/e26690 %U https://doi.org/10.2196/26690 %U http://www.ncbi.nlm.nih.gov/pubmed/34309565 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e21837 %T A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial %A Moltrecht,Bettina %A Patalay,Praveetha %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Evidence-based Practice Unit, University College London & Anna Freud National Centre, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 020 7794 ext 2313, Julian.childs@annafreud.org %K emotion regulation %K digital mental health %K mhealth %K school intervention %K child mental health %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. Objective: This study investigates the use of a new app-based intervention designed to support children’s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. Methods: As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). Results: The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention’s usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children’s emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. Conclusions: We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children’s emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys. %M 34259642 %R 10.2196/21837 %U https://mhealth.jmir.org/2021/7/e21837 %U https://doi.org/10.2196/21837 %U http://www.ncbi.nlm.nih.gov/pubmed/34259642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25256 %T A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness–Implementation Hybrid Cluster Randomized Controlled Trial %A Sutherland,Rachel %A Brown,Alison %A Nathan,Nicole %A Yoong,Serene %A Janssen,Lisa %A Chooi,Amelia %A Hudson,Nayerra %A Wiggers,John %A Kerr,Nicola %A Evans,Nicole %A Gillham,Karen %A Oldmeadow,Christopher %A Searles,Andrew %A Reeves,Penny %A Davies,Marc %A Reilly,Kathryn %A Cohen,Brad %A Wolfenden,Luke %+ Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, Australia, 61 2 4924 6499, rachel.sutherland@health.nsw.gov.au %K childhood obesity %K lunchboxes %K children %K child nutrition %K mHealth %K schools %K hybrid %K randomized controlled trial %K technology %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x %M 34185013 %R 10.2196/25256 %U https://www.jmir.org/2021/6/e25256/ %U https://doi.org/10.2196/25256 %U http://www.ncbi.nlm.nih.gov/pubmed/34185013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24659 %T Professionals’ and Students’ Perceived Needs for an Online Supportive Application for Reducing School Absence and Stimulating Reintegration: Concept Mapping Study %A Hoogsteder,Mariette H H %A Douma,Linda N %A Eskens,Charlotte G A %A Berendsen,Renske L %A Vanneste,Yvonne T M %A Schaafsma,Frederieke G %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 20 4445965, m.hoogsteder@amsterdamumc.nl %K medical absenteeism %K secondary education %K eHealth %K mHealth %K mobile health %K students %K schools, health occupations %K youth health physicians %K concept mapping %D 2021 %7 21.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: To limit students’ medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students’ autonomy regarding their situation. Objective: This study aimed to identify professionals’ and students’ perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. Methods: Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. Results: Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. Conclusions: Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism. %M 34152275 %R 10.2196/24659 %U https://formative.jmir.org/2021/6/e24659 %U https://doi.org/10.2196/24659 %U http://www.ncbi.nlm.nih.gov/pubmed/34152275 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e27958 %T Building Primary-School Children’s Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study %A Nicolaidou,Iolie %A Stavrou,Evi %A Leonidou,Georgia %+ Department of Communication and Internet Studies, Cyprus University of Technology, PO Box 50329, Limassol, 3603, Cyprus, 357 25 002105, iolie.nicolaidou@cut.ac.cy %K COVID-19 %K interactive learning environment %K internet-based cognitive behavioral therapy %K parents %K prevention intervention %K primary school children %K psychological resilience %K teachers %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Resilience is a person’s mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children’s resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program “Friends,” to overcome accessibility issues associated with delivering cognitive behavioral therapy–based interventions in formal and informal education settings. Objective: This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment’s usability. Methods: A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children’s anxiety symptoms, namely the Greek translation of the original Spence Children’s Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. Results: In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students’ reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=–6.99; P<.001), identification of somatic symptoms of stress (t19=–7.31; P<.001), and identification of stress management techniques (t19=–6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. Conclusions: This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access. %M 34106080 %R 10.2196/27958 %U https://pediatrics.jmir.org/2021/2/e27958 %U https://doi.org/10.2196/27958 %U http://www.ncbi.nlm.nih.gov/pubmed/34106080 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24937 %T Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups %A Norris,Anne E %A Thalasinos,Roxana Delcampo %A Hecht,Michael L %+ REAL Prevention, LLC, 817 Kingsbridge Dr, Oviedo, FL, 32765, United States, 1 4074161727, anne@real-prevention.com %K implementation science %K mobile apps %K peer influence %K early intervention %K adolescent health %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency. %M 34076578 %R 10.2196/24937 %U https://formative.jmir.org/2021/6/e24937 %U https://doi.org/10.2196/24937 %U http://www.ncbi.nlm.nih.gov/pubmed/34076578 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28673 %T Pool Testing as a Strategy for Prevention of SARS-CoV-2 Outbreaks in Schools: Protocol for a Feasibility Study %A Sweeney-Reed,Catherine M %A Wolff,Doreen %A Niggel,Jakob %A Kabesch,Michael %A Apfelbacher,Christian %+ Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, , Germany, 49 (0)391 6728224, catherine.sweeney-reed@med.ovgu.de %K SARS-CoV-2 %K COVID-19 %K schools %K pool testing %K gargle test %K test strategy %K monitoring %K surveillance %K PCR %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: School closures are a widely implemented strategy for limiting infection spread in the current COVID-19 pandemic. The negative impact of school closures on children and young people is increasingly apparent, however. Objective: We aim to evaluate the feasibility of an infection monitoring program in schools to enable targeted quarantining to replace school closures. The program is currently being implemented in two model schools in Magdeburg, Germany, within the framework of the Study of Coronavirus Outbreak Prevention in Magdeburg Schools (Studie zur Ausbruchsvermeidung von Corona an Magdeburger Schulen [STACAMA]). Methods: Five pupils per class are pseudorandomly selected twice a week and asked to provide a gargle sample over a 16-week evaluation period. RNA is extracted from each sample individually in a laboratory and pooled according to school class for real-time reverse transcription polymerase chain reaction (rRT-PCR) analysis. Immediate individual sample testing will be carried out in the case of a positive pool test. Individual RNA extraction prior to pooling and application of rRT-PCR result in high test sensitivity. Testing will be performed in strict adherence to data protection standards. All participating pupils will receive a 16-digit study code, which they will be able to use to access their test Results: When the study commenced on December 2, 2020, 520 (52%) pupils and their families or guardians had consented to study participation. The study was suspended after four test rounds due to renewed school closures resulting from rising regional infection incidence. Testing resumed when schools reopened on March 8, 2021, at which time consent to participation was provided for 54% of pupils. We will quantitatively and qualitatively evaluate the logistics and acceptability of the program. Conclusions: The findings from this study should inform the design of infection surveillance programs in schools based on gargle samples and a PCR-based pool testing procedure, enabling the identification of aspects that may require adaptation before large-scale implementation. Our focus on each step of the logistics and on the experiences of families should enable a robust assessment of the feasibility of such an approach. International Registered Report Identifier (IRRID): DERR1-10.2196/28673 %M 33979297 %R 10.2196/28673 %U https://www.researchprotocols.org/2021/5/e28673 %U https://doi.org/10.2196/28673 %U http://www.ncbi.nlm.nih.gov/pubmed/33979297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24496 %T Experiences and Attitudes of Elementary School Students and Their Parents Toward Online Learning in China During the COVID-19 Pandemic: Questionnaire Study %A Cui,Shu %A Zhang,Chao %A Wang,Shijiang %A Zhang,Xingong %A Wang,Lei %A Zhang,Ling %A Yuan,Qiuyu %A Huang,Cui %A Cheng,Fangshuo %A Zhang,Kai %A Zhou,Xiaoqin %+ Department of Psychiatry, Chaohu Hospital, Anhui Medical University, 64 Chaohu Road, Chaohu, Hefei, China, 86 055182324014, zhouxqlulu@126.com %K attitude %K elementary school students %K parents %K online learning %K COVID-19 %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to widespread SARS-CoV-2 infection, an emergency homeschooling plan was rigorously implemented throughout China. Objective: This study aimed to investigate the experiences and attitudes of elementary school students and their parents (two generations from the same family) toward online learning in China during the pandemic. Methods: A 16-item questionnaire was distributed at the 10-day and 40-day marks after the start of the first online course to 867 parent-child pairs and 141 parent-child pairs, respectively. The questionnaire was comprised of questions pertaining to course and homework completeness, effectiveness, reliability, and abundance as well as the students’ enthusiasm for taking part in online classes and their satisfaction with the courses. Results: Our findings indicate that 90.7% (786/867) of students exhibited high or moderate enthusiasm for participating in online classes. However, most students performed poorly in online learning classes and after-school homework. With regard to satisfaction, parents' and students' average scores were 7.35 and 7.25, respectively (10-point scoring system). During the second stage of this study, parents' positive evaluations for online learning declined, including those for the effectiveness and reliability of the courses. Furthermore, the proportion of students who completed the courses and homework on time decreased; this difference proved statistically significant (P=.047). The parents’ and students’ overall satisfaction with online learning also declined during the second stage (parents: 7.21; students: 7.23); however, the difference in overall satisfaction between the two stages was not statistically significant (parents: P=.53; students: P=.60). Several of the parents (315/867, 36.2%) indicated that assisting with and supervising the students’ online learning resulted in increased stress. Further, 36% of parents expressed dissatisfaction with or provided suggestions for online learning; most parents and students hoped to return to face-to-face classes (parents: 823/867, 94.9%; students: 811/867, 93.5%). Finally, our results presented the following six main issues that parents were the most concerned about: (1) disappointment regarding timely interaction in courses; (2) apprehensiveness about students’ understanding of the course; (3) the increased burden of annoying adult responsibilities; (4) concern about children's eyesight; (5) the idea that teachers’ explanations were not detailed enough; and (6) concerns about the decline of students' interest in and attention toward online courses. Conclusions: Online learning can prevent the spread of infectious diseases while still allowing elementary school students to attain knowledge. However, in our study, children’s completion of the courses and homework were not satisfactory. Furthermore, their parents often experienced stress and had many concerns and complaints. Measures such as increasing the interactivity of the courses and prohibiting teachers from assigning tasks to parents could improve the effectiveness of these courses and the mental health of parents and students. %M 33878022 %R 10.2196/24496 %U https://www.jmir.org/2021/5/e24496 %U https://doi.org/10.2196/24496 %U http://www.ncbi.nlm.nih.gov/pubmed/33878022 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e22822 %T Participatory Design of an Activities-Based Collective Mentoring Program in After-School Care Settings: Connect, Promote, and Protect Program %A Milton,Alyssa C %A Stewart,Elizabeth %A Ospina-Pinillos,Laura %A Davenport,Tracey %A Hickie,Ian B %+ Faculty of Medicine and Health, University of Sydney, Professor Marie Bashir Centre, Camperdown, 2050, Australia, 61 +61 2 9515 1592, alyssa.milton@sydney.edu.au %K participatory design %K children %K after school care %K health %K well-being %K program development %K community consultation %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Out of school hours care (OSHC) services provide a unique opportunity to deliver early intervention programs to enhance primary school–aged children’s social, emotional, physical, and cognitive well-being; however, such programs are currently lacking. Objective: This study aims to address the lack of well-being programs for children accessing OSHC services in the research literature by using participatory design (PD) to collaboratively develop and test an OSHC well-being program—the connect, promote, and protect program (CP3). Methods: The study employed methods of PD, user (acceptance) testing, and iterative knowledge translation to develop a novel well-being program framework—CP3—with key stakeholders (eg, children, OSHC staff, volunteers, families, clinicians, educators, and researchers). Thematic techniques were used to interpret and translate the qualitative information obtained during the research and design cycles. Results: The co-design process generated the CP3 model, which comprises a group-based mentoring approach to facilitate enhanced activities in OSHC settings. Activities are underpinned by 4 key principles of program delivery: build well-being and resilience, broaden horizons, inspire and engage, and connect communities. Conclusions: To our knowledge, the CP3 program is the first co-designed well-being program developed specifically for OSHC services. This co-design process is key to ensuring local community needs—particularly those of young people accessing OSHC—are met and that these individuals are meaningfully and actively involved in all stages of the research and design process, from conception to implementation, evaluation, and continuous improvement. %M 33843603 %R 10.2196/22822 %U https://pediatrics.jmir.org/2021/2/e22822 %U https://doi.org/10.2196/22822 %U http://www.ncbi.nlm.nih.gov/pubmed/33843603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25513 %T A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App %A Thornton,Louise %A Gardner,Lauren Anne %A Osman,Bridie %A Green,Olivia %A Champion,Katrina Elizabeth %A Bryant,Zachary %A Teesson,Maree %A Kay-Lambkin,Frances %A Chapman,Cath %A , %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), 160 City Road, Sydney, 2006, Australia, 61 286279012, lauren.gardner@sydney.edu.au %K mHealth %K mobile phone %K chronic disease %K adolescents %K health promotion %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. %M 33843590 %R 10.2196/25513 %U https://formative.jmir.org/2021/4/e25513 %U https://doi.org/10.2196/25513 %U http://www.ncbi.nlm.nih.gov/pubmed/33843590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25838 %T Effects of a School-Based Physical Activity Intervention for Obesity and Health-Related Physical Fitness in Adolescents With Intellectual Disability: Protocol for a Randomized Controlled Trial %A Wang,Aiwei %A Gao,Yang %A Wang,Jingjing %A Tong,Tomas K %A Sun,Yan %A Yu,Siyue %A Zhao,Hong %A Zou,Daozhi %A Zhang,Ziheng %A Qi,Yuling %A Zuo,Nan %A Bu,Danran %A Zhang,Dexing %A Xie,Yaojie %A Baker,Julien S %+ Department of Sport, Physical Education and Health, Hong Kong Baptist University, AAB 927 Academic and Administration Building, 15 Baptist University Road, Hong Kong, China, 852 34113082, gaoyang@hkbu.edu.hk %K children %K intellectual disability %K physical activity %K overweight %K obesity %K intervention %D 2021 %7 22.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity accompanied by lower levels of health-related physical fitness (HRPF) is a major threat to public health both internationally and locally. Children with intellectual disability, especially adolescents, have a higher risk of being overweight/obese and having poor HRPF levels. Therefore, more interventions are needed to help this population attain their optimal health levels. However, there has been relatively limited research on this population compared with on their typically developing peers. Objective: The proposed study aims to fill this knowledge gap by developing and examining the success of a physical activity (PA) intervention for the target population. Methods: The proposed study will be a 12-week, school-based randomized controlled trial. The participants (N=48) will be recruited from special schools for students with mild intellectual disability and then randomly allocated to either the intervention group (IG) or the wait-list control group (CG). During the intervention period, the participants in the IG will receive a fun game–based moderate-to-vigorous PA (MVPA) training program (2 sessions/week, 60 minutes/session, for a total of 24 sessions). The intensity of the activities will increase in a progressive manner. Participants in the CG will receive no program during the study period, but the same PA program will be provided to them after the completion of the study. To observe and evaluate the sustaining effects of the intervention, follow-up testing will be scheduled for the participants 12 weeks after the intervention concludes. The study outcomes will include primary outcomes (obesity- and fitness-related outcomes) and a secondary outcome (blood pressure). All of the measurements will be taken at 3 time points. After the follow-up tests, the same PA training program will be provided to the participants in the CG. Results: This study is ongoing. The participants were recruited from October 2020 to November 2020. The total duration of the study is 13 months. Study results are expected at the end of 2021. Conclusions: The proposed study is expected to reduce obesity and improve HRPF levels in children with intellectual disability. If proven effective, the intervention will be made accessible to more special schools and mainstream schools with students with intellectual disability. Furthermore, the study can serve as an example for international researchers, policy makers, and members of the public who are seeking to tackle the problem of obesity and poor HRPF among children with intellectual disability. Trial Registration: ClinicalTrials.gov NCT04554355; https://www.clinicaltrials.gov/ct2/show/NCT04554355 International Registered Report Identifier (IRRID): PRR1-10.2196/25838 %M 33749611 %R 10.2196/25838 %U https://www.researchprotocols.org/2021/3/e25838 %U https://doi.org/10.2196/25838 %U http://www.ncbi.nlm.nih.gov/pubmed/33749611 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25870 %T The Building Educators’ Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial %A Parker,Belinda L %A Chakouch,Cassandra %A Subotic-Kerry,Mirjana %A Batterham,Philip J %A Mackinnon,Andrew %A Newby,Jill M %A Whitton,Alexis E %A McGoldrick,Janey %A Cockayne,Nicole %A O'Dea,Bridianne %+ Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, 2031, Australia, 61 290659057, belinda.parker@blackdog.org.au %K mental health training %K schools %K teachers %K educators %K mental health %K student mental health %K secondary school %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators’ Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed. Objective: The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators’ confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators’ frequency of providing help to students and improving their mental health knowledge and reducing educators’ psychological distress and stigma toward students with mental health issues. Methods: The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment. Results: Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021. Conclusions: This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students’ mental health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208 International Registered Report Identifier (IRRID): DERR1-10.2196/25870 %M 33625374 %R 10.2196/25870 %U https://www.researchprotocols.org/2021/2/e25870 %U https://doi.org/10.2196/25870 %U http://www.ncbi.nlm.nih.gov/pubmed/33625374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20898 %T Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial %A Hirvonen,Maija %A Purcell,Carrie %A Elliott,Lawrie %A Bailey,Julia V %A Simpson,Sharon Anne %A McDaid,Lisa %A Moore,Laurence %A Mitchell,Kirstin Rebecca %A , %+ MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley St, Glasgow, G3 7HR, United Kingdom, 44 1413537500, kirstin.mitchell@glasgow.ac.uk %K social media %K sexual health %K sex education %K peer education %K process evaluation %K school %K feasibility studies %K adolescent %K social networking %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources. Objective: The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention. Methods: Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data. Results: Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to—rather than embedded in—their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied. Conclusions: Invitation-only social media groups formed around peer supporters’ existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding. %M 33591287 %R 10.2196/20898 %U http://www.jmir.org/2021/2/e20898/ %U https://doi.org/10.2196/20898 %U http://www.ncbi.nlm.nih.gov/pubmed/33591287 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e19430 %T App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation %A Sun,Yuewen %A Luo,Rong %A Li,Yuan %A He,Feng J %A Tan,Monique %A MacGregor,Graham A %A Liu,Hueiming %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, 100600, China, 86 10 8280 0177, zpuhong@georgeinstitute.org.cn %K mobile health %K mobile phone %K process evaluation %K salt reduction %K health education %D 2021 %7 10.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/19430 %M 33565991 %R 10.2196/19430 %U http://www.researchprotocols.org/2021/2/e19430/ %U https://doi.org/10.2196/19430 %U http://www.ncbi.nlm.nih.gov/pubmed/33565991 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26567 %T Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study %A Kuriyan,Aparajita %A Kinkler,Grace %A Cidav,Zuleyha %A Kang-Yi,Christina %A Eiraldi,Ricardo %A Salas,Eduardo %A Wolk,Courtney Benjamin %+ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Philadelphia, PA, 19104, United States, 1 215 746 6099, cbenja@upenn.edu %K teams %K Team Strategies and Tools to Enhance Performance and Patient Safety %K school mental health %K school health %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. Objective: The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. Methods: Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. Results: Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. Conclusions: This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. Trial Registration: ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228 International Registered Report Identifier (IRRID): DERR1-10.2196/26567 %M 33555258 %R 10.2196/26567 %U https://www.researchprotocols.org/2021/2/e26567 %U https://doi.org/10.2196/26567 %U http://www.ncbi.nlm.nih.gov/pubmed/33555258 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25062 %T An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study %A Sauch Valmaña,Glòria %A Vidal-Alaball,Josep %A Garcia Furió,Victoria %A Testoni,Giorgia %A Espelt,Albert %A Exposito,Katarin %A Saigí-Rubió,Francesc %A Carré,Núria %A Sanz,Ikuska %A Vicens,Victor %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K mHealth %K telehealth %K teenager %K health promotion and sexual health %K health promotion %K sexual health %D 2021 %7 3.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients’ safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 %M 33533729 %R 10.2196/25062 %U https://www.researchprotocols.org/2021/2/e25062 %U https://doi.org/10.2196/25062 %U http://www.ncbi.nlm.nih.gov/pubmed/33533729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21636 %T Factors Associated With Dropout of Participants in an App-Based Child Injury Prevention Study: Secondary Data Analysis of a Cluster Randomized Controlled Trial %A Li,Jie %A Ning,Peishan %A Cheng,Peixia %A Schwebel,David C %A Yang,Yang %A Wei,Xiang %A He,Jieyi %A Wang,Wanhui %A Li,Ruotong %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 app-based intervention %K unintentional injury %K attrition %K influencing factors %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. Objective: We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. Methods: The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. Results: In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9% (437/1510) in the intervention group and 35.7% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition. Conclusions: Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 %M 33512318 %R 10.2196/21636 %U https://www.jmir.org/2021/1/e21636 %U https://doi.org/10.2196/21636 %U http://www.ncbi.nlm.nih.gov/pubmed/33512318 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e22680 %T Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial %A Balestrin,Mariana %A Brasil,Carla Cristina Bauermann %A Bellei,Ericles Andrei %A Kirsten,Vanessa Ramos %A Wagner,Mario Bernardes %+ Faculty of Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), 2400 Ramiro Barcelos, Room 220, Porto Alegre, 90035-003, Brazil, 55 51 33085601, mari_dalmolin@hotmail.com %K school health services %K healthy diet %K pediatric obesity %K schools %K snacks %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: School cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings. Objective: We aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil. Methods: We will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95% CI. Results: This project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021. Conclusions: To our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals. Trial Registration: Brazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhk International Registered Report Identifier (IRRID): DERR1-10.2196/22680 %M 33464219 %R 10.2196/22680 %U http://www.researchprotocols.org/2021/1/e22680/ %U https://doi.org/10.2196/22680 %U http://www.ncbi.nlm.nih.gov/pubmed/33464219 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25860 %T Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial %A Agley,Jon %A Jun,Mikyoung %A Eldridge,Lori %A Agley,Daniel L %A Xiao,Yunyu %A Sussman,Steve %A Golzarri-Arroyo,Lilian %A Dickinson,Stephanie L %A Jayawardene,Wasantha %A Gassman,Ruth %+ Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, 501 N Morton St, Suite 110, Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K cyberbullying %K bullying %K social-emotional learning %K SEL %K social-emotional competence %K RCT %K randomized controlled trial %K outcome %K emotion %K bully %K prevention %K school %K intervention %K assessment %K effectiveness %K implementation %K fidelity %K reception %K children %K young adults %K adolescents %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students’ receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants’ social-emotional competence. The intervention’s impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. Trial Registration: Clinicaltrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID): RR2-10.2196/17900 %M 33338986 %R 10.2196/25860 %U http://mental.jmir.org/2021/1/e25860/ %U https://doi.org/10.2196/25860 %U http://www.ncbi.nlm.nih.gov/pubmed/33338986 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e20940 %T Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study %A Knight,Louise %A Atuhaire,Lydia %A Allen,Elizabeth %A Namy,Sophie %A Anton-Erxleben,Katharina %A Nakuti,Janet %A Mirembe,Angel Faridah %A Nakiboneka,Mastula %A Seeley,Janet %A Weiss,Helen A %A Parkes,Jenny %A Bonell,Chris %A Naker,Dipak %A Devries,Karen %+ London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 020 7636 8636, Louise.Knight@lshtm.ac.uk %K violence %K long-term follow-up %K whole-school %K intervention %K adolescents %K Uganda %K resilience %K non-randomised %D 2020 %7 7.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Violence against children in schools is a global public health problem. There is growing evidence that school-based interventions can be effective in reducing violence against children in schools. However, there is little evidence on the long-term impact of such interventions. The Good School Toolkit, developed by Raising Voices, a Uganda-based nonprofit organization, is a whole-school violence prevention intervention that aims to change the operational culture of primary schools. In 2014, the Good School Toolkit was evaluated through a cluster randomized controlled trial (Good Schools Study) and found to reduce teacher-to-student and student-to-student violence. Objective: This protocol describes quantitative analyses to explore long-term outcomes of the Good School Toolkit intervention among adolescents in Uganda, including the extent to which it is associated with peer-violence victimization (primary outcome) and peer-violence perpetration, intimate-partner violence, acceptance of teacher-violence, equitable gender attitudes, agency, self-regulation, peer connectedness, social assets, psychological assets, and retention in school (secondary outcomes). Methods: This is a nonrandomized quasi-experimental 4-year follow-up study of adolescents who attended the 42 Good Schools Study primary schools in 2014; 21 schools initiated the Good School Toolkit intervention during the trial from 2012, and 19 schools initiated the intervention after the trial (during the later delivery phase) from 2015; 2 schools did not implement the intervention. Students in the final school grade (Primary 7) during 2014 of the 19 primary schools in the later delivery phase are expected to have left school prior to toolkit delivery in 2015. Wave 1 data were collected in 2014 from 3431 grade Primary 5 to Primary 7 school students aged 11-14 years; these students were followed up in 2018-2019 when aged 16-19 years and invited to participate in the Wave 2 survey. Data were collected in face-to-face interviews by trained Ugandan field researchers. Toolkit exposure groups are defined as exposed during the Good Schools Study trial (from 2012), as exposed during later delivery (from 2015), or not exposed including those expected to have completed Primary 7 prior to later delivery or from the 2 schools that did not implement the toolkit. Associations between outcomes at Wave 2 and toolkit exposure groups will be analyzed using mixed-effect multivariable logistic and linear regression models for binary and continuous outcomes, respectively. This analysis is exploratory and aims to generate hypotheses on if, and under what circumstances, the toolkit influences later adolescent outcomes. Results: Data collection was completed in August 2019. Conclusions: To our knowledge, this is the first long-term follow-up study of adolescents exposed to a school-based violence-prevention intervention in sub-Saharan Africa. If the intervention reduces violence and improves other outcomes in later adolescence, then this study supports primary school interventions as key to achieving long-term population impacts. The pattern of effects will inform where reinforced or additional interventions are needed. International Registered Report Identifier (IRRID): DERR1-10.2196/20940 %M 33283762 %R 10.2196/20940 %U https://www.researchprotocols.org/2020/12/e20940 %U https://doi.org/10.2196/20940 %U http://www.ncbi.nlm.nih.gov/pubmed/33283762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e18522 %T Sedentariness and Back Health in Western Cape Primary School Students: Protocol for a Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial %A Fisher,Dominic %A Louw,Quinette %A Thabane,Lehana %+ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Room 4095 Education Building, FMHS, Francie van Zijl Avenue, Parow Valley, PO Box 241, Cape Town, 8000, South Africa, 27 021 938 9300, dominic@sun.ac.za %K sitting %K standing %K postural dynamism %K sit-stand desks %K classroom %K school %K sedentary %K children %D 2020 %7 30.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite growing evidence of deleterious health outcomes associated with sedentary behavior, prolonged static sitting in classrooms remains ubiquitous in primary schools. Sedentary behavior is associated with the development of cardio-metabolic conditions and poor back health. Preventative strategies to reduce sedentary behavior and its negative health effects may be required in a resource-constrained environment such as South Africa. Objective: The primary objective of this study is to assess the feasibility of conducting a full trial to evaluate the effects of a multifaceted intervention comprising novel multifunctional classroom furniture and a video-based curriculum versus usual care on sedentary behavior among students aged 10-11 years in primary schools. The secondary objective is to assess the preliminary effects of the intervention on sedentary behavior and postural dynamism. Methods: Eighty grade 5 or 6 students, aged 10 and 11 years, in mixed-gender schools within the Western Cape metropolitan urban area in Cape Town, South Africa are eligible to participate in this pilot cluster stepped-wedge trial design with classroom as the unit of randomization. Data will be collected at the schools. The intervention will comprise multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum on sedentary behavior. Usual practice is the absence of the intervention. The primary outcomes assessed will be (1) adherence to the intervention and (2) project pragmatics. The secondary outcomes will be (1) sedentariness measured using activPAL3 microsensors and (2) postural dynamism measured using Noraxon Myomotion inertial measurement units. We randomized the school to the first or second start of the intervention. This is an open-label trial and therefore blinding will not be possible for any group. Descriptive analysis of the feasibility and physiological outcomes will be presented. We will report the preliminary estimates of the effects of the intervention on sedentariness and postural dynamism using the mean difference and 95% CI. Results: At the time of submission, two classrooms have been recruited into the study. Baseline physical activity and postural dynamism data have been collected from 10 participants from each class. Conclusions: The results of this feasibility stepped-wedge cluster randomized controlled trial will be useful in informing the design of the main trial to assess whether this multifaceted intervention of multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum versus usual care has any effect on sedentary behavior in low-resource-setting primary schools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR1-10.2196/18522 %M 33089783 %R 10.2196/18522 %U http://www.researchprotocols.org/2020/11/e18522/ %U https://doi.org/10.2196/18522 %U http://www.ncbi.nlm.nih.gov/pubmed/33089783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22612 %T Social Media Surveillance in Schools: Rethinking Public Health Interventions in the Digital Age %A Burke,Colin %A Bloss,Cinnamon %+ University of California, San Diego, 9500 Gilman Drive MC0896, La Jolla, CA, 92093-0896, United States, 1 8585349595, cbloss@ucsd.edu %K social media %K surveillance %K privacy %K public health %K students %K schools %K social media surveillance %K school safety %K mental health %K adolescents %D 2020 %7 12.11.2020 %9 Viewpoint %J J Med Internet Res %G English %X Growing public concern about student safety and well-being has led schools and school districts to contract private companies to implement new technologies that target and surveil students’ activity on social media websites. Although innovative solutions for addressing student safety and health are needed, it is unclear whether the implementation of social media surveillance in schools is an effective strategy. Currently, there is no evidence to support the claims made by social media surveillance companies, as well as the schools that hire them, that these technologies can address the myriad of public health issues facing today’s students. Instead, these digital surveillance systems may only serve to exacerbate the problems that youth—especially those from historically marginalized groups—already face. %M 33179599 %R 10.2196/22612 %U http://www.jmir.org/2020/11/e22612/ %U https://doi.org/10.2196/22612 %U http://www.ncbi.nlm.nih.gov/pubmed/33179599 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e21100 %T Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation %A Galanti,Maria Rosaria %A Pulkki-Brännström,Anni-Maria %A Nilsson,Maria %+ Centre for Epidemiology and Community Health, Solnavägen 1E, Stockholm , Sweden, 46 704718984, rosaria.galanti@ki.se %K tobacco use %K prevention %K school %K social influence %K public commitment %K cluster randomized trial %K observational study %D 2020 %7 29.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent’s commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. Objective: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program’s implementation. Methods: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. Results: The study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. Conclusions: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID): DERR1-10.2196/21100 %M 33000762 %R 10.2196/21100 %U http://www.researchprotocols.org/2020/10/e21100/ %U https://doi.org/10.2196/21100 %U http://www.ncbi.nlm.nih.gov/pubmed/33000762 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20976 %T Repeated Psychosocial Screening of High School Students Using YouthCHAT: Cohort Study %A Thabrew,Hiran %A Kumar,Harshali %A Goldfinch,Mary %A Cavadino,Alana %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, The University of Auckland, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K mental health %K school health services %K eHealth %D 2020 %7 26.10.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Psychosocial problems are common during adolescence and can have long-lasting effects on health and on academic and social functioning. YouthCHAT, an electronic HEEADSSS (home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality and safety)-aligned instrument, has recently been demonstrated to be an acceptable and effective school-based psychosocial screener for 13-year-old (Year 9) high school students. Objective: This study aims to compare acceptability and detection rates with repeated YouthCHAT screenings of high school students when they are 13 years old (Year 9) and 14 years old (Year 10). Methods: We invited all Year-10 students to complete a YouthCHAT screening in 2018. Rates of positively identified issues were compared between the subset of students screened in both 2017 and 2018. Student acceptability toward YouthCHAT was investigated through focus group sessions. Onward clinical referral rates in 2018 were also investigated to explore the potential referral burden following screening. Data analysis for rates of positively identified issues were conducted with the McNemar test. Chi-square, Fisher exact test, and Kruskal-Wallis test were used to analyze the focus group data. Results: Of 141 eligible Year-10 students, 114 (81%) completed a YouthCHAT screening during 2018, and 97 (85%) of them completed it for a second time. Apart from depression, which increased (P=.002), and perceived life stress, which decreased (P=.04), rates of identified issues were broadly similar between 13 and 14 years of age. Repeated screenings via YouthCHAT was acceptable to students and time-efficient (mean, 6 minutes and 32 seconds) but did not reduce the overall number of individuals with identified issues. Onward clinical referrals from positive screens were mostly managed by school-based health services without the need for external referrals. Conclusions: Although further evaluation is needed, our results support the value of YouthCHAT as an acceptable and effective instrument with which to achieve routine identification of psychosocial issues and early intervention within a high school environment. %M 33104007 %R 10.2196/20976 %U http://pediatrics.jmir.org/2020/2/e20976/ %U https://doi.org/10.2196/20976 %U http://www.ncbi.nlm.nih.gov/pubmed/33104007 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e21155 %T Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health %A Katapally,Tarun Reddy %+ Johnson Shoyama Graduate School of Public Policy, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 3065854544, tarun.katapally@uregina.ca %K Indigenous youth %K mental health %K school policies %K health policy %K digital health interventions %K mHealth %K systems integration %K land-based learning %K physical activity %D 2020 %7 25.9.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Indigenous youth mental health is an urgent public health issue, which cannot be addressed with a one-size-fits-all approach. The success of health policies in Indigenous communities is dependent on bottom-up, culturally appropriate, and strengths-based prevention strategies. In order to maximize the effectiveness of these strategies, they need to be embedded in replicable and contextually relevant mechanisms such as school curricula across multiple communities. Moreover, to engage youth in the twenty-first century, especially in rural and remote areas, it is imperative to leverage ubiquitous mobile tools that empower Indigenous youth and facilitate novel Two-Eyed Seeing solutions. Smart Indigenous Youth is a 5-year community trial, which aims to improve Indigenous youth mental health by embedding a culturally appropriate digital health initiative into school curricula in rural and remote Indigenous communities in Canada. This policy analysis explores the benefits of such upstream initiatives. More importantly, this article describes evidence-based strategies to overcome barriers to implementation through the integration of citizen science and community-based participatory research action. %M 32975527 %R 10.2196/21155 %U http://pediatrics.jmir.org/2020/2/e21155/ %U https://doi.org/10.2196/21155 %U http://www.ncbi.nlm.nih.gov/pubmed/32975527 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e17815 %T School-Based Multicomponent Intervention to Promote Physical Activity and Reduce Sedentary Time of Disadvantaged Children Aged 6-10 Years: Protocol for a Randomized Controlled Trial %A Bernal,Caroline Maite Marie %A Lhuisset,Lena %A Fabre,Nicolas %A Bois,Julien %+ Universite de Pau & des Pays de l’Adour, e2s UPPA, MEPS, 11 rue Maurane Saulnier, Tarbes, 65000, France, 33 681004186 ext 681004186, bernalcaroline@gmail.com %K children %K school %K intervention %K promotion %K physical activity %K sedentary time %K attention %K academic achievement %D 2020 %7 23.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: In our modern society, physical activity (PA) is decreasing and sedentary time (ST) is increasing, especially for children from disadvantaged neighborhoods. School-based interventions to promote PA and decrease ST are therefore required among this population in order to change children’s lifestyle habits. Moreover, attentional capacities and academic achievement can be enhanced by chronic PA during childhood. The relationships between these variables have been poorly studied with this population. Objective: The objective of this study is to present the rationale and methods for a randomized controlled trial among 6-10-year-old children with low socioeconomic status that will (1) evaluate the effectiveness of a school-based intervention designed to promote PA and reduce ST and (2) study the relationships between PA, ST, motor skills, attentional capacities, and academic achievement. Methods: A randomized controlled trial was conducted in 2 eligible primary schools. During academic year 2016-2017, 1 school was randomly assigned as the experiment one and the other was assigned as the control one. Five assessments times were used: baseline (T1 [November 2016] to T2 [June 2017]), follow-up (T3 [November 2017] to T4 [June 2018]), and final assessment (T5 [June 2019]). The school-based intervention included various components on different levels of the socioecological model: (1) curriculum-based program for children; (2) sensitization workshops and newsletters for parents; (3) training workshops for teachers; (4) environmental adaptation of playgrounds and reorganization of recess time; (5) time adaptation of lunch breaks; and (6) collaboration with political groups. PA, ST, motor skills, and attentional capacities were evaluated and academic achievement was recorded. Results: The presented intervention and its different assessments have been successfully implemented. In order to achieve the 2 objectives of this randomized controlled trial, data analyses are about to be completed. Conclusions: The implementation of this randomized controlled trial can help to determine effective strategies to promote PA in the context of increasing prevalence of physical inactivity among children with sedentary lifestyle which will be useful for researchers, stakeholders, and public policy makers. Trial Registration: ClinicalTrials.gov NCT03983447; https://clinicaltrials.gov/ct2/show/NCT03983447 International Registered Report Identifier (IRRID): RR1-10.2196/17815 %M 32965238 %R 10.2196/17815 %U http://www.researchprotocols.org/2020/9/e17815/ %U https://doi.org/10.2196/17815 %U http://www.ncbi.nlm.nih.gov/pubmed/32965238 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e14816 %T Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting %A Wang,Bo %A Deveaux,Lynette %A Lunn,Sonja %A Dinaj-Koci,Veronica %A Ghosh,Samiran %A Li,Xiaoming %A Marshall,Sharon %A Rolle,Glenda %A Forbes,Nikkiah %A Stanton,Bonita %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Albert Sherman Center, Worcester, MA, United States, 1 774 455 4672, bo.wang@umassmed.edu %K adolescent %K HIV prevention %K implementation %K sustainability %K evidence-based intervention %D 2020 %7 21.8.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs. Objective: This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time. Methods: This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5. Results: It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023. Conclusions: The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy. International Registered Report Identifier (IRRID): PRR1-10.2196/14816 %M 32821065 %R 10.2196/14816 %U http://www.researchprotocols.org/2020/8/e14816/ %U https://doi.org/10.2196/14816 %U http://www.ncbi.nlm.nih.gov/pubmed/32821065 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e14371 %T Evaluation of the Universal Prevention Program Klasse2000 in Fourth Grade Primary School Children: Protocol for a Propensity Score-Matching Approach %A Kliem,Sören %A Krieg,Yvonne %A Lohmann,Anna %A Mößle,Thomas %+ Ernst-Abbe-Hochschule, Carl-Zeiß-Promenade 2, Jena, , Germany, 49 036 4120 5801, Soeren.Kliem@eah-jena.de %K Klasse2000 %K prevention program %K student survey %K propensity score matching %K evaluation %D 2020 %7 20.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Klasse2000 is the most widely adopted school-based prevention program in Germany. It addresses health promotion, addiction, and violence prevention in primary schools. As a universal prevention program, it has reached more than 1.4 million German children in the past 25 years. Objective: The effectiveness of Klasse2000 will be evaluated with a large representative survey among students. Students who have participated in the prevention program (intervention group) will be compared with students who did not participate (control group). The comparison will cover the following outcome domains: well-being, self-esteem, emotion regulation, food habits, behavioral problems, and school and classroom atmosphere. Furthermore, victimization and perpetration regarding bullying, alcohol consumption, smoking, and media consumption are assessed. Methods: To control for potential group differences, treatment effects will be estimated using propensity score-matching, which matches students from the intervention and control groups based on an identical propensity score or a propensity score that does not differ by more than a previously defined distance. The treatment effect will then be estimated in the matched sample taking the matching process into account. Results: Enrollment of schools began in March 2017. A total of 6376 students participated in the survey (n=4005 in control group; n=2371 in Klasse2000). The parent survey was returned by 52.13% (3324/6376) of parents. Results are expected in mid-2020. Conclusions: The results on the effectiveness of the Klasse2000 prevention program will form an empirical basis for legitimizing universal prevention programs and for planning future prevention approaches. Trial Registration: German Clinical Trials Register DRKS00014332; https://tinyurl.com/y2trvq4p International Registered Report Identifier (IRRID): DERR1-10.2196/14371 %M 32815524 %R 10.2196/14371 %U https://www.researchprotocols.org/2020/8/e14371 %U https://doi.org/10.2196/14371 %U http://www.ncbi.nlm.nih.gov/pubmed/32815524 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17699 %T Using Smart Bracelets to Assess Heart Rate Among Students During Physical Education Lessons: Feasibility, Reliability, and Validity Study %A Sun,Jiangang %A Liu,Yang %+ School of Physical Education and Sport Training, Shanghai University of Sport, 650 Qingyuanhuan Rd, Shanghai, 200438, China, 86 21 6550 7989, docliuyang@hotmail.com %K physical education %K heart rate %K validation %K feasibility %K reliability %K Fizzo %K Polar %K wrist-worn devices %K physical education lesson %K monitoring %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of wrist-worn wearables are being examined in the context of health care. However, studies of their use during physical education (PE) lessons remain scarce. Objective: We aim to examine the reliability and validity of the Fizzo Smart Bracelet (Fizzo) in measuring heart rate (HR) in the laboratory and during PE lessons. Methods: In Study 1, 11 healthy subjects (median age 22.0 years, IQR 3.75 years) twice completed a test that involved running on a treadmill at 6 km/h for 12 minutes and 12 km/h for 5 minutes. During the test, participants wore two Fizzo devices, one each on their left and right wrists, to measure their HR. At the same time, the Polar Team2 Pro (Polar), which is worn on the chest, was used as the standard. In Study 2, we went to 10 schools and measured the HR of 24 students (median age 14.0 years, IQR 2.0 years) during PE lessons. During the PE lessons, each student wore a Polar device on their chest and a Fizzo on their right wrist to measure HR data. At the end of the PE lessons, the students and their teachers completed a questionnaire where they assessed the feasibility of Fizzo. The measurements taken by the left wrist Fizzo and the right wrist Fizzo were compared to estimate reliability, while the Fizzo measurements were compared to the Polar measurements to estimate validity. To measure reliability, intraclass correlation coefficients (ICC), mean difference (MD), standard error of measurement (SEM), and mean absolute percentage errors (MAPE) were used. To measure validity, ICC, limits of agreement (LOA), and MAPE were calculated and Bland-Altman plots were constructed. Percentage values were used to estimate the feasibility of Fizzo. Results: The Fizzo showed excellent reliability and validity in the laboratory and moderate validity in a PE lesson setting. In Study 1, reliability was excellent (ICC>0.97; MD<0.7; SEM<0.56; MAPE<1.45%). The validity as determined by comparing the left wrist Fizzo and right wrist Fizzo was excellent (ICC>0.98; MAPE<1.85%). Bland-Altman plots showed a strong correlation between left wrist Fizzo measurements (bias=0.48, LOA=–3.94 to 4.89 beats per minute) and right wrist Fizzo measurements (bias=0.56, LOA=–4.60 to 5.72 beats per minute). In Study 2, the validity of the Fizzo was lower compared to that found in Study 1 but still moderate (ICC>0.70; MAPE<9.0%). The Fizzo showed broader LOA in the Bland-Altman plots during the PE lessons (bias=–2.60, LOA=–38.89 to 33.69 beats per minute). Most participants considered the Fizzo very comfortable and easy to put on. All teachers thought the Fizzo was helpful. Conclusions: When participants ran on a treadmill in the laboratory, both left and right wrist Fizzo measurements were accurate. The validity of the Fizzo was lower in PE lessons but still reached a moderate level. The Fizzo is feasible for use during PE lessons. %M 32663136 %R 10.2196/17699 %U http://mhealth.jmir.org/2020/8/e17699/ %U https://doi.org/10.2196/17699 %U http://www.ncbi.nlm.nih.gov/pubmed/32663136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e14778 %T Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study %A Langlet,Billy %A Maramis,Christos %A Diou,Christos %A Maglaveras,Nikolaos %A Fagerberg,Petter %A Heimeier,Rachel %A Lekka,Irini %A Delopoulos,Anastasios %A Ioakimidis,Ioannis %+ The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Blickagången 16, Huddinge, , Sweden, 46 08 524 810 95, billy.langlet@ki.se %K mHealth %K eHealth %K dietary behavior %K lifestyle behavioral monitoring %K lifestyle interventions %K obesity %K mobile phone %K smartphone %K weight management %K overweight %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the “mHealth evidence reporting and assessment checklist,” and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a ‘Good’ grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70% the first week to 76% the second week. Participants reported that 40% of the registered meals were home-prepared, while 34% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. %M 32706684 %R 10.2196/14778 %U http://mhealth.jmir.org/2020/7/e14778/ %U https://doi.org/10.2196/14778 %U http://www.ncbi.nlm.nih.gov/pubmed/32706684 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e16338 %T Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study %A Adrian,Molly %A Coifman,Jessica %A Pullmann,Michael D %A Blossom,Jennifer B %A Chandler,Casey %A Coppersmith,Glen %A Thompson,Paul %A Lyon,Aaron R %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St, Suite 110, Seattle, WA, 98115, United States, 1 206 221 1689, adriam@uw.edu %K technology-enabled services %K suicide prevention %K school-based mental health %K user-centered design %K mobile phone %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. Objective: This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. Methods: A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. Results: Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. Conclusions: Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation. %M 32706691 %R 10.2196/16338 %U https://mental.jmir.org/2020/7/e16338 %U https://doi.org/10.2196/16338 %U http://www.ncbi.nlm.nih.gov/pubmed/32706691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18226 %T A One-Step, Streamlined Children’s Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation %A Ma,Shuoxin %A Guan,Yongqing %A Yuan,Yazhen %A Tai,Yuan %A Wang,Tan %+ TerryDr Infomation Technology, Room A3-701, #180 RuanJianDaDao, YuHuaTai District, Nanjing, 210000, China, 86 13813998278, shuoxinma@163.com %K vision screening %K resource-limited application %K photorefraction %K strabismus %K myopia %K anisometropia %K mHealth %K screening %D 2020 %7 13.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young children’s vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. Objective: This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. Methods: A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child’s personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child’s risk for strabismus, myopia, and anisometropia was then derived and consultation given. Results: A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People’s Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. Conclusions: The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program’s design specifications. %M 32673243 %R 10.2196/18226 %U http://mhealth.jmir.org/2020/7/e18226/ %U https://doi.org/10.2196/18226 %U http://www.ncbi.nlm.nih.gov/pubmed/32673243 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17702 %T Effectiveness of the InCharge Prevention Program to Promote Healthier Lifestyles: Protocol for a Randomized Controlled Trial %A Mesman,Mathijs %A Onrust,Simone %A Verkerk,Renée %A Hendriks,Hanneke %A Van den Putte,Bas %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe achtergracht 166, Amsterdam, , Netherlands, 31 0641711825, m.mesman@uva.nl %K school-based health intervention %K adolescents %K health behavior %K healthy lifestyle %K quality of life %K behavior change %D 2020 %7 8.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: InCharge is a newly developed school-based health intervention aimed at older adolescents. It aims to promote a healthier lifestyle by increasing self-regulation skills. After the InCharge program’s effectiveness was previously investigated in a pilot study, the content of the program was adapted. Objective: This study describes the protocol of a cluster randomized controlled trial that aims to investigate the effectiveness of the InCharge program. Methods: A cluster randomized controlled trial including 70 classes with older adolescents (aged 16 years or older) in the Netherlands will be conducted to test the effectiveness of the InCharge program. After schools are recruited, randomization occurs at the class level. The trial consists of the following two conditions: an experimental condition and a control condition. Participants in the experimental condition will be given the InCharge intervention, consisting of four lessons of 50 minutes, with each lesson containing three assignments of approximately 15 minutes. While participants in the experimental condition will receive InCharge, participants in the control condition will receive regular academic school courses. Surveys are administered 1 week before the intervention (baseline), 1 week after the intervention (posttest), and 12 weeks after the intervention (follow-up). Variables of interest include, but are not limited to, self-regulation; predictors of snack intake, physical activity, and alcohol use; and interpersonal communication regarding these health behaviors. In addition to surveys, observations will be conducted during the first and fourth lessons, teachers will be interviewed, and focus groups will be held with a selection of students from the intervention condition. Results: Enrollment started in September 2017. As of June 2019, a total of 1216 participants were enrolled for this trial. Findings will be published in peer-reviewed journals and presented at conferences. The trial has been approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences of the University of Amsterdam (reference no.: 2017-PC-8244). Conclusions: In this study protocol, the design of a cluster randomized controlled trial is described, which assesses how effectively the school-based intervention InCharge stimulates healthier lifestyles in late adolescents. We hypothesize that participants in the experimental condition will consume less alcohol, eat fewer unhealthy snacks, and be more physically active compared with participants in the control condition. Trial Registration: Netherlands Trial Register (NL6654); https://www.trialregister.nl/trial/6654 International Registered Report Identifier (IRRID): RR1-10.2196/17702 %M 32673278 %R 10.2196/17702 %U http://www.researchprotocols.org/2020/7/e17702/ %U https://doi.org/10.2196/17702 %U http://www.ncbi.nlm.nih.gov/pubmed/32673278 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e15348 %T The Sign 4 Little Talkers Intervention to Improve Listening, Understanding, Speaking, and Behavior in Hearing Preschool Children: Outcome Evaluation %A Davidson,Rosemary %A Randhawa,Gurch %+ Institute for Health Research, University of Bedfordshire, University Square, Luton, LU1 3JU, United Kingdom, 44 1234 400 ext 400, rosemary.davidson@beds.ac.uk %K sign language %K early years %K intervention %K disadvantage %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances; however, a significant proportion of children fail to meet the expected standards in these early years outcomes when they start school. Factors influencing the development of language and communication include low income, gender, and having English as an additional language (EAL). Objective: This study aimed to determine whether the Sign 4 Little Talkers (S4LT) program improves key developmental outcomes in hearing preschool children. S4LT was developed to address gaps in the attainment of vocabulary and communication skills in preschool children, identified through routine monitoring of outcomes in early years. Signs were adapted and incorporated into storybooks to improve vocabulary, communication, and behavior in hearing children. Methods: An evaluation of S4LT was conducted to measure key outcomes pre- and postintervention in 8 early years settings in Luton, United Kingdom. A total of 118 preschool children were tested in 4 early years outcomes domains—listening, speaking, understanding, and managing feelings and behavior—as well as Leuven well-being scales and the number of key words understood and spoken. Results: Statistically significant results were found for all measures tested: words spoken (P<.001) and understood (P<.001), speaking (P<.001), managing feelings and behavior (P<.001), understanding (P<.001), listening and attention (P<.001), and well-being (P<.001). Approximately two-thirds of the children made expected or good progress, often progressing multiple steps in educational attainment after being assessed as developmentally behind at baseline. Conclusions: The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development and become school ready by improving their command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support. %M 32452813 %R 10.2196/15348 %U https://pediatrics.jmir.org/2020/1/e15348 %U https://doi.org/10.2196/15348 %U http://www.ncbi.nlm.nih.gov/pubmed/32452813 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e15930 %T Improving the Lifestyle of Adolescents Through Peer Education and Support in Vietnam: Protocol for a Pilot Cluster Randomized Controlled Trial %A Tang,Hong K %A Nguyen,Ngoc-Minh %A Dibley,Michael J %A Nguyen,Trang H H D %A Alam,Ashraful %+ Department of Epidemiology, Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 70000, Vietnam, 84 2838668018 ext 149, hong.tang@pnt.edu.vn %K peer education %K peer support %K peer leader %K adolescents %K dietary behaviors %K physical activity %K Vietnam %D 2020 %7 26.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Ho Chi Minh City, Vietnam, recent studies found a rapid increase in overweight and obesity in adolescents. There is a need for effective health promotion interventions to support healthy diets and encourage a physically active lifestyle. This study will help fill an evidence gap on effective interventions to prevent excess weight gain in adolescents and generate new insights about peer-led education to promote healthy lifestyles. Objective: We aim to assess the feasibility and acceptability of a combined peer-led and peer support intervention among junior high school students in Ho Chi Minh City. Additionally, the efficacy of the intervention on adolescents’ dietary practices and time spent on physical activity will also be measured in this pilot study. Methods: The Peer Education and Peer Support (PEPS) project is a pilot cluster randomized controlled trial with 2 intervention and 2 control schools. The intervention consists of 4 weekly education sessions of why and how to choose healthy food and drinks and how to be more physically active. Additionally, the intervention includes a school-based and online support system to help maintain student engagement during the intervention. We will use in-depth interviews with students, peer leaders, teachers, and parents; focus group discussions with peer educators; and direct observation of the school environment and peer leaders’ interactions with the students. Acceptability and feasibility of the intervention will be assessed. We will also quantitatively assess limited efficacy by measuring changes in student’ physical activity levels and dietary behaviors. Results: We delivered the peer education intervention at the start of each school year over 3 months for all new grade 6 adolescents in the selected schools, followed by peer support and home engagement activities over 6 months until the end of the school year. There was a baseline assessment and 2 post-intervention assessments: the first immediately after the intervention to assess the short-term impact and the second at the end of the school year to assess the sustained impact on changes in adiposity, diet, and physical activity. Conclusions: The findings of this study will be used to develop a larger-scale cluster randomized controlled trial to examine the impact of a multicomponent, school- and home-based health promotion intervention. The trial will use innovative peer education methods to reduce overweight and obesity and improve dietary choices and physical activity levels in Vietnamese adolescents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000421134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376690&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/15930 %M 32589155 %R 10.2196/15930 %U http://www.researchprotocols.org/2020/6/e15930/ %U https://doi.org/10.2196/15930 %U http://www.ncbi.nlm.nih.gov/pubmed/32589155 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e18419 %T Determining the Impact of a School-Based Health Education Package for Prevention of Intestinal Worm Infections in the Philippines: Protocol for a Cluster Randomized Intervention Trial %A Mationg,Mary Lorraine S %A Williams,Gail M %A Tallo,Veronica L %A Olveda,Remigio M %A Aung,Eindra %A Alday,Portia %A Reñosa,Mark Donald %A Daga,Chona Mae %A Landicho,Jhoys %A Demonteverde,Maria Paz %A Santos,Eunice Dianne %A Bravo,Thea Andrea %A Angly Bieri,Franziska A %A Li,Yuesheng %A Clements,Archie C A %A Steinmann,Peter %A Halton,Kate %A Stewart,Donald E %A McManus,Donald P %A Gray,Darren J %+ Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, 300 Herston Rd Herston Queensland, Brisbane, 4006, Australia, 61 7 3362 0401, Don.McManus@qimrberghofer.edu.au %K soil-transmitted helminths %K school-based health educational intervention %K Magic Glasses %K integrated control %K randomized controlled trial %K Philippines %D 2020 %7 25.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Repeated mass drug administration (MDA) of antihelminthics to at-risk populations is still the main strategy for the control of soil-transmitted helminth (STH) infections. However, MDA, as a stand-alone intervention, does not prevent reinfection. Accordingly, complementary measures to prevent STH reinfection, such as health education and improved sanitation, as part of an integrated control approach, are required to augment the effectiveness of MDA for optimal efficiency and sustainability. Objective: The aim of this study is to determine the impact and generalizability of a school-based health education package entitled The Magic Glasses for STH prevention in the Philippines. Methods: We conducted a cluster randomized controlled intervention trial, involving 2020 schoolchildren aged 9-10 years, in 40 schools in Laguna Province, Philippines, to evaluate the impact of the school-based health education package for the prevention of STHs. The trial was conducted over the course of 1 year (June 2016 to July 2017). A total of 20 schools were randomly assigned to the intervention arm, in which The Magic Glasses Philippines health education package was delivered with the standard health education activities endorsed by the Philippines Department of Health (DOH) and the Department of Education (DepEd). The other 20 schools comprised the control arm of the study, where the DOH/DepEd’s standard health education activities were done. At baseline, parasitological assessments and a knowledge, attitude, and practice survey were carried out in all schools. In addition, height, weight, and hemoglobin levels were obtained from each child (after parental consent), and their school attendance and academic performance in English and mathematics were accessed from the school records. The baseline and 2 follow-up surveys were completed using the same study measurements and quality-control assessments. Results: Key results from this cluster randomized intervention trial will shed light on the impact that The Magic Glasses health education package will have against STH infections in schoolchildren in the province of Laguna, located on the Island of Luzon, in the Calabarzon Region of the Philippines. Conclusions: The results of the trial will be used to assess the generalizability of the impact of The Magic Glasses health education package in different epidemiological and cultural settings, providing evidence for translation of this health education package into public health policy and practice in the Asian region and beyond. Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12616000508471; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368849 International Registered Report Identifier (IRRID): DERR1-10.2196/18419 %M 32584263 %R 10.2196/18419 %U https://www.researchprotocols.org/2020/6/e18419 %U https://doi.org/10.2196/18419 %U http://www.ncbi.nlm.nih.gov/pubmed/32584263