TY - JOUR AU - Shetty, Sheela AU - Nayak, S. Baby AU - George, Anice AU - Shetty, Avinash AU - Guddattu, Vasudeva PY - 2025/4/28 TI - Evidence of Interventions for the Prevention of Unintentional Injuries: Scoping Review JO - JMIR Pediatr Parent SP - e67877 VL - 8 KW - prevention KW - injury KW - education KW - health KW - child KW - children KW - unintentional injury KW - disability KW - youth KW - surveillance KW - surveillance data KW - risk factor KW - injury intervention KW - literature search KW - scoping review KW - scoping literature review KW - policymaker KW - preventative measure KW - preventive measure N2 - Background: Unintentional injuries are the leading cause of death and disability among young children. Preventive strategies for unintentional injuries are mainly based on surveillance data and identifying risk factors. Objective: This study aimed to review and synthesize published literature that determined the effectiveness of interventions for preventing unintentional injuries among children. Methods: The methodological framework was supported by The Joanna Briggs Institute Reviewer?s Manual ? Methodology for JBI Scoping Reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The inclusion criteria to include the studies in the review were unintentional injuries in children, interventions to prevent injuries, a brief description of the intervention and the outcome of the intervention, and articles published in a peer-reviewed journal and written in the English language. Results: In total, 21 articles were included in the review following the systematic search of key databases such as Web of Science, PubMed/MEDLINE, Scopus, ScienceDirect, and gray literature for studies published between July 2013 and May 2023. Of the 21 articles, 16 were randomized controlled trials, 4 were nonrandomized controlled trials, and 1 was a mixed method study. The findings of the review showed that interventions, either as a single measure (video-based teaching, testimonial story-based teaching, health education, storybook reading) or in combination (knowledge quiz and simulation test, module-based teaching along with personal counseling, and teaching with the help of video and poster), have shown a considerable decline in the number and severity of injuries. The studies included various target populations, including children and adolescents between 0 and 19 years old. Conclusions: The review results indicate the need to plan, implement, and reinforce preventive measures and techniques to reduce unintentional injuries among children. They can also serve as a useful indicator for policymakers. UR - https://pediatrics.jmir.org/2025/1/e67877 UR - http://dx.doi.org/10.2196/67877 ID - info:doi/10.2196/67877 ER - 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 - Butt, L. Michelle AU - Willett, Jayne Ysabella AU - Miller, Vicky AU - Jacobs, Brenda AU - Ferron, Mae Era AU - Wright, L. Amy PY - 2024/11/22 TI - Indigenous Parents? Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study JO - JMIR Pediatr Parent SP - e64994 VL - 7 KW - child KW - parenting KW - qualitative KW - Indigenous health KW - support programs N2 - Background: Parenting support programs enhance parents? health and their child?s development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents? experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents? experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. UR - https://pediatrics.jmir.org/2024/1/e64994 UR - http://dx.doi.org/10.2196/64994 UR - http://www.ncbi.nlm.nih.gov/pubmed/39576680 ID - info:doi/10.2196/64994 ER - TY - JOUR AU - Aldridge, Grace AU - Wu, Ling AU - Seguin, Paolo Joshua AU - Robinson, Jennifer AU - Battaglia, Elizabeth AU - Olivier, Patrick AU - Yap, H. Marie B. PY - 2024/11/22 TI - Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study JO - JMIR Form Res SP - e55639 VL - 8 KW - co-design KW - service design KW - intervention KW - digital technology KW - parenting KW - children KW - technology KW - parenting program KW - health care services KW - adverse childhood experience KW - ACE KW - mental disorder KW - innovate KW - social services KW - community health KW - evidence-based KW - parenting intervention N2 - Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent?s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite?s design. Results: PaRK-Lite?s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents? empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. UR - https://formative.jmir.org/2024/1/e55639 UR - http://dx.doi.org/10.2196/55639 UR - http://www.ncbi.nlm.nih.gov/pubmed/39576676 ID - info:doi/10.2196/55639 ER - TY - JOUR AU - Rivera Rivera, Nathalie Jessica AU - AuBuchon, E. Katarina AU - Smith, Marjanna AU - Starling, Claire AU - Ganacias, G. Karen AU - Danielson, Aimee AU - Patchen, Loral AU - Rethy, A. Janine AU - Blumenthal, Joseph H. AU - Thomas, D. Angela AU - Arem, Hannah PY - 2024/11/14 TI - Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study JO - JMIR Pediatr Parent SP - e56807 VL - 7 KW - postpartum care KW - newborn care KW - health education KW - chatbot KW - mHealth KW - mobile health KW - feedback KW - health equity N2 - Background: The 42 days after delivery (?fourth trimester?) are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical ?fourth trimester,? we developed 2 ruled-based chatbots?one for birthing individuals and one for newborn caregivers?that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot?s impact on health outcomes and reduce disparities. UR - https://pediatrics.jmir.org/2024/1/e56807 UR - http://dx.doi.org/10.2196/56807 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56807 ER - TY - JOUR AU - Garikipati, Anurag AU - Ciobanu, Madalina AU - Singh, Preet Navan AU - Barnes, Gina AU - Dinenno, A. Frank AU - Geisel, Jennifer AU - Mao, Qingqing AU - Das, Ritankar PY - 2024/10/30 TI - Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review JO - JMIR Pediatr Parent SP - e62878 VL - 7 KW - applied behavior analysis KW - autism spectrum disorder KW - parent training KW - patient outcomes KW - skill acquisition KW - pediatrics N2 - Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual?s life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap. Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (?Forta?), as measured by progress toward skill acquisition within multiple focus areas (FAs). Methods: Parents received ?40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25?40 hours/week) treatment plans. Retrospective data were evaluated over ?90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13?22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house. Results: Improved goal achievement success between weeks 1?20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045). Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care. UR - https://pediatrics.jmir.org/2024/1/e62878 UR - http://dx.doi.org/10.2196/62878 ID - info:doi/10.2196/62878 ER - TY - JOUR AU - Lee, JooHyun AU - Lim, JaeHyun AU - Kang, Soyeon AU - Kim, Sujin AU - Jung, Yoon So AU - Hong, Soon-Beom AU - Park, Rang Yu PY - 2024/10/28 TI - Mobile App?Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial JO - JMIR Hum Factors SP - e52295 VL - 11 KW - autism spectrum disorder KW - parent training program KW - parent education KW - behavioral problems KW - child behavior KW - mobile app KW - feasibility KW - mHealth KW - evidence-based parent training N2 - Background: In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. Objective: We aimed to develop and evaluate the feasibility of a mobile app?assisted parent training program for reducing problem behaviors in children with ASD. Methods: This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app?assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app?assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Results: Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of ?0.5 (95% CI ?4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of ?2.1 (95% CI ?8.5 to 2.5). However, there was no significant difference in Clinical Global Impression?Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference ?2, 95% CI ?4 to 1). Caregivers? stress evaluated using the Korean Parenting Stress Index Fourth Edition?Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. Conclusions: The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices? accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. Trial Registration: CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112 UR - https://humanfactors.jmir.org/2024/1/e52295 UR - http://dx.doi.org/10.2196/52295 UR - http://www.ncbi.nlm.nih.gov/pubmed/39466295 ID - info:doi/10.2196/52295 ER - TY - JOUR AU - Mertens, Ellen AU - Ye, Guoquan AU - Beuckels, Emma AU - Hudders, Liselot PY - 2024/10/23 TI - Parenting Information on Social Media: Systematic Literature Review JO - JMIR Pediatr Parent SP - e55372 VL - 7 KW - parenting KW - social media KW - parenting information KW - systematic literature review KW - bibliometric literature review KW - thematic analysis N2 - Background: Social media has become extremely popular among parents to seek parenting information. Despite the increasing academic attention to the topic, studies are scattered across various disciplines. Therefore, this study broadens the scope of the existing reviews by transcending narrow academic subdomains and including all relevant research insights related to parents? information seeking on social media and its consequent effects. Objective: The aims of this systematic literature review were to (1) identify influential journals and scholars in the field; (2) examine the thematic evolution of research on parenting and social media; and (3) pinpoint research gaps, providing recommendations for future exploration. Methods: On the basis of a criteria for identifying scholarly publications, we selected 338 studies for this systematic literature review. We adopted a bibliometric analysis combined with a content thematic analysis to obtain data-driven insights with a profound understanding of the predominant themes in the realm of parenting and social media. Results: The analysis revealed a significant increase in research on parenting and social media since 2015, especially in the medical domain. The studies in our review spanned 232 different research fields, and the most prolific journal was JMIR Pediatrics and Parenting. The thematic analysis identified 4 emerging research themes in the studies: parenting motivations to seek information, nature of parenting content on social media, impact of parenting content, and interventions for parents on social media. Conclusions: This study provides critical insights into the current research landscape of parenting and social media. The identified themes, research gaps, and future research recommendations provide a foundation for future studies, guiding researchers toward valuable areas for exploration. UR - https://pediatrics.jmir.org/2024/1/e55372 UR - http://dx.doi.org/10.2196/55372 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55372 ER - TY - JOUR AU - Pokorna, Nikola AU - Palmer, Melanie AU - Pearson, Oliver AU - Beckley-Hoelscher, Nicholas AU - Shearer, James AU - Kostyrka-Allchorne, Katarzyna AU - Robertson, Olly AU - Koch, Marta AU - Slovak, Petr AU - Day, Crispin AU - Byford, Sarah AU - Waite, Polly AU - Creswell, Cathy AU - Sonuga-Barke, S. Edmund J. AU - Goldsmith, Kimberley PY - 2024/10/8 TI - Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e53864 VL - 7 KW - parenting KW - intervention KW - smartphone app KW - randomized controlled trial KW - COVID-19 pandemic KW - moderators KW - conduct problems KW - emotional problems N2 - Background: A smartphone app, Parent Positive, was developed to help parents manage their children?s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children?s emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive?s effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=?0.41, 95% CI ?0.82 to 0.0004; P=.05) or significant (T3: B=?0.76, 95% CI ?1.22 to ?0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive?s potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 UR - https://pediatrics.jmir.org/2024/1/e53864 UR - http://dx.doi.org/10.2196/53864 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378100 ID - info:doi/10.2196/53864 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 - McGrane Minton, Heather AU - Murray, Linda AU - Allan, J. Marjorie AU - Perry, Roslyn AU - Bettencourt, F. Amie AU - Gross, Deborah AU - Strano, Lauri AU - Breitenstein, M. Susan PY - 2024/7/3 TI - Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation JO - JMIR Pediatr Parent SP - e55280 VL - 7 KW - COVID-19 KW - implementation KW - internet-based intervention KW - parenting KW - community dissemination KW - hybrid delivery N2 - Background: Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. Objective: This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. Methods: This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. Results: In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child?s behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Conclusions: Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed. UR - https://pediatrics.jmir.org/2024/1/e55280 UR - http://dx.doi.org/10.2196/55280 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55280 ER - TY - JOUR AU - So, Hei Jeffrey Tsz AU - Nambiar, Smita AU - Byrne, Rebecca AU - Gallegos, Danielle AU - Baxter, A. Kimberley PY - 2024/5/30 TI - Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops JO - JMIR Pediatr Parent SP - e57849 VL - 7 KW - co-design KW - fathers KW - child nutrition KW - child feeding KW - intervention design KW - digital delivery KW - parenting KW - participatory KW - videoconference KW - communication technology N2 - Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers? experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers? experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation?Behavior model. The interview data illuminated factors influencing fathers? initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers? diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men?s caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child?s age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. UR - https://pediatrics.jmir.org/2024/1/e57849 UR - http://dx.doi.org/10.2196/57849 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815260 ID - info:doi/10.2196/57849 ER - TY - JOUR AU - Glassman, Jill AU - Humphreys, L. Kathryn AU - Jauregui, Adam AU - Milstein, Arnold AU - Sanders, Lee PY - 2024/5/22 TI - Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study JO - JMIR Pediatr Parent SP - e43315 VL - 7 KW - child health KW - parent-child relationship KW - screen time KW - technoference KW - health equity N2 - Background: The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. Objective: We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. Methods: In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. Results: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Conclusions: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based ?screen time rules? not only for their children but also for themselves. UR - https://pediatrics.jmir.org/2024/1/e43315 UR - http://dx.doi.org/10.2196/43315 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446995 ID - info:doi/10.2196/43315 ER - TY - JOUR AU - Pretorius, Kelly AU - Kang, Sookja AU - Choi, Eunju PY - 2024/4/23 TI - Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images JO - JMIR Pediatr Parent SP - e54610 VL - 7 KW - SUID KW - SIDS KW - parenting KW - safe sleep KW - photo analysis 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 - sleep KW - safety KW - death KW - mortality KW - social media KW - picture KW - pictures KW - photo KW - photos KW - photographs KW - image KW - images KW - Facebook KW - mother KW - mothers KW - parent KW - co-sleeping KW - sudden infant death KW - sudden unexpected infant death KW - adherence KW - parent education KW - parents' education KW - awareness N2 - Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers? group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers? group in May 2019. After trialing various search terms, searching for the term ?SIDS? on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers. UR - https://pediatrics.jmir.org/2024/1/e54610 UR - http://dx.doi.org/10.2196/54610 ID - info:doi/10.2196/54610 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 - Augustin, Michaela AU - Licata-Dandel, Maria AU - Breeman, D. Linda AU - Harrer, Mathias AU - Bilgin, Ayten AU - Wolke, Dieter AU - Mall, Volker AU - Ziegler, Margret AU - Ebert, Daniel David AU - Friedmann, Anna PY - 2023/3/10 TI - Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e41804 VL - 11 KW - children KW - crying problems KW - sleeping problems KW - feeding problems KW - feeding KW - regulatory problems KW - intervention study KW - Mobile Health Care KW - health app KW - mobile app KW - patient education KW - psychoeducation KW - eHealth KW - mobile health KW - mHealth KW - parenting KW - baby KW - babies KW - sleep KW - crying KW - newborn KW - mobile phone N2 - Background: Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. Objective: We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children?s symptoms decreased more than those of the parents who did not use the app. Methods: Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. Results: The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). Conclusions: This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children?s symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. Trial Registration: German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001 UR - https://mhealth.jmir.org/2023/1/e41804 UR - http://dx.doi.org/10.2196/41804 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897641 ID - info:doi/10.2196/41804 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 - Preuhs, Katharina AU - van Keulen, Hilde AU - Andree, Rosa AU - Wins, Sophie AU - van Empelen, Pepijn PY - 2022/4/19 TI - A Tailored Web-Based Video Intervention (ParentCoach) to Support Parents With Children With Sleeping Problems: User-Centered Design Approach JO - JMIR Form Res SP - e33416 VL - 6 IS - 4 KW - positive parenting KW - usability testing KW - lower health literacy KW - user-centered design KW - iterative development KW - eHealth KW - web-based intervention KW - mobile health KW - mHealth KW - parenting N2 - Background: Many parents frequently struggle with undesirable or problematic behavior (ie, temper tantrums and whining) displayed by their child. To support parents in promoting positive parenting skills (ie, recognizing challenging situations and reacting appropriately), the interactive video e-learning tool ParentCoach was developed. The tool aims to teach parents generic behavioral responses by means of situational learning, tailoring, and problem solving. The first demonstration focused on sleeping problems. Objective: The aim of this paper is to illustrate the user-centered development of ParentCoach. Methods: We conducted usability, understandability, and acceptance tests among the target group (29 parents, 7 youth health care professionals, and 4 individuals with former lower health literacy) in different phases of the development process via focus groups, interviews, and surveys. This allowed for relevant insights on specifications and user requirements to guide the development and revision of the tool in each iteration. Results: Iterative testing and development allowed for the final demonstration of ParentCoach to be experienced as a relevant and accessible parenting intervention that can be used as a stand-alone program or in combination with another program. Conclusions: This paper elaborates on the iterative development process and its benefits for the final demonstration of ParentCoach. UR - https://formative.jmir.org/2022/4/e33416 UR - http://dx.doi.org/10.2196/33416 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438640 ID - info:doi/10.2196/33416 ER - TY - JOUR AU - Shimabukuro, Shizuka AU - Daley, David AU - Endo, Takahiro AU - Harada, Satoshi AU - Tomoda, Akemi AU - Yamashita, Yushiro AU - Oshio, Takashi AU - Guo, Boliang AU - Ishii, Atsuko AU - Izumi, Mio AU - Nakahara, Yukiko AU - Yamamoto, Kazushi AU - Yao, Akiko AU - Tripp, Gail PY - 2022/4/19 TI - The Effectiveness and Cost-effectiveness of Well Parent Japan for Japanese Mothers of Children With ADHD: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e32693 VL - 11 IS - 4 KW - ADHD KW - parent training KW - Japan KW - New Forest Parent Programme KW - parent stress management N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently, in Japan, there are limited interventions available to target ADHD. Well Parent Japan (WPJ), a new hybrid parent-training program, provides a culturally acceptable and effective way to help support Japanese children with ADHD and their parents. Objective: This pragmatic multicenter randomized controlled trial aims to provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services. Methods: Mothers of children (aged 6-12 years) diagnosed with ADHD were recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka, and Okinawa). The mothers were randomized to receive immediate treatment or TAU. The effectiveness and cost-effectiveness of WPJ over TAU at the end of the intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal parent domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being; and the parent-child relationship and maternal child domain parenting stress. Data analysis will follow intention-to-treat principles with treatment effects quantified through analysis of covariance using multilevel modeling. An incremental cost-effectiveness ratio will be used to analyze the cost-effectiveness of the WPJ intervention. Results: Study funding was secured through a proof-of-concept grant in July 2018. Approval by the institutional review board for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 and was completed in April 2022. Participant recruitment (N=124) was completed in May 2021. Effectiveness and cost-effectiveness analyses are expected to be completed by July 2022 and December 2022, respectively. These timelines are subject to change owing to the COVID-19 pandemic. Conclusions: This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ in children and families by comparing WPJ directly with the usual clinical care offered for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost-effectiveness of WPJ with TAU in Japan. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN66978270; https://www.isrctn.com/ISRCTN66978270 International Registered Report Identifier (IRRID): DERR1-10.2196/32693 UR - https://www.researchprotocols.org/2022/4/e32693 UR - http://dx.doi.org/10.2196/32693 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438647 ID - info:doi/10.2196/32693 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 - Cunningham, Chentel AU - Sung, Hyelin AU - Benoit, James AU - Conway, Jennifer AU - Scott, D. Shannon PY - 2022/3/21 TI - Multimedia Knowledge Translation Tools for Parents About Childhood Heart Failure: Environmental Scan JO - JMIR Pediatr Parent SP - e34166 VL - 5 IS - 1 KW - environmental scan KW - pediatrics heart failure KW - parent audience KW - knowledge translation KW - web-based educational tools N2 - Background: Childhood heart failure is a factor in many hospital admissions each year. It can impose a steep learning curve for parents who need to learn the key information to care for their child at home. In this study, we conducted an environmental scan to identify and assess web-based knowledge translation tools about childhood heart failure for parent audiences developed within North America. Objective: The aim of this study is to inventory tools publicly available to parents about childhood heart failure from popular web-based venues, assess how each tool communicates health information, and explore how they were developed. Methods: Our search strategy included two commonly used multimedia-based platforms: two app stores (Google Play and Apple App Store) and one search engine (Advanced Google Search). Common search terms were used, and results were uploaded to Microsoft Excel for screening between 2 reviewers. The inclusion criteria for the tools were as follows: content focused on educating parents about their child?s heart failure, developed in the English language, and originating within Canada and the United States. A total of 2 reviewers screened the app store and internet search results for relevant tools. Each tool was assessed using the Suitability Assessment of Materials (SAM), a validated tool that objectively assesses the suitability of how health information is communicated to a particular audience. Key informants who were involved in tool development were identified and invited for a qualitative interview using a semistructured format to provide data about the development process. Key themes were identified in the semistructured interview process. Results: Frequencies and SAM percent ratings of eligible tools were reported. No apps exist for parents relating to pediatric heart failure. Overall, 17 relevant internet tools were identified, and their suitability was assessed for the parent audience. Most tools scored well in layout and type, but they scored lower in readability and graphics. Qualitative interviews with key informants revealed three key themes: timely and introductory knowledge, credible and trustworthy knowledge, and challenges and evolution in knowledge. Conclusions: This is the first environmental scan looking for parent tools relating to childhood heart failure in Canada and the United States. Findings from this study reveal that there are no apps on this topic and there is a small number of tools for parents on the internet (n=17). Using the SAM, no tools scored in the superior range, and further work in knowledge translation strategies needs to be done in this area to improve more effective education to parents and caregivers who have a child with heart failure. These findings will inform the development of a new resource on children?s heart failure that targets parents and caregiver audiences. UR - https://pediatrics.jmir.org/2022/1/e34166 UR - http://dx.doi.org/10.2196/34166 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311676 ID - info:doi/10.2196/34166 ER - TY - JOUR AU - Becker, J. Sara AU - Helseth, A. Sarah AU - Kelly, M. Lourah AU - Janssen, Tim AU - Wolff, C. Jennifer AU - Spirito, Anthony AU - Wright, Thomas PY - 2022/2/28 TI - Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-Assisted Parenting Intervention JO - JMIR Res Protoc SP - e35934 VL - 11 IS - 2 KW - adolescent KW - residential KW - technology-assisted KW - substance use KW - parent KW - randomized controlled trial KW - RCT KW - intervention KW - eHealth KW - problem behaviour KW - problem behavior N2 - Background: Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment)?a technology-assisted parenting intervention informed by extensive formative research?as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. Objective: This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. Methods: Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART+TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multimethod follow-up assessments consisting of self-reported parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6, 12, and 24 weeks postdischarge from residential care. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. Results: The trial was funded in August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021, with recruitment beginning in February 2022. Conclusions: The proposed research has the potential to advance the field by serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. Trial Registration: ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385 International Registered Report Identifier (IRRID): PRR1-10.2196/35934 UR - https://www.researchprotocols.org/2022/2/e35934 UR - http://dx.doi.org/10.2196/35934 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225821 ID - info:doi/10.2196/35934 ER - TY - JOUR AU - Macam, Reyes Samantha AU - Mack, Wendy AU - Palinkas, Lawrence AU - Kipke, Michele AU - Javier, Rivera Joyce PY - 2022/2/17 TI - Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e21867 VL - 11 IS - 2 KW - Filipino KW - mental health KW - prevention KW - parenting practices KW - community health N2 - Background: Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. Objective: The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. Methods: This study uses a randomized controlled 2-arm individually randomized group treatment pretest?posttest design for 180 parent?child dyads. Individuals are eligible if they are ?18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics? Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. Results: Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. Conclusions: Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. Trial Registration: ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170 International Registered Report Identifier (IRRID): DERR1-10.2196/21867 UR - https://www.researchprotocols.org/2022/2/e21867 UR - http://dx.doi.org/10.2196/21867 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175200 ID - info:doi/10.2196/21867 ER - TY - JOUR AU - Swindle, Taren AU - Poosala, B. Anwesh AU - Zeng, Nan AU - Børsheim, Elisabet AU - Andres, Aline AU - Bellows, L. Laura PY - 2022/1/11 TI - Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review JO - J Med Internet Res SP - e28230 VL - 24 IS - 1 KW - physical activity KW - preschool children KW - digital KW - technology KW - intervention N2 - Background: Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children. Objective: The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions. Methods: This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes. Results: In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies. Conclusions: The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children. UR - https://www.jmir.org/2022/1/e28230 UR - http://dx.doi.org/10.2196/28230 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014962 ID - info:doi/10.2196/28230 ER - TY - JOUR AU - Gupta, Aarushi AU - Cafazzo, A. Joseph AU - IJzerman, J. Maarten AU - Swart, F. Joost AU - Vastert, Sebastiaan AU - Wulffraat, M. Nico AU - Benseler, Susanne AU - Marshall, Deborah AU - Yeung, Rae AU - Twilt, Marinka PY - 2021/12/24 TI - Genomic Health Literacy Interventions in Pediatrics: Scoping Review JO - J Med Internet Res SP - e26684 VL - 23 IS - 12 KW - pediatrics KW - patient education KW - genetics KW - genomics KW - mHealth KW - digital health KW - internet KW - genetic knowledge KW - genomic health literacy KW - children KW - adolescents N2 - Background: The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective: The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods: A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results: Of the 4618 studies, 14 studies (n=6, 43% qualitative, n=6, 43% mixed methods, and n=2, 14% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions: This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts. UR - https://www.jmir.org/2021/12/e26684 UR - http://dx.doi.org/10.2196/26684 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951592 ID - info:doi/10.2196/26684 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 - Cooray, Nipuna AU - Sun, Louise Si AU - Ho, Catherine AU - Adams, Susan AU - Keay, Lisa AU - Nassar, Natasha AU - Brown, Julie PY - 2021/12/20 TI - Toward a Behavior Theory?Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study JO - JMIR Pediatr Parent SP - e29731 VL - 4 IS - 4 KW - child injury KW - Behaviour Change Wheel KW - mobile app KW - mobile phone N2 - Background: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory?informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory? and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn?s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory?informed mobile intervention for injury prevention refined using the person-based approach. UR - https://pediatrics.jmir.org/2021/4/e29731 UR - http://dx.doi.org/10.2196/29731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932004 ID - info:doi/10.2196/29731 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 - TY - JOUR AU - Kavanagh, John David AU - Connolly, Jennifer AU - Fisher, Jane AU - Halford, Kim W. AU - Hamilton, Kyra AU - Hides, Leanne AU - Milgrom, Jeannette AU - Rowe, Heather AU - Scuffham, A. Paul AU - White, M. Katherine AU - Wittkowski, Anja AU - Appleton, Shelley AU - Sanders, Davina PY - 2021/11/26 TI - The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial JO - J Med Internet Res SP - e23659 VL - 23 IS - 11 KW - perinatal KW - depression KW - prevention KW - men KW - self-guided KW - internet N2 - Background: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective: This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods: The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks? gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples? randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results: Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ?50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions: Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277 UR - https://www.jmir.org/2021/11/e23659 UR - http://dx.doi.org/10.2196/23659 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842534 ID - info:doi/10.2196/23659 ER - TY - JOUR AU - Hurst, Rachel AU - Liljenquist, Kendra AU - Lowry, J. Sarah AU - Szilagyi, G. Peter AU - Fiscella, A. Kevin AU - Weaver, R. Marcia AU - Porras-Javier, Lorena AU - Ortiz, Janette AU - Sotelo Guerra, J. Laura AU - Coker, R. Tumaini PY - 2021/11/25 TI - A Parent Coach?Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e27054 VL - 10 IS - 11 KW - preventive care KW - well-child care KW - community health centers N2 - Background: The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. Objective: This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. Methods: This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ?12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician?s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. Results: Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. Conclusions: This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. Trial Registration: ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898 International Registered Report Identifier (IRRID): DERR1-10.2196/27054 UR - https://www.researchprotocols.org/2021/11/e27054 UR - http://dx.doi.org/10.2196/27054 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842563 ID - info:doi/10.2196/27054 ER - TY - JOUR AU - Chin, Samuel AU - Carlin, Rebecca AU - Mathews, Anita AU - Moon, Rachel PY - 2021/11/15 TI - Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study JO - JMIR Pediatr Parent SP - e27297 VL - 4 IS - 4 KW - sleep position KW - bed-sharing KW - social norms KW - social media KW - safe sleep KW - bedding N2 - Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of ?likes? for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of ?likes? for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of ?likes? was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. UR - https://pediatrics.jmir.org/2021/4/e27297 UR - http://dx.doi.org/10.2196/27297 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779783 ID - info:doi/10.2196/27297 ER - TY - JOUR AU - Mathur, Mala AU - Kerr, R. Bradley AU - Babal, C. Jessica AU - Eickhoff, C. Jens AU - Coller, J. Ryan AU - Moreno, A. Megan PY - 2021/11/2 TI - US Parents? Acceptance of Learning About Mindfulness Practices for Parents and Children: National Cross-sectional Survey JO - JMIR Pediatr Parent SP - e30242 VL - 4 IS - 4 KW - mindfulness KW - mental health KW - general pediatrics KW - pediatrics KW - children KW - parents KW - acceptability KW - well-being KW - parenting N2 - Background: Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents? acceptance of learning about mindfulness practices. Objective: This study aims to assess parents? beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds. Methods: We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds. Results: Participants (N=3000) were 87% (n=2621) female and 82.5% (n=2466) Caucasian. Most (n=1913, 64.2%) reported beliefs that mindfulness can be beneficial when parenting, 56.4% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1% (n=768; P<.001). Parents interested in learning about mindfulness were more likely to be male 62.6% (n=223; P<.001). There was no significant difference in interest in learning about mindfulness from a health care provider based on race. Conclusions: This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices. UR - https://pediatrics.jmir.org/2021/4/e30242 UR - http://dx.doi.org/10.2196/30242 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726605 ID - info:doi/10.2196/30242 ER - TY - JOUR AU - O'Dell, M. Sean AU - Fisher, R. Heidi AU - Schlieder, Victoria AU - Klinger, Tracey AU - Kininger, L. Rachel AU - Cosottile, McKenna AU - Cummings, Stacey AU - DeHart, Kathy PY - 2021/10/5 TI - Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study JO - JMIR Pediatr Parent SP - e27551 VL - 4 IS - 4 KW - primary care KW - parenting KW - targeted prevention KW - behavioral intervention technology KW - behavioral health N2 - 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. UR - https://pediatrics.jmir.org/2021/4/e27551 UR - http://dx.doi.org/10.2196/27551 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609324 ID - info:doi/10.2196/27551 ER - 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 - Oakley-Girvan, Ingrid AU - Watterson, L. Jessica AU - Jones, Cheryl AU - Houghton, C. Lauren AU - Gibbons, P. Marley AU - Gokal, Kajal AU - Magsamen-Conrad, Kate PY - 2021/7/30 TI - Use of Social Media for Cancer Prevention Through Neighborhood Social Cohesion: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e28147 VL - 10 IS - 7 KW - social cohesion KW - mothers KW - neighborhood KW - physical activity KW - social media KW - social KW - behavior KW - health outcomes KW - socioeconomic status KW - community health KW - chronic disease KW - social network KW - feasibility KW - wellbeing KW - cancer N2 - Background: Social cohesion is associated with healthier behaviors and better health outcomes, and therefore may offer a mechanism for promoting better health. Low socioeconomic status (SES) communities face higher rates of chronic disease due to both community- and individual-level factors. Objective: The aim of this study is to leverage social cohesion to promote healthier behaviors and prevent chronic disease in a low SES community. This protocol outlines the methodology for a pilot study to assess the feasibility of an intervention (Free Time For Wellness [FT4W]) using a social networking platform (Nextdoor) with mothers living in an urban, low-income community to improve social cohesion and promote healthy behaviors. Methods: The study will involve three phases: (I) co-designing the intervention with mothers in the neighborhoods of interest, (II) implementing the intervention with community leaders through the social networking platform, and (III) evaluating the intervention?s feasibility. Phase I of the study will include qualitative data collection and analysis from in-depth, semistructured interviews and a co-design group session with mothers. Phases II and III of the study include a pre- and postintervention survey of participating mothers. Neighborhood-level data on social cohesion will also be collected to enable comparison of outcomes between neighborhoods with higher and lower baseline social cohesion. Results: As of March 2021, recruitment and data collection for this study are complete. This protocol outlines our original study plan, although the final enrollment numbers and intervention implementation deviated from our initial planned methodology that is outlined in this protocol. These implementation learnings will be shared in subsequent publications of our study results. Conclusions: Ultimately, this study aims to: (1) determine the barriers and facilitators to finding free time for wellness among a population of low-income mothers to inform the co-design process, and (2) implement and study the feasibility of an intervention that leverages social cohesion to promote physical activity in a community of low-income mothers. The results of this study will provide preliminary feasibility evidence to inform a larger effectiveness trial, and will further our understanding of how social cohesion might influence well-being. International Registered Report Identifier (IRRID): RR1-10.2196/28147 UR - https://www.researchprotocols.org/2021/7/e28147 UR - http://dx.doi.org/10.2196/28147 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328445 ID - info:doi/10.2196/28147 ER - TY - JOUR AU - Davidson, C. Jennifer AU - Karadzhov, Dimitar AU - Wilson, Graham PY - 2021/7/29 TI - Practitioners? and Policymakers? Successes, Challenges, Innovations, and Learning in Promoting Children?s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey JO - JMIR Res Protoc SP - e31013 VL - 10 IS - 7 KW - mobile phones KW - smartphone app KW - qualitative KW - mixed method KW - international KW - survey KW - service providers KW - policy KW - practice KW - children?s rights KW - well-being KW - COVID-19 KW - pandemic KW - app KW - mHealth KW - children N2 - Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children?s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children?s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children?s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners?, managers?, and policymakers? efforts to support children?s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies?the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents? sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 UR - https://www.researchprotocols.org/2021/7/e31013 UR - http://dx.doi.org/10.2196/31013 UR - http://www.ncbi.nlm.nih.gov/pubmed/34323850 ID - info:doi/10.2196/31013 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 - Chambers, T. Christine AU - Dol, Justine AU - Parker, A. Jennifer AU - Caes, Line AU - Birnie, A. Kathryn AU - Taddio, Anna AU - Campbell-Yeo, Marsha AU - Halperin, A. Scott AU - Langille, Jennifer PY - 2020/3/4 TI - Implementation Effectiveness of a Parent-Directed YouTube Video (?It Doesn?t Have To Hurt?) on Evidence-Based Strategies to Manage Needle Pain: Descriptive Survey Study JO - JMIR Pediatr Parent SP - e13552 VL - 3 IS - 1 KW - pain management KW - child KW - knowledge translation KW - social media N2 - Background: Despite the availability of high-quality evidence and clinical practice guidelines for the effective management of pediatric pain, this evidence is rarely used in practice for managing children?s pain from needle procedures such as vaccinations. Parents are generally unaware of pain management strategies they can use with their children. Objective: This study aimed to develop, implement, and evaluate the implementation effectiveness of a parent-directed YouTube video on evidence-based strategies to manage needle pain in children. Methods: This was a descriptive study. Analytics were extracted from YouTube to describe video reach. A Web-based survey was used to seek parent and health care professional (HCP) feedback about the video. The 2-minute 18-second video was launched on YouTube on November 4, 2013. In the video, a 4-year-old girl tells parents what they should and should not do to help needles hurt less. The key evidence-based messages shared in the video were distraction, deep breathing, and topical anesthetic creams. A group of parents (n=163) and HCPs (n=278) completed the Web-based survey. Measures of reach included number of unique views, country where the video was viewed, sex of the viewer, and length of watch time. The Web-based survey assessed implementation outcomes of the video, such as acceptability, appropriateness, penetration, and adoption. Results: As of November 4, 2018 (5 years after launch), the video had 237,132 unique views from 182 countries, with most viewers watching an average of 55.1% (76/138 seconds) of the video. Overall, both parents and HCPs reported strong acceptance of the video (ie, they liked the video, found it helpful, and felt more confident) and reported significant improvements in plans to use distraction, deep breathing, and topical anesthetic creams. Conclusions: This parent-directed YouTube video was an acceptable and appropriate way to disseminate evidence about the procedure of pain management to a large number of parents. UR - http://pediatrics.jmir.org/2020/1/e13552/ UR - http://dx.doi.org/10.2196/13552 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130190 ID - info:doi/10.2196/13552 ER - TY - JOUR AU - Doty, L. Jennifer AU - Brady, S. Sonya AU - Monardez Popelka, Javiera AU - Rietveld, Laura AU - Garcia-Huidobro, Diego AU - Doty, J. Matthew AU - Linares, Roxana AU - Svetaz, Veronica Maria AU - Allen, L. Michele PY - 2020/1/24 TI - Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach JO - JMIR Form Res SP - e12618 VL - 4 IS - 1 KW - mobile application KW - eHealth KW - community-based participatory research KW - Hispanic Americans, family N2 - Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent?s intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents? technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. UR - https://formative.jmir.org/2020/1/e12618 UR - http://dx.doi.org/10.2196/12618 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012034 ID - info:doi/10.2196/12618 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 - Grace, Rebekah AU - Baird, Kelly AU - Elcombe, Emma AU - Webster, Vana AU - Barnes, Jacqueline AU - Kemp, Lynn PY - 2019/11/21 TI - Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables JO - JMIR Pediatr Parent SP - e13023 VL - 2 IS - 2 KW - volunteer home visiting KW - randomized controlled trial KW - families KW - support services KW - social relationships KW - community KW - Volunteer Family Connect N2 - Background: Volunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children. Objective: This paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills. Methods: The RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group). Results: The intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the ?Guidance? subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable ?parenting sense of competence? and largely neutral findings for the primary outcome variable ?community connectedness,? the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving. Conclusions: The Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 UR - http://pediatrics.jmir.org/2019/2/e13023/ UR - http://dx.doi.org/10.2196/13023 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750834 ID - info:doi/10.2196/13023 ER - TY - JOUR AU - Moon, Y. Rachel AU - Mathews, Anita AU - Oden, Rosalind AU - Carlin, Rebecca PY - 2019/07/09 TI - Mothers? Perceptions of the Internet and Social Media as Sources of Parenting and Health Information: Qualitative Study JO - J Med Internet Res SP - e14289 VL - 21 IS - 7 KW - internet KW - parenting KW - social media KW - focus groups N2 - Background: Traditionally, guidance and support to new parents have come from family, friends, and health care providers. However, the internet and social media are growing sources of guidance and support for parents. Little is known about how the internet and social media are used by parents of young infants and specifically about parental perceptions of the internet and social media as sources of parenting and infant health information. Objective: The aim of this study was to explore, using qualitative methods, parental perceptions of the advantages and disadvantages of the internet and social media as sources of parenting and health information regarding their infant. Methods: A total of 28 mothers participated in focus groups or individual interviews. Probing questions concerning parenting and health information sources were asked. Themes were developed in an iterative manner from coded data. Results: The central themes were (1) reasons that mothers turn to the internet for parenting and health information, (2) cautionary advice about the internet, and (3) reasons that mothers turn to social media for parenting and health information. Mothers appreciated the ability to gather unlimited information and multiple opinions quickly and anonymously, but recognized the need to use reputable sources of information. Mothers also appreciated the immediacy of affirmation, support, and tailored information available through social media. Conclusions: The internet and social media are rapidly becoming important and trusted sources of parenting and health information that mothers turn to when making infant care decisions. UR - https://www.jmir.org/2019/7/e14289/ UR - http://dx.doi.org/10.2196/14289 UR - http://www.ncbi.nlm.nih.gov/pubmed/31290403 ID - info:doi/10.2196/14289 ER - TY - JOUR AU - Ponum, Mahvish AU - Hasan, Osman AU - Khan, Saadia PY - 2019/05/14 TI - EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases JO - Interact J Med Res SP - e12664 VL - 8 IS - 2 KW - infectious diseases KW - mHealth KW - causes of death N2 - Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. UR - http://www.i-jmr.org/2019/2/e12664/ UR - http://dx.doi.org/10.2196/12664 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094329 ID - info:doi/10.2196/12664 ER - TY - JOUR AU - De Roo, Monica AU - Wong, Gina AU - Rempel, R. Gwen AU - Fraser, N. Shawn PY - 2019/05/09 TI - Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire JO - JMIR Pediatr Parent SP - e11561 VL - 2 IS - 1 KW - mentalization KW - parent reflective functioning KW - questionnaire design KW - parenting N2 - Background: Parental reflective functioning (PRF) is the capacity parents have to understand their own mental states and those of their children, as well as the influence of those mental states on behavior. Parents with greater capacity for PRF are more likely to foster secure attachment with their children. The Parental Development Interview is a gold standard measure of PRF but is hampered by cost, training, and length of administration. The 18-item Parent Reflective Functioning Questionnaire (PRFQ-18) is a simpler option developed to capture 3 types of PRF: (1) prementalizing, (2) parent?s certainty, and (3) interest and curiosity surrounding a child?s mental state. Objective: The aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents. Methods: We examined the factor structure and discriminant and construct validity of the PRFQ-18 among 306 parents (males=120 and females=186) across Canada; the age range of children was 0 to 12 years. Parents also completed Web-based measures of perceived stress, parental coping, parenting competence, and social support. Results: A confirmatory factor analysis confirmed the hypothesized 3-factor structure of the PRFQ-18 providing evidence that the PRFQ-18 may be a useful and practical measure of PRF in Canadian adults and showed minor revisions may improve the suitability of the PRFQ-18 for assessing PRF. Conclusions: These results add support for the construct validity of the PRFQ-18. UR - http://pediatrics.jmir.org/2019/1/e11561/ UR - http://dx.doi.org/10.2196/11561 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518301 ID - info:doi/10.2196/11561 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 -