%0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67872 %T Association Between the Parenting Competence and Quality of Life of Family Caregivers of Children Aged 0-3 Years: Cross-Sectional Study %A He,Wei %A Zhou,Le-shan %A Hu,Long-yi %K child %K toddler %K pediatric %K infant %K quality of life %K QoL %K family caregiver %K caregiver %K well-being %K competence %K quality of life factors %K parenting competency %K correlation %K child health department %K tertiary hospital %K convenience sampling %K parenting competency scale %K family caregiver quality of life scale %D 2025 %7 16.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The quality of life (QoL) for family caregivers significantly influences not only their own well-being but also the well-being of children aged 0‐3 years. Competence stands out as a crucial subjective factor that impacts this QoL. Objective: This study aimed to examine the factors affecting the QoL of caregivers of children aged 0‐3 years and its correlation with parenting competency. Methods: Caregivers of children aged 0‐3 years from the child health department of a tertiary hospital in Changsha, Hunan Province, were chosen as the study sample through convenience sampling. The study investigated the relationship between parenting competency and the caregivers’ QoL, utilizing general information, the parenting competency scale, and the family caregiver quality of life scale. Results: In this study, 291 family caregivers, including 13 fathers and 278 mothers of children aged 0‐3 years, were evaluated. The mean (SD) parenting competence score was 68.70 (9.816) and the mean (SD) QoL score was 56.81 (8.922). It was found that higher caregiver QoL scores were significantly associated with greater parenting competence (R=0.665, P<.001). Furthermore, each dimension of parenting competence demonstrated a significant positive correlation with each dimension of the QoL (P<.001). Conclusions: The data suggest a notable association between parenting competence and QoL among family caregivers of children aged 0‐3 years. This association has implications for improving fertility rates, as enhancing parenting competence may reduce childcare-related stress and thereby enhance the overall QoL. %R 10.2196/67872 %U https://pediatrics.jmir.org/2025/1/e67872 %U https://doi.org/10.2196/67872 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65754 %T Examination of Chronic Sorrow Among Parents of Children With Disabilities: Cross-Sectional Study %A Al Anazi,Samaa %A Alhujaili,Naseem %A Sinqali,Dina %A Al Heej,Ftoon %A Al Somali,Lojain %A Khayat,Samaher %A Ramboo,Talah %K chronic sorrow %K sadness %K parent %K disability %K pediatric %K infant %K neonatal %K children %K youth %K adolescence %K Saudi Arabia %D 2025 %7 2.7.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Parents of children with disabilities face many challenges when providing care, along with persistent worry and fear about the child’s health outcomes and the impact of the disability on their lives. These parents experience stressful situations and face many emotions, one of which is chronic sorrow (CS). Therefore, the theory of CS was introduced to examine and measure feelings of CS among parents. Little research has been conducted with Saudi parents with a child with disabilities and the utilization of CS theory in this population is limited. Objective: This study aims to examine the application of CS theory on parents of children with disabilities in Saudi Arabia. Methods: A cross-sectional design was used to obtain data from 89 participants who are parents of children with disabilities. A web-based questionnaire was distributed to measure CS. Results: The study examined the concepts within CS theory. The concept of loss experience yielded a moderately high score (mean 3.3, SD 1.10); of all the variables measuring loss experience, parents scored high in feeling sad when thinking about their child’s disability (mean 3.9, SD 1.24). Parents also reported a moderately high score (mean 3.3, SD 1.06) for the concept of disparity, specifically when their child does not meet the same developmental milestones as their peers (mean 3.8, SD 1.30). Feelings of CS also displayed a moderately high score (mean 3, SD 0.87), with the periodic nature of CS scoring the highest within the concept of CS (mean 3.6, SD 1.16). In addition, internal and external management methods that parents believe are effective were examined. Internal management of CS was believed to be of high importance (mean 4.6, SD 0.33), specifically the belief of fatalism (mean 4.8, SD 0.50). Parents also viewed external management as important in navigating their emotions (mean 4.5, SD 0.42), specifically social support from family and the community (mean 4.7, SD 0.55). This study identified strong positive relationships between sorrow and loss experience and disparity (both r=0.765 and P<.001). Lastly, the study found no relationship between CS and time elapsed since parents received their child’s diagnosis (r=−0.009; P=.94). Conclusions: This study applied the theory of CS to the parents of children with disabilities and they reported feelings of loss, disparity, and CS. Therefore, this population should be screened and provided with parental emotional care. Interventions to enhance parental mental health and well-being and support CS management should be developed and used by health care workers. Parental acceptance of their child’s disability does not mean the absence of CS, as it is part of the normal grieving process. Anticipating CS triggers and applying internal and external management are essential to improving parental mental health and child health outcomes. %R 10.2196/65754 %U https://pediatrics.jmir.org/2025/1/e65754 %U https://doi.org/10.2196/65754 %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 e67546 %T Hospitalization and Mortality in Brazilian Children and Adolescents Due to COVID-19: Retrospective Study %A Pereira de Godoy,Ana Carolina %A Bulgarelli Bestetti,Reinaldo %K COVID-19 %K children %K mortality %K Brazil %K retrospective study %K morbidity %K hospitalization %D 2025 %7 20.5.2025 %9 %J JMIR Pediatr Parent %G English %X Background: COVID-19 is currently one of the most important medical challenges as it affects the entire population, with children and adolescents being infected as easily as adults. Objective: The objective of this study was to evaluate the prevalence of mortality in children and adolescents aged <19 years, compared to that of adults. Methods: This retrospective, observational study analyzed the medical records of all patients diagnosed with COVID-19 by real-time reverse transcription–quantitative polymerase chain reaction who were hospitalized at Hospital de Base and the Infant and Maternal Hospital of São José do Rio Preto, São Paulo, Brazil. Out of a total of 8986 hospitalized patients who were COVID-19 positive, 383 (4.26%) were children and adolescents aged <19 years (group 1), and 8603 (95.74%) were adults (group 2). Results: Overall, mortality was significantly higher (P<.001) in group 2 (2185/8603, 25.4%) compared to group 1 (12/383, 3.1%). A total of 11 (92%) of the 12 patients in group 1 that died had associated diseases. The mortality rates by age group were as follows: infants aged <1 year, 1.6% (2/123); children aged 1-4 years, 4% (4/95); children aged 5-9 years, 2% (1/47); adolescents aged 10-14 years, 2% (1/40); and adolescents aged 15-19 years, 5% (4/78). Conclusions: Mortality from COVID-19 in children and adolescents was significantly lower than that in adults and was associated with other comorbidities. %R 10.2196/67546 %U https://pediatrics.jmir.org/2025/1/e67546 %U https://doi.org/10.2196/67546 %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 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 e68119 %T Enhancing Effect of eHealth Use on the Associations Between Social Supports and Well-Being in Japanese Employed Women Providing Childcare or Care: Bayesian Structural Equation Modeling Study %A Yamaji,Noyuri %A Yoneoka,Daisuke %A Suzuki,Daichi %A Sasayama,Kiriko %A Ota,Erika %A Nishimura,Etsuko %A Tachimori,Hisateru %A Saito,Eiko %+ , Institute of Clinical Epidemiology, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 1428555, Japan, 81 337848892, yamaji.n@med.showa-u.ac.jp %K eHealth %K social support %K well-being %K women’s health %K caregivers %K working women %D 2025 %7 26.6.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The increasing prevalence of information and communication technologies has made health-related information and social support more accessible on the web. However, limited evidence exists on how eHealth and social support affect the well-being of employed women who also serve as caregivers in Japan. Objective: This study aimed to assess the relationship between social support and well-being among employed Japanese women providing childcare or caregiving and explore eHealth use’s role in enhancing this relationship. Methods: We conducted a cross-sectional study using secondary data analysis from a nationwide web-based questionnaire survey of 10,000 employed women aged 20-65 years, administered from February 28, 2023, to March 7, 2023. The primary study used a quota random sampling approach based on age and geographic area from the research company’s panel. For this analysis, we focused on a subgroup of 2456 women who reported either caring for children less than 7 years old or providing other caregiving responsibilities. We employed a Bayesian structural equation model to estimate the enhancing effect of eHealth on the relationship between social support and 4 well-being indicators: life satisfaction, worthwhileness, happiness, and anxiety. Results: Among the 2456 employed women included, 1784 (72.6%) received social support and 1635 (66.6%) obtained health-related information via eHealth. Bayesian structural equation model analysis revealed that the standardized total effects of social support on well-being were 0.20 (95% CI 0.13-0.27) in the group without eHealth use and 0.47 (95% CI 0.45-0.50) in the group with eHealth use. Conclusions: The findings suggest that eHealth may enhance the positive impact of social support on the well-being of employed Japanese women providing childcare or caregiving. This study highlights the potential of eHealth interventions in supporting social support and well-being among working women with caregiving responsibilities in Japan. %M 40570325 %R 10.2196/68119 %U https://pediatrics.jmir.org/2025/1/e68119 %U https://doi.org/10.2196/68119 %U http://www.ncbi.nlm.nih.gov/pubmed/40570325 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e58752 %T Using WhatsApp for Nutrition Surveillance Among Children Under 5 Years in West Java, Indonesia: Cross-Sectional Survey and Feasibility Study %A Aisyah,Dewi Nur %A Mayadewi,Chyntia Aryanti %A Utami,Astri %A Rahman,Fauziah Mauly %A Adriani,Nathasya Humaira %A Al Farozi,Erlangga %A Sayoko,Meldi Hafizh %A Chairunisa,Aulia %A Restiana,Liza %A Manikam,Logan %A Kozlakidis,Zisis %K WhatsApp %K Posyandu %K nutrition surveillance %K nutrition %K nutritional %K mHealth %K mobile health %K app %K anthropometric %K data collection %K surveillance %K chatbots %K digital %K digital health %K digital technology %K digital intervention %K pediatric %K infant %K baby %K neonatal %K toddler %K child %D 2025 %7 15.5.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Large-scale programs involving nutrition-specific interventions have been carried out in Indonesia as a community-based approach at the primary care level across cities and districts, throughout the age-specific target population (ie, children under 5 years). Objective: The aim of this paper is to describe the potential use of WhatsApp as a tool for recording and monitoring the growth of children under 5 years by Posyandu (Pos Pelayanan Terpadu or community-based health service post), investigating its potential in enhancing health programs and services. Methods: Data were collected from Posyandu cadres in Bogor District, West Java, from March to June 2022. The anthropometric measurement data were reported in real time through a WhatsApp chatbot, automatically analyzed by the system, and presented in a structured dashboard. A qualitative assessment was carried out using a cross-sectional survey conducted from March to July 2022. Results: The study involved 42 Posyandu in 3 villages, engaging 282 staff, and the WhatsApp chatbot recorded anthropometric data for 4571 children under 5 years. The qualitative assessment indicated widespread system utilization, with 50% (45/90) affirming comprehensive data input. Additionally, 66.4% (83/129) found the system easy to use, and 66.7% (82/123) expressed clarity in comprehending variables. Moreover, 75.6% (93/123) found the data input flow easily understood, and 74% (91/123) suggested that the system contributed to enhancing Posyandu activities and the quality of data reporting. Regarding staff proficiency, 63.5% (80/126) affirmed their adeptness in using the system, and 71% (88/124) asserted their high capability in providing training to colleagues. Conclusions: The potential use of WhatsApp as a surveillance tool for recording children’s nutritional status is promising, suggesting broader applications within health programs. Nonetheless, this expansion requires additional improvements, including human resource preparation, Posyandu infrastructure development, and strong regulatory support. %R 10.2196/58752 %U https://pediatrics.jmir.org/2025/1/e58752 %U https://doi.org/10.2196/58752 %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 e65581 %T Preliminary Effectiveness of a Postnatal mHealth and Virtual Social Support Intervention on Newborn and Infant Health and Feeding Practices in Punjab, India: Quasi-Experimental Pre-Post Pilot Study %A Verma,Garima Singh %A Gopalakrishnan,Lakshmi %A Ayadi,Alison El %A Diamond-Smith,Nadia %A Bagga,Rashmi %A Dhir,Shashi Kant %A Singh,Pushpendra %A Gill,Navneet %A Miglani,Vaibhav %A Mutyala,Naveen %A Kankaria,Ankita %A Kaur,Jasmeet %A Ahuja,Alka %A Kumar,Vijay %A Duggal,Mona %K digital health %K mHealth %K mobile health %K app %K postpartum %K health education %K social support %K India %K infant morbidity %K care seeking %K postnatal %K maternal %K mother %K text message %K virtual support %K online support %K pediatric %K infant %K baby %K neonate %K newborn %K breastfeeding %K feeding %D 2025 %7 27.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: We evaluated a pilot mobile health (mHealth) intervention aimed at improving postnatal maternal and infant health. The intervention featured provider-led group sessions for education, health care communication, in-person care referrals, and virtual mHealth support for postpartum mothers through weekly calls, texts, interactive voice response (IVR), and a phone app. Objective: We aimed to assess the preliminary effectiveness of the pilot mHealth intervention, MeSSSSage (Maa Shishu Swasthya Sahayak Samooh, which means maternal and child health support group), on infant health knowledge, behaviors, and outcomes at 6 months post partum. We focus on maternal knowledge of infant danger signs and optimal young child feeding practices at 6 months post partum and also evaluate maternal care-seeking behaviors for infants, adherence to age-appropriate immunization, and infant and young child feeding practices such as early initiation of breastfeeding and complementary feeding. Methods: We evaluated the preliminary effectiveness of an intervention on maternal health knowledge among 135 participants in Punjab, India, who completed pre- and postintervention surveys. The intervention, led by research personnel with backgrounds similar to community health officers, aimed to empower society and support universal health coverage if successful. We assessed changes in knowledge of maternal danger signs and the appropriate age for introducing different food groups over 6 months post partum. Additionally, we examined postintervention differences in health-seeking behavior for infants, adherence to age-appropriate immunizations, and adoption of breastfeeding and complementary feeding practices among women in the synchronous (group call), asynchronous (IVR and app), and control arms. Results: Of 12 infant risk factors, maternal knowledge of infant danger signs remained low (mean range: 1.85-2.31 preintervention and 1.81-2.22 postintervention). Participants in the synchronous arm had a statistically significant higher mean increase (mean difference: 0.87, 95% CI 0.06‐1.69) compared to the control arm. Participants in synchronous arms had nearly 3-fold increased odds of infant health checkup by a clinical provider than asynchronous arm participants (odds ratio [OR] 2.72, 95% CI 1.02-7.23). No significant differences were noted in age-appropriate vaccine coverage among infants between arms, though vaccination coverage was more than 80% across all arms. Early initiation of breastfeeding remained low across all arms (~47%). Conclusions: Our pilot study on group-based mHealth education and virtual social support during the postnatal phase showed modest yet promising results. Rigorous testing is crucial to strengthening the limited evidence base for group-oriented mHealth approaches. Trial Registration: ClinicalTrials.gov NCT04693585; https://clinicaltrials.gov/study/NCT04693585 %R 10.2196/65581 %U https://pediatrics.jmir.org/2025/1/e65581 %U https://doi.org/10.2196/65581 %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 e60764 %T An Online Family Literacy and Wellness Program for Latino Dual Language Learners: Pilot Randomized Waitlist Controlled Trial %A Guerrero,Kevin D %A Lakata,Lucia %A Lima,Daniel %A Mendoza,Caroline %A Uthirasamy,Nila %A Morrow,Lesley M %A Perez-Cortes,Silvia %A Pellerano,Maria %A Bator,Alicja %A Ohman Strickland,Pamela %A Crabtree,Benjamin F %A Jimenez,Manuel E %K pediatrics %K children %K family %K English as a second language %K ESL %K child development %K development %K wellness %K health equity %K dual language learner %K literacy %K language %K Latinos %K Spanish %K Hispanic %K randomized %K controlled trials %D 2025 %7 19.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Early childhood interventions can simultaneously promote positive health and early language experiences, but implementation and health equity often receive insufficient attention during the development process. Objective: We apply a health equity lens to refine and pilot-test a family literacy and wellness program designed for Latino dual language learners (DLLs) entering kindergarten and their caregivers. Methods: In collaboration with a parent and community advisory board, we refined an 8-week family literacy and wellness program and conducted a pilot randomized controlled trial (RCT) with a waitlist control. The program, specifically designed by our interprofessional team for Latino DLLs, uses health topics (ie, nutrition, physical activity, sleep, and social-emotional development) to (1) introduce foundational language and literacy skills to children; (2) empower families to engage in health and home literacy activities using a strengths-based approach; and (3) encourage maintenance of families’ home language. We assessed reach by collecting sociodemographic information; attendance and acceptability using a parent survey; and preliminary effects on home literacy activities through a validated parent-report instrument (StimQ2 quantity, quality, content, and concepts subdomains) and on child literacy skills using investigator-developed assessments. We analyzed quantitative data using descriptive statistics and regression analyses. Results: Parents and community advisors informed the program content. A total of 32 parent-child dyads were enrolled in the pilot RCT. All parents identified as Latino, and half had not completed high school, indicating that we reached the intended audience. Parents rated the program as highly acceptable, and 23 (72%) participants attended at least half of the sessions. After participation, group 1 had higher StimQ2 quality scores (effect size 0.99, P=.02) and higher quantity scores (effect size 1.01, P=.04) compared with group 2. Conclusions: Similar interprofessional collaborations may be a promising strategy to promote equity in early language experiences for Latino DLLs and their families. Trial Registration: ClinicalTrials.gov NCT05339464; https://clinicaltrials.gov/ct2/show/NCT05339464 %R 10.2196/60764 %U https://pediatrics.jmir.org/2025/1/e60764 %U https://doi.org/10.2196/60764 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66175 %T A Low-Cost, Social Media–Supported Intervention for Caregivers to Enhance Toddlers’ Language Learning: Mixed Methods Feasibility and Acceptability Study %A Romano,Mollie %A Abarca,Diana %A Baehman,Frances %+ School of Communication Science and Disorders, Communication and Early Childhood Research and Practice Center, Florida State University, 201 W Bloxham Street, Tallahassee, FL, 32306-1200, United States, 1 850 322 0152, mollie.romano@cci.fsu.edu %K social media %K language development %K toddler %K infant %K infancy %K pediatric %K language learning %K feasibility %K acceptability %K caregiver %K TikTok %K mixed methods %K short video %K qualitative analysis %K child support %K health information %D 2025 %7 23.6.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Widely accessible, cost-effective early language development interventions for caregivers of young children are needed to promote optimal outcomes in children in the United States. Social media short-form videos, such as those on TikTok, may be a natural fit for delivering this type of intervention. Objective: This study aims to examine the feasibility and acceptability of a low-intensity, short-term social media intervention for caregivers of young toddlers. Methods: In total, 25 caregivers of children aged between 12 and 18 months participated in this study. We shared 32 short-form videos via TikTok over an 8-week period to help increase caregivers’ knowledge about early childhood communication. We examined metrics to characterize participant engagement, explored measures of changes in caregivers’ knowledge, and conducted a qualitative analysis of caregiver interviews after the intervention. Results: Results indicated that most caregivers were able to consistently view the videos, with approximately 75% (16/21) viewership per video (mean 15.75 likes out of 21 possible likes), and caregivers reported positive effects of the intervention on their knowledge of how to support their child’s communication. The results of the exploratory measure of change in caregiver knowledge were positive but not statistically significant (t21=–1.357; P=.09). Caregivers offered suggestions for content and enhancements to videos for future investigations. Conclusions: Low-cost, short-term social media interventions could be an effective means to equip caregivers with the information they need to advance their children’s language abilities, particularly for families from lower-income backgrounds whose access to health information about their young children may be limited. %M 40550118 %R 10.2196/66175 %U https://pediatrics.jmir.org/2025/1/e66175 %U https://doi.org/10.2196/66175 %U http://www.ncbi.nlm.nih.gov/pubmed/40550118 %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 e67149 %T Evaluating the Impact of Pediatric Digital Mental Health Care on Caregiver Burnout and Absenteeism: Longitudinal Observational Study %A Lawrence-Sidebottom,Darian %A McAlister,Kelsey %A Beam,Aislinn Brenna %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A McCutchen,Donna %A Goodgame Huffman,Landry %A Huberty,Jennifer %K digital mental health intervention %K mental health %K mental illnesses %K mental disorders %K child behavioral health %K child behavior %K workplace outcomes %K pediatrics %K children %K youth %K adolescents %K adolescence %K teenagers %K digital %K digital health %K digital technology %K digital interventions %D 2025 %7 27.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Caregivers of children with mental health challenges are at heightened risk for burnout and absenteeism. This strain affects both their well-being and work performance, contributing to widespread workplace issues. Digital mental health interventions (DMHIs) are increasingly used to support pediatric mental health, but their impact on caregiver outcomes remains underexplored. Objective: This study aimed to explore the associations between caregiver burnout, absenteeism (ie, missing work), comorbid symptoms, and child mental health problems, and to assess whether caregiver burnout and absenteeism improved as their child participated in a pediatric DMHI. Methods: This retrospective study included 6506 caregivers whose children (aged 1‐17 years) received care from Bend Health, Inc, a pediatric DMHI providing digital-based therapy and coaching, digital content, and caregiver support. Caregiver burnout, absenteeism, comorbid symptoms, and child mental health symptoms were measured by monthly assessments. Cumulative link models were used to assess the associations of between child symptoms and caregiver outcomes and to assess changes in caregiver outcomes over the course of the DMHI. Analyses of baseline associations included the full sample (n=6506), while analyses of pre-post changes in caregiver outcomes were conducted in caregivers with elevated burnout (n=2121) and absenteeism (n=1327) who had an assessment after starting care. Results: At baseline, 45.96% (2990/6506) of caregivers reported elevated burnout and 28.96% (1884/6506) reported elevated absenteeism. More severe burnout was associated with having a child with elevated symptoms of any type (all P<.01). More severe absenteeism was significantly associated with having a child with elevated symptoms of depression (z=3.33; P<.001), anxiety (z=3.96; P<.001), inattention (z=2.48; P=.013), and hyperactivity (z=2.12; P=.03). Burnout decreased for 68.64% (1456/2121) and absenteeism decreased for 87.26% (1158/ 1327). Greater months in care was associated with less severe caregiver burnout (z=−5.48; P<.001) and absenteeism (z=−6.74; P<.001). Conclusions: DMHIs for children may reduce caregiver burnout and absenteeism. These findings emphasize the value of employers offering pediatric DMHIs as part of employee benefits, potentially enhancing workplace outcomes. %R 10.2196/67149 %U https://pediatrics.jmir.org/2025/1/e67149 %U https://doi.org/10.2196/67149 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e70409 %T Exploring the Acceptance and Opportunities of Using a Specific Generative AI Chatbot to Assist Parents in Managing Pediatric Rheumatological Chronic Health Conditions: Mixed Methods Study %A Lau,Cheryl W Y %A Kupiec,Klaudia %A Livermore,Polly %K pediatric health care chatbot %K technology acceptance %K parental attitudes %K children and young people's involvement %K chronic disease management %K AI hesitancy %K chronic health condition %K artificial intelligence %D 2025 %7 1.7.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Health care chatbots can be used to support patients and their families with everyday decision-making. While there is some research on integrating artificial intelligence into pediatric care, no study has focused on the opportunity of implementing a generative artificial intelligence chatbot for pediatric rheumatology. Pediatric rheumatology conditions require intense family input, which can often leave families struggling to navigate disease flares, pain, fatigue, medication side effects and adherence, and support of their child, often when pediatric rheumatology departments are shut. Understanding how we can support families better, without the need for increased personnel, will have implications for the health care systems. Objective: The study aimed to explore parental and children and young people’s acceptance of chatbot use in a pediatric context, and understand how a chatbot could be specifically used for managing a child’s chronic health condition. Methods: This study was a mixed methods design, using both a family workshop and a subsequent questionnaire. Results: In total, 22 participants contributed to the qualitative design using the world café methodology at a workshop, and 47 participants (36 parents and 11 children and young people) completed quantitative data via a questionnaire. Participants expressed their likelihood of using chatbot technology, including ChatGPT, due to its accessibility. However, participants had significantly greater intention (parents: P<.001; children and young people: P=.006) to use a specific chatbot over ChatGPT, due to increased trust, credibility, and specificity in design. Children and young people and parents should be distinguished as 2 user groups in chatbot design, reflecting their specific needs in chatbot features and personalization. Conclusions: Overall, the study reinforced the need for a specialized and trusted chatbot designed with input from health professionals to assist families in managing complex chronic health conditions to support families in between appointments and complement existing face-to-face care. Future research should evaluate users’ engagement with a functional prototype to investigate its usefulness and explore its implementation into families’ everyday lives. Importantly, the current findings have broader implications for the field of pediatric health care, as similarly tailored chatbot interventions could benefit families who are managing other chronic health conditions. %R 10.2196/70409 %U https://pediatrics.jmir.org/2025/1/e70409 %U https://doi.org/10.2196/70409 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65023 %T Exploring Service Users’ Experiences of a Community-Based Intervention to Improve Follow-Up at Bharatpur Eye Hospital in Nepal: Qualitative Study %A Shrestha,Manisha %A Bhandari,Gopal %A Bhandari,Sadhan %A Murthy,Gudlavalleti Venkata Satyanarayana %A Priya,Ruchi %A Pandey,Binod %A Chaudhary,Daya Shankar %A Giri,Puspa %A Kamalakannan,Sureshkumar %A , %K qualitative study %K barriers %K facilitators %K Nepal %K follow-up %K eye care services %K child health %K follow-up care %D 2025 %7 25.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Follow-up to eye care services for children, especially in the context of Nepal, is essential for ensuring a continuum of care. Hence, as a continued effort, we designed this study to explore the service users’ experience of a community-based intervention to improve follow-up at Bharatpur Eye Hospital (BEH) in Nepal. Objective: This study aimed to explore service users’ experiences and perceptions of the community-based follow-up intervention for eye care services implemented by BEH in Nepal. Methods: A qualitative study using an in-depth interview approach was used. Participants were purposively selected for this research study. Participants who were part of a quasi-experimental study conducted to improve follow-up services in BEH and their service catchment area were chosen. Participants who had not attended even a single follow-up visit and participants who attended at least one follow-up were recruited for this qualitative study. Based on the distance from the base hospital and the follow-up status, 65 participants were initially found eligible for the qualitative study. However, only 17 participants were available and consented. Topic guides were developed for the purpose of in-depth interviews specifically for participants who had not attended even the first follow-up visits and those who attended at least one follow-up visit. A total of 2 ophthalmic assistants, who were not a part of the main intervention study, conducted the interviews. Results: In total, 17 service users whose children were receiving services from BEH participated in the qualitative study. We identified 4 key themes that provided invaluable information about the barriers and facilitators to follow-up as well as the experiences (positive or negative) of the participants that need to be considered in any future initiatives to improve follow-up in Nepal. Conclusions: This study highlights the need for systematic development of interventions to address the unmet need for eye care services in the community through innovative, scalable solutions. As a next step, the BEH team will be working to develop such scalable solutions for Nepal. Such interventions will also need to be optimized for similar settings and countries to meet the goals of universal health coverage, vision 2030, and sustainable development goals worldwide. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/study/NCT04837534 %R 10.2196/65023 %U https://pediatrics.jmir.org/2025/1/e65023 %U https://doi.org/10.2196/65023 %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 e60523 %T The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis %A Senyard,Emma-Leigh %A Rowe,Arlen %A Krishnamoorthy,Govind %A Spence,Susan H %A Donovan,Caroline %A March,Sonja %K youth %K adolescent %K teen %K teenager %K anxiety %K eHealth %K internet %K engagement %K mental health %K participation %K cognitive behavioral therapy %K CBT %K psychotherapy %K self-help %K self-guided %K retention %K attrition %K dropout %K digital mental health %K web-based %D 2025 %7 2.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Digital mental health (dMH) interventions offer the ability to reach many more adolescents with anxiety than face-to-face therapy. While efficacious dMH interventions are available for adolescents, premature dropout and low engagement are common, especially if delivered on a self-help basis without any form of therapist guidance. This is concerning, given that higher engagement, in terms of the number of sessions completed, has been repeatedly associated with improved clinical outcomes. The reasons for poor adolescent engagement in dMH programs are unclear. A clear understanding of when and why disengagement occurs is important in order to seek to improve engagement rates. Contemporary models consider engagement as multifaceted, comprising both “use” (eg, amount of content completed, frequency of use, duration spent logged into the dMH program, and depth of use, such as word or character count) and “user experience” (eg, interest and satisfaction in the program and affect and attention whilst engaging in the program). Objective: This study investigated the role of demographic and early engagement (EE) factors, specifically program use, in predicting overall program engagement and continued engagement, respectively, in a self-directed, internet-based cognitive behavioral therapy program for adolescent anxiety, namely, BRAVE Self-Help. It examined multiple measures of program use, including task completion, homework completion, and depth of response (character count of responses typed into program tasks). It also examined the moderating role of baseline anxiety severity. Methods: Data collected between July 2014 and May 2020 from 2850 adolescents aged 12 to 18 years who participated in BRAVE Self-Help were analyzed via a series of moderated regressions. Results: Results showed that EE (in terms of program use) was associated with continued engagement, demonstrated by early tasks (tasks completed in the first two sessions; R2=0.035; P<.001) and early depth (characters written in the first two sessions; R2=0.08; P<.001) predicting continued depth of program response (total character count of responses typed into all program tasks from sessions 3 to 10). Demographic factors and anxiety severity did not directly impact adolescents’ engagement in BRAVE Self-Help. Conclusions: These findings highlight the need to investigate ways to (1) enhance EE and (2) better understand how to measure and capture all aspects of program engagement. %R 10.2196/60523 %U https://pediatrics.jmir.org/2025/1/e60523 %U https://doi.org/10.2196/60523 %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 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 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 e73237 %T eHealth Literacy and Adolescent Health in Japanese Female High School Students in Sendai: Cross-Sectional Study %A Takeda,Takashi %A Yoshimi,Kana %A Kai,Sayaka %A Inoue,Fumi %+ Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka-Sayama, 589-8511, Japan, 81 72 366 0221 ext 3393, take@med.kindai.ac.jp %K female adolescents %K mental health %K premenstrual symptoms %K self-esteem %K eHealth %D 2025 %7 30.6.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In the digital age, adolescents increasingly rely on online sources for health-related information. eHealth literacy—defined as the ability to find, evaluate, and apply online health information—plays a crucial role in health outcomes. However, limited research exists on eHealth literacy among Japanese high school students, particularly on its association with menstrual health and psychological well-being. Objective: This study aimed to assess the eHealth literacy of Japanese female high school students and examine its association with premenstrual symptoms, psychological distress, loneliness, and self-esteem. Methods: A cross-sectional, web-based survey was conducted in December 2024 among 1607 female students from 2 public high schools in Sendai, Japan. A total of 909 students with regular menstrual cycles completed all survey items. The survey included the eHealth Literacy Scale (eHEALS), Premenstrual Symptoms Questionnaire, Kessler Psychological Distress Scale (K6), Revised UCLA Loneliness Scale, Rosenberg Self-Esteem Scale, and a numerical rating scale for menstrual pain. Statistical analyses, including Student t tests, chi-square tests, correlation analyses, and logistic regression analyses, were used to examine the relationships between eHealth literacy and various health outcomes. Results: The mean eHEALS score was 22.8 (SD 7.3), with 32.1% (292/909) of participants classified as having high eHealth literacy (eHEALS≥26). Students with higher eHealth literacy reported significantly lower levels of loneliness and higher self-esteem. The severity of premenstrual symptoms, particularly feeling overwhelmed, was significantly lower in the high eHealth literacy group. Additionally, interpersonal difficulties related to premenstrual symptoms were less prevalent among students with high eHealth literacy. Pearson correlation analysis indicated negative associations between the eHEALS score and psychological distress (K6) and loneliness, whereas a positive association was observed with self-esteem. Logistic regression analysis showed that high self-esteem was significantly associated with high eHealth literacy. Conclusions: This study highlights the importance of eHealth literacy in adolescent health care. Higher eHealth literacy is linked to lower levels of loneliness, higher self-esteem, and reduced premenstrual symptom severity, particularly feeling overwhelmed. Although the cross-sectional design limits causal conclusions, these findings suggest that higher eHealth literacy is associated with better mental and reproductive health in adolescents. Future research should adopt longitudinal designs, include more diverse populations—such as male adolescents—and explore additional contributing factors to better elucidate these associations. %M 40587180 %R 10.2196/73237 %U https://pediatrics.jmir.org/2025/1/e73237 %U https://doi.org/10.2196/73237 %U http://www.ncbi.nlm.nih.gov/pubmed/40587180 %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 e68943 %T A Companion Robot for Children With Asthma: Descriptive Development and Feasibility Pilot Study %A Sangngam,Jinnaphat %A Rungamornrat,Somsiri %A Santipipat,Rungnapa %A Ponthanee,Kunchira %K companion robot %K app %K asthma %K children %K caregiver %K model %D 2025 %7 23.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Consistent medication use and proper inhaler technique are essential in pediatric asthma, and young children require supportive tools to maintain these practices. Objective: This study aimed to investigate the caregivers’ ability to use a companion robot–assisted app for children with asthma, their attitudes toward the usage, and the characteristics that hinder or facilitate the implementation. Methods: This study employed a descriptive design. The sample group consisted of 30 children with asthma aged 3‐6 years who received treatment at an asthma clinic and their caregivers. The companion robot for children with asthma called “Pukkabot,” which is an innovation that is developed to teach inhalation techniques and to raise awareness about consistent medication administration through positive reinforcement, was examined. Data collection included personal information questionnaires, the System Usability Scale (SUS) for evaluating usage and overall satisfaction, and interviews to gather attitudes toward apps and characteristics that hinder or facilitate. Data were analyzed with descriptive statistics and content analysis. Results: The study revealed that the scores for usability and overall satisfaction were 80.6, which is above the standard threshold and rated at grade A or an excellent level. Additionally, caregivers stated that the companion robots were easy to use, not complicated, had appropriately sized screens, and demonstrated clear images and sounds. The detailed steps for inhalation were exhibited, and reminders included those of medication times. The children with asthma enjoyed the app and were very interested, making most caregivers want to continue their use. Conclusions: Caregivers were generally satisfied with the usability, finding it easy to use and engaging, which successfully attracted the interest of the children with asthma. Therefore, the companion robot may be used further, with the following recommendations: improving its physical design, adding content, incorporating tracking and symptom assessment systems, and creating a downloadable mobile app for greater accessibility and convenience. Trial Registration: Thai Clinical Trials Registry TCTR20240912001; https://www.thaiclinicaltrials.org/show/TCTR20240912001 %R 10.2196/68943 %U https://pediatrics.jmir.org/2025/1/e68943 %U https://doi.org/10.2196/68943 %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 e64831 %T Impact of COVID-19 on Dutch General Practitioner Prenatal Primary Care: Retrospective, Observational Cohort Study Using an Interrupted Time-Series Approach %A Berends-Hoekstra,Wikje %A Homburg,Maarten %A Oenema,Anke %A Berends,Matthijs Simeon %A Peters,Lilian %K pregnant women %K COVID-19 pandemic %K general practitioner %K GP %K health care–seeking behavior %K interrupted time-series analysis %K health policy %K primary care %D 2025 %7 27.5.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic significantly impacted primary health care–seeking behavior of the general population. The extent to which health care–seeking behavior of pregnant women in general practitioner (GP) care was affected remains largely unknown. The unique health care needs of pregnant women necessitate regular monitoring and care to ensure the well-being of expectant mothers, fetuses, and neonates, as timely interventions and screenings can profoundly influence the long-term health outcomes. Understanding how pandemic-related changes have influenced pregnant women’s primary health care–seeking behavior is essential for developing targeted interventions and informing policy decisions to improve health outcomes for expectant mothers, fetuses, and neonates, both during public health emergencies and in routine health care settings. Objective: This study aims to examine the impact of different COVID-19 pandemic phases on health care–seeking behavior among pregnant women in Dutch GP practices throughout 2020 and 2021. By analyzing clinical electronic health record (EHR) GP data, we aim to evaluate the health care consumption, occurrence of pregnancy-relevant symptoms and diagnoses, and types of contact (ie, regular consultations, phone consultations, home visits, and digital consultations) during different pandemic phases. Methods: Using a retrospective cohort design, EHRs of selected pregnant women from 3 Dutch GP networks between 2019 and 2021 were analyzed, comparing 6 pandemic phases divided into 13 subphases with a prepandemic phase. Contact rates were analyzed by interrupted time-series analyses, pregnancy-relevant symptoms, and diagnoses by comparing the frequency of pregnancy-relevant International Classification of Primary Care (ICPC) code registrations and type of contact by descriptive statistics. Results: In total, 10,985 pregnant women were included, yielding 39,023 patient-GP contacts. Contact rates fluctuated significantly across pandemic phases, with the sharpest declines at the onset and the end of the pandemic. Pregnancy-relevant symptoms and diagnosis in the category related to pregnancy showed the highest variability across the pandemic phases, such as an increase in the frequency of health care consumption concerning gestational diabetes mellitus and nausea or vomiting of pregnancy. Detailed statistical results are reported in the main text. Contacts for symptoms and diagnosis like digestive or urinary tract problems did not fluctuate across the pandemic phases. The number of physical contacts decreased, while telephone contacts increased. Conclusions: By analyzing EHR data from over 10,000 pregnant women, this study highlights the pandemic’s impact on pregnant women’s GP health care–seeking behavior, including declining health care consumption trends during the initial and end phases of the pandemic (2020‐2021). The observed increase in GDM and its potential long-term effects underscore the need for enhanced public health strategies within GP practices, ensuring continuous access to prenatal care and striving for improved outcomes of expectant mothers, their fetuses, and neonates during times of pandemics and in routine health care settings. %R 10.2196/64831 %U https://pediatrics.jmir.org/2025/1/e64831 %U https://doi.org/10.2196/64831 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66645 %T COVID-19 Vaccine Uptake, Sources of Information and Side Effects Reported by Pregnant Women in Western Australia: Cross-Sectional Cohort Survey %A Catalano,Nicole %A Mehta,Shailender %K pregnancy %K COVID-19 vaccination %K COVID-19 %K uptake %K vaccine uptake %K side effects %K pregnant %K Australia %K public health %K maternity %D 2025 %7 23.6.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Pregnant women are a priority group for COVID-19 vaccination due to their vulnerability as a high-risk cohort. However, the currentCOVID-19 vaccine uptake rate for COVID-19 vaccination among pregnant women in Western Australia remains largely unknown. Objective: This study aimed to explore pregnant women’s vaccination uptake rates, information sources, and experiences regarding COVID-19 vaccination during pregnancy. We hypothesized that uptake of vaccination among pregnant women is higher than indicated in previous studies, given differences in disease burden and public health restrictions at the time when data was collected. Methods: A cross-sectional survey was administered electronically to maternity patients at a single tertiary metropolitan hospital in Perth, Western Australia. Results: A total of 520 women participated in the study. Overall, the antenatal COVID-19 vaccination rate was 79% (n=398). Approximately, 51% (n=256) of the women felt well-informed about the vaccine, and information was sourced primarily from their general practitioner (n=301, 60%), midwives (n=174, 35%), and obstetric doctors (n=64, 13%). Compared to Caucasian women, those of non-Caucasian ethnicity (n=332, 66% vs n=170, 34%; P=.07) and those born outside Australia (n=235, 47%) reported lower rates of vaccine information provision by the hospital staff (n=22, 34% vs n=42, 66%; P=.04). Conclusions: The COVID-19 vaccine uptake among pregnant women was encouragingly high in our study, with favorable attitudes and acceptance for the vaccine observed in the majority of pregnant women. This self-reported study also identified opportunities for enhanced cultural competence and further education and training for hospital staff regarding COVID-19 vaccine information provision to ethnically diverse women. Further studies examining such interventions are warranted. %R 10.2196/66645 %U https://pediatrics.jmir.org/2025/1/e66645 %U https://doi.org/10.2196/66645 %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