TY - JOUR AU - Seiterö, Anna AU - Henriksson, Pontus AU - Thomas, Kristin AU - Henriksson, Hanna AU - Löf, Marie AU - Bendtsen, Marcus AU - Müssener, Ulrika PY - 2025/4/22 TI - Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial JO - J Med Internet Res SP - e69425 VL - 27 KW - mHealth KW - multiple behavior KW - high school students KW - digital behavior change intervention KW - public health KW - telemedicine KW - randomized controlled trial N2 - Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ?4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI ?0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 UR - https://www.jmir.org/2025/1/e69425 UR - http://dx.doi.org/10.2196/69425 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69425 ER - TY - JOUR AU - Sidhu, Amrita AU - Shegog, Ross AU - Craig-Rushing, Stephanie AU - Trevino, Nicole AU - Singer, Michelle AU - Jessen, Cornelia AU - Gorman, Gwenda AU - Simpson, Sean AU - Peskin, Melissa AU - Hernandez, Belinda AU - Markham, Christine PY - 2025/4/16 TI - Using the Healthy Native Youth Implementation Toolbox to Provide Web-Based Adolescent Health Promotion Decision Support to American Indian and Alaska Native Communities: Implementation Study JO - JMIR Form Res SP - e67885 VL - 9 KW - implementation KW - culturally relevant program KW - evidence-based health promotion KW - user engagement KW - reach KW - decision support system KW - American Indian KW - Alaska KW - native communities KW - youth KW - adolescent KW - decision support KW - Alaska native KW - health inequities KW - sexual KW - reproductive KW - mental health KW - AI/AN KW - Tribal organization KW - Google Analytics KW - toolbox N2 - Background: American Indian and Alaska Native (AI/AN) youth experience numerous health inequities, including those in sexual, reproductive, and mental health. Implementation of culturally relevant, age-appropriate evidence-based programs may mitigate these inequities. However, numerous barriers limit the adoption and implementation of evidence-based adolescent health promotion programs in AI/AN communities. Objective: This study examines user reach and engagement from 2022 to 2024 of web-based decision support (the Healthy Native Youth [HNY] website and the embedded HNY Implementation Toolbox), designed to increase the implementation of evidence-based adolescent health promotion programming in AI/AN communities. Methods: Promotional strategies were designed for optimal geographic reach to Tribal organizations, opinion leaders, federal decision makers, and funders. Promotional channels included grassroots, community, and professional networks. We used Google Analytics to examine the uptake of the HNY website and HNY Implementation Toolbox from January 2022 to January 2024. The Toolbox provides culturally relevant tools and templates to help users navigate through 5 phases of program adoption and implementation: Gather, Choose, Prepare, Implement, and Grow. User reach was estimated by demographic characteristics and geographic location; user engagement was estimated by visit frequency and duration, bounce rates, and frequency of page and tool access. Results: Over the study period, page views of the HNY website and HNY Toolbox increased 10-fold and 27-fold, respectively. Over the 2-year evaluation period since the Toolbox ?go live? date, approximately 1 in 8 users of the HNY website visited the Toolbox. The majority of HNY website users were located in Washington (n=1515), California (n=1290), and Oregon (n=1019) and were aged between 18 and 24 (n=1559, 21.7%) and 25?34 (n=1676, 23.29%) years. Toolbox users were primarily located in California (n=1238), Washington (n=1142), and Oregon (n=986), mostly aged between 35 and 44 years (n=444, 35%). Both website and Toolbox users were primarily female, who accessed the site and Toolbox via desktop computers. The most frequently accessed phase pages within the Implementation Toolbox were Gather, Choose, Implement, and Prepare, as supported by bounce rates and average time on page. The most viewed phase was the ?Gather? phase, with 3278 views. The most frequently downloaded tools within the Toolbox were Gather: Community Needs and Resource Assessment, with 136 downloads. The phases and tools accessed may have differed based on the user?s goal or stage of implementation. Conclusions: Findings indicate positive initial reach and engagement of the HNY website and HNY Implementation Toolbox among AI/AN educators that has consistently increased over the 2 years. The provision of web-based decision support that guides AI/AN users through the adoption, implementation, and maintenance of culturally relevant, age-appropriate, evidence-based adolescent health promotion programs in their communities may help increase the implementation of effective adolescent health promotion programs to ultimately increase health equity among AI/AN youth. UR - https://formative.jmir.org/2025/1/e67885 UR - http://dx.doi.org/10.2196/67885 ID - info:doi/10.2196/67885 ER - TY - JOUR AU - Toh, Hui Siao AU - Davis, Courtney AU - Bte Khaider, Khairunisa AU - Ong, Quan Zhi AU - Lim, Kai Ethel Jie AU - Chew, Elaine Chu Shan PY - 2025/3/5 TI - Codevelopment of an mHealth App With Health Care Providers, Digital Health Experts, Community Partners, and Families for Childhood Obesity Management: Protocol for a Co-Design Process JO - JMIR Res Protoc SP - e59238 VL - 14 KW - childhood obesity KW - mHealth KW - mobile health KW - co-design KW - IDEAS framework N2 - Background: Childhood obesity is increasing in Singapore, with most cases persisting into adulthood and leading to poor health outcomes. The current evidence for childhood obesity interventions shows a clear dose-response effect, where effectiveness improves with an increasing number of treatment hours. A minimum threshold of ?26 hours over a 2- to 12-month period is required to achieve significant outcomes. The Kick Start Move Smart program is the first online community-based multidisciplinary program to treat pediatric obesity in Singapore. It has demonstrated feasibility and acceptability, with 70% of participants completing the recommended ?26 hours of intervention. Preliminary data show significantly lower BMI and improved quality of life in participants compared to controls. Successful families are positive outliers who developed strategies for health in the context of an obesogenic environment. This positive outlier approach indicates that solutions to challenges that a community faces exist within certain individual members, and these strategies can be generalized and promoted to improve the health of others in the same community. A mobile health (mHealth) app targeting parents is a critical missing link in the currently available interventions to support parental self-management of childhood obesity. Using a combination of behavioral theory and user-centered design approaches is important for designing mHealth apps. One recommended framework is Integrate, Design, Assess, and Share (IDEAS), which aims to facilitate the development of more effective interventions by engaging perspectives from different stakeholders. Objective: This study aims to (1) describe the co-design protocol of an mHealth app using the IDEAS framework as a low-intensity intervention or as an adjunct to more intensive existing pediatric obesity interventions and (2) assess the usability, acceptability, and engagement of the app by parents. Methods: A clinician-led co-design approach will be undertaken with a multidisciplinary team using the IDEAS framework. Phase 1 involves stakeholder engagement and the formation of a core committee and a parent advisory board. Phase 2 involves developing the app content through focus group and expert panel discussions. Phase 3 involves developing a prototype app and gathering feedback. Phase 4 involves piloting the minimum viable product by parent users and evaluating its effectiveness through interviews and questionnaires. Results: In April 2023, a parent advisory board was formed, and stakeholders were engaged as part of phase 1. Phases 2 and 3 were completed in June 2024. Focus group discussions were held with the parent advisory board and stakeholders to identify family strategies and patient-centric outcomes and provide feedback on the app. As of January 2025, the app is complete, and we are now in the middle of data collection from participants. Participants will provide feedback to the research team, and the app will be updated accordingly. Conclusions: An evidence-based, theory-driven mHealth app developed using a structured design framework can bridge the gap in delivering multidisciplinary care in community settings for families with overweight children. International Registered Report Identifier (IRRID): DERR1-10.2196/59238 UR - https://www.researchprotocols.org/2025/1/e59238 UR - http://dx.doi.org/10.2196/59238 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053786 ID - info:doi/10.2196/59238 ER - TY - JOUR AU - Yang, Alina PY - 2025/2/20 TI - Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders JO - J Med Internet Res SP - e70020 VL - 27 KW - adolescent health KW - digital health literacy KW - adolescents KW - online health information KW - co-design KW - health education KW - eHealth literacy KW - social media UR - https://www.jmir.org/2025/1/e70020 UR - http://dx.doi.org/10.2196/70020 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70020 ER - TY - JOUR AU - Zuair, Areeg AU - Alhowaymel, M. Fahad AU - Jalloun, A. Rola AU - Alzahrani, S. Naif AU - Almasoud, H. Khalid AU - Alharbi, H. Majdi AU - Alnawwar, K. Rayan AU - Alluhaibi, N. Mohammed AU - Alharbi, S. Rawan AU - Aljohan, M. Fatima AU - Alhumaidi, N. Bandar AU - Alahmadi, A. Mohammad PY - 2025/1/24 TI - Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non?Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study JO - JMIR Pediatr Parent SP - e67213 VL - 8 KW - adolescent obesity KW - macronutrient education KW - cardiovascular fitness KW - body composition KW - health literacy KW - body image KW - macronutrient KW - educational KW - obesity KW - weight KW - overweight KW - fitness KW - nutrition KW - diet KW - patient education KW - student KW - school KW - youth KW - adolescent KW - teenager KW - metabolic KW - eating KW - physical activity KW - exercise N2 - Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non?weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non?weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and ?² tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9% (36/95), while 50.5% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial ?²=0.268). There was no significant change in students? body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non?weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. UR - https://pediatrics.jmir.org/2025/1/e67213 UR - http://dx.doi.org/10.2196/67213 ID - info:doi/10.2196/67213 ER - TY - JOUR AU - Leung, May May AU - Mateo, F. Katrina AU - Dublin, Marlo AU - Harrison, Laura AU - Verdaguer, Sandra AU - Wyka, Katarzyna PY - 2025/1/15 TI - Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial JO - JMIR Form Res SP - e58460 VL - 9 KW - childhood obesity KW - preadolescents KW - racial and ethnic minority populations KW - dietary behaviors KW - BMI KW - digital health N2 - Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of 50%) reporting that they used a smartphone to access their designated app either ?once a fortnight? or ?once/twice in total.? Improved sun health knowledge?particularly about the UV Index?was observed in participants who were given access to Sun Safe compared with those who used the placebo (?6.2 [percentage correct] difference in predicted means, 95% CI ?12.4 to ?0.03; P=.049; 2-way ANOVA). Unexpectedly, there were significantly more sunburn events in the Sun Safe group (relative risk 1.7, 95% CI 1.1-1.8; P=.02; Fisher exact test), although no differences in time spent outdoors or sun-protective behaviors were reported. COVID-19 pandemic?related community-wide shutdowns during April 2020 (when schools were closed) reduced the time spent outdoors by >100 minutes per day (?105 minutes per day difference in predicted means, 95% CI ?150 to ?59 minutes per day; P=.002; paired 2-tailed Student t test). Sun Safe was well-rated by participants, particularly for information (mean 4.2, SD 0.6 out of 5). Conclusions: Access to the Sun Safe app increased sun health knowledge among young teenagers in these pilot intervention studies. Further investigations with larger sample sizes are required to confirm these observations and further test the effects of Sun Safe on sun-protective behaviors. UR - https://derma.jmir.org/2022/1/e35137 UR - http://dx.doi.org/10.2196/35137 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632872 ID - info:doi/10.2196/35137 ER - TY - JOUR AU - Kouvari, Matina AU - Karipidou, Melina AU - Tsiampalis, Thomas AU - Mamalaki, Eirini AU - Poulimeneas, Dimitrios AU - Bathrellou, Eirini AU - Panagiotakos, Demosthenes AU - Yannakoulia, Mary PY - 2022/2/14 TI - Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e30675 VL - 24 IS - 2 KW - childhood obesity KW - eHealth KW - mHealth KW - digital health KW - youth KW - mobile phone N2 - Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference ?0.61, 95% CI ?1.10 to ?0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference ?0.36, 95% CI ?0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. UR - https://www.jmir.org/2022/2/e30675 UR - http://dx.doi.org/10.2196/30675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156934 ID - info:doi/10.2196/30675 ER - TY - JOUR AU - Ilskens, Karina AU - Wrona, J. Kamil AU - Dockweiler, Christoph AU - Fischer, Florian PY - 2022/2/2 TI - An Evidence Map on Serious Games in Preventing Sexually Transmitted Infections Among Adolescents: Systematic Review About Outcome Categories Investigated in Primary Studies JO - JMIR Serious Games SP - e30526 VL - 10 IS - 1 KW - serious games KW - entertainment education KW - STI KW - STD KW - sexual health KW - effect KW - impact KW - sexually transmitted infections KW - adolescents KW - adolescent sexual health N2 - Background: Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective: The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods: A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results: Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions: This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents? sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior. UR - https://games.jmir.org/2022/1/e30526 UR - http://dx.doi.org/10.2196/30526 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107438 ID - info:doi/10.2196/30526 ER - TY - JOUR AU - Abraham, Olufunmilola AU - Szela, Lisa AU - Khan, Mahnoor AU - Geddam, Amrita PY - 2022/1/24 TI - Exploring Middle School Students? Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study JO - JMIR Serious Games SP - e31172 VL - 10 IS - 1 KW - adolescents KW - adolescent education KW - adolescent health KW - older children KW - middle school students KW - cancer awareness KW - cancer education KW - cancer prevention KW - health education KW - serious games N2 - Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students? preferences for the use of SGs for cancer prevention education. The study also characterized the students? perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on ?Cancer, Clear & Simple,? a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants? gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least ?some? gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters? outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. UR - https://games.jmir.org/2022/1/e31172 UR - http://dx.doi.org/10.2196/31172 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643533 ID - info:doi/10.2196/31172 ER - TY - JOUR AU - Decker, J. Martha AU - Harrison, Salish AU - Price, Melisa AU - Gutmann-Gonzalez, Abigail AU - Yarger, Jennifer AU - Tenney, Rachel PY - 2022/1/12 TI - Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study JO - JMIR Hum Factors SP - e31381 VL - 9 IS - 1 KW - adolescent KW - sex education KW - technology KW - mobile app KW - implementation KW - California KW - health educator N2 - Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths? sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators? experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators? experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators? familiarity with the app increased and functionality improved. Technology issues were also more common in non?school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents? use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 UR - https://humanfactors.jmir.org/2022/1/e31381 UR - http://dx.doi.org/10.2196/31381 UR - http://www.ncbi.nlm.nih.gov/pubmed/35019842 ID - info:doi/10.2196/31381 ER - TY - JOUR AU - Barnes, Courtney AU - Yoong, Lin Sze AU - Nathan, Nicole AU - Wolfenden, Luke AU - Wedesweiler, Taya AU - Kerr, Jayde AU - Ward, S. Dianne AU - Grady, Alice PY - 2021/12/15 TI - Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e25902 VL - 23 IS - 12 KW - childcare center KW - web-based KW - nutrition KW - healthy eating KW - randomized controlled trial KW - intervention KW - implementation N2 - Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children?s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w UR - https://www.jmir.org/2021/12/e25902 UR - http://dx.doi.org/10.2196/25902 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914617 ID - info:doi/10.2196/25902 ER - TY - JOUR AU - Beerthuizen, Thijs AU - Rikkers-Mutsaerts, M. E. R. V. AU - Snoeck-Stroband, B. Jiska AU - Sont, K. Jacob PY - 2021/12/7 TI - The Role of Education, Monitoring, and Symptom Perception in Internet-Based Self-management Among Adolescents With Asthma: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e17959 VL - 4 IS - 4 KW - web-based monitoring KW - internet self-management KW - adolescents KW - asthma KW - education KW - perception N2 - Background: Internet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider. Objective: We aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs. Methods: We conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention. Results: Adolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: ?0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: ?0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: ?0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers. Conclusions: Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life. UR - https://pediatrics.jmir.org/2021/4/e17959 UR - http://dx.doi.org/10.2196/17959 UR - http://www.ncbi.nlm.nih.gov/pubmed/34879001 ID - info:doi/10.2196/17959 ER - TY - JOUR AU - Park, Jihyun AU - Park, Mi-Jeong AU - Seo, Young-Gyun PY - 2021/11/17 TI - Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e29003 VL - 23 IS - 11 KW - ICT KW - eHealth KW - mHealth KW - weight loss KW - obesity KW - BMI KW - meta-analysis KW - randomized controlled trial KW - children KW - adolescents KW - mobile phone N2 - Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=?1.26 kg/m2, 95% CI ?2.24 to ?0.28), lifestyle modification comparator (WMD=?1.75, 95% CI ?2.76 to ?0.74), intervention involving both boys and girls (WMD=?1.30, 95% CI ?2.14 to ?0.46), and intervention involving obesity only (WMD=?1.92, 95% CI ?3.75 to ?0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. UR - https://www.jmir.org/2021/11/e29003 UR - http://dx.doi.org/10.2196/29003 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787572 ID - info:doi/10.2196/29003 ER - TY - JOUR AU - Van de Kop, Huib AU - Toussaint, Huub AU - Janssen, Mirka AU - Busch, Vincent AU - Verhoeff, Arnoud PY - 2021/7/28 TI - Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e28273 VL - 10 IS - 7 KW - physical activity KW - participatory KW - adolescents KW - protocol KW - assets KW - school-based KW - students KW - participation KW - school-age children KW - teenagers KW - exercise N2 - Background: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. Objective: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. Methods: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students? assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. Results: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10× 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). Conclusions: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. Trial Registration: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636 International Registered Report Identifier (IRRID): DERR1-10.2196/28273 UR - https://www.researchprotocols.org/2021/7/e28273 UR - http://dx.doi.org/10.2196/28273 UR - http://www.ncbi.nlm.nih.gov/pubmed/34121666 ID - info:doi/10.2196/28273 ER -