TY - JOUR AU - Leitner, Kirstin AU - Cutri-French, Clare AU - Mandel, Abigail AU - Christ, Lori AU - Koelper, Nathaneal AU - McCabe, Meaghan AU - Seltzer, Emily AU - Scalise, Laura AU - Colbert, A. James AU - Dokras, Anuja AU - Rosin, Roy AU - Levine, Lisa PY - 2025/4/22 TI - A Conversational Agent Using Natural Language Processing for Postpartum Care for New Mothers: Development and Engagement Analysis JO - JMIR AI SP - e58454 VL - 4 KW - conversational agent KW - postpartum care KW - text messaging KW - postpartum KW - natural language processing KW - pregnancy KW - parents KW - newborns KW - development KW - patient engagement KW - physical recovery KW - infant KW - infant care KW - survey KW - breastfeeding KW - support KW - patient support KW - patient satisfaction N2 - Background: The ?fourth trimester,? or postpartum time period, remains a critical phase of pregnancy that significantly impacts parents and newborns. Care poses challenges due to complex individual needs as well as low attendance rates at routine appointments. A comprehensive technological solution could provide a holistic and equitable solution to meet care goals. Objective: This paper describes the development of patient engagement data with a novel postpartum conversational agent that uses natural language processing to support patients post partum. Methods: We report on the development of a postpartum conversational agent from concept to usable product as well as the patient engagement with this technology. Content for the program was developed using patient- and provider-based input and clinical algorithms. Our program offered 2-way communication to patients and details on physical recovery, lactation support, infant care, and warning signs for problems. This was iterated upon by our core clinical team and an external expert clinical panel before being tested on patients. Patients eligible for discharge around 24 hours after delivery who had delivered a singleton full-term infant vaginally were offered use of the program. Patient demographics, accuracy, and patient engagement were collected over the first 6 months of use. Results: A total of 290 patients used our conversational agent over the first 6 months, of which 112 (38.6%) were first time parents and 162 (56%) were Black. In total, 286 (98.6%) patients interacted with the platform at least once, 271 patients (93.4%) completed at least one survey, and 151 (52%) patients asked a question. First time parents and those breastfeeding their infants had higher rates of engagement overall. Black patients were more likely to promote the program than White patients (P=.047). The overall accuracy of the conversational agent during the first 6 months was 77%. Conclusions: It is possible to develop a comprehensive, automated postpartum conversational agent. The use of such a technology to support patients postdischarge appears to be acceptable with very high engagement and patient satisfaction. UR - https://ai.jmir.org/2025/1/e58454 UR - http://dx.doi.org/10.2196/58454 ID - info:doi/10.2196/58454 ER - TY - JOUR AU - Dol, Justine AU - Campbell-Yeo, Marsha AU - Aston, Megan AU - McMillan, Douglas AU - Grant, K. Amy PY - 2025/4/2 TI - 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 JO - JMIR Pediatr Parent SP - e62841 VL - 8 KW - mHealth KW - mobile health KW - SMS text message KW - text messages KW - messaging KW - self-efficacy KW - postpartum depression KW - postpartum anxiety KW - social support KW - intervention KW - postpartum KW - postnatal KW - mental health KW - parenting KW - mother KW - depression KW - anxiety KW - RCT KW - randomized controlled trial N2 - 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 UR - https://pediatrics.jmir.org/2025/1/e62841 UR - http://dx.doi.org/10.2196/62841 ID - info:doi/10.2196/62841 ER - TY - JOUR AU - Mishina, Kaisa AU - Baumel, Amit AU - Kinnunen, Malin AU - Ristkari, Terja AU - Heinonen, Emmi AU - Hinkka-Yli-Salomäki, Susanna AU - Sourander, Andre PY - 2025/3/13 TI - BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study JO - J Med Internet Res SP - e65391 VL - 27 KW - parent training KW - universal intervention KW - online intervention KW - irritability KW - conduct problems KW - hyperactivity KW - preschool KW - mental health KW - strongest families KW - positive parenting KW - parenting skills KW - parent-child relationships KW - parent satisfaction KW - BePresent KW - feasibility study KW - single-arm pre-post intervention study N2 - Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child?s behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child?s 3-year health check-up were recruited from children?s health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%?84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents? ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P?.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. UR - https://www.jmir.org/2025/1/e65391 UR - http://dx.doi.org/10.2196/65391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65391 ER - TY - JOUR AU - Gaynor, Mathew AU - Hesketh, Kylie AU - Gebremariam, Kidane AU - Wynter, Karen AU - Laws, Rachel PY - 2025/2/21 TI - Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study JO - JMIR Pediatr Parent SP - e64171 VL - 8 KW - fathers KW - parenting resources KW - health promotion KW - My Baby Now KW - MBN KW - app KW - mobile phone N2 - 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. UR - https://pediatrics.jmir.org/2025/1/e64171 UR - http://dx.doi.org/10.2196/64171 UR - http://www.ncbi.nlm.nih.gov/pubmed/39982774 ID - info:doi/10.2196/64171 ER - TY - JOUR AU - Tamannur, Tahazid AU - Das, Kumar Sadhan AU - Nesa, Arifatun AU - Nahar, Foijun AU - Nowshin, Nadia AU - Binty, Haque Tasnim AU - Shakil, Azam Shafiul AU - Kundu, Kumar Shuvojit AU - Siddik, Bakkar Md Abu AU - Rafsun, Mahmud Shafkat AU - Habiba, Umme AU - Farhana, Zaki AU - Sultana, Hafiza AU - Kamil, Abdulbasah Anton AU - Rahman, Meshbahur Mohammad PY - 2025/2/3 TI - Mothers? Knowledge of and Practices Toward Oral Hygiene of Children Aged 5-9 Years in Bangladesh: Cross-Sectional Study JO - JMIRx Med SP - e59379 VL - 6 KW - mothers? knowledge and practices KW - oral hygiene KW - child oral health KW - Bangladesh N2 - Background: Healthy oral hygiene is crucial for overall health and well-being. Parents? dental care knowledge and practices affect their children?s oral health. Objective: This study examined mothers? knowledge and practices regarding their children?s oral hygiene through a cross-sectional survey. Methods: This cross-sectional survey was conducted from January 1 to December 31, 2022, in Dhaka, Bangladesh. Mothers? knowledge and practices regarding their children?s oral hygiene were assessed through a semistructured questionnaire. Statistical analyses, including the ?2 test and Pearson correlation test, were performed. The Mann-Whitney U and Kruskal-Wallis 1-way ANOVA tests were also used to show the average variations in knowledge and practices among different sociodemographic groups. Results: Of 400 participants, the mean age of mothers was 30.94 (SD 5.15) years, and 388 (97%) were of the Muslim faith, 347 (86.8%) were housewives, and 272 (68%) came from nuclear families. A total of 165 (41.3%) participants showed good knowledge of their children?s oral hygiene, followed by 86 (21.5%) showing moderately average knowledge, 75 (18.8%) showing average knowledge, and 74 (18.5%) showing poor knowledge. A total of 182 (45.5%) mothers had children with good oral hygiene practices, followed by mothers with children who had average (n=78, 19.5%), moderately average (n=75, 18.8%), and poor (n=65, 16.3%) oral hygiene practices. The mother?s knowledge level was significantly associated with age (P=.01), education (P<.001), family size (P=.03), and monthly income (P<.001). On the other hand, educational status (P=.002) and income (P=.04) were significantly associated with the mother?s practices regarding their children?s oral hygiene. Nonparametric analysis revealed that mothers who were older (mean knowledge score: 12.13, 95% CI 10.73-13.54 vs 11.21, 95% CI 10.85-11.58; P=.01), with a bachelor?s degree or higher (mean knowledge score: 12.93, 95% CI 12.55?13.31 vs 9.66, 95% CI 8.95?10.37; P<.001), who were working mothers (mean knowledge score: 12.30, 95% CI 11.72?12.89 vs 11.45, 95% CI 11.17?11.73; P=.03), and who had a higher family income (mean knowledge score: 12.49, 95% CI 12.0?12.98 vs 10.92, 95% CI 10.48?11.36; P<.001) demonstrated significantly higher levels of oral health knowledge. Conversely, good oral hygiene practices were significantly associated with higher maternal education (mean practice score: 6.88, 95% CI 6.54?7.22 vs 6.01, 95% CI 5.63?6.40; P<.001) and family income (mean practice score: 6.77, 95% CI 6.40?7.14 vs 5.96, 95% CI 5.68?6.24; P=.002). The mother?s knowledge was also significantly and positively correlated (Pearson correlation coefficient r=0.301; P<.001) with their children?s oral hygiene practices, shown by both the Pearson chi-square (?2=25.2; P<.001) test and correlation coefficient. Conclusions: The mothers? knowledge and their children?s oral hygiene practices were inadequate. The mother?s age, education level, family size, and monthly income significantly influenced their knowledge level. Children?s oral hygiene habits were significantly associated with family income and the mother?s educational status. This underscores the need for educational programs, accessible dental care services, oral health education in the curriculum, media and technology involvement in oral health educational campaigns, and proper research and monitoring. UR - https://xmed.jmir.org/2025/1/e59379 UR - http://dx.doi.org/10.2196/59379 ID - info:doi/10.2196/59379 ER - TY - JOUR AU - Kakon, Hafiz Shahria AU - Soron, Rashid Tanjir AU - Hossain, Sharif Mohammad AU - Haque, Rashidul AU - Tofail, Fahmida PY - 2025/1/14 TI - Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e62943 VL - 8 KW - screen time KW - parental supervision KW - Strength and Difficulties Questionnaire KW - Spencer Children Anxiety Scale KW - Pittsburgh Sleep Quality Scale KW - children KW - sleep quality KW - headache KW - behavioral problems N2 - Background: Children?s screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6?14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1% versus 161/336 students, 47.9%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3%) and peer difficulties (121/420 students, 28.8%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools. UR - https://pediatrics.jmir.org/2025/1/e62943 UR - http://dx.doi.org/10.2196/62943 ID - info:doi/10.2196/62943 ER - TY - JOUR AU - Onishi, Ryuta PY - 2024/12/19 TI - Parental Information-Use Strategies in a Digital Parenting Environment and Their Associations With Parental Social Support and Self-Efficacy: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e58757 VL - 7 KW - parenting KW - information use KW - digital society KW - online information KW - social support KW - self-efficacy KW - parents KW - surveys KW - information seeking KW - information behaviors KW - resources KW - children KW - youth KW - pediatric N2 - Background: In today?s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNSs) has become widespread. Amid the mix of online and offline information sources, there is a need to discover effective information-seeking methods for solving parenting problems. Objective: This study aimed to identify patterns of information use among parents of young children in the digital age and elucidate the characteristics of these patterns through a comparative analysis of parental social support and self-efficacy. Methods: An internet-based survey was administered to fathers and mothers of children aged 0-3 years. Convenience sampling, facilitated by an internet-based survey company, was adopted, and data from 227 fathers and 206 mothers were analyzed. The survey included questions on personal characteristics, frequency of use of different sources of parenting information (websites, SNSs, parenting apps, family, friends, and professionals), availability of parental social support, and parental self-efficacy. The Partitioning Around Medoids (PAM) clustering algorithm was used to identify patterns in parenting information use. Results: A total of 4 clusters were identified: multisource gatherers (n=161), offline-centric gatherers (n=105), online-centric gatherers (n=86), and minimal information gatherers (n=68). The availability of parental social support was perceived to be relatively higher among multisource and offline-centric gatherers compared with online-centric and minimal information gatherers. Parental self-efficacy was highest among multisource gatherers, followed by offline-centric and online-centric gatherers, and lowest among minimal information gatherers. Conclusions: This study contributes to the evidence that online information can effectively complement offline information in addressing parenting challenges, although its ability to fully replace offline sources remains limited. Parenting support professionals are encouraged to understand parents? current information use strategies and actively foster their social relationships, helping them to adopt more diverse and comprehensive approaches to information use. UR - https://pediatrics.jmir.org/2024/1/e58757 UR - http://dx.doi.org/10.2196/58757 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58757 ER - TY - JOUR AU - Erika, Ayu Kadek AU - Fadilah, Nur AU - Latif, Insani Aulia AU - Hasbiah, Nurhikmawaty AU - Juliaty, Aidah AU - Achmad, Harun AU - Bustamin, Anugrayani PY - 2024/12/17 TI - Stunting Super App as an Effort Toward Stunting Management in Indonesia: Delphi and Pilot Study JO - JMIR Hum Factors SP - e54862 VL - 11 KW - stunting KW - stunting prevention KW - mobile app N2 - Background: Currently, 30 million children are experiencing acute malnutrition, and 8 million children are severely underweight. Objective: This study aimed to develop a stunting super app, a one-stop app designed to prevent and manage stunting in Indonesia. Methods: This study consisted of three stages. Stage 1 used a 3-round Delphi study involving 12 experts. In stage 2, 4 experts and a parent of children with stunted growth created an Android app containing stunting educational materials. In stage 3, a pilot study involving a control group was conducted to evaluate parents? knowledge about stunting prevention through the app and standard interventions. Results: In the Delphi study, 11 consensus statements were extracted; arranged in three major themes, including maternal health education, child health education, and environmental education; and applied in the form of the Sistem Evaluasi Kesehatan Anak Tumbuh Ideal (SEHATI) app. This app was assessed using a content validity index, with a cumulative agreement of ?80% among the 5 individuals. The pilot study showed an increase in the knowledge of mothers of toddlers with stunted growth before and after the educational intervention (P=.001). Conclusions: The SEHATI app provides educational content on stunting prevention that can increase the knowledge of mothers of toddlers with stunted growth. UR - https://humanfactors.jmir.org/2024/1/e54862 UR - http://dx.doi.org/10.2196/54862 ID - info:doi/10.2196/54862 ER - TY - JOUR AU - Zhou, Peng AU - Song, Huiqi AU - Lau, C. Patrick W. AU - Shi, Lei AU - Wang, Jingjing PY - 2024/9/12 TI - Effectiveness of a Parent-Based eHealth Intervention for Physical Activity, Dietary Behavior, and Sleep Among Preschoolers: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e58344 VL - 13 KW - physical activity KW - dietary behavior KW - sleep KW - electronic health KW - eHealth KW - preschoolers KW - parenting N2 - Background: Preschoolers? lifestyles have become physically inactive and sedentary, their eating habits have become unhealthy, and their sleep routines have become increasingly disturbed. Parent-based interventions have shown promise to improve physical activity (PA), improve dietary behavior (DB), and reduce sleep problems among preschoolers. However, because of the recognized obstacles of face-to-face approaches (eg, travel costs and time commitment), easy access and lower costs make eHealth interventions appealing. Previous studies that examined the effectiveness of parent-based eHealth for preschoolers? PA, DB, and sleep have either emphasized 1 variable or failed to balance PA, DB, and sleep modules and consider the intervention sequence during the intervention period. There is an acknowledged gap in parent-based eHealth interventions that target preschoolers raised in Chinese cultural contexts. Objective: This study aims to investigate the effectiveness of a parent-based eHealth intervention for PA, DB, and sleep problems among Chinese preschoolers. Methods: This 2-arm, parallel, randomized controlled trial comprises a 12-week intervention with a 12-week follow-up. A total of 206 parent-child dyads will be randomized to either an eHealth intervention group or a control group. Participants allocated to the eHealth intervention group will receive 12 interactive modules on PA, DB, and sleep, with each module delivered on a weekly basis to reduce the sequence effect on variable outcomes. The intervention is grounded in social cognitive theory. It will be delivered through social media, where parents can obtain valid and updated educational information, have a social rapport, and interact with other group members and facilitators. Participants in the control group will receive weekly brochures on PA, DB, and sleep recommendations from kindergarten teachers, but they will not receive any interactive components. Data will be collected at baseline, 3 months, and 6 months. The primary outcome will be preschoolers? PA. The secondary outcomes will be preschoolers? DB, preschoolers? sleep duration, preschoolers? sleep problems, parents? PA, parenting style, and parental feeding style. Results: Parent-child dyads were recruited in September 2023. Baseline and posttest data collection occurred from October 2023 to March 2024. The follow-up data will be obtained in June 2024. The results of the study are expected to be published in 2025. Conclusions: The parent-based eHealth intervention has the potential to overcome the barriers of face-to-face interventions and will offer a novel approach for promoting a healthy lifestyle among preschoolers. If this intervention is found to be efficacious, the prevalence of unhealthy lifestyles among preschoolers may be alleviated at a low cost, which not only has a positive influence on the health of individuals and the well-being of the family but also reduces the financial pressure on society to treat diseases caused by poor lifestyle habits. Trial Registration: ClinicalTrials.gov NCT06025019; https://clinicaltrials.gov/study/NCT06025019 International Registered Report Identifier (IRRID): DERR1-10.2196/58344 UR - https://www.researchprotocols.org/2024/1/e58344 UR - http://dx.doi.org/10.2196/58344 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58344 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Solano, Luque Juan AU - Talbot, Charlotte AU - Giacco, Domenico PY - 2024/9/5 TI - Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience JO - JMIR Pediatr Parent SP - e53907 VL - 7 KW - digital microintervention KW - parenting app KW - product management KW - parent KW - parents KW - parenting KW - app KW - apps KW - usability KW - acceptability KW - family KW - families KW - interview KW - interviews KW - pediatric KW - pediatrics KW - child KW - children KW - youths KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - behavior KW - behaviors KW - disruptive behavior KW - thematic analysis N2 - Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents? values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family?s experience. Conclusions: Parents? use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. UR - https://pediatrics.jmir.org/2024/1/e53907 UR - http://dx.doi.org/10.2196/53907 ID - info:doi/10.2196/53907 ER - TY - JOUR AU - Piris-Borregas, Salvador AU - Bellón-Vaquerizo, Beatriz AU - Velasco-Echeburúa, Leticia AU - Niño-Díaz, Lidia AU - Sánchez-Aparicio, Susana AU - López-Maestro, María AU - Pallás-Alonso, Rosa Carmen PY - 2024/8/30 TI - Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study JO - JMIR Pediatr Parent SP - e55411 VL - 7 KW - family-centered care KW - neonatal intensive care unit KW - kangaroo mother care KW - mother KW - mothers KW - parent KW - parents KW - parental KW - ICU KW - intensive care KW - training KW - education KW - educational KW - premature KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - intensive care unit N2 - Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low?birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning ?Take Care of Me? in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5?20 vs 7, IQR 4?10.5 d; P<.001), feeding (median 53.5, IQR 34?68 vs 44.5, IQR 37?62 d; P=.049), and observation of neurobehavior (median 18, IQR 9?33 vs 11, IQR 7?16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7?23 vs 21, IQR 10?31 d; P=.02), diaper change (median 9.5, IQR 4?20 vs 14.5, IQR 9?32 d; P=.04), and infection prevention (median 1, IQR 1?2 vs 6, IQR 3?12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. UR - https://pediatrics.jmir.org/2024/1/e55411 UR - http://dx.doi.org/10.2196/55411 ID - info:doi/10.2196/55411 ER - TY - JOUR AU - Zhu, Shimin AU - Hu, Yuxi AU - Wang, Ruobing AU - Qi, Di AU - Lee, Paul AU - Ngai, Wa So AU - Cheng, Qijin AU - Wong, Ching Paul Wai PY - 2024/8/30 TI - Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial JO - JMIR Res Protoc SP - e63220 VL - 13 KW - implicit theory KW - fixed mindset KW - mental health KW - secondary school students KW - belief in change N2 - Background: Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children?s affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child?s internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Objective: Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children?s academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. Methods: A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Results: Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. Conclusions: This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/63220 UR - https://www.researchprotocols.org/2024/1/e63220 UR - http://dx.doi.org/10.2196/63220 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63220 ER - TY - JOUR AU - Li, Yun AU - Xiao, Qiuli AU - Chen, Min AU - Jiang, Chunhua AU - Kang, Shurong AU - Zhang, Ying AU - Huang, Jun AU - Yang, Yulin AU - Li, Mu AU - Jiang, Hong PY - 2024/7/4 TI - Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e54623 VL - 10 KW - health literacy KW - WeChat KW - cluster randomized controlled trial KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - parental KW - parenting KW - parents KW - parent KW - China KW - Chinese KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - toddler KW - toddlers N2 - Background: Parental health literacy is important to children?s health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)?based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children?s health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The ? coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention?s effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (?=2.51, 95% CI 0.12-4.91) and higher psychological scores (?=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children?s health outcomes. Furthermore, despite slight subgroup differences in the intervention?s effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model?based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740 UR - https://publichealth.jmir.org/2024/1/e54623 UR - http://dx.doi.org/10.2196/54623 ID - info:doi/10.2196/54623 ER - TY - JOUR AU - Pease, Anna AU - Ingram, Jenny AU - Lambert, Becky AU - Patrick, Karen AU - Pitts, Kieren AU - Fleming, J. Peter AU - Blair, S. Peter AU - PY - 2024/2/22 TI - A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner JO - JMIR Pediatr Parent SP - e49952 VL - 7 KW - safer sleep KW - parent education KW - co-design KW - process evaluation KW - sudden infant death syndrome KW - SIDS KW - sleep KW - baby KW - babies KW - infant KW - infants KW - prototype KW - interface KW - develop KW - development KW - sleeping KW - pattern KW - tool KW - parent KW - infant mortality KW - risk KW - risks KW - assessment KW - death KW - mortality KW - parents KW - parenting KW - risk assessment KW - sudden unexpected death in infancy KW - SUDI KW - approach KW - antenatal KW - postnatal KW - user testing KW - user experience KW - web-based KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives N2 - Background: Successful national safer sleep campaigns in the United Kingdom have lowered the death rates from sudden unexpected death in infancy (SUDI) over the past 3 decades, but deaths persist in socioeconomically deprived families. The circumstances of current deaths suggest that improvements in support for some families to follow safer sleep advice more consistently could save lives. Objective: This study aimed to develop and evaluate a risk assessment and planning tool designed to improve the uptake of safer sleep advice in families with infants at increased risk of SUDI. Methods: A co-design approach was used to develop the prototype interface of a web-based tool with 2 parts: an individual SUDI risk assessment at birth and a downloadable plan for safety during times of disruption. The advice contained within the tool is concordant with national guidance from the Lullaby Trust, the United Nations International Children?s Emergency Fund (UNICEF), and the National Institute for Health and Care Excellence. User testing of the prototype tool was conducted by inviting health visitors, midwives, and family nurses to use it with families eligible for additional support. Qualitative interviews with health professionals and families allowed for iterative changes to the tool and for insights into its function and influence on parental behavior. Results: A total of 22 health professionals were enrolled in the study, of whom 20 (91%) were interviewed. They reported appreciating the functionality of the tool, which allowed them to identify at-risk families for further support. They felt that the tool improved how they communicated about risks with families. They suggested expanding its use to include relevance in the antenatal period and having versions available in languages other than English. They reported using the tool with 58 families; 20 parents gave consent to be interviewed by the research team about their experiences with the tool. Families were positive about the tool, appreciated the trustworthy information, and felt that it was useful and appropriate and that the plans for specific infant sleeps would be of benefit to them and other family members. Conclusions: Our tool combines risk assessment and safety planning, both of which have the potential to improve the uptake of lifesaving advice. Refinements to the tool based on these findings have ensured that the tool is ready for further evaluation in a larger study before being rolled out to families with infants at increased risk. UR - https://pediatrics.jmir.org/2024/1/e49952 UR - http://dx.doi.org/10.2196/49952 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386377 ID - info:doi/10.2196/49952 ER - TY - JOUR AU - Li, Kexin AU - Magnuson, I. Katherine AU - Beuley, Grace AU - Davis, Logan AU - Ryan-Pettes, R. Stacy PY - 2023/6/1 TI - Features, Design, and Adherence to Evidence-Based Behavioral Parenting Principles in Commercial mHealth Parenting Apps: Systematic Review JO - JMIR Pediatr Parent SP - e43626 VL - 6 KW - mobile phone KW - parent KW - behavioral parent training KW - parent management training KW - mobile apps KW - mobile health KW - mHealth KW - child KW - adolescent N2 - Background: There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy for such concerns, they have limitations and challenges when disseminated in the community. Behavioral-based parenting techniques form an integral part of well-established, family-based interventions for adolescent behavioral problems and are ideal for dissemination through coupling with smartphone technology. Despite the vast number of ?parent? apps currently available in commercial markets, there is a dearth of reviews focused on evaluating mobile health apps through the lens of behavioral parenting training (BPT). Objective: This study aimed to conduct a systematic review of commercial mobile health apps for parents to increase effective parenting skills that include behavioral components. Methods: A search of the Google Play and Apple App Stores identified 57 apps that were included in the review and coded for availability, popularity, and infrastructure. In total, 89% (51/57) of them were sufficiently functional to be assessed for app design quality (engagement, functionality, esthetics, and information), and 53% (30/57) proceeded to the final evaluation of level of adherence to BPT principles. Results: In total, 57 apps met the initial inclusion criteria. Accessibility was high across these apps given that 44% (25/57) were available on both the Google Play and Apple App Stores and 68% (39/57) were free of charge. However, privacy concerns were addressed inconsistently among the apps. App design quality was average across the included apps, and apps with positive user star ratings or a high number of downloads received higher ratings on app design quality. In contrast, the identified apps largely fell short in providing BPT components adequately and with high interactivity, with low levels of adherence to BPT (mean 20.74%, SD 11%) across all commercial apps evaluated. Commercially popular apps did not show higher levels of adherence to BPT. Overall, a moderate relationship between app design quality and adherence to BPT was found. App features that have been found to increase user engagement, such as gamification and individualization, were only observed in a small minority of apps. Overall, there was a lack of focus on teenage development. Conclusions: Future app developers hoping to increase the dissemination of BPT should aim for free and accessible apps that balance high-quality design features (eg, simple esthetics, interactivity, and individualization) with content consistent with BPT principles. They should also consider key issues that are inconsistently addressed in current apps, including privacy and teenage development. Future app developments will likely benefit from multisector (industry and academic) collaboration throughout the design process and involving end users (ie, parents) during different stages of app development. UR - https://pediatrics.jmir.org/2023/1/e43626 UR - http://dx.doi.org/10.2196/43626 UR - http://www.ncbi.nlm.nih.gov/pubmed/37261886 ID - info:doi/10.2196/43626 ER - TY - JOUR AU - Champion, E. Katrina AU - Hunter, Emily AU - Gardner, A. Lauren AU - Thornton, K. Louise AU - Chapman, Cath AU - McCann, Karrah AU - Spring, Bonnie AU - Slade, Tim AU - Teesson, Maree AU - Newton, C. Nicola PY - 2023/4/4 TI - Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents JO - JMIR Pediatr Parent SP - e42272 VL - 6 KW - parents KW - adolescents KW - prevention KW - risk behaviors KW - intervention KW - mobile phone N2 - Background: Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective: This study aimed to assess parents? knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention. Methods: An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents? perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data. Results: A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4%), vegetable intake (7/126, 5.6%), and weekend recreational screen time (7/130, 5.4%) was very low. Overall, parents? perceived knowledge of health guidelines was moderate, ranging from 50.6% (80/158) for screen time to 72.8% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2% (46/104) and 42% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7% rated very or extremely important), and other important program features were ease of use (89/122, 72.9%), paced learning (79/126, 62.7%), and appropriate program length (74/126, 58.8%). Conclusions: The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents. UR - https://pediatrics.jmir.org/2023/1/e42272 UR - http://dx.doi.org/10.2196/42272 UR - http://www.ncbi.nlm.nih.gov/pubmed/37014696 ID - info:doi/10.2196/42272 ER - TY - JOUR AU - Bahorski, Jessica AU - Romano, Mollie AU - McDougal, May Julie AU - Kiratzis, Edie AU - Pocchio, Kinsey AU - Paek, Insu PY - 2023/2/28 TI - Development of an Individualized Responsive Feeding Intervention?Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study JO - JMIR Res Protoc SP - e44329 VL - 12 KW - responsive feeding KW - infant growth KW - infant nutrition N2 - Background: Responsive infant feeding occurs when a parent recognizes the infant?s cues of hunger or satiety and responds promptly to these cues. It is known to promote healthy dietary patterns and infant weight gain and is recommended as part of the Dietary Guidelines for Americans. However, the use of responsive infant feeding can be challenging for many parents. Research is needed to assist caregivers recognize infant hunger or satiety cues and overcoming barriers to using responsive infant feeding. Objective: The Learning Early Infant Feeding Cues (LEIFc) intervention was designed to fill this gap by using a validated coaching approach, SS-OO-PP-RR (?super,? Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review), to promote responsive infant feeding. Guided by the Obesity-Related Behavioral Intervention Trials model, this study aims to test the feasibility and fidelity of the LEIFc intervention in a group of mother-infant dyads. Methods: This pre-post quasi-experimental study with no control group will recruit mothers (N=30) in their third trimester (28 weeks and beyond) of pregnancy from community settings. Study visit 1 will occur prenatally in which written and video material on infant feeding and infant hunger and satiety cues is provided. Demographic information and plans for infant feeding are also collected prenatally via self-report surveys. The use of responsive infant feeding via subjective (survey) and objective (video) measures is recorded before (study visit 2, 1 month post partum) and after (study visit 5, 4 months post partum) intervention. Coaching on responsive infant feeding during a feeding session is provided by a trained interventionist using the SS-OO-PP-RR approach at study visits 3 (2 months post partum) and 4 (3 months post partum). Infant feeding practices are recorded via survey, and infant weight and length are measured at each postpartum study visit. Qualitative data on the LEIFc intervention are provided by the interventionist and mother. Infant feeding videos will be coded and tabulated for instances of infant cues and maternal responses. Subjective measures of responsive infant feeding will also be tabulated. The use of responsive infant feeding pre-post intervention will be analyzed using matched t tests. Qualitative data will be examined to guide intervention refinement. Results: This study initially began in spring 2020 but was halted because of the COVID-10 pandemic. With new funding, recruitment, enrollment, and data collection began in April 2022 and will continue until April 2023. Conclusions: After refinement, the LEIFc intervention will be tested in a pilot randomized controlled trial. The long-term goal is to implement LEIFc in the curricula of federally funded maternal-child home visiting programs that serve vulnerable populations?those that often have infant feeding practices that do not align with recommendations and are less likely to use responsive infant feeding. International Registered Report Identifier (IRRID): DERR1-10.2196/44329 UR - https://www.researchprotocols.org/2023/1/e44329 UR - http://dx.doi.org/10.2196/44329 UR - http://www.ncbi.nlm.nih.gov/pubmed/36853761 ID - info:doi/10.2196/44329 ER - TY - JOUR AU - Mirzadegan, A. Isaac AU - Blanton, C. Amelia AU - Meyer, Alexandria PY - 2022/9/30 TI - Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis JO - JMIR Pediatr Parent SP - e37449 VL - 5 IS - 3 KW - parental engagement KW - parenting intervention KW - parenting education KW - intent to enroll KW - measure development N2 - Background: Prevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement. Objective: We aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated. Methods: In a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria. Results: Three PRAM factors emerged (?Acceptability of Parenting Resources,? ?Interest in Learning Parenting Strategies,? and ?Acceptability of Parenting Websites?), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited. Conclusions: The findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement. UR - https://pediatrics.jmir.org/2022/3/e37449 UR - http://dx.doi.org/10.2196/37449 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178725 ID - info:doi/10.2196/37449 ER - TY - JOUR AU - Campbell, Alyson AU - Hartling, Lisa AU - Plourde, Vickie AU - Scott, D. Shannon PY - 2022/5/10 TI - Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study JO - JMIR Pediatr Parent SP - e36317 VL - 5 IS - 2 KW - concussion KW - mTBI KW - usability evaluation KW - knowledge assessment KW - knowledge translation KW - parent knowledge KW - parent confidence KW - patient engagement KW - educational tool N2 - Background: Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. Objective: The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. Methods: A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. Results: A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=?0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=?5.083; P<.001). Conclusions: Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents? knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents? confidence in managing their child?s concussion. UR - https://pediatrics.jmir.org/2022/2/e36317 UR - http://dx.doi.org/10.2196/36317 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536631 ID - info:doi/10.2196/36317 ER - TY - JOUR AU - Sourander, Andre AU - Ristkari, Terja AU - Kurki, Marjo AU - Gilbert, Sonja AU - Hinkka-Yli-Salomäki, Susanna AU - Kinnunen, Malin AU - Pulkki-Råback, Laura AU - McGrath, J. Patrick PY - 2022/4/4 TI - Effectiveness of an Internet-Based and Telephone-Assisted Training for Parents of 4-Year-Old Children With Disruptive Behavior: Implementation Research JO - J Med Internet Res SP - e27900 VL - 24 IS - 4 KW - parent training KW - early intervention KW - implementation KW - disruptive behavior KW - behavior problems KW - preschool children KW - internet-assisted KW - child mental health KW - mental health KW - behavior KW - intervention KW - children KW - parents N2 - Background: There is a lack of effectiveness studies when digital parent training programs are implemented in real-world practice. The efficacy of the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention on the disruptive behavior of 4-year-old children was studied in a randomized controlled trial setting in Southwest Finland between 2011 and 2013. After that, the intervention was implemented nationwide in child health clinics from 2015 onwards. Objective: The main aim of this study was to compare the treatment characteristics and effectiveness of the SFSW parent training intervention between the families who received the intervention when it was implemented as a normal practice in child health clinics and the families who received the same intervention during the randomized controlled trial. Methods: The implementation group comprised 600 families who were recruited in the SFSW intervention between January 2015 and May 2017 in real-world implementation. The RCT intervention group comprised 232 families who were recruited between October 2011 and November 2013. The same demographic and child and parent measures were collected from both study groups and were compared using linear mixed-effect models for repeated measurements. The child psychopathology and functioning level were measured using the Child Behavior Checklist (CBCL) version 1.5-5 for preschool children, the Inventory of Callous-Unemotional Traits (ICU), and a modified version of the Barkley Home Situations Questionnaire. Parenting skills were measured using the 31-item Parenting Scale and the shorter 21-item Depression, Anxiety and Stress Scale (DASS-21). The estimated child and parent outcomes were adjusted for CBCL externalizing scores at baseline, maternal education, duration of the behavior problems, and paternal age. The baseline measurements of each outcome were used as covariates. Results: The implementation group was more likely to complete the intervention than the RCT intervention group (514/600, 85.7% vs 176/232, 75.9%, respectively; P<.001). There were no significant differences between the implementation and RCT intervention groups with regard to child measures, including CBCL externalizing score (?0.2, 95% CI ?1.3 to 1.6; P=.83), total score (?0.7, 95% CI ?3.0 to 4.5; P=.70), internalizing score (?0.3, 95% CI ?1.0 to 1.6; P=.64), and ICU total score (?0.4, 95% Cl ?1.9 to 1.2; P=.64). No significant difference was detected in the Parenting Scale total score (0.0, 95% Cl ?0.1 to 0.1; P=.50), while DASS-21 total score differed nearly significantly (2.5, 95% Cl 0.0-5.1; P=.05), indicating better improvement in the implementation group. Conclusions: The internet-based and telephone-assisted SFSW parent training intervention was effectively implemented in real-world settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems. Our initiative could also provide a quick socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT01750996; https://clinicaltrials.gov/ct2/show/NCT01750996 International Registered Report Identifier (IRRID): RR2-10.1186/1471-2458-13-985 UR - https://www.jmir.org/2022/4/e27900 UR - http://dx.doi.org/10.2196/27900 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377332 ID - info:doi/10.2196/27900 ER - TY - JOUR AU - Mörelius, Evalotte AU - Robinson, Suzanne AU - Arabiat, Diana AU - Whitehead, Lisa PY - 2021/12/22 TI - Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review JO - J Med Internet Res SP - e31665 VL - 23 IS - 12 KW - child KW - child health services KW - digital technology KW - health literacy KW - infant KW - internet-based intervention KW - parents KW - patient compliance KW - pediatric hospitals N2 - Background: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child?s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents? engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results: Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents? health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386 UR - https://www.jmir.org/2021/12/e31665 UR - http://dx.doi.org/10.2196/31665 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941559 ID - info:doi/10.2196/31665 ER - TY - JOUR AU - Chu, Wai Joanna Ting AU - Wadham, Angela AU - Jiang, Yannan AU - Stasiak, Karolina AU - Shepherd, Matthew AU - Bullen, Christopher PY - 2021/12/20 TI - Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e17723 VL - 4 IS - 4 KW - parenting KW - mHealth KW - text messaging KW - recruitment N2 - Background: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. Objective: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. Methods: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. Results: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). Conclusions: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307 UR - https://pediatrics.jmir.org/2021/4/e17723 UR - http://dx.doi.org/10.2196/17723 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932007 ID - info:doi/10.2196/17723 ER - @Article{info:doi/10.2196/27551, author="O'Dell, M. Sean and Fisher, R. Heidi and Schlieder, Victoria and Klinger, Tracey and Kininger, L. Rachel and Cosottile, McKenna and Cummings, Stacey and DeHart, Kathy", title="Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2021", month="Oct", day="5", volume="4", number="4", pages="e27551", keywords="primary care", keywords="parenting", keywords="targeted prevention", keywords="behavioral intervention technology", keywords="behavioral health", abstract="Background: Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. Objective: The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. Methods: We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. Results: Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child's age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. Conclusions: These findings provide a rich understanding of the complexity involved in meeting parents' needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children. ", doi="10.2196/27551", url="https://pediatrics.jmir.org/2021/4/e27551", url="http://www.ncbi.nlm.nih.gov/pubmed/34609324" } TY - JOUR AU - Mackert, Michael AU - Mandell, Dorothy AU - Donovan, Erin AU - Walker, Lorraine AU - Henson-García, Mike AU - Bouchacourt, Lindsay PY - 2021/8/17 TI - Mobile Apps as Audience-Centered Health Communication Platforms JO - JMIR Mhealth Uhealth SP - e25425 VL - 9 IS - 8 KW - health communication KW - mHealth KW - mobile apps KW - mobile health KW - prenatal health KW - pregnancy KW - audience-centered UR - https://mhealth.jmir.org/2021/8/e25425 UR - http://dx.doi.org/10.2196/25425 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402797 ID - info:doi/10.2196/25425 ER - TY - JOUR AU - Yuwen, Weichao AU - Duran, Miriana AU - Tan, Minghui AU - Ward, M. Teresa AU - Cheng, Chieh Sunny AU - Ramirez, Magaly PY - 2021/6/22 TI - Self-Care Needs and Technology Preferences Among Parents in Marginalized Communities: Participatory Design Study JO - JMIR Pediatr Parent SP - e27542 VL - 4 IS - 2 KW - asthma KW - caregiving KW - self-care KW - parents KW - qualitative research KW - culturally appropriate technology KW - minority groups KW - marginalization N2 - Background: Ten million parents provide unpaid care to children living with chronic conditions, such as asthma, and a high percentage of these parents are in marginalized communities, including racial and ethnic minority and low-income families. There is an urgent need to develop technology-enabled tailored solutions to support the self-care needs of these parents. Objective: This study aimed to use a participatory design approach to describe and compare Latino and non-Latino parents? current self-care practices, needs, and technology preferences when caring for children with asthma in marginalized communities. Methods: The participatory design approach was used to actively engage intended users in the design process and empower them to identify needs and generate design ideas to meet those needs. Results: Thirteen stakeholders participated in three design sessions. We described Latino and non-Latino parents? similarities in self-care practices and cultural-specific preferences. When coming up with ideas of technologies for self-care, non-Latino parents focused on improving caregiving stress through journaling, daily affirmations, and tracking feelings, while Latino parents focused more on relaxation and entertainment. Conclusions: Considerations need to be taken beyond language differences when developing technology-enabled interventions for diverse populations. The community partnership approach strengthened the study?s inclusive design. UR - https://pediatrics.jmir.org/2021/2/e27542 UR - http://dx.doi.org/10.2196/27542 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156343 ID - info:doi/10.2196/27542 ER - TY - JOUR AU - Pavuluri, Haritha AU - Grant, Alicia AU - Hartman, Alexander AU - Fowler, Lauren AU - Hudson, Jennifer AU - Springhart, Patrick AU - Kennedy, Blair Ann PY - 2021/6/15 TI - Implementation of iPads to Increase Compliance With Delivery of New Parent Education in the Mother?Baby Unit: Retrospective Study JO - JMIR Pediatr Parent SP - e18830 VL - 4 IS - 2 KW - technology KW - handheld computers KW - workflow KW - education KW - newborn KW - head trauma N2 - Background: Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting. Objective: The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother?baby unit resulted in improved rates of parents? acceptance of the opportunity to view an educational video about AHT. Methods: We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother?baby unit. Results: Compliance increased overall (P<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (?=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance. Conclusions: Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother?baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother?baby unit. UR - https://pediatrics.jmir.org/2021/2/e18830 UR - http://dx.doi.org/10.2196/18830 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128809 ID - info:doi/10.2196/18830 ER - TY - JOUR AU - Hammons, J. Amber AU - Villegas, Elizabeth AU - Robart, Ryan PY - 2021/6/8 TI - ?It's Been Negative for Us Just All the Way Across the Board?: Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic JO - JMIR Pediatr Parent SP - e29411 VL - 4 IS - 2 KW - children KW - COVID-19 KW - experiences KW - family KW - outcomes KW - pandemic KW - parenting KW - parents KW - screen time N2 - Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families? experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children?s ST habits as the country attempts to establish a new normal. UR - https://pediatrics.jmir.org/2021/2/e29411 UR - http://dx.doi.org/10.2196/29411 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081606 ID - info:doi/10.2196/29411 ER - TY - JOUR AU - Manjong, Titu Florence AU - Verla, Siysi Vincent AU - Egbe, Obinchemti Thomas AU - Nsagha, Shey Dickson PY - 2021/5/20 TI - Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e23115 VL - 10 IS - 5 KW - nutrition education KW - caregivers KW - nutrition outcomes KW - indigenous children N2 - Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce. Objective: This study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers? knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon. Methods: A two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child?caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers? peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers? knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea. Results: Baseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child?caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript. Conclusions: The findings of this study will provide evidence on the impact of culturally tailored and health belief model?based nutrition education on behavior change as a complementary strategy for strengthening health facility?based approaches in the reduction of malnutrition burden among the study population International Registered Report Identifier (IRRID): DERR1-10.2196/23115 UR - https://www.researchprotocols.org/2021/5/e23115 UR - http://dx.doi.org/10.2196/23115 UR - http://www.ncbi.nlm.nih.gov/pubmed/34014173 ID - info:doi/10.2196/23115 ER - TY - JOUR AU - Buabbas, Ali AU - Hasan, Huda AU - Shehab, Abdulmohsen Abrar PY - 2021/5/20 TI - Parents? Attitudes Toward School Students? Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study JO - JMIR Pediatr Parent SP - e24196 VL - 4 IS - 2 KW - smartphones KW - overuse impact KW - school students KW - parents? attitudes N2 - Background: Parents? awareness of the risks of the overuse of smartphones (SPs) among their children and parents? attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue. Objective: This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it. Methods: The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait. Results: A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5%) than male (45/120, 37.5%) respondents. Almost all of the participants (118/120, 98.3%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children?s health (117/120, 97.5%). Although the participants, mostly the mothers, supervised their children?s use of SPs closely (106/120, 88.3%), the majority could not control their children?s length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children. Conclusions: Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested. UR - https://pediatrics.jmir.org/2021/2/e24196 UR - http://dx.doi.org/10.2196/24196 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878024 ID - info:doi/10.2196/24196 ER - TY - JOUR AU - Taylor, W. Rachael AU - Conlon, A. Cathryn AU - Beck, L. Kathryn AU - von Hurst, R. Pamela AU - Te Morenga, A. Lisa AU - Daniels, Lisa AU - Haszard, J. Jill AU - Meldrum, M. Alison AU - McLean, H. Neve AU - Cox, M. Alice AU - Tukuafu, Lesieli AU - Casale, Maria AU - Brown, J. Kimberley AU - Jones, A. Emily AU - Katiforis, Ioanna AU - Rowan, Madeleine AU - McArthur, Jenny AU - Fleming, A. Elizabeth AU - Wheeler, J. Ben AU - Houghton, A. Lisa AU - Diana, Aly AU - Heath, M. Anne-Louise PY - 2021/4/21 TI - Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study JO - JMIR Res Protoc SP - e29048 VL - 10 IS - 4 KW - infant KW - diet KW - complementary feeding KW - food pouch KW - baby-led weaning KW - iron KW - growth KW - eating behavior KW - feeding behavior KW - dental health KW - choking KW - breast milk N2 - Background: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food ?pouches? and ?baby-led weaning? (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. Objective: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. Methods: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide ?dose-to-mother? technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. Results: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. Conclusions: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. International Registered Report Identifier (IRRID): DERR1-10.2196/29048 UR - https://www.researchprotocols.org/2021/4/e29048 UR - http://dx.doi.org/10.2196/29048 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881411 ID - info:doi/10.2196/29048 ER - TY - JOUR AU - Morris, Sara AU - Geraghty, Sadie AU - Sundin, Deborah PY - 2021/2/23 TI - Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e23514 VL - 10 IS - 2 KW - breech presentation KW - midwifery KW - methodology KW - Delphi technique N2 - Background: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women?s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals? knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. International Registered Report Identifier (IRRID): DERR1-10.2196/23514 UR - https://www.researchprotocols.org/2021/2/e23514 UR - http://dx.doi.org/10.2196/23514 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620329 ID - info:doi/10.2196/23514 ER - TY - JOUR AU - Donelle, Lorie AU - Hall, Jodi AU - Hiebert, Bradley AU - Jackson, Kimberley AU - Stoyanovich, Ewelina AU - LaChance, Jessica AU - Facca, Danica PY - 2021/2/17 TI - Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study JO - JMIR Pediatr Parent SP - e25388 VL - 4 IS - 1 KW - parenting KW - digital health KW - technology KW - health literacy KW - information seeking N2 - Background: The transition to parenting?that is, the journey from preconception through pregnancy and postpartum periods?is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents? experiences with and uses of digital technology during 4 stages?prenatal, pregnancy, labor, and postpartum?of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents? type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: ?Is this normal; is this happening to you?!?, ?Am I having a heart attack; what is this??, and ?Anyone can put anything on Wikipedia?: Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers? perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents. UR - https://pediatrics.jmir.org/2021/1/e25388 UR - http://dx.doi.org/10.2196/25388 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595440 ID - info:doi/10.2196/25388 ER - TY - JOUR AU - Rhodes, Alexandra AU - Kheireddine, Sara AU - Smith, D. Andrea PY - 2020/12/9 TI - Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App (Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e23157 VL - 8 IS - 12 KW - pregnancy KW - parenting KW - app KW - COVID-19 KW - pregnancy support KW - postnatal support KW - perinatal KW - mental well-being KW - physical well-being KW - support KW - well-being KW - experience KW - attitude KW - needs N2 - Background: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service?approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users? needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby?s development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges. UR - http://mhealth.jmir.org/2020/12/e23157/ UR - http://dx.doi.org/10.2196/23157 UR - http://www.ncbi.nlm.nih.gov/pubmed/33264100 ID - info:doi/10.2196/23157 ER - TY - JOUR AU - Lovell, Belinda AU - Steen, Mary AU - Esterman, Adrian AU - Brown, Angela PY - 2020/8/13 TI - The Parenting Education Needs of Women Experiencing Incarceration in South Australia: Proposal for a Mixed Methods Study JO - JMIR Res Protoc SP - e18992 VL - 9 IS - 8 KW - prison KW - parenting programs KW - education KW - women KW - mothers. N2 - Background: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated. Objective: This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal; the authors acknowledge the diversity within Aboriginal cultures. Methods: This study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed. Results: A scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government. Conclusions: The scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women?s voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study. International Registered Report Identifier (IRRID): PRR1-10.2196/18992 UR - http://www.researchprotocols.org/2020/8/e18992/ UR - http://dx.doi.org/10.2196/18992 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673211 ID - info:doi/10.2196/18992 ER - TY - JOUR AU - Fatori, Daniel AU - Argeu, Adriana AU - Brentani, Helena AU - Chiesa, Anna AU - Fracolli, Lislaine AU - Matijasevich, Alicia AU - Miguel, C. Euripedes AU - Polanczyk, Guilherme PY - 2020/7/28 TI - Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e13686 VL - 8 IS - 7 KW - mHealth KW - early childhood development KW - maternal care KW - randomized clinical trial KW - daily diary KW - ambulatory assessment N2 - Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 UR - https://mhealth.jmir.org/2020/7/e13686 UR - http://dx.doi.org/10.2196/13686 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720906 ID - info:doi/10.2196/13686 ER - TY - JOUR AU - McGoron, Lucy AU - Ratner, Horn Hilary AU - Knoff, AG Kathryn AU - Hvizdos, Erica AU - Ondersma, J. Steven PY - 2019/11/29 TI - A Pragmatic Internet Intervention to Promote Positive Parenting and School Readiness in Early Childhood: Initial Evidence of Program Use and Satisfaction JO - JMIR Pediatr Parent SP - e14518 VL - 2 IS - 2 KW - child rearing KW - child development N2 - Background: Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them. Objective: This study aimed to evaluate engagement in the 5-a-Day Parenting program, a technology-based program designed with low-income families in mind, to promote daily use of 5 specific parenting activities conducive to children?s school readiness. Following earlier pilot data, the program was enhanced with an initial motivational e-intervention and tailored text messages designed to promote engagement. Methods: Parents were recruited from local childcare centers and through a participant registry. We examined rates of receipt of program text messages and use of video-based content on the program website, 3 factors that may affect website use, and satisfaction with key program elements. Results: A total of 360 parents of young children learned about the study and had the opportunity to use the 5-a-Day Parenting website. Of these, 94 parents participated in the study, and 33% (31/94) accessed the video-based content on the website at least once. No association was found between website use and program recruitment approach, program-affiliation message, sociocontextual risk, and baseline use of the five parenting activities. Satisfaction with text messages and video-based content was high. Conclusions: For some parents, technology-based programs appear useful; however, engagement could still be enhanced. Additional research should seek innovative strategies for promoting engagement in Web-based parenting programs. UR - http://pediatrics.jmir.org/2019/2/e14518/ UR - http://dx.doi.org/10.2196/14518 UR - http://www.ncbi.nlm.nih.gov/pubmed/31782739 ID - info:doi/10.2196/14518 ER - TY - JOUR AU - Tangherlini, R. Timothy AU - Roychowdhury, Vwani AU - Glenn, Beth AU - Crespi, M. Catherine AU - Bandari, Roja AU - Wadia, Akshay AU - Falahi, Misagh AU - Ebrahimzadeh, Ehsan AU - Bastani, Roshan PY - 2016/11/22 TI - ?Mommy Blogs? and the Vaccination Exemption Narrative: Results From A Machine-Learning Approach for Story Aggregation on Parenting Social Media Sites JO - JMIR Public Health Surveill SP - e166 VL - 2 IS - 2 KW - vaccination KW - social media KW - machine learning KW - personal narratives KW - Internet KW - health knowledge KW - attitudes KW - practice N2 - Background: Social media offer an unprecedented opportunity to explore how people talk about health care at a very large scale. Numerous studies have shown the importance of websites with user forums for people seeking information related to health. Parents turn to some of these sites, colloquially referred to as ?mommy blogs,? to share concerns about children?s health care, including vaccination. Although substantial work has considered the role of social media, particularly Twitter, in discussions of vaccination and other health care?related issues, there has been little work on describing the underlying structure of these discussions and the role of persuasive storytelling, particularly on sites with no limits on post length. Understanding the role of persuasive storytelling at Internet scale provides useful insight into how people discuss vaccinations, including exemption-seeking behavior, which has been tied to a recent diminution of herd immunity in some communities. Objective: To develop an automated and scalable machine-learning method for story aggregation on social media sites dedicated to discussions of parenting. We wanted to discover the aggregate narrative frameworks to which individuals, through their exchange of experiences and commentary, contribute over time in a particular topic domain. We also wanted to characterize temporal trends in these narrative frameworks on the sites over the study period. Methods: To ensure that our data capture long-term discussions and not short-term reactions to recent events, we developed a dataset of 1.99 million posts contributed by 40,056 users and viewed 20.12 million times indexed from 2 parenting sites over a period of 105 months. Using probabilistic methods, we determined the topics of discussion on these parenting sites. We developed a generative statistical-mechanical narrative model to automatically extract the underlying stories and story fragments from millions of posts. We aggregated the stories into an overarching narrative framework graph. In our model, stories were represented as network graphs with actants as nodes and their various relationships as edges. We estimated the latent stories circulating on these sites by modeling the posts as a sampling of the hidden narrative framework graph. Temporal trends were examined based on monthly user-poststatistics. Results: We discovered that discussions of exemption from vaccination requirements are highly represented. We found a strong narrative framework related to exemption seeking and a culture of distrust of government and medical institutions. Various posts reinforced part of the narrative framework graph in which parents, medical professionals, and religious institutions emerged as key nodes, and exemption seeking emerged as an important edge. In the aggregate story, parents used religion or belief to acquire exemptions to protect their children from vaccines that are required by schools or government institutions, but (allegedly) cause adverse reactions such as autism, pain, compromised immunity, and even death. Although parents joined and left the discussion forums over time, discussions and stories about exemptions were persistent and robust to these membership changes. Conclusions: Analyzing parent forums about health care using an automated analytic approach, such as the one presented here, allows the detection of widespread narrative frameworks that structure and inform discussions. In most vaccination stories from the sites we analyzed, it is taken for granted that vaccines and not vaccine preventable diseases (VPDs) pose a threat to children. Because vaccines are seen as a threat, parents focus on sharing successful strategies for avoiding them, with exemption being the foremost among these strategies. When new parents join such sites, they may be exposed to this endemic narrative framework in the threads they read and to which they contribute, which may influence their health care decision making. UR - http://publichealth.jmir.org/2016/2/e166/ UR - http://dx.doi.org/10.2196/publichealth.6586 UR - http://www.ncbi.nlm.nih.gov/pubmed/27876690 ID - info:doi/10.2196/publichealth.6586 ER - TY - JOUR AU - Doty, L. Jennifer AU - Rudi, H. Jessie AU - Pinna, M. Keri L. AU - Hanson, K. Sheila AU - Gewirtz, H. Abigail PY - 2016/06/22 TI - If You Build It, Will They Come? Patterns of Internet-Based and Face-To-Face Participation in a Parenting Program for Military Families JO - J Med Internet Res SP - e169 VL - 18 IS - 6 KW - parenting KW - evidence-based practice KW - military KW - prevention KW - Internet KW - interactive media N2 - Background: Some evidence suggests parents are drawn to media-based interventions over face-to-face interventions, but little is known about the factors associated with parents? use of Internet-based or Internet-enhanced programs, especially among military families. Research is needed to understand characteristics of parents who may be most likely to use online components or attend face-to-face meetings in order to ensure maximum engagement. Objective: In this study, we examined characteristics that predict various patterns of Internet use and face-to-face attendance in a parenting program designed for military families. Methods: An ecological framework guided analysis of differences in patterns of Internet-based use and face-to-face attendance by parents? demographic characteristics (gender, education, employment, and child age), incentives offered, and number of months the parent was deployed. We reported differences in the total number of online components completed over the 14 modules, total number of face-to-face sessions attended, and the use of different types of online components accessed (videos, downloadable handouts, mindfulness exercises, knowledge checks, and downloadable summaries). Then, we computed multinomial logistic regression accounting for nestedness (parents within families) to examine associations between demographic, programmatic, and military-related characteristics and patterns of engagement (use of online components and attendance at face-to-face sessions). Results: Just over half (52.2%, 193/370) of the participants used the online components at least once, and the majority of participants (73.2%, 271/370) attended at least 1 face-to-face session. An examination of different patterns of participation revealed that compared with those who participated primarily in face-to-face sessions, parents who participated online but had little face-to-face participation were more likely to have received incentives than those who did not (95% CI 1.9-129.7). Among participants who had been deployed, those who had earned a 4-year degree (95% CI 1.0-2.2) and those who had been offered incentives to participate online (95% CI 2.1-58.6) were more likely to be highly engaged in online components and attend face-to-face compared with those who attended primarily face-to-face. However, those with a high number of months of deployment (95% CI 0.6-1.0) were less likely to be in the pattern of highly engaged in online components and face-to-face attendance. Compared with those who participated primarily face-to-face, deployed mothers were about 4 times more likely to engage in moderate online use with face-to-face attendance than deployed fathers (95% CI 1.21-11.83) and participate primarily online (95% CI 0.77-25.20). Conclusions: Results imply that parents may be drawn to different delivery options of a parenting program (online components vs face-to-face sessions) depending on their education level, incentives to engage in online components, and their military-related experience. Results suggest potential directions for tailoring Internet-based interventions. UR - http://www.jmir.org/2016/6/e169/ UR - http://dx.doi.org/10.2196/jmir.4445 UR - http://www.ncbi.nlm.nih.gov/pubmed/27334833 ID - info:doi/10.2196/jmir.4445 ER - TY - JOUR AU - Lange, Anne-Mette AU - Daley, David AU - Frydenberg, Morten AU - Rask, U. Charlotte AU - Sonuga-Barke, Edmund AU - Thomsen, H. Per PY - 2016/04/13 TI - The Effectiveness of Parent Training as a Treatment for Preschool Attention-Deficit/Hyperactivity Disorder: Study Protocol for a Randomized Controlled, Multicenter Trial of the New Forest Parenting Program in Everyday Clinical Practice JO - JMIR Res Protoc SP - e51 VL - 5 IS - 2 KW - ADHD KW - preschool KW - child KW - treatment KW - parents KW - parent training KW - psycho-social KW - RCT, clinical KW - psychological KW - multi-centre KW - TAU KW - non-pharmacological N2 - Background: Parent training is recommended as the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. Objective: The objective of this trial is to investigate whether the NFPP can be effectively delivered for children referred through official community pathways in everyday clinical practice. Methods: A multicenter randomized controlled parallel arm trial design is employed. There are two treatment arms, NFPP and treatment as usual. NFPP consists of eight individually delivered parenting sessions, where the child attends during three of the sessions. Outcomes are examined at three time points (T1, T2, T3): T1 (baseline), T2 (week 12, post intervention), and T3 (6 month follow/up). 140 children between the ages of 3-7, with a clinical diagnosis of ADHD, informed by the Development and Well Being Assessment, and recruited from three child and adolescent psychiatry departments in Denmark will take part. Randomization is on a 1:1 basis, stratified for age and gender. Results: The primary endpoint is change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (ADHD-RS) by T2. Secondary outcome measures include: effects on this measure at T3 and T2 and T3 measures of teacher reported Preschool ADHD-RS scores, parent and teacher rated scores on the Strength & Difficulties Questionnaire, direct observation of ADHD behaviors during Child?s Solo Play, observation of parent-child interaction, parent sense of competence, and family stress. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of nonpharmacological treatments. Conclusions: The trial will provide evidence as to whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice. Trial Registration: ClinicalTrials.gov NCT01684644; https://clinicaltrials.gov/ct2/show/NCT01684644?term= NCT01684644&rank=1 (Archived by WebCite at http://www.webcitation/6eOOAe8Qe) UR - http://www.researchprotocols.org/2016/2/e51/ UR - http://dx.doi.org/10.2196/resprot.5319 UR - http://www.ncbi.nlm.nih.gov/pubmed/27076496 ID - info:doi/10.2196/resprot.5319 ER -