%0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e64171 %T Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study %A Gaynor,Mathew %A Hesketh,Kylie %A Gebremariam,Kidane %A Wynter,Karen %A Laws,Rachel %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, 75 Pigdons Road, Geelong, 3216, Australia, 61 3 9244 6613, mgaynor@deakin.edu.au %K fathers %K parenting resources %K health promotion %K My Baby Now %K MBN %K app %K mobile phone %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Evolving societal trends are resulting in fathers having an increasing influence on the health-related behaviors that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child’s health. However, parenting resources typically target mothers, with fathers being excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find that mobile health (mHealth) technology does not provide material they can engage with. Objective: This study aimed to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource, the My Baby Now app, as a case study. Methods: A total of 14 purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups and interviews were transcribed verbatim, then coded using a combination of deductive and inductive methods. Reflexive thematic analysis was undertaken to identify patterns and themes. Results: Current parenting apps provide parenting information that can be unappealing for fathers. To improve paternal engagement with mHealth resources, fathers highlighted the need for father specific information, with an increase in positive imagery and positive descriptions of fathers in their parenting role. There should be father-exclusive domains such as forums, and also push notifications to provide positive reinforcement and encouragement for fathers. Conclusions: mHealth has the capacity to deliver information to fathers when needed. This reduces the risk of paternal frustration and disengagement from parenting. Further benefit will be gained by research to understand possible differences in mHealth app usage by fathers of differing socioeconomic position, cultural backgrounds, and family status, such as single fathers and same-sex couples. %M 39982774 %R 10.2196/64171 %U https://pediatrics.jmir.org/2025/1/e64171 %U https://doi.org/10.2196/64171 %U http://www.ncbi.nlm.nih.gov/pubmed/39982774 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65107 %T Implementing Diabetes Distress Screening in a Pediatric Endocrinology Clinic Using a Digital Health Platform: Quantitative Secondary Data Analysis %A Kahhan,Nicole A %A Fox,Larry A %A Benson,Matthew %A Patton,Susana R %K type 1 diabetes %K diabetes mellitus, type 1 %K pediatric %K child %K children %K youth %K parents %K diabetes distress %K eHealth %K screening %K digital health %K diabetes %K diabetic %K type 1 %K DM %K T1D %K endocrinology %K alert %K best practice alert %K BPA %K patient education %D 2025 %7 6.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Type 1 diabetes (T1D) management requires following a complex and constant regimen relying on child or caregiver behaviors, skills, and knowledge. Psychological factors such as diabetes distress (DD), depression, and burnout are pertinent considerations in the treatment of pediatric T1D. Approximately 40% of youth and 61% of caregivers experience DD. Implementation of DD screening as part of clinical best practice is recommended and may facilitate treatment referral, perhaps leading to improved health or well-being for youth with T1D and their caregivers. By building on existing institutional infrastructure when available, screening via digital health platforms (applications, or “apps”) may allow for timely screening of, and response to, DD. Objective: This work details the creation, implementation, and refinement of a process to screen for DD in youth and their caregivers in the context of routine T1D care using a digital health platform. Methods: DD screening was implemented in an outpatient endocrinology clinic over 1 year as part of a larger screen-to-treat trial for children aged 8‐12.99 years and their caregivers. Validated measures were sent via digital health platform to be completed prior to the clinic visit. Results were initially reviewed manually, but a digital best practice alert (BPA) was later built to notify staff of elevated scores. Families experiencing DD received resources sent via the digital health platform. For this secondary analysis, child demographics and glycated hemoglobin A1c (HbA1c) were collected. Results: During the screening period, absolute completion rates were 36.78% and 38.83%, with adjusted screening rates at 52.02% and 54.48%, for children and caregivers, respectively. A total of 21 children (mean HbA1c 8.04%, SD 1.39%) and 26 caregivers (child mean HbA1c 8.04%, SD 1.72%) reported elevated DD. Prior to BPA development, resources were sent to all but 1 family. After BPA implementation, all families were sent resources. Conclusions: Early findings indicate that DD education, screening, and response can be integrated via digital platforms in a freestanding outpatient endocrinology clinic, thereby facilitating timely treatment referral and provision of resources for those identified with distress. Notably, in the observed 1-year screening period, screening rates were low, and barriers to implementation were identified. While some implementation challenges were iteratively addressed, there is a need for future quality improvement initiatives to improve screening rates and the identification of, or response to, DD in our pediatric patients and their families. Trial Registration: ClinicalTrials.gov NCT05268250; https://clinicaltrials.gov/study/NCT05268250 %R 10.2196/65107 %U https://pediatrics.jmir.org/2025/1/e65107 %U https://doi.org/10.2196/65107 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66401 %T Exploring Stress and Stress-Reduction With Caregivers and Clinicians in the Neonatal Intensive Care Unit to Inform Intervention Development: Qualitative Interview Study %A Ginsberg,Kristin Harrison %A Alsweiler,Jane %A Rogers,Jenny %A Ross,Phoebe %A Serlachius,Anna %K neonatal intensive care unit %K NICU %K parents %K preterm infants %K stress %K stress reduction %K intervention development %K digital %K neonatology %K pediatric %K infants %K babies %K neonatal %K toddler %K children %K caregiver %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K remote consultation %K qualitative study %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Parents and caregivers with preterm babies in the neonatal intensive care unit (NICU) experience high levels of distress and are at an increased risk of anxiety, depression, and acute stress disorders. Effective interventions to reduce this distress are well described in the literature, but this research has been conducted primarily in Europe and North America. To our knowledge, few interventions of this sort have been developed in Australasia, and none have been developed or tested in Aotearoa New Zealand. Objective: The primary aims of this study were to explore sources of stress with caregivers and clinicians in a NICU in Aotearoa New Zealand and gather participant ideas on ways to reduce caregiver stress to inform intervention development. Methods: This qualitative design used an essentialist and realist methodology to generate findings aimed at future intervention development. Overall, 10 NICU clinicians (neonatologists, nurses, and mental health clinicians) and 13 caregivers (mothers, fathers, and extended family members) of preterm babies, either currently admitted or discharged from the NICU within the last 12 months, were recruited to participate in interviews exploring stress and stress-reduction in the NICU. Results: The 23 participants included 10 clinicians (all female, with an average of 15 years of experience in the NICU) and 13 parents and caregivers (majority of them were female; 10/13, 77%) of preterm babies. We identified 6 themes relevant to intervention development. Three themes focused on caregiver stress: the emotional “rollercoaster” of NICU; lack of support, both culturally and emotionally; and caregivers feeling “left out” and confused. Three themes focused on participant-proposed solutions to reduce stress: caregiver empowerment, improving emotional support, and communication on “my” terms (ie, digitally). Conclusions: Participants reported high levels of caregiver stress in the NICU, and they proposed a range of stress-reducing solutions, including increasing caregiver empowerment and improving emotional and cultural support. Clinicians and caregivers also strongly agreed on providing more information for caregivers in digital, mobile-friendly formats. %R 10.2196/66401 %U https://pediatrics.jmir.org/2025/1/e66401 %U https://doi.org/10.2196/66401 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62841 %T Impact of a 6-Week Postpartum Text Messaging Program (Essential Coaching for Every Mother) at 6 Months: Follow-Up Study to a Randomized Controlled Trial %A Dol,Justine %A Campbell-Yeo,Marsha %A Aston,Megan %A McMillan,Douglas %A Grant,Amy K %K mHealth %K mobile health %K SMS text message %K text messages %K messaging %K self-efficacy %K postpartum depression %K postpartum anxiety %K social support %K intervention %K postpartum %K postnatal %K mental health %K parenting %K mother %K depression %K anxiety %K RCT %K randomized controlled trial %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown. Objective: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial. Methods: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis. Results: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6%) than mothers in the control group (16/68, 23.5%; P=.007). Conclusions: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum. Trial Registration: ClincialTrials.gov NCT04730570; https://clinicaltrials.gov/study/NCT04730570 International Registered Report Identifier (IRRID): RR2-10.2196/27138 %R 10.2196/62841 %U https://pediatrics.jmir.org/2025/1/e62841 %U https://doi.org/10.2196/62841 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59377 %T Fetal Birth Weight Prediction in the Third Trimester: Retrospective Cohort Study and Development of an Ensemble Model %A Gao,Jing %A Jie,Xu %A Yao,Yujun %A Xue,Jingdong %A Chen,Lei %A Chen,Ruiyao %A Chen,Jiayuan %A Cheng,Weiwei %K fetal birthweight %K ensemble learning model %K machine learning %K prediction model %K ultrasonography %K macrosomia %K low birth weight %K birth weight %K fetal %K AI %K artificial intelligence %K prenatal %K prenatal care %K Shanghai %K neonatal %K maternal %K parental %D 2025 %7 10.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Accurate third-trimester birth weight prediction is vital for reducing adverse outcomes, and machine learning (ML) offers superior precision over traditional ultrasound methods. Objective: This study aims to develop an ML model on the basis of clinical big data for accurate prediction of birth weight in the third trimester of pregnancy, which can help reduce adverse maternal and fetal outcomes. Methods: From January 1, 2018 to December 31, 2019, a retrospective cohort study involving 16,655 singleton live births without congenital anomalies (>28 weeks of gestation) was conducted in a tertiary first-class hospital in Shanghai. The initial set of data was divided into a train set for algorithm development and a test set on which the algorithm was divided in a ratio of 4:1. We extracted maternal and neonatal delivery outcomes, as well as parental demographics, obstetric clinical data, and sonographic fetal biometry, from electronic medical records. A total of 5 basic ML algorithms, including Ridge, SVM, Random Forest, extreme gradient boosting (XGBoost), and Multi-Layer Perceptron, were used to develop the prediction model, which was then averaged into an ensemble learning model. The models were compared using accuracy, mean squared error, root mean squared error, and mean absolute error. International Peace Maternity and Child Health Hospital's Research Ethics Committee granted ethical approval for the usage of patient information (GKLW2021-20). Results: Train and test sets contained a total of 13,324 and 3331 cases, respectively. From a total of 59 variables, we selected 17 variables that were readily available for the “few feature model,” which achieved high predictive power with an accuracy of 81% and significantly exceeded ultrasound formula methods. In addition, our model maintained superior performance for low birth weight and macrosomic fetal populations. Conclusions: Our research investigated an innovative artificial intelligence model for predicting fetal birth weight and maximizing health care resource use. In the era of big data, our model improves maternal and fetal outcomes and promotes precision medicine. %R 10.2196/59377 %U https://pediatrics.jmir.org/2025/1/e59377 %U https://doi.org/10.2196/59377 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e64561 %T Preoperative Anxiety Management Practices in Pediatric Anesthesia: Comparative Analysis of an Online Survey Presented to Experts and Social Media Users %A Sablewski,Armin %A Eimer,Christine %A Nemeth,Marcus %A Miller,Clemens %K pediatric anesthesia %K pharmacological interventions %K nonpharmacological interventions %K preoperative %K anxiety %K anxiety management %K practices %K anesthesia %K comparative analysis %K online survey %K preoperative anxiety %K challenges %K postoperative outcome %K pediatric %K infant %K baby %K neonatal %K toddler %K child %K social media %K survey %K anesthesia provider %D 2025 %7 27.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological and nonpharmacological interventions are used to reduce children’s anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. Health care professionals using social media as a source of medical expertise may offer insights into their management approaches. Objective: A public survey targeting health care professionals was disseminated via social media platforms to evaluate current practices in anxiety management in children. The same questions were posed during an annual meeting of pediatric anesthesiologists with their responses serving as reference. The primary objective was to compare pediatric anesthesia expertise between the groups, while secondary objectives focused on identifying similarities and differences in preoperative anxiety management strategies hypothesizing expertise differences between the groups. Methods: Two surveys were conducted. The first survey targeted 100 attendees of the German Scientific Working Group on Pediatric Anesthesia in June 2023 forming the “Expert Group” (EG). The second open survey was disseminated on social media using a snowball sampling approach, targeting followers of a pediatric anesthesia platform to form the “Social Media Group” (SG). The answers to the 24 questions were compared and statistically analyzed. Questions were grouped into 5 categories (pediatric anesthesia expertise, representativity, structural conditions, practices of pharmacological management, and practices in nonpharmacological management). Results: A total of 194 responses were analyzed (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs 10 y, P<.001), higher specialist status (97.6% vs 64.6%, P<.001), and a greater pediatric anesthesia volume (43.9% vs 12% with more than 500 cases per year, P<.001). Regarding the representativity, 2 items out of 4 were statistically significant (level of care of institution, annual caseload of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups. Conclusions: Despite heterogeneous approaches, health care professionals using social media demonstrated less expertise in pediatric anesthesia but showed minimal differences in the daily management of preoperative anxiety compared with pediatric anesthesia experts. Our study highlights the potential for meaningful use of social media but future studies should explore the impact of social media health care professionals’ knowledge in other specific topics. Additionally, regarding preoperative anxiety, further recommendations are needed that could help to standardize and improve anxiety levels in children. %R 10.2196/64561 %U https://pediatrics.jmir.org/2025/1/e64561 %U https://doi.org/10.2196/64561 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e58586 %T A Noninvasive Approach to Assess the Prevalence of and Factors Associated With Anemia Risk in Malaysian Children Under Three Years of Age: Cross-Sectional Study %A Jalaludin,Muhammad Yazid %A Kiau,Ho Bee %A Hasim,Suriati %A Lee,Wai Khew %A Low,Angie %A Kazim,Nik Harlina Nik %A Hoi,Jia Tse %A Taher,Sri Wahyu %K anemia %K iron deficiency %K children %K Masimo Rad-67 %K noninvasive assessment %K Malaysia %D 2025 %7 24.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Anemia remains a significant public health concern with adverse effects among children. Noninvasive screening assessments enable the early detection and prompt treatment of anemia. However, there is limited literature on the use of such screening assessments. Objective: The study aimed to assess the prevalence of and factors associated with being at risk of anemia among Malaysian children aged ≥6 months to ≤36 months by using a noninvasive hemoglobin assessment. Methods: This was a cross-sectional study (from July to December 2022) of outpatient Malaysian children, aged ≥6 months to ≤36 months, who were selected from five maternal-and-child health clinics by convenience sampling. At risk of anemia was defined as a total hemoglobin level of <12 g/dL, measured using the Masimo Rad-67, a noninvasive screening device for total hemoglobin levels. The χ2 and multiple logistic regression analyses were used to assess the prevalence and factors associated with being at risk of anemia, using R-Studio (version 4.0.0). Results: The study included 1201 participants, of whom 30% (95% CI 28‐33) were at risk of anemia. Children aged 6‐12 months (210/364, 57.7%, P<.001), those of Asian Malay race (238/364, 65.4%, P<.05), those residing in the Klang district (123/371, 33.9%, P<.05), those born via a normal vaginal delivery (275/364, 75.5%, P<.05), those without a family history of thalassemia (284/364, 78.0%, P<.05), and those with lower weight-for-age Z scores (P<.05) were associated with being at risk of anemia. Children aged 6‐12 months (adjusted odds ratio=1.73; 95% CI 1.34‐2.24) had higher odds of being at risk of anemia compared to children aged >12‐36 months. However, weight-for-age (adjusted odds ratio=0.88; 95% CI 0.80‐0.98) was associated with lower odds of being at risk of anemia. Conclusions: The current study revealed a substantial prevalence of Malaysian children being at risk of developing anemia. The study results therefore imply a need for more community education and awareness on anemia, including nutrition education, as well as targeted community screening to enable the early detection and prompt treatment of anemia cases. Anemia reduction strategies in Malaysia should consider the highlighted factors indicative of higher risk of anemia. Trial Registration: Clinicaltrials.gov NCT05181436, https://clinicaltrials.gov/study/NCT05181436 %R 10.2196/58586 %U https://pediatrics.jmir.org/2025/1/e58586 %U https://doi.org/10.2196/58586 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65471 %T Parental Experiences of Administering Pediatric Tuina for Sleep and Appetite in Early School-Aged Children With Attention-Deficit/Hyperactivity Disorder: Qualitative Study in Hong Kong %A Chen,Shu-Cheng %A Lo,Kwai-Ching %A Li,Han %A Wong,Pong-Ming %A Pang,Lok-Yi %A Qin,Jing %A Yeung,Wing-Fai %K pediatric massage %K child %K traditional Chinese medicine %K TCM %K ADHD %K qualitative study %K complementary medicine %K attention deficit %K hyperactivity %K massage %K tuina %K tui na %K mental health %K sleep %K appetite %K parent %K parenting %K interview %K focus group %K anmo %K attention-deficit/hyperactivity disorder %D 2025 %7 30.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Previous research suggested that parent-administered pediatric tuina could improve symptoms of attention-deficit/hyperactivity disorder (ADHD), such as sleep quality and appetite. Objective: This study aimed to explore the experiences and perceptions of parents administering pediatric tuina to school-aged children with ADHD in Hong Kong. Methods: This qualitative study was embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for improving sleep and appetite in school-aged children diagnosed with ADHD. Purposive sampling was used to invite 12 parents who attended a pediatric tuina training program and delivered the intervention to their children at home for at least 8 weeks. Data were collected through semistructured focus group interviews and individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Two main themes emerged: (1) effects of parent-administered pediatric tuina and (2) parents’ experience of administering pediatric tuina. Parents reported significant improvements in children’s sleep quality, appetite, behavior, mental state, and academic performance. Facilitators provided professional guidance and applied a user-friendly course design. Challenges included difficulties in mastering techniques, locating acupuncture points, and time management. Participants suggested the need for more traditional Chinese medicine pattern diagnostic sessions, real-time supervision methods, and extended follow-up to better observe long-term effects. Conclusions: Parent-administered pediatric tuina was perceived to improve children’s sleep quality and appetite significantly, along with other aspects of well-being. Professional guidance and a structured training program facilitated implementation, and challenges highlighted the need for more frequent diagnostic sessions, real-time supervision, and extended follow-up. Trial Registration: ClinicalTrials.gov NCT06007742; https://clinicaltrials.gov/study/NCT06007742 %R 10.2196/65471 %U https://pediatrics.jmir.org/2025/1/e65471 %U https://doi.org/10.2196/65471 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e64618 %T Perspectives of Adolescents and Young Adults With Inflammatory Bowel Disease on a Biopsychosocial Transition Intervention: Qualitative Interview Study %A Allemang,Brooke %A Miatello,Ashleigh %A Browne,Mira %A Barwick,Melanie %A Maini,Pranshu %A Eszczuk,Joshua %A Pandit,Chetan %A Sadhra,Tandeep %A Forhan,Laura %A Bollegala,Natasha %A Fu,Nancy %A Lee,Kate %A Dekker,Emily %A Nistor,Irina %A Ahola Kohut,Sara %A Keefer,Laurie %A Griffiths,Anne Marie %A Walters,Thomas D %A Micsinszki,Samantha %A Mack,David R %A Lawrence,Sally %A Kroeker,Karen I %A de Guzman,Jacqueline %A Tausif,Aalia %A Tersigni,Claudia %A Anthony,Samantha J %A Benchimol,Eric I %K gastroenterology %K inflammatory bowel disease %K biopsychosocial %K patient-oriented research %K transition to adult care %K qualitative methods %K young adults %K qualitative %K adolescents %K patient perspectives %K Crohn's disease %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The transition from pediatric to adult health care marks a complex and pivotal process for adolescents and young adults with inflammatory bowel disease (IBD). This group requires support regarding disease self-management, skill development, and system navigation in preparation for transition. Evidence-based interventions are needed to promote optimal health and psychosocial outcomes for adolescents and young adults with IBD during this period. Objective: A qualitative study embedded within a randomized controlled trial was conducted to evaluate the perceived impact of a biopsychosocial transition intervention on the transition experiences of adolescents and young adults, their views on the intervention, and recommendations for future care. Methods: This patient-oriented research study used a qualitative descriptive design. Virtual semistructured interviews were held with 21 adolescents and young adults with IBD (16‐18 y) enrolled in the randomized controlled trial (intervention arm n=11 and control arm n=10). Interviews were audio-recorded, transcribed, and analyzed using an inductive approach to reflexive thematic analysis. Five members of a Youth Advisory Panel with lived experience of IBD collaborated throughout data analysis, interpretation, and the presentation of findings. Results: We constructed three themes through our analysis: (1) making meaning of transitions in care; (2) perceptions and impact of the biopsychosocial transition intervention; and (3) considerations for future transition care, including the importance of individualized support. Conclusions: Our findings illustrate the importance of relationships and the impact of a biopsychosocial intervention on adolescents’ and young adults’ confidence, knowledge, and self-management skills during transition. The results, which indicate the criticality of tailoring transition supports according to adolescents’ and young adults’ preferences and characteristics, will be used to refine the biopsychosocial intervention before it can be scaled and spread. %R 10.2196/64618 %U https://pediatrics.jmir.org/2025/1/e64618 %U https://doi.org/10.2196/64618 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e63270 %T Perspectives on Swedish Regulations for Online Record Access Among Adolescents With Serious Health Issues and Their Parents: Mixed Methods Study %A Hagström,Josefin %A Blease,Charlotte %A Harila,Arja %A Lähteenmäki,Päivi %A Scandurra,Isabella %A Hägglund,Maria %+ Participatory eHealth and Health Data Research Group, Department of Women’s and Children’s Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 752 37, Sweden, 46 734697474, josefin.hagstrom@uu.se %K health care professionals %K adolescent health %K patient-accessible electronic health record %K electronic health record %K patient portal %K survey %K eHealth %K interviews %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: With the increasing implementation of patient online record access (ORA), various approaches to access to minors’ electronic health records have been adopted globally. In Sweden, the current regulatory framework restricts ORA for minors and their guardians when the minor is aged between 13 and 15 years. Families of adolescents with complex health care needs often desire health information to manage their child’s care and involve them in their care. However, the perspectives of adolescents with serious health issues and their parents have not been studied. Objective: This study aims to qualitatively and quantitatively investigate the perceived benefits and risks of ORA and the awareness of and views on ORA regulations among adolescents with serious health issues and their parents in Sweden. Methods: We used a convergent mixed methods (qualitative and quantitative) design, consisting of a survey and semistructured individual interviews with adolescents with serious health issues (aged 13-18 y) and their parents. Participants were recruited via social media and in clinics. Quantitative data were presented descriptively. Interviews were audio recorded, transcribed, and analyzed using inductive thematic content analysis. Results: The survey population included 88 individuals (adolescents: n=31, 35%; parents: n=57, 65%). Interviews were completed by 8 (26%) of the 31 adolescents and 17 (30%) of the 57 parents. The mean age of the surveyed adolescents was 16 (SD 1.458) years, and most of the parents (29/57, 51%) were aged 45 to 54 years. The surveys indicated that most of the parents (51/56, 91%) were critical of the access gap, and most of the adolescents (20/31, 65%) were unaware of the age at which they could gain access. In the interviews, adolescents and parents identified benefits related to ORA that were categorized into 6 themes (empowering adolescents, improved emotional state, enhanced documentation accuracy, improved partnership and communication, supported parental care management, and better prepared for appointments) and risks related to ORA that were categorized into 4 themes (emotional distress and confusion, threatened confidentiality, increased burden, and low usability). Adolescents’ and parents’ views on ORA regulations were categorized into 3 themes (challenges of the access gap, balancing respect for autonomy and support, and suggested regulatory change). Conclusions: In Sweden, ORA regulations and a lack of available information cause significant inconvenience for adolescents with serious health issues and their parents. Views on access age limits differed, with adolescents expressing their perceived need for independent access, while parents exhibited concerns about adolescents having ORA. The findings indicated the importance of increased education, dialogue, and flexibility to uphold confidential and consistent delivery of adolescent health care. Further exploration is needed to understand the experiences of adolescents and parents in diverse clinical and geographic contexts, as well as the perspectives of pediatric health care professionals on restrictive ORA regulations. %M 39869908 %R 10.2196/63270 %U https://pediatrics.jmir.org/2025/1/e63270 %U https://doi.org/10.2196/63270 %U http://www.ncbi.nlm.nih.gov/pubmed/39869908 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e55023 %T Digital Health Program to Support Family Caregivers of Children Undergoing Growth Hormone Therapy: Qualitative Feasibility Study %A Jiménez-Díaz,Alba %A Pierantonelli,Maitena %A Morte Coscolín,Patricia %A Salinas-Uhalte,Amaia %A Quer-Palomas,Silvia %A Rivera-Romero,Octavio %A Herrero,Rocío %A Fernández-Luque,Luis %A Baños,Rosa %A Berrios,Ricardo C %A de Arriba,Antonio %+ Unidad de Endocrinología Pediátrica, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1, Zaragoza, 50009, Spain, 34 976765500, adearriba@salud.aragon.es %K growth hormone deficiency %K mobile based solutions %K caregivers %K technology acceptance %K digital health %K children %K therapy %K feasibility study %K health condition %K psychological burden %K quality of life %K wellbeing %K pediatric %K mobile Health %K mHealth %K behavioral change %K parent-child relationship %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Caregivers of children with growth hormone deficiency often face emotional challenges (eg, stress) associated with their children’s health conditions. This psychological burden might affect children’s adherence to treatment and hinder their health-related quality of life (HrQoL). This assumption is leading to seriously considering multidimensional clinical approaches to pediatric health conditions where the emotional well-being of caregivers should be accounted for to optimize children’s health outcomes. Novel mobile health (mHealth) solutions based on emotional and behavioral change techniques can play a promising role because they are increasingly used within different health areas to support adaptive psychological functioning. However, whether and how mHealth solutions of this type of emotional well-being support caregivers of children with growth-related problems is an issue that needs to be clarified. Objective: This study aimed to gather qualitative information to better understand individualized experiences of caregiving of children undergoing growth hormone therapy (GHt) and perceived barriers or facilitators for the adoption of an mHealth solution called Adhera Caring Digital Program (ACDP). Methods: A total of 10 family caregivers were recruited at Miguel Servet Children’s Hospital, and they engaged with the ACDP for 1 month. The ACDP is a mobile-based digital intervention focused on promoting the overall well-being of family caregivers which provides access to personalized education, motivational mobile-based messages, and mental well-being exercises such as mindfulness or respiratory exercises. Subsequently, an individual semistructured interview was performed to gather qualitative user experience information. Results: The digital intervention was well-received. The ACDP was found to be useful, easy to use, and understandable, addressing all the difficulties expressed by caregivers. It was also noted to be particularly helpful at the beginning of the treatment and, for some families, became a natural tool that strengthened the parent-child relationship. Conclusions: The ACDP is a promising and well-accepted tool that enhances the experience of patients and caregivers. It improves the management of growth hormone deficiency and promotes the overall well-being of family caregivers. Trial Registration: ClinicalTrials NCT04812665; https://clinicaltrials.gov/study/NCT04812665 International Registered Report Identifier (IRRID): RR2-10.1186/s12911-022-01935-1 %M 39908086 %R 10.2196/55023 %U https://pediatrics.jmir.org/2025/1/e55023 %U https://doi.org/10.2196/55023 %U http://www.ncbi.nlm.nih.gov/pubmed/39908086 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67289 %T Community Caregivers’ Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study %A Elkourdi,Farah %A Asan,Onur %+ Department of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 2012165514, oasan@stevens.edu %K pediatric care %K children with medical complexity %K family-centered care %K health information technology %K health care software solutions %K mobile phone %K artificial intelligence %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children’s needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non–English-speaking immigrant populations. Objective: This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources. Methods: We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity. Results: We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies. Conclusions: The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity. %M 39928943 %R 10.2196/67289 %U https://pediatrics.jmir.org/2025/1/e67289 %U https://doi.org/10.2196/67289 %U http://www.ncbi.nlm.nih.gov/pubmed/39928943 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59159 %T Using a Consumer Wearable Activity Monitoring Device to Study Physical Activity and Sleep Among Adolescents in Project Viva: Cohort Study %A Zhang,Yutong %A Bornkamp,Nicole %A Hivert,Marie-France %A Oken,Emily %A James,Peter %K wearable device %K Fitbit %K physical activity %K sleep %K adolescents %K behavior risk %K mobile phone %D 2025 %7 4.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The increasing prevalence of physical inactivity and insufficient sleep in adolescents likely contribute to worsening cardiometabolic and mental health. However, obtaining accurate behavioral measures is a challenge. Consumer wearable devices offer a user-friendly method to assess physical activity and sleep. Objective: This study aimed to describe the process and the preliminary results of physical activity and sleep collected using a consumer wearable Fitbit device in an adolescent cohort. Methods: We provided Fitbit Charge 2 or Charge 3 wrist-worn activity monitors to adolescent participants in Project Viva, a Boston, Massachusetts area cohort, from 2017 to 2022. We invited participants to wear the devices for ≥7 days for 24 hours a day to measure their physical activity, heart rate, and sleep, and allowed them to keep the device as a participation incentive. Results: We collected over 7 million minutes of physical activity, heart rate, and sleep data from 677 participants, 53% (356/677) of whom were female. The mean (SD) age of participants was 17.7 (0.7) years. Among the 677 participants, 65% (n=439) were non-Hispanic White, 14% (n=947) were non-Hispanic Black, 10% (n=69) were Hispanic, 3.2% (n=22) were non-Hispanic Asian, and 7.8% (n=53) belonged to other races. Participants demonstrated a high adherence to the research protocol, with the mean (SD) wear duration of 7.5 (1.1) days, and 90% of participants (612/677) had 5 or more days wearing the device for >600 minutes/day. The mean (SD) number of steps was 8883 (3455) steps/day and the mean (SD) awake sedentary time was 564 (138) minutes/day. Male participants were more often engaged in very active (27 minutes/day) and moderately active physical activity (29 minutes/day) compared with female participants (15 and 17 minutes/day, respectively). Over 87% (588/677) of participants had sleep data available for 5 or more days, among whom the average nightly sleep duration was 7.9 (SD 0.9) hours. Conclusions: This study demonstrated the feasibility of using consumer wearable devices to measure physical activity and sleep in a cohort of US adolescents. The high compliance rates provide valuable insights into adolescent behavior patterns and their influence on chronic disease development and mental health outcomes. %R 10.2196/59159 %U https://pediatrics.jmir.org/2025/1/e59159 %U https://doi.org/10.2196/59159 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65451 %T Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation %A Thompson,Jessica R %A Weber,Summer J %A Mulvaney,Shelagh A %A Goggans,Susanna %A Brown,Madeline %A Faiola,Anthony %A Maamari,Lynn %A Hull,Pamela C %+ , Department of Health Policy and Administration, The Pennsylvania State University, 601E Ford Building, University Park, PA, 16802-1503, United States, 1 8148638129, jrthompson@psu.edu %K mHealth %K childhood obesity %K mixed methods %K pediatric %K healthy lifestyle behaviors %K preschool children %K mobile application %K diet %K physical activity %K exercise %K media use %K sleep %K development %K semi-structured interviews %K healthy eating %K parents %K caregivers %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. %M 39970437 %R 10.2196/65451 %U https://pediatrics.jmir.org/2025/1/e65451 %U https://doi.org/10.2196/65451 %U http://www.ncbi.nlm.nih.gov/pubmed/39970437 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67137 %T Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes %A Ibrahim,Radhwan Hussein %A Yaas,Marghoob Hussein %A Hamarash,Mariwan Qadir %A Al-Mukhtar,Salwa Hazim %A Abdulghani,Mohammed Faris %A Al Mushhadany,Osama %K cognitive behavioral therapy %K CBT %K psychotherapy %K mHealth %K app %K adolescents %K teenager %K mental health %K usability %K engagement %K anxiety %K depression %K user experience %K UX %K focus group %K interview %K digital health %D 2025 %7 11.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited. Objective: This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes. Methods: A qualitative study was conducted with 40 adolescents aged 13‐19 years (mean age 15.8, SD 1.9 years; 18/40, 45% male; 22/40, 55% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50%), depression (15/40, 38%), and both (5/40, 13%). Of these, 10 (25%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests. Results: The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16‐19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13‐15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95% CI 1.6‐5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95% CI 1.7‐5.6; P=.001). Usability challenges included complex navigation (20/40, 50%), interface design issues (12/40, 30%), and content overload (8/40, 20%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50%) and gamification features (10/40, 25%), while lack of personalization (14/40, 35%) and external distractions (18/40, 45%) were significant barriers. Mood improvement (15/40, 38%) and learning new coping skills (12/40, 30%) were the most reported outcomes. Conclusions: The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement. %R 10.2196/67137 %U https://pediatrics.jmir.org/2025/1/e67137 %U https://doi.org/10.2196/67137 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59489 %T The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study %A Larsson,Anna %A Weineland,Sandra %A Nissling,Linnea %A Lilja,Josefine L %+ Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, FoU primär och nära vård Södra Älvsborg, Sven Eriksonsplatsen 4, Borås, 503 38, Sweden, 46 104359410, anna.caroline.larsson@vgregion.se %K adolescents %K parental support %K anxiety %K depression %K primary care %K mental health %K ACT %K acceptance and commitment therapy %K iACT %K internet-delivered acceptance and commitment therapy %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support. Objective: This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning. Methods: Adolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children’s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children’s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution. Results: The iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children’s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: –2.94; P=.003; r=–0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: –2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children’s Global Assessment Scale were found. Conclusions: The results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study. %M 39752209 %R 10.2196/59489 %U https://pediatrics.jmir.org/2025/1/e59489 %U https://doi.org/10.2196/59489 %U http://www.ncbi.nlm.nih.gov/pubmed/39752209 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66448 %T Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study %A Kim,Sol I %A Jin,Jae-Chan %A Yoo,Seo-Koo %A Han,Doug Hyun %+ Department of Psychiatry, Chung Ang University Hospital, 102 Heusok ro, Seoul, 06973, Republic of Korea, 82 62993132, hduk70@gmail.com %K coronavirus pandemic %K internet use pattern %K internet games %K short-form videos %K social network system %K depressed mood %K internet use %K pandemic %K internet %K COVID-19 %K video %K internet behavior %K social media %K internet addiction %K depression %K anxiety %K digital platforms %K mobile phone %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents’ psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 (χ23=8.16, P=.04). Furthermore, this study showed that the Young’s Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. %M 39933170 %R 10.2196/66448 %U https://pediatrics.jmir.org/2025/1/e66448 %U https://doi.org/10.2196/66448 %U http://www.ncbi.nlm.nih.gov/pubmed/39933170 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e63500 %T Effects of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Four-Armed Randomized Controlled Trial %A Zhu,Shimin %A Hu,Yuxi %A Qi,Di %A Tse,Samson %A Chan,Ko Ling %A Sun,Jessica %A Lee,Paul %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, GH348, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China (Hong Kong), 852 2766 5787, jasmine.zhu@polyu.edu.hk %K belief-in-change %K growth mindset %K mental health %K secondary school students %K brief intervention %K randomized controlled trial %D 2025 %7 18.4.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Anxiety disorders are the most common mental health conditions worldwide, yet 65% of those affected do not access services. The high prevalence of anxiety and the low rate of intervention uptake highlight the urgent need to develop timely, scalable, and effective interventions suitable for adolescents. This study adapted existing single-session interventions (SSIs) to further develop an SSI focused on a growth mindset regarding negative emotions for adolescent mental health. Objective: The study aims to compare the effectiveness of 4 SSIs, SSI of a growth mindset for anxiety (SIGMA), SIGMA with boosters (SIGMA-Booster), SSI of a growth mindset of personality (SSIGP), and an active control group (support therapy [ST]), in reducing adolescent anxiety. Methods: Classes from each secondary school were randomized to 1 of 4 intervention conditions: SIGMA, SIGMA-Booster, SSIGP, or ST. Each intervention took approximately 45 minutes online. Participants reported on anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-harming thoughts, perceived control, hopelessness, attitude toward help-seeking, and psychological well-being (secondary outcomes) at preintervention, 2-week follow-up, and 8-week follow-up. Participants also completed a feedback scale postintervention. Generalized estimating equations were used to examine the effectiveness of the SSIs. Results: A total of 731 adolescents from 7 secondary schools were randomized. The intent-to-treat analysis found a significant decrease in anxiety symptoms. The mean and 95% CI at baseline were 6.8 (6.0-7.6) for SIGMA-Booster, 6.5 (5.8-7.3) for SIGMA, 7.0 (6.2-7.7) for SSIGP, and 6.9 (6.1-7.7) for ST. At the 2-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.7 (4.9-6.5) for SIGMA, 5.4 (4.6-6.2) for SSIGP, and 5.7 (4.9-6.4) for ST. At the 8-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.3 (4.5-6.0) for SIGMA, 5.6 (4.8-6.4) for SSIGP, and 5.8 (5.1-6.6) for ST. These reductions were observed across all 4 groups. Moderation analysis found that participants with higher motivation for change, higher baseline anxiety scores, and fixed mindsets showed greater improvements in anxiety symptoms. Most participants (459/731, 62.8%) viewed the feasibility and acceptability of the SSIs positively. Conclusions: The SSI for all 4 groups was effective in reducing anxiety and depression among adolescents over 8 weeks. Our data suggest the potential benefits of brief web-based interventions for adolescents, which could serve as scalable, destigmatized, and cost-effective alternatives to school-based programs. The intervention effects may have been underestimated, as this study did not exclude adolescents with minimal or no anxiety symptoms. Future studies should focus on the specific effects of interventions for adolescents with varying levels of anxiety symptoms. Trial Registration: ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880 %M 40249649 %R 10.2196/63500 %U https://pediatrics.jmir.org/2025/1/e63500 %U https://doi.org/10.2196/63500 %U http://www.ncbi.nlm.nih.gov/pubmed/40249649 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65163 %T Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study %A Butorac,Isobel %A McNaney,Roisin %A Seguin,Joshua Paolo %A Olivier,Patrick %A Northam,Jaimie C %A Tully,Lucy A %A Carl,Talia %A Carter,Adrian %+ School of Psychological Sciences, Monash University, 770 Blackburn Road, Clayton, 3800, Australia, 61 9905 0100, isobel.butorac@monash.edu %K digital mental health %K young people %K cultural diversity %K web-based and mobile health interventions %K qualitative methods %K user-centered design %K human-computer interaction %D 2025 %7 22.4.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. Objective: The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based “check-in” tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. Methods: We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Results: Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. Conclusions: The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study’s findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations. %M 40262130 %R 10.2196/65163 %U https://pediatrics.jmir.org/2025/1/e65163 %U https://doi.org/10.2196/65163 %U http://www.ncbi.nlm.nih.gov/pubmed/40262130 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e58301 %T Children’s and Their Parents’ Experiences With Home-Based Guided Hypnotherapy: Qualitative Study %A Ganzevoort,Ilse N %A van der Veen,Adriëlla L %A Alma,Manna A %A Berger,Marjolein Y %A Holtman,Gea A %K qualitative study %K primary health care %K children %K functional abdominal pain %K irritable bowel syndrome %K hypnotherapy %K eHealth %K abdominal pain %K child %K parents %K accessibility %K questionnaire %K interviews %K thematic analysis %K home guided %K primary care %K mobile phone %D 2025 %7 27.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Management of children with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) is difficult in primary care. When education and reassurance do not alleviate symptoms, primary care physicians lack treatment options for children with FAP or IBS. Home-based guided hypnotherapy is a promising treatment because of its accessibility. To address feasibility, it is of utmost importance to take experiences from children and their parents into account. Objective: We aimed to explore children’s and their parents’ experiences with home-based guided hypnotherapy for children with FAP or IBS. Methods: This qualitative study used open-ended questions from a questionnaire and in-depth semistructured interviews with children and their parents who had a hypnotherapy intervention prescribed. The interviews were audio-recorded and transcribed verbatim. Data were collected and analyzed iteratively using thematic content analysis. Results: A total of 76 children were eligible, and we collected questionnaire data from 56 children. A total of 23 interviews were conducted with 10 children and 15 parents. Six themes emerged from questionnaire data and interviews: impression of the exercises, not for everyone, influence of perceived effect, integrating exercises in daily life, content and practicalities of the website, and customization to personal preferences. Children with FAP or IBS experienced home-based guided hypnotherapy and the exercises differently, ranging from boring to fun. From interviews with the parents, it emerged that hypnotherapy is not suitable for everyone; for example, when children are very young or have a low developmental level, cannot sit still, cannot surrender to the exercises, or are too energetic or stressed, it might be difficult to comply. Experiences were shaped by the influence of a perceived effect and to which extent children were able to integrate exercises in daily life. The content and practicalities of the website also influenced experiences, and hypnotherapy that is adaptable to personal preferences, including by appearance and content, would be highly appreciated. Conclusions: The children and parents experienced home-based guided hypnotherapy differently, ranging from boring to fun. Hypnotherapy might be difficult or boring for some children. The children enjoyed hypnotherapy when they liked the topic or story, felt positive effects, could easily integrate exercises in daily life, or enjoyed the website in general. The children’s experiences and adherence can be further improved by adding short exercises and customizing hypnotherapy to their personal preferences on the website’s appearance and content. This could increase effectiveness but must be studied further. Trial Registration: ClinicalTrials.gov NCT05636358; https://clinicaltrials.gov/study/NCT05636358 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069653 %R 10.2196/58301 %U https://pediatrics.jmir.org/2025/1/e58301 %U https://doi.org/10.2196/58301 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65826 %T Digital Interventions for Patients With Juvenile Idiopathic Arthritis: Systematic Review and Meta-Analysis %A Ren,Zihan %A Chen,Yawen %A Li,Yufeng %A Fan,Panyu %A Liu,Zhao %A Shen,Biyu %K juvenile idiopathic arthritis %K digital intervention %K application %K children health care %K pediatrics %D 2025 %7 21.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Juvenile idiopathic arthritis (JIA) is a chronic rheumatic condition requiring long-term, multidisciplinary treatment, which consumes significant health care resources and family energy. This study aims to analyze the effectiveness of digital interventions on patient outcomes in individuals with JIA. Objective: This meta-analysis aimed to evaluate the impact of digital interventions on alleviating symptoms and improving overall well-being in children and adolescents with JIA. Methods: A systematic search of 5 databases identified randomized controlled trials assessing the impact of digital interventions on physiological and psychological outcomes in adolescents and children (average age ≤19 y). Outcomes included pain, physical activity, health-related quality of life, self-efficacy, and disease-related issues. A total of 2 reviewers independently screened papers and extracted data on intervention functionalities and outcomes, assessing the risk of bias. A meta-analysis using a random-effects model synthesized the results. Results: The review included 11 studies involving 885 patients with JIA. Digital interventions included educational (eg, self-management training), therapeutic (eg, pain management), and behavioral (eg, promoting physical activity) approaches. These were delivered through websites, telephone consultations, video conferences, apps, and interactive games, with durations ranging from 8 to 24 weeks and no clear link observed between intervention length and outcomes. Compared with conventional control groups, digital interventions were significantly effective in alleviating pain (standardized mean difference [SMD] −0.19, 95% CI −0.35 to −0.04) and enhancing physical activity levels (SMD 0.37, 95% CI 0.06-0.69). Marginal improvements in health-related quality of life, self-efficacy, and disease-related issues were observed, but these did not reach statistical significance (SMD −0.04, 95% CI −0.19 to 0.11; SMD 0.05, 95% CI −0.11 to 0.20; and SMD 0.09, 95% CI −0.11 to 0.29, respectively). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach rated the quality of evidence for pain, health-related quality of life, self-efficacy, and disease-related issues as moderate, while the evidence quality for physical activity was assessed as low. Conclusions: Digital interventions can alleviate pain and enhance physical activity in patients with JIA. However, given the limited sample size and high risk of bias in some studies, further high-quality research is needed to improve the treatment and management of JIA. Trial Registration: PROSPERO CRD42023471223; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023471223 %R 10.2196/65826 %U https://pediatrics.jmir.org/2025/1/e65826 %U https://doi.org/10.2196/65826 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67877 %T Evidence of Interventions for the Prevention of Unintentional Injuries: Scoping Review %A Shetty,Sheela %A Nayak,Baby S %A George,Anice %A Shetty,Avinash %A Guddattu,Vasudeva %K prevention %K injury %K education %K health %K child %K children %K unintentional injury %K disability %K youth %K surveillance %K surveillance data %K risk factor %K injury intervention %K literature search %K scoping review %K scoping literature review %K policymaker %K preventative measure %K preventive measure %D 2025 %7 28.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Unintentional injuries are the leading cause of death and disability among young children. Preventive strategies for unintentional injuries are mainly based on surveillance data and identifying risk factors. Objective: This study aimed to review and synthesize published literature that determined the effectiveness of interventions for preventing unintentional injuries among children. Methods: The methodological framework was supported by The Joanna Briggs Institute Reviewer’s Manual – Methodology for JBI Scoping Reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The inclusion criteria to include the studies in the review were unintentional injuries in children, interventions to prevent injuries, a brief description of the intervention and the outcome of the intervention, and articles published in a peer-reviewed journal and written in the English language. Results: In total, 21 articles were included in the review following the systematic search of key databases such as Web of Science, PubMed/MEDLINE, Scopus, ScienceDirect, and gray literature for studies published between July 2013 and May 2023. Of the 21 articles, 16 were randomized controlled trials, 4 were nonrandomized controlled trials, and 1 was a mixed method study. The findings of the review showed that interventions, either as a single measure (video-based teaching, testimonial story-based teaching, health education, storybook reading) or in combination (knowledge quiz and simulation test, module-based teaching along with personal counseling, and teaching with the help of video and poster), have shown a considerable decline in the number and severity of injuries. The studies included various target populations, including children and adolescents between 0 and 19 years old. Conclusions: The review results indicate the need to plan, implement, and reinforce preventive measures and techniques to reduce unintentional injuries among children. They can also serve as a useful indicator for policymakers. %R 10.2196/67877 %U https://pediatrics.jmir.org/2025/1/e67877 %U https://doi.org/10.2196/67877 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59215 %T Novel Profiles of Family Media Use: Latent Profile Analysis %A Hamp,Nicole %A Radesky,Jenny %A Weeks,Heidi M %A Miller,Alison L %A Kaciroti,Niko %K preschool %K child %K digital media %K mobile media %K media use %K latent profile analysis %K computer use %K LPA %K technology use %K survey %K questionnaire %K pediatrics %D 2025 %7 6.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as “screen time” must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information. Objective: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media. Methods: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership. Results: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership. Conclusions: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes. %R 10.2196/59215 %U https://pediatrics.jmir.org/2025/1/e59215 %U https://doi.org/10.2196/59215 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e60038 %T Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study %A Fitzgerald,Haley %A Frank,Madison %A Kasula,Katelyn %A Krans,Elizabeth E %A Krishnamurti,Tamar %K substance use disorder %K substance use screening %K mHealth %K mobile health apps %K pregnancy %K technology %D 2025 %7 13.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0.46) years; most were White (21/28, 75%) and Medicaid insured (26/28, 93%), with an annual household income of