TY - JOUR AU - Seiterö, Anna AU - Henriksson, Pontus AU - Thomas, Kristin AU - Henriksson, Hanna AU - Löf, Marie AU - Bendtsen, Marcus AU - Müssener, Ulrika PY - 2025/4/22 TI - Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial JO - J Med Internet Res SP - e69425 VL - 27 KW - mHealth KW - multiple behavior KW - high school students KW - digital behavior change intervention KW - public health KW - telemedicine KW - randomized controlled trial N2 - Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ?4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI ?0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 UR - https://www.jmir.org/2025/1/e69425 UR - http://dx.doi.org/10.2196/69425 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69425 ER - TY - JOUR AU - Meyer, Eric AU - Sauzéon, Hélène AU - Saint-Supery, Isabeau AU - Mazon, Cecile PY - 2025/4/17 TI - Evaluating a Web-Based Application to Facilitate Family-School-Health Care Collaboration for Children With Neurodevelopmental Disorders in Inclusive Settings: Protocol for a Nonrandomized Trial JO - JMIR Res Protoc SP - e63378 VL - 14 KW - neurodevelopmental disorders KW - coeducation KW - whole-school approach KW - family-professional partnership KW - web application KW - inclusive education KW - family-school-health care N2 - Background: An individual education plan (IEP) is a key element in the support of the schooling of children with special educational needs or disabilities. The IEP process requires effective communication and strong partnership between families, school staff, and health care practitioners. However, these stakeholders often report their collaboration as limited and difficult to maintain, leading to difficulties in implementing and monitoring the child?s IEP. Objective: This paper aims to describe the study protocol used to evaluate a technological tool (CoEd application) aiming at fostering communication and collaboration between family, school, and health care in the context of inclusive education. Methods: This protocol describes a longitudinal, nonrandomized controlled trial, with baseline, 3 month, and 6-month follow-up assessments. The intervention consisted of using the web-based CoEd application for 3 months to 6 months. This application is composed of a child?s file in which stakeholders of the support team can share information about the child?s profile, skills, aids and adaptations, and daily events. The control group is asked to function as usual to support the child in inclusive settings. To be eligible, a support team must be composed of at least two stakeholders, including at least one of the parents. Additionally, the pupil had to be aged between 10 years and 16 years, enrolled in secondary school, be taught in mainstream settings, and have an established or ongoing diagnosis of autism spectrum disorder, attention-deficit/hyperactivity disorder, or intellectual disability (IQ<70). Primary outcome measures cover stakeholders? relationships, self-efficacy, and attitudes toward inclusive education, while secondary outcome measures are related to stakeholders? burden and quality of life, as well as children?s school well-being and quality of life. We plan to analyze data using ANCOVA to investigate pre-post and group effects, with a technological skills questionnaire as the covariate. Results: After screening for eligibility, 157 participants were recruited in 37 support teams, composed of at least one parent and one professional (school, health care). In September 2023, after the baseline assessment, the remaining 127 participants were allocated to the CoEd intervention (13 teams; n=82) or control condition (11 teams; n=45). Conclusions: We expect that the CoEd application will improve the quality of interpersonal relationships in children?s IEP teams (research question [RQ]1), will show benefits for the child (RQ2), and improve the well-being of the child and the stakeholders (RQ3). Thanks to the participatory design, we also expect that the CoEd application will elicit a good user experience (RQ4). The results from this study could have several implications for educational technology research, as it is the first to investigate the impacts of a technological tool on co-educational processes. International Registered Report Identifier (IRRID): DERR1-10.2196/63378 UR - https://www.researchprotocols.org/2025/1/e63378 UR - http://dx.doi.org/10.2196/63378 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63378 ER - TY - JOUR AU - Wang, Naibo AU - Wang, Chen AU - Zhang, Puhong AU - Li, Yinghua AU - He, J. Feng AU - Li, Li AU - Li, Yuan AU - Luo, Rong AU - Wan, Dezhi AU - Xu, Lewei AU - Deng, Lifang AU - Wu, Lei PY - 2025/3/27 TI - Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up JO - J Med Internet Res SP - e60092 VL - 27 KW - school-based health education KW - EduSaltS KW - mobile health KW - salt reduction KW - cluster randomized trial N2 - Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)? and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention?s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren?s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were ?0.24 g/day (95% CI ?0.82 to 0.33), ?0.68 mm Hg (95% CI ?2.32 to 0.95), and ?1.37 mm Hg (95% CI ?2.79 to 0.06), respectively. For adults, the intervention group?s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were ?1.06 g/day (95% CI ?1.81 to ?0.30), ?2.26 mm Hg (95% CI ?4.26 to ?0.26), and ?2.33 mm Hg (95% CI ?3.84 to ?0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 UR - https://www.jmir.org/2025/1/e60092 UR - http://dx.doi.org/10.2196/60092 UR - http://www.ncbi.nlm.nih.gov/pubmed/40017342 ID - info:doi/10.2196/60092 ER - TY - JOUR AU - March, A. Christine AU - Naame, Elissa AU - Libman, Ingrid AU - Proulx, N. Chelsea AU - Siminerio, Linda AU - Miller, Elizabeth AU - Lyon, R. Aaron PY - 2025/3/26 TI - School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners JO - JMIR Diabetes SP - e64096 VL - 10 KW - type 1 diabetes KW - user-centered design KW - school health KW - collaborative care model KW - implementation research KW - pediatric KW - usability testing KW - virtual intervention KW - multisystem community partners KW - children KW - youth KW - diabetes management support KW - health system partners KW - psychosocial interventions KW - quantitative assessments KW - qualitative assessments N2 - Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation. Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams. Methods: We recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA. Results: In the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10%-60% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue (?=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings. Conclusions: Cross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing. UR - https://diabetes.jmir.org/2025/1/e64096 UR - http://dx.doi.org/10.2196/64096 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64096 ER - TY - JOUR AU - Dolón-Poza, María AU - Gabaldón-Pérez, Ana-Marta AU - Berrezueta-Guzman, Santiago AU - López Gracia, David AU - Martín-Ruiz, María-Luisa AU - Pau De La Cruz, Iván PY - 2025/3/14 TI - Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform JO - JMIR Hum Factors SP - e60424 VL - 12 KW - developmental language disorder KW - simple language delay KW - adaptive screening system KW - early childhood education KW - pervasive therapy N2 - Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform?s utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 UR - https://humanfactors.jmir.org/2025/1/e60424 UR - http://dx.doi.org/10.2196/60424 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60424 ER - TY - JOUR AU - Prochnow, Tyler AU - Dunton, F. Genevieve AU - de la Haye, Kayla AU - Pollack Porter, M. Keshia AU - Lee, Chanam PY - 2025/2/21 TI - Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e68667 VL - 14 KW - physical activity KW - youth KW - social environment KW - built environment KW - ecological momentary assessment KW - social network analysis KW - phenotypes KW - accelerometry KW - GPS N2 - Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study?s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 UR - https://www.researchprotocols.org/2025/1/e68667 UR - http://dx.doi.org/10.2196/68667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68667 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Peralta, Claudia AU - Peck, Matt AU - Reilly, Blaine AU - Buller, K. Mary PY - 2025/2/21 TI - Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study JO - JMIR Hum Factors SP - e67962 VL - 12 KW - technology-based bullying intervention KW - STAC-T KW - usability testing KW - middle school KW - rural N2 - Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. UR - https://humanfactors.jmir.org/2025/1/e67962 UR - http://dx.doi.org/10.2196/67962 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67962 ER - TY - JOUR AU - Dassaye, Reshmi AU - Chetty, Terusha AU - Daniels, Brodie AU - Gaffoor, Zakir AU - Spooner, Elizabeth AU - Ramraj, Trisha AU - Mthethwa, Ncengani AU - Nsibande, Faith Duduzile AU - Pillay, Saresha AU - Bhana, Arvin AU - Magasana, Vuyolwethu AU - Reddy, Tarylee AU - Mohlabi, Khanya AU - Moore, Linda Penelope AU - Burgers, A. Wendy AU - de Oliveira, Tulio AU - Msomi, Nokukhanya AU - Goga, Ameena PY - 2024/12/19 TI - SARS-CoV-2 Infections in a Triad of Primary School Learners (Grades 1-7), Their Parents, and Teachers in KwaZulu-Natal, South Africa: Protocol for a Cross-Sectional and Nested Case-Cohort Study JO - JMIR Res Protoc SP - e52713 VL - 13 KW - COVID-19 KW - SARS-CoV-2 KW - learners KW - seroprevalence KW - long COVID KW - transmission dynamics N2 - Background: In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics. Objective: This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings. Methods: Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques. Results: A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024. Conclusions: This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers. International Registered Report Identifier (IRRID): DERR1-10.2196/52713 UR - https://www.researchprotocols.org/2024/1/e52713 UR - http://dx.doi.org/10.2196/52713 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52713 ER - TY - JOUR AU - Bunnell, E. Brian AU - Schuler, R. Kaitlyn AU - Ivanova, Julia AU - Flynn, Lea AU - Barrera, F. Janelle AU - Niazi, Jasmine AU - Turner, Dylan AU - Welch, M. Brandon PY - 2024/12/12 TI - Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study JO - JMIR Hum Factors SP - e56567 VL - 11 KW - mental health KW - mental illness KW - mental disease KW - mental disorder KW - homework KW - homework challenge KW - therapy KW - therapist KW - barriers KW - adult client KW - adult KW - technology-based solution KW - health technology KW - digital health KW - digital technology KW - digital intervention KW - mobile phone N2 - Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act?compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. UR - https://humanfactors.jmir.org/2024/1/e56567 UR - http://dx.doi.org/10.2196/56567 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56567 ER - TY - JOUR AU - Gerchow, Lauren AU - Lanier, Yzette AU - Fayard, Anne-Laure AU - Squires, Allison PY - 2024/11/19 TI - Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City JO - JMIR Pediatr Parent SP - e60692 VL - 7 KW - adolescent KW - reproductive health KW - sexual health KW - cocreation KW - co-design KW - human-centered design N2 - Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. UR - https://pediatrics.jmir.org/2024/1/e60692 UR - http://dx.doi.org/10.2196/60692 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60692 ER - TY - JOUR AU - Basilico, Sara AU - Conti, Vittoria Maria AU - Ardoino, Ilaria AU - Breda, Chiara AU - Loperfido, Federica AU - Klaic, Elena AU - Spialtini, Linda AU - Foresta, Andreana AU - Orsini, Francesca AU - Ojeda Fernandez, Luisa Maria AU - Conca Bonizzoni, Stefano AU - Modena, Elisabetta AU - Tootoonchi Hamedani, Yasamin AU - Villa, Federica AU - Cena, Hellas AU - Baviera, Marta AU - Franchi, Carlotta PY - 2024/10/30 TI - Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle (LIVELY) for Childhood Obesity Prevention: Study Protocol JO - JMIR Res Protoc SP - e57509 VL - 13 KW - childhood obesity KW - school education KW - family education KW - healthy lifestyle KW - sustainability KW - primary prevention KW - nutritional intervention KW - physical activity KW - community engagement KW - lifestyle habits KW - socio-economic status KW - LIVELY study N2 - Background: Childhood obesity has become a significant public health concern over the past 2 decades, posing multifactorial challenges, including modifiable factors like dietary habits, physical activity, screen time, and sleeping habits. Prevention efforts require a comprehensive approach comprising educational interventions, collaboration among multidisciplinary teams, and community engagement. Since schools play a central role in children's lives, they are the ideal setting for promoting healthy habits. Objective: The LIVELY (Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle) study will assess the prevalence of overweight and obesity in primary school children and identify contributing factors within families. Additionally, it aims to implement and evaluate a multidimensional, multidisciplinary intervention to foster a sustainable and healthy lifestyle, ultimately working toward preventing obesity in school-aged children. Methods: During the school year, each class will be individually involved in a multidimensional educational intervention covering the topics of healthy, sustainable nutrition and lifestyle. Children will also participate in a multimedia lab where they will create an animated cartoon. The lectures will engage them through various methods, including direct instructions, games, and drawing activities, to stimulate and enhance their learning and involvement. Results: Data collection began in October 2023 and will last until the end of October 2024. A sample of 227 children from 14 classes was included in the study. The mean age was 8.9 (SD 1.2) years, and 48% (n=110) were males. Among the overall sample, 18.1% (n=41; 95% CI 13.7%-23.7%) were overweight, while 5.3% (n=12; 95% CI 3%-9%) had obesity. Males had a higher prevalence of obesity than females (9.1%, n=10 vs 1.7%, n=3, P=.03, respectively). Otherwise, the prevalence of central obesity was similar between the two (P=.329). Data analysis and the presentation of the complete results will be available after the end of 2024. Conclusions: The study could lead to the structuring of an educational intervention model in school settings aimed at preventing childhood obesity. Moreover, it could help raise awareness of childhood obesity and help prevent this public health issue. Trial Registration: ClinicalTrials.gov NCT05966051; https://clinicaltrials.gov/study/NCT05966051 International Registered Report Identifier (IRRID): DERR1-10.2196/57509 UR - https://www.researchprotocols.org/2024/1/e57509 UR - http://dx.doi.org/10.2196/57509 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57509 ER - TY - JOUR AU - Kvestad, Ingrid AU - Adolfsen, Frode AU - Angeles, Corinne Renira AU - Brandseth, Lekve Oda AU - Breivik, Kyrre AU - Evertsen, Grete Janne AU - Foer, Kvåle Irene AU - Haaland, Morten AU - Homola, Millerjord Birgit AU - Hoseth, Elisabeth Gro AU - Jonsson, Josefine AU - Kjerstad, Egil AU - Kyrrestad, Henriette AU - Martinussen, Monica AU - Moberg, Annelene AU - Moberg, Karianne AU - Skogstrand, Anita AU - Solberg, Remme Line AU - Aasheim, Merete PY - 2024/10/24 TI - Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e60626 VL - 13 KW - peer bullying in early childhood education and care KW - The Bernese Program KW - cluster randomized controlled trial KW - bullying KW - child KW - preschool KW - program evaluation N2 - Background: A new and growing body of research has studied bullying among children in early childhood education and care centers (ECECs). The Bernese Program (Be-Prox) is designed to systematically prevent and handle bullying between children in Swiss ECECs. However, the effectiveness of the Be-Prox intervention has not yet been explored in a Norwegian ECEC setting. Objective: This study aims to evaluate the effectiveness of Be-Prox in preventing and handling bullying among peers in Norwegian ECECs. Methods: ECECs from 2 Norwegian municipalities were invited to participate in a cluster randomized controlled trial (RCT) to evaluate the effectiveness of the Be-Prox intervention on peer bullying in Norwegian ECECs. After baseline measures were taken, project ECECs were randomized to either an intervention or a control arm. The Be-Prox intervention was introduced to ECECs in the intervention arm through 6 modules over a 9-month period immediately after the randomization. ECECs in the control arm participated in the data collection and were offered the Be-Prox intervention the following year. The primary outcome of the effect evaluation is the mean sum of negative behavior between peers after the Be-Prox training is completed in the intervention arm. Secondary outcomes include child bystander behavior, teacher self-efficacy, and ECEC?s authoritative climate. An extensive implementation and process evaluation, as well as cost-effectiveness analyses, will be conducted alongside the RCT. Results: Baseline data collection was conducted in September 2023, and the postintervention data collection started in May 2024. At baseline, we collected data on 708 children and 413 personnel from 38 project ECECs in the 2 Norwegian municipalities. The results from the study will be available in late 2024 at the earliest. Conclusions: The proposed project includes a comprehensive evaluation of the effectiveness of Be-Prox in Norwegian ECECs directly targeting the prevention and handling of bullying, including implementation and cost-effectiveness evaluations. The results from the project have the potential to fill in identified knowledge gaps in the understanding of negative behavior and bullying between peers in ECECs, and how these may be prevented. If proven efficient, our ambition is to offer Be-Prox to Norwegian ECECs as an evidence-based practice to prevent and handle bullying among preschool children. Trial Registration: ClinicalTrials.gov NCT06040437; https://clinicaltrials.gov/study/NCT06040437 International Registered Report Identifier (IRRID): DERR1-10.2196/60626 UR - https://www.researchprotocols.org/2024/1/e60626 UR - http://dx.doi.org/10.2196/60626 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60626 ER - TY - JOUR AU - Iyer, Priya AU - Iyer, Lina AU - Carter, Nicole AU - Iyer, Ranjani AU - Stirling, Amy AU - Priya, Lakshmi AU - Sriraman, Ushma PY - 2024/9/30 TI - Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study JO - JMIR Form Res SP - e56355 VL - 8 KW - Heartfulness, anxiety, loneliness, high school, satisfaction with life KW - self-care KW - develop KW - stress KW - stress management KW - effectiveness KW - life satisfaction KW - students KW - student KW - support KW - web-based program KW - time management KW - educational KW - mental health KW - tool KW - tools N2 - Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder?Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 UR - https://formative.jmir.org/2024/1/e56355 UR - http://dx.doi.org/10.2196/56355 UR - http://www.ncbi.nlm.nih.gov/pubmed/39047180 ID - info:doi/10.2196/56355 ER - TY - JOUR AU - Dolling-Boreham, M. Roberta AU - Mohan, Akshay AU - Abdelhack, Mohamed AU - Elton-Marshall, Tara AU - Hamilton, A. Hayley AU - Boak, Angela AU - Felsky, Daniel PY - 2024/9/12 TI - Identifying Psychosocial and Ecological Determinants of Enthusiasm In Youth: Integrative Cross-Sectional Analysis Using Machine Learning JO - JMIR Public Health Surveill SP - e48705 VL - 10 KW - subjective well-being KW - Ontario Student Drug Use and Health Survey (OSDUHS) KW - machine learning KW - Shapley additive explanations (SHAP) KW - extreme gradient boosting (XGBoost) KW - psychosocial KW - ecological KW - determinants KW - enthusiasm KW - mental health KW - well-being KW - youth KW - public health KW - student KW - self-reported N2 - Background: Understanding the factors contributing to mental well-being in youth is a public health priority. Self-reported enthusiasm for the future may be a useful indicator of well-being and has been shown to forecast social and educational success. Typically, cross-domain measures of ecological and health-related factors with relevance to public policy and programming are analyzed either in isolation or in targeted models assessing bivariate interactions. Here, we capitalize on a large provincial data set and machine learning to identify the sociodemographic, experiential, behavioral, and other health-related factors most strongly associated with levels of subjective enthusiasm for the future in a large sample of elementary and secondary school students. Objective: The aim of this study was to identify the sociodemographic, experiential, behavioral, and other health-related factors associated with enthusiasm for the future in elementary and secondary school students using machine learning. Methods: We analyzed data from 13,661 participants in the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (grades 7-12) with complete data for our primary outcome: self-reported levels of enthusiasm for the future. We used 50 variables as model predictors, including demographics, perception of school experience (i.e., school connectedness and academic performance), physical activity and quantity of sleep, substance use, and physical and mental health indicators. Models were built using a nonlinear decision tree?based machine learning algorithm called extreme gradient boosting to classify students as indicating either high or low levels of enthusiasm. Shapley additive explanations (SHAP) values were used to interpret the generated models, providing a ranking of feature importance and revealing any nonlinear or interactive effects of the input variables. Results: The top 3 contributors to higher self-rated enthusiasm for the future were higher self-rated physical health (SHAP value=0.62), feeling that one is able to discuss problems or feelings with their parents (SHAP value=0.49), and school belonging (SHAP value=0.32). Additionally, subjective social status at school was a top feature and showed nonlinear effects, with benefits to predicted enthusiasm present in the mid-to-high range of values. Conclusions: Using machine learning, we identified key factors related to self-reported enthusiasm for the future in a large sample of young students: perceived physical health, subjective school social status and connectedness, and quality of relationship with parents. A focus on perceptions of physical health and school connectedness should be considered central to improving the well-being of youth at the population level. UR - https://publichealth.jmir.org/2024/1/e48705 UR - http://dx.doi.org/10.2196/48705 UR - http://www.ncbi.nlm.nih.gov/pubmed/39264706 ID - info:doi/10.2196/48705 ER - TY - JOUR AU - Jeffery, C. Mairi AU - Deighton, Jessica AU - Lereya, Tanya Suzet PY - 2024/9/9 TI - Establishing Priorities for Improving Data Collection and Measurement of Mental Health and Well-Being of Adolescents With Special Educational Needs Within Nonmainstream Schools: Protocol for a Delphi Study JO - JMIR Res Protoc SP - e58610 VL - 13 KW - special educational needs KW - special schools KW - alternative provision KW - mental health KW - well-being KW - school-based measurement N2 - Background: There are more than 1.5 million children and young people in England with special educational needs (SEN), with over 160,000 young people in the United Kingdom attending a special school or alternative provision (AP) setting. Young people with SEN have been found to be at risk for poorer mental health and well-being than non-SEN peers. However, there is a range of both school-related and research challenges associated with identifying difficulties in a timely manner. Objective: This Delphi study aims to determine a list of stakeholder priorities for improving school-based measurement of mental health and well-being among young people with SEN, at an aggregated level, within secondary special school or AP settings. A secondary objective is to inform the implementation of school-based well-being surveys, improve engagement in special schools or AP settings, and improve survey response rates among children and young people with SEN. Methods: A mixed methods Delphi study will be conducted, including a scoping review and preliminary focus groups with school staff members and researchers to establish key issues. This will be followed by a 2-round Delphi survey to determine a list of stakeholder priorities for improving the measurement of mental health and well-being at an aggregate level within special schools and AP settings. A final stakeholder workshop will be held to discuss the findings. A list of recommendations will be drafted as a report for special schools and AP settings. Results: The study has received ethical approval from the University College London Research Ethics Committee. The stage 1 scoping review has commenced. Recruitment for focus groups will begin in Autumn 2024. The first round of the Delphi survey will commence in early 2025, and the second round of the Delphi survey in the spring of 2025. The final workshop will commence in mid-2025 with final results expected in late 2025. Conclusions: There is a need for clear recommendations for special schools and AP settings on priorities for improving the measurement of mental health and well-being problems among young people with SEN. There is also a need for recommendations to researchers implementing school-based well-being surveys, including the #BeeWell program, to enable them to improve their engagement in special schools and AP settings and ensure surveys are accessible. International Registered Report Identifier (IRRID): PRR1-10.2196/58610 UR - https://www.researchprotocols.org/2024/1/e58610 UR - http://dx.doi.org/10.2196/58610 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250211 ID - info:doi/10.2196/58610 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 - Rulison, Kelly AU - Weaver, GracieLee AU - Milroy, Jeffrey AU - Beamon, Emily AU - Kelly, Samantha AU - Ameeni, Ali AU - Juma, Amina AU - Abualgasim, Fadhel AU - Husain, Jaafar AU - Wyrick, David PY - 2024/7/17 TI - Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research JO - JMIR Form Res SP - e58322 VL - 8 KW - Antiextremism KW - peaceful coexistence KW - intervention KW - evaluation KW - international KW - multiphase optimization strategy KW - preparation phase KW - extremism KW - extremist KW - peace KW - peaceful KW - resistance KW - violent KW - violence KW - radical KW - radicalism KW - Bahrain KW - education KW - educational KW - school KW - schools KW - student KW - students KW - drug KW - drugs KW - abuse KW - substance N2 - Background: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. Objective: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. Methods: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. Results: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). Conclusions: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons. UR - https://formative.jmir.org/2024/1/e58322 UR - http://dx.doi.org/10.2196/58322 UR - http://www.ncbi.nlm.nih.gov/pubmed/39018090 ID - info:doi/10.2196/58322 ER - @Article{info:doi/10.2196/53072, author="Goncalves, Aurelie and Lespiau, Florence and Briet, Ga{\"e}tan and Vaillant-Coindard, Eug{\'e}nie and Palermo, Ang{\`e}le and Decobert, Elsa and Allegret-Bourdon, Nathan and Charbonnier, Elodie", title="Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study", journal="JMIR Serious Games", year="2024", month="Feb", day="23", volume="12", pages="e53072", keywords="learning support", keywords="exergaming", keywords="physics playground", keywords="educational games", keywords="primary school", keywords="children", abstract="Background: There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children's interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant. Objective: The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration). Methods: This interventional study had a pre-post design and used the Play L{\"U} exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play L{\"U} requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play L{\"U} and a motor skills circuit behind the L{\"U} setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Gr{\"o}{\"o}ve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Ga{\"i}a application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills. Results: The implementation of this exergaming program was welcomed by the school's administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6\%; W=933.0; P=.002; rrb=?0.39, 95\% CI ?0.58 to ?0.16) and motivation in mathematics (+0.7, +9.8\%; W=381.5; P=.005; rrb=?0.44, 95\% CI ?0.66 to ?0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups. Conclusions: The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children. ", doi="10.2196/53072", url="https://games.jmir.org/2024/1/e53072", url="http://www.ncbi.nlm.nih.gov/pubmed/38393767" } TY - JOUR AU - Burke, Colin AU - Triplett, Cynthia AU - Rubanovich, Kseniya Caryn AU - Karnaze, M. Melissa AU - Bloss, S. Cinnamon PY - 2024/2/6 TI - Attitudes Toward School-Based Surveillance of Adolescents? Social Media Activity: Convergent Parallel Mixed Methods Survey JO - JMIR Form Res SP - e46746 VL - 8 KW - social media KW - surveillance KW - privacy KW - public health KW - students KW - schools KW - social media monitoring KW - SMM KW - school safety KW - mental health KW - adolescents N2 - Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults? overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. UR - https://formative.jmir.org/2024/1/e46746 UR - http://dx.doi.org/10.2196/46746 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319696 ID - info:doi/10.2196/46746 ER - TY - JOUR AU - Zhang, Xiaojuan AU - Wen, Justin Yingkun AU - Han, Ning AU - Jiang, Yawen PY - 2024/1/29 TI - The Effect of a Video-Assisted Health Education Program Followed by Peer Education on the Health Literacy of COVID-19 and Other Infectious Diseases Among School Children: Quasi-Randomized Controlled Trial JO - JMIR Hum Factors SP - e43943 VL - 11 KW - infectious diseases KW - primary school students KW - quasi-randomized controlled trial KW - video-assisted health education KW - peer education KW - item response theory KW - IRT N2 - Background: To improve the engagement and effectiveness of traditional health programs, it is necessary to explore alternative models of health education including video-assisted lectures and peer education. Objective: This study aimed to evaluate the effects of a combination of video-assisted lectures and peer education on health literacy related to infectious diseases among students. Methods: Third-grade classes from 11 pilot schools in Longgang District of Shenzhen, China, were randomized to the intervention and control groups. In the intervention group, a video-assisted interactive health education program was conducted twice over a time span of 5 months. Each of the 2 sessions included a 40-minute lecture on COVID-19 and other common infectious diseases in schools and a 5-minute science video. In addition, 5 ?little health supervisors? at the end of the first session were elected in each class, who were responsible for helping class members to learn health knowledge and develop good hygiene habits. Students answered the same quiz before the first and after the second session. Models based on item response theory (IRT) were constructed to score the students? knowledge of infectious diseases based on the quiz. Results: In total, 52 classes and 2526 students (intervention group: n=1311; control group: n=1215) were enrolled. Responses of the baseline survey were available for 2177 (86.2%; intervention group: n=1306; control group: n=871) students and those of the postintervention survey were available for 1862 (73.7%; intervention group: n=1187; control group: n=675). There were significant cross-group differences in the rates of correctly answering questions about influenza symptoms, transmission, and preventive measures; chicken pox symptoms; norovirus diarrhea symptoms; mumps symptoms; and COVID-19 symptoms. Average IRT scores of questions related to infectious diseases in the intervention and control groups were, respectively, ?0.0375 (SD 0.7784) and 0.0477 (SD 0.7481) before the intervention (P=.01), suggesting better baseline knowledge in the control group. After the intervention, the average scores of the intervention and control groups were 0.0543 (SD 0.7569) and ?0.1115 (SD 0.7307), respectively (P<.001), suggesting not only significantly better scores but also greater improvement in the intervention group. Conclusions: After the health education project, the correct answer rate of infectious disease questions in the intervention group was higher than that of the control group, which indicates significant effects of the combination of video-assisted lectures and peer education for the promotion of health literacy. In addition, the intervention effect of the first session persisted for at least 4 months up to the second session. As such, the proposed program was effective in improving the health literacy of school children in relation to infectious diseases and should be considered for massive health promotion campaigns during pandemics. Trial Registration: ISRCTN ISRCTN49297995; https://www.isrctn.com/ISRCTN49297995 UR - https://humanfactors.jmir.org/2024/1/e43943 UR - http://dx.doi.org/10.2196/43943 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285496 ID - info:doi/10.2196/43943 ER - TY - JOUR AU - Xu, Yi AU - Yang, Hongshen AU - Jin, Zhou AU - Xiang, Jian AU - Xu, Haiyun AU - Pokay, Huang Yili AU - Mao, Haibo AU - Cai, Xugong AU - Wu, Yili AU - Wang, Baofeng Deborah PY - 2023/10/26 TI - Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation JO - JMIR Form Res SP - e46494 VL - 7 KW - adolescents KW - digital mental health clinic KW - emotional distress KW - mental health service KW - secondary school N2 - Background: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. Objective: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. Methods: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. Results: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. Conclusions: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended. UR - https://formative.jmir.org/2023/1/e46494 UR - http://dx.doi.org/10.2196/46494 UR - http://www.ncbi.nlm.nih.gov/pubmed/37883144 ID - info:doi/10.2196/46494 ER - TY - JOUR AU - Hermsen, Sander AU - Van Abswoude, Femke AU - Steenbergen, Bert PY - 2023/10/5 TI - The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study JO - JMIR Form Res SP - e46350 VL - 7 KW - active living KW - adolescents KW - physical activity KW - digital health KW - mobile phone N2 - Background: Participation in organized sports and other forms of active living have important health benefits in adolescence and adulthood. Unfortunately, the transition to secondary school has been shown to be a barrier to participation. Social networks can play important roles in activating adolescents, and information and communication technology (ICT) interventions can augment this role. To date, there are few insights into what adolescents themselves think and feel about barriers to and motivators for active living, the role of their social networks in active living, and the potential of ICT for physical activity (PA). Objective: This study aimed to gather insights into the perspectives of adolescents aged 12 to 14 years on active living and sports participation, motivators and demotivators for active living, and the potential roles of their social network and of ICT. Methods: A total of 26 adolescents aged 12 to 14 years from different levels of Dutch secondary schools participated in 1 of 5 semistructured focus group interviews, in which they talked about sports and PA, their social networks, their ICT use, and the role of social networks and ICT in PA. All interviews were transcribed and analyzed using a thematic qualitative approach. Results: The study showed that all participants were physically active, although the transition to secondary school made this difficult, mostly because of time constraints. Participants saw positive physical and mental health effects as important benefits of active living. They regarded social benefits as strong motivators for active living: being together, making friends, and having fun together. However, the social network could also demotivate through negative peer judgment and negative feedback. Participants were willing to share their own positive experiences and hear about those from close peers and friends but would not share their own (and were not interested in others?) negative experiences or personal information. Participants were mainly interested in descriptive norms set by others and obtained inspiration from others for PA. With respect to using ICT for active living, participants stated a preference for social challenges among friends, personalized feedback, goals, activities, and rewards. Competition was seen as less important or even unattractive. If mentioned, participants felt that this should be with friends, or peers of a similar level, with fun being more important than the competition itself. Conclusions: This study shows that adolescents feel that their social network is and can be a strong driver of active living. They are willing to use ICT-based solutions that make use of social networks for PA as long as these solutions involve their current (close) network and use an approach based on being together and having fun together. UR - https://formative.jmir.org/2023/1/e46350 UR - http://dx.doi.org/10.2196/46350 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796582 ID - info:doi/10.2196/46350 ER - TY - JOUR AU - Gómez-Restrepo, Carlos AU - Sarmiento-Suárez, José María AU - Alba-Saavedra, Magda AU - Calvo-Valderrama, Gabriela Maria AU - Rincón-Rodríguez, Javier Carlos AU - Bird, Jane Victoria AU - Priebe, Stefan AU - van Loggerenberg, Francois PY - 2023/10/4 TI - Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post?Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial JO - JMIR Form Res SP - e46757 VL - 7 KW - mental health KW - digital intervention KW - psychosocial intervention KW - armed conflict KW - adolescents KW - school KW - DIALOG+ KW - DIALOG+S KW - mobile phone N2 - Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post?armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 UR - https://formative.jmir.org/2023/1/e46757 UR - http://dx.doi.org/10.2196/46757 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792465 ID - info:doi/10.2196/46757 ER - TY - JOUR AU - Kegelaers, Jolan AU - Baetens, Imke AU - Soyez, Veerle AU - Van Heel, Martijn AU - Van Hove, Lisa AU - Wylleman, Paul PY - 2023/8/18 TI - Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project JO - JMIR Res Protoc SP - e49670 VL - 12 KW - children KW - physical activity KW - psychological symptoms KW - sport KW - well-being KW - youth N2 - Background: Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people?s specific needs, challenges, and motivations when designing novel mental health promotion interventions. Objective: The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program. Methods: A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence. Results: Participant recruitment will commence in September 2023. The full project will be completed by March 2027. Conclusions: With this intervention, we aim to provide a direct contribution to the promotion of children and young people?s mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations. International Registered Report Identifier (IRRID): PRR1-10.2196/49670 UR - https://www.researchprotocols.org/2023/1/e49670 UR - http://dx.doi.org/10.2196/49670 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594846 ID - info:doi/10.2196/49670 ER - TY - JOUR AU - Milton, Clare Alyssa AU - Mengesha, Zelalem AU - Ballesteros, Kristin AU - McClean, Tom AU - Hartog, Saskia AU - Bray-Rudkin, Lucie AU - Ngo, Cathy AU - Hickie, Ian PY - 2023/7/25 TI - Supporting Children?s Social Connection and Well-Being in School-Age Care: Mixed Methods Evaluation of the Connect, Promote, and Protect Program JO - JMIR Pediatr Parent SP - e44928 VL - 6 KW - participatory design KW - evaluation KW - children KW - school-age care KW - after-school care KW - health KW - well-being KW - program development KW - community consultation N2 - Background: School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school?age children?s social, emotional, physical, and cognitive well-being. Objective: This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. Methods: A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. Results: The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children?s well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children?s prosocial behaviors increased (mean difference=0.64; P=.04; t57=?2.06, 95% CI ?1.36 to ?0.02) and peer problems decreased (mean difference=?0.69; P=.01; t57=2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. Conclusions: To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them. UR - https://pediatrics.jmir.org/2023/1/e44928 UR - http://dx.doi.org/10.2196/44928 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490323 ID - info:doi/10.2196/44928 ER - TY - JOUR AU - Wray, Bridget AU - Grimes, Amanda AU - Eighmy, Katlyn AU - Lightner, Joseph PY - 2022/11/23 TI - The Relationship Between Social Integration and Physical Activity, Diet, and Sleep Among Youths: Cross-sectional Survey Study JO - JMIR Pediatr Parent SP - e40354 VL - 5 IS - 4 KW - social integration KW - youth KW - nutrition KW - sleep KW - physical activity KW - adults KW - exercise KW - health KW - wellness KW - health behavior KW - school students KW - diet KW - children KW - health behavior intervention N2 - Background: Social integration has been shown to predict physical activity (PA), diet, and sleep in adults. However, these associations have not been well-studied in youth samples. Using a life course perspective, it is imperative to study this in youths as social and health behaviors are established early in life. Objective: The purpose of this study was to understand the relationship between social integration and PA, diet, and sleep for urban, middle-school youth. Methods: Cross-sectional baseline data from middle-school youths (N=73) who participated in an afterschool health behavior intervention were included in this study. Results: Time with friends significantly predicted moderate to vigorous intensity PA (?=.33, P=.02). Time spent with family was significantly related to fruit consumption (t66=1.38, P=.005) and vegetable consumption (t72=1.96, P=.01). Conclusions: Social integration appears to be related to both PA and nutrition behaviors in youths. Future research should expand on our findings to explain how different domains of social integration may impact youths? health behaviors. International Registered Report Identifier (IRRID): RR2-10.2196/37126 UR - https://pediatrics.jmir.org/2022/4/e40354 UR - http://dx.doi.org/10.2196/40354 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416871 ID - info:doi/10.2196/40354 ER - TY - JOUR AU - Kristjansson, L. Alfgeir AU - Santilli, M. Annette AU - Mills, Rosalina AU - Layman, M. Hannah AU - Smith, L. Megan AU - Mann, J. Michael AU - MacKillop, James AU - James, E. Jack AU - Lilly, L. Christa AU - Kogan, M. Steven PY - 2022/8/5 TI - Risk and Resilience Pathways, Community Adversity, Decision-making, and Alcohol Use Among Appalachian Adolescents: Protocol for the Longitudinal Young Mountaineer Health Study Cohort JO - JMIR Res Protoc SP - e40451 VL - 11 IS - 8 KW - adolescence KW - middle school KW - Appalachia KW - caffeine KW - alcohol use KW - Young Mountaineer Health Study KW - prevention N2 - Background: Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use. Objective: The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school?aged youth in resource-poor Appalachian rural communities. Methods: This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. Results: In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes. Conclusions: The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021. International Registered Report Identifier (IRRID): DERR1-10.2196/40451 UR - https://www.researchprotocols.org/2022/8/e40451 UR - http://dx.doi.org/10.2196/40451 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930337 ID - info:doi/10.2196/40451 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Buller, K. Mary PY - 2022/8/3 TI - Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study JO - JMIR Form Res SP - e40022 VL - 6 IS - 8 KW - teacher bullying interventions KW - technology-based bullying intervention KW - STAC KW - middle school N2 - Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers? attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation. UR - https://formative.jmir.org/2022/8/e40022 UR - http://dx.doi.org/10.2196/40022 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921129 ID - info:doi/10.2196/40022 ER - TY - JOUR AU - Tran, Lien Phuong AU - Chirpaz, Emmanuel AU - Boukerrou, Malik AU - Bertolotti, Antoine PY - 2022/6/13 TI - Impact of a Papillomavirus Vaccination Promotion Program in Middle School: Study Protocol for a Cluster Controlled Trial JO - JMIR Res Protoc SP - e35695 VL - 11 IS - 6 KW - HPV vaccine KW - vaccination program KW - middle school KW - school KW - student KW - women's health KW - sexual health KW - cervical cancer KW - vaccination KW - papillomavirus KW - vaccine KW - public education KW - patient education KW - community education KW - promotion KW - program KW - youth KW - children KW - protocol KW - mortality KW - uterine cervical cancer KW - cancer KW - HPV KW - health promotion KW - girls KW - intervention KW - parent KW - training N2 - Background: On Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for human papillomavirus (HPV) vaccination is low. Objective: The main objective of the study is to evaluate the impact of a health promotion program promoting HPV vaccination on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. Methods: This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered containing information to students and parents, training of general practitioners, and free school-based vaccination (in a ?health bus?). Children who attend this program will constitute the intervention group and will be compared to children from another middle school who will not attend the program constituting the control group. Results: Recruitment began in October 2020. In the intervention school, of 780 students, 245 were randomly selected in the 12 classes. In the control school, 259 students out of 834 were randomly selected. Conclusions: In this study, we explore the impact of a health promotion program combining information toward students, parents, and general practitioners with free school-based vaccination. We expect a significantly higher HPV vaccination coverage in the intervention school as compared to the control school, whether it be among girls or boys. The final implication would be an extension of this program in all middle schools on the Island and thus an increase in HPV vaccination coverage. Trial Registration: ClinicalTrials.gov NCT04459221; https://clinicaltrials.gov/ct2/show/NCT04459221 International Registered Report Identifier (IRRID): DERR1-10.2196/35695 UR - https://www.researchprotocols.org/2022/6/e35695 UR - http://dx.doi.org/10.2196/35695 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700023 ID - info:doi/10.2196/35695 ER - TY - JOUR AU - Davidson, Rosemary AU - Randhawa, Gurch PY - 2022/5/20 TI - The Sign 4 Big Feelings Intervention to Improve Early Years Outcomes in Preschool Children: Outcome Evaluation JO - JMIR Pediatr Parent SP - e25086 VL - 5 IS - 2 KW - language development KW - sign language KW - early years outcomes KW - well-being N2 - Background: Any delays in language development may affect learning, profoundly influencing personal, social, and professional trajectories. The effectiveness of the Sign 4 Big Feelings (S4BF) intervention was investigated by measuring changes in early years outcomes (EYOs) after a 3-month period. Objective: This study aims to determine whether children?s well-being and EYOs significantly improve (beyond typical, expected development) after the S4BF intervention period and whether there are differences between boys and girls in progress achieved. Methods: An evaluation of the S4BF intervention was conducted with 111 preschool-age children in early years settings in Luton, United Kingdom. Listening, speaking, understanding, and managing feelings and behavior, in addition to the Leuven well-being scale, were assessed in a quasi-experimental study design to measure pre- and postintervention outcomes. Results: Statistically and clinically significant differences were found for each of the 7 pre- and postmeasures evaluated: words understood and spoken, well-being scores, and the 4 EYO domains. Gender differences were negligible in all analyses. Conclusions: Children of all abilities may benefit considerably from S4BF, but a language-based intervention of this nature may be transformational for children who are behind developmentally, with English as an additional language, or of lower socioeconomic status. Trial Registration: ISRCTN Registry ISRCTN42025531; https://doi.org/10.1186/ISRCTN42025531 UR - https://pediatrics.jmir.org/2022/2/e25086 UR - http://dx.doi.org/10.2196/25086 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594062 ID - info:doi/10.2196/25086 ER - TY - JOUR AU - Zapolski, Tamika AU - Whitener, MacKenzie AU - Khazvand, Shirin AU - Crichlow, Queenisha AU - Revilla, Rebecca AU - Salgado, F. Eduardo AU - Aalsma, Matthew AU - Cyders, Melissa AU - Salyers, Michelle AU - Wu, Wei PY - 2022/5/12 TI - Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e32490 VL - 11 IS - 5 KW - dialectical behavioral therapy KW - adolescents KW - high school KW - intervention KW - teenagers KW - risk-taking behavior KW - impulsivity KW - emotion dysregulation KW - social and emotional learning KW - youth N2 - Background: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school?s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions. International Registered Report Identifier (IRRID): DERR1-10.2196/32490 UR - https://www.researchprotocols.org/2022/5/e32490 UR - http://dx.doi.org/10.2196/32490 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551054 ID - info:doi/10.2196/32490 ER - TY - JOUR AU - Grimes, Amanda AU - Lightner, S. Joseph AU - Eighmy, Katlyn AU - Wray, D. Bridget AU - Valleroy, Ella AU - Baughn, Maya PY - 2022/5/4 TI - Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e37126 VL - 11 IS - 5 KW - intervention protocol KW - physical activity KW - food intake KW - nutrition KW - healthy eating KW - middle schoolers KW - youth KW - school KW - student KW - fitness KW - exercise KW - food consumption KW - diet KW - fruit consumption KW - vegetable consumption N2 - Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 UR - https://www.researchprotocols.org/2022/5/e37126 UR - http://dx.doi.org/10.2196/37126 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507392 ID - info:doi/10.2196/37126 ER - TY - JOUR AU - Ntalindwa, Theoneste AU - Nduwingoma, Mathias AU - Uworwabayeho, Alphonse AU - Nyirahabimana, Pascasie AU - Karangwa, Evariste AU - Rashid Soron, Tanjir AU - Westin, Thomas AU - Karunaratne, Thashmee AU - Hansson, Henrik PY - 2022/4/19 TI - Adapting the Use of Digital Content to Improve the Learning of Numeracy Among Children With Autism Spectrum Disorder in Rwanda: Thematic Content Analysis Study JO - JMIR Serious Games SP - e28276 VL - 10 IS - 2 KW - autism KW - learning KW - ICT KW - e-learning KW - education KW - children KW - ASD KW - teaching KW - teachers KW - communication KW - communication technology KW - online content KW - Rwanda KW - gamification KW - school KW - school-age children KW - behavior N2 - Background: Many teachers consider it challenging to teach children with autism spectrum disorder (ASD) in an inclusive classroom due to their unique needs and challenges. The integration of information communication technology (ICT) in the education system allows children with ASD to improve their learning. However, these ICT tools should meet their needs to lead a productive life. Objective: This study aimed to examine the possibilities of re-creating and adapting digital content to improve the learning of numeracy among children with ASD in inclusive school settings. Methods: We conducted 7 focus group discussions (FGDs) with 56 teachers from 7 schools and 14 parents from April to November 2019. Each of the FGDs took around 1 hour. Two clustered sets of questions were used: (1) general knowledge about teaching children with ASD and (2) analysis of selected online educational video content of early math (specifically, counting numbers). The researchers used video to understand current methodologies used in teaching children with ASD, possibilities of adaptation of the content in the current teaching environment, future challenges when the content is adapted, and possible solutions to overcome those challenges. All data, including audio recordings, field notes, and participants? comments, were transcribed, recorded, and analyzed following the steps recommended in qualitative data analysis. Results: The researchers identified ten themes from the analysis of the data: (1) awareness of the existence of ASD among children in schools and the community, (2) acceptance of children with ASD in an inclusive classroom and the community, (3) methods and models used when teaching children with ASD, (4)realia used to improve the learning of children with ASD, (5) the design of educational digital content, (6) the accessibility of online educational content, (7) quality of the content of the educational multimedia, (8) the opportunity of using the translated and re-created content inside and outside the classroom, (9) the relevance of the digital content in the Rwandan educational system, and (10) enhancement of the accessibility and quality of the digital content. We found that participants assumed that the content translation, gamification, and re-creation would help teach children with ASD. Moreover, they recommended contextualizing the content, increasing access to digital devices, and further research in the education of different subjects. Conclusions: Although many studies have identified the possibilities of using ICT to support children with ASD, few studies have documented the possibilities of integrating the existing technologies tested in the international community. This study is charting new territory to investigate online content to suit the context of schools. This study recommends further exploration of possible methodologies, such as applied behavior analysis or verbal behavior therapy, and the development of contextualized technologies that respond to the educational needs of children with ASD. UR - https://games.jmir.org/2022/2/e28276 UR - http://dx.doi.org/10.2196/28276 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438638 ID - info:doi/10.2196/28276 ER - TY - JOUR AU - Pearson, Nicole AU - Finch, Meghan AU - Sutherland, Rachel AU - Kingsland, Melanie AU - Wolfenden, Luke AU - Wedesweiler, Taya AU - Herrmann, Vanessa AU - Yoong, Lin Sze PY - 2022/3/17 TI - An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children?s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e27760 VL - 24 IS - 3 KW - nutrition KW - mHealth KW - child KW - preschool KW - parents N2 - Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children?s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children?s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children?s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children?s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI ?163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (?1.98 kJ, 95% CI ?343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children?s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 UR - https://www.jmir.org/2022/3/e27760 UR - http://dx.doi.org/10.2196/27760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297768 ID - info:doi/10.2196/27760 ER - TY - JOUR AU - ?orgo, Andrej AU - Crnkovi?, Nu?a AU - Gabrovec, Branko AU - Cesar, Katarina AU - Selak, ?pela PY - 2022/3/15 TI - Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study JO - J Med Internet Res SP - e30778 VL - 24 IS - 3 KW - online study KW - stress KW - COVID-19 KW - postsecondary students KW - pandemic KW - epidemiology KW - educational institutions KW - online education KW - pedagogy KW - mental health N2 - Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students? mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study?related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students? negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. UR - https://www.jmir.org/2022/3/e30778 UR - http://dx.doi.org/10.2196/30778 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171098 ID - info:doi/10.2196/30778 ER - TY - JOUR AU - Abraham, Olufunmilola AU - Szela, Lisa AU - Khan, Mahnoor AU - Geddam, Amrita PY - 2022/1/24 TI - Exploring Middle School Students? Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study JO - JMIR Serious Games SP - e31172 VL - 10 IS - 1 KW - adolescents KW - adolescent education KW - adolescent health KW - older children KW - middle school students KW - cancer awareness KW - cancer education KW - cancer prevention KW - health education KW - serious games N2 - Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students? preferences for the use of SGs for cancer prevention education. The study also characterized the students? perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on ?Cancer, Clear & Simple,? a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants? gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least ?some? gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters? outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. UR - https://games.jmir.org/2022/1/e31172 UR - http://dx.doi.org/10.2196/31172 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643533 ID - info:doi/10.2196/31172 ER - TY - JOUR AU - Burn, Anne-Marie AU - Ford, J. Tamsin AU - Stochl, Jan AU - Jones, B. Peter AU - Perez, Jesus AU - Anderson, K. Joanna PY - 2022/1/10 TI - Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study JO - JMIR Form Res SP - e30565 VL - 6 IS - 1 KW - mental health KW - assessment KW - young people KW - youth KW - schools KW - computerized adaptive testing KW - mobile apps KW - user-centered design KW - coproduction KW - qualitative study N2 - Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles?an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. UR - https://formative.jmir.org/2022/1/e30565 UR - http://dx.doi.org/10.2196/30565 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006079 ID - info:doi/10.2196/30565 ER - TY - JOUR AU - Stapinski, Lexine AU - Routledge, Kylie AU - Snijder, Mieke AU - Doyle, Michael AU - Champion, Katrina AU - Chapman, Cath AU - Ward, James AU - Baumgart, Amanda AU - Lee, Kylie K. S. AU - Teesson, Maree AU - Newton, Nicola PY - 2022/1/7 TI - A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e34530 VL - 11 IS - 1 KW - Aboriginal and Torres Strait Islander KW - prevention KW - alcohol KW - tobacco KW - substance use KW - universal prevention KW - well-being KW - harm minimization KW - Indigenous KW - web-based N2 - Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 UR - https://www.researchprotocols.org/2022/1/e34530 UR - http://dx.doi.org/10.2196/34530 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994696 ID - info:doi/10.2196/34530 ER - TY - JOUR AU - Koziol-McLain, Jane AU - Wilson, Denise AU - Vandal, C. Alain AU - Eruera, Moana AU - Nada-Raja, Shyamala AU - Dobbs, Terry AU - Roguski, Michael AU - Barbarich-Unasa, Wai Te PY - 2021/12/30 TI - Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial JO - JMIR Res Protoc SP - e24792 VL - 10 IS - 12 KW - indigenous KW - M?ori KW - young people KW - relationships KW - school KW - mHealth KW - smartphone app KW - mobile phone N2 - Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or wh?nau (indigenous M?ori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and M?ori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the M?ori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous M?ori?centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 UR - https://www.researchprotocols.org/2021/12/e24792 UR - http://dx.doi.org/10.2196/24792 UR - http://www.ncbi.nlm.nih.gov/pubmed/34967750 ID - info:doi/10.2196/24792 ER - TY - JOUR AU - Barnes, Courtney AU - Yoong, Lin Sze AU - Nathan, Nicole AU - Wolfenden, Luke AU - Wedesweiler, Taya AU - Kerr, Jayde AU - Ward, S. Dianne AU - Grady, Alice PY - 2021/12/15 TI - Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e25902 VL - 23 IS - 12 KW - childcare center KW - web-based KW - nutrition KW - healthy eating KW - randomized controlled trial KW - intervention KW - implementation N2 - Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children?s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w UR - https://www.jmir.org/2021/12/e25902 UR - http://dx.doi.org/10.2196/25902 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914617 ID - info:doi/10.2196/25902 ER - TY - JOUR AU - Davies, M. Sian AU - Jardine, Jenni AU - Gutridge, Kerry AU - Bernard, Zara AU - Park, Stephen AU - Dawson, Tom AU - Abel, M. Kathryn AU - Whelan, Pauline PY - 2021/12/13 TI - Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study JO - JMIR Form Res SP - e30668 VL - 5 IS - 12 KW - digital mental health KW - acceptability KW - feasibility KW - child and adolescent mental health and well-being KW - school-based mental health care KW - prevention KW - digital assessment and monitoring KW - reading screening or ability N2 - Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (?1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. UR - https://formative.jmir.org/2021/12/e30668 UR - http://dx.doi.org/10.2196/30668 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898446 ID - info:doi/10.2196/30668 ER - TY - JOUR AU - Mastorci, Francesca AU - Piaggi, Paolo AU - Trivellini, Gabriele AU - Doveri, Cristina AU - Casu, Anselmo AU - Bastiani, Luca AU - Marinaro, Irene AU - Vassalle, Cristina AU - Pingitore, Alessandro PY - 2021/12/2 TI - Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study JO - JMIR Form Res SP - e24840 VL - 5 IS - 12 KW - adolescent KW - well-being management KW - schools KW - web tool KW - health promotion N2 - Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups. UR - https://formative.jmir.org/2021/12/e24840 UR - http://dx.doi.org/10.2196/24840 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860668 ID - info:doi/10.2196/24840 ER - TY - JOUR AU - Brussoni, Mariana AU - Han, S. Christina AU - Jacob, John AU - Munday, Fritha AU - Zeni, Megan AU - Walters, Melanie AU - Cheng, Tina AU - Schneeberg, Amy AU - Fox, Emily AU - Oberle, Eva PY - 2021/11/18 TI - A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators? Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial JO - JMIR Res Protoc SP - e31041 VL - 10 IS - 11 KW - early years KW - risky play KW - teacher KW - childcare KW - early learning KW - risk perception KW - outdoor play N2 - Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs? and ELCC administrators? perceptions and practices in support of children?s outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children?s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children?s play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children?s access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041 UR - https://www.researchprotocols.org/2021/11/e31041 UR - http://dx.doi.org/10.2196/31041 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792479 ID - info:doi/10.2196/31041 ER - TY - JOUR AU - Kaiser, Sabine AU - Martinussen, Monica AU - Adolfsen, Frode AU - Breivik, Kyrre AU - Kyrrestad, Henriette PY - 2021/11/8 TI - An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31789 VL - 10 IS - 11 KW - cyberbullying KW - intervention KW - mobile app KW - adolescents KW - NettOpp KW - mental health KW - health care N2 - Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 UR - https://www.researchprotocols.org/2021/11/e31789 UR - http://dx.doi.org/10.2196/31789 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747704 ID - info:doi/10.2196/31789 ER - TY - JOUR AU - Moltrecht, Bettina AU - Patalay, Praveetha AU - Deighton, Jessica AU - Edbrooke-Childs, Julian PY - 2021/7/14 TI - A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial JO - JMIR Mhealth Uhealth SP - e21837 VL - 9 IS - 7 KW - emotion regulation KW - digital mental health KW - mhealth KW - school intervention KW - child mental health KW - mobile phone N2 - Background: Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. Objective: This study investigates the use of a new app-based intervention designed to support children?s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. Methods: As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). Results: The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention?s usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children?s emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. Conclusions: We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children?s emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys. UR - https://mhealth.jmir.org/2021/7/e21837 UR - http://dx.doi.org/10.2196/21837 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259642 ID - info:doi/10.2196/21837 ER - TY - JOUR AU - Sutherland, Rachel AU - Brown, Alison AU - Nathan, Nicole AU - Yoong, Serene AU - Janssen, Lisa AU - Chooi, Amelia AU - Hudson, Nayerra AU - Wiggers, John AU - Kerr, Nicola AU - Evans, Nicole AU - Gillham, Karen AU - Oldmeadow, Christopher AU - Searles, Andrew AU - Reeves, Penny AU - Davies, Marc AU - Reilly, Kathryn AU - Cohen, Brad AU - Wolfenden, Luke PY - 2021/6/24 TI - A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness?Implementation Hybrid Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e25256 VL - 23 IS - 6 KW - childhood obesity KW - lunchboxes KW - children KW - child nutrition KW - mHealth KW - schools KW - hybrid KW - randomized controlled trial KW - technology N2 - Background: There is significant opportunity to improve the nutritional quality of foods packed in children?s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health?based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness?implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children?s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (?117.26 kJ; 95% CI ?195.59 to ?39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (?88.38 kJ; 95% CI ?172.84 to ?3.92; P=.04) and consumed (?117.17 kJ; 95% CI ?233.72 to ?0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children?s lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school?aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school?aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x UR - https://www.jmir.org/2021/6/e25256/ UR - http://dx.doi.org/10.2196/25256 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185013 ID - info:doi/10.2196/25256 ER - TY - JOUR AU - Hoogsteder, H. Mariette H. AU - Douma, N. Linda AU - Eskens, A. Charlotte G. AU - Berendsen, L. Renske AU - Vanneste, M. Yvonne T. AU - Schaafsma, G. Frederieke PY - 2021/6/21 TI - Professionals? and Students? Perceived Needs for an Online Supportive Application for Reducing School Absence and Stimulating Reintegration: Concept Mapping Study JO - JMIR Form Res SP - e24659 VL - 5 IS - 6 KW - medical absenteeism KW - secondary education KW - eHealth KW - mHealth KW - mobile health KW - students KW - schools, health occupations KW - youth health physicians KW - concept mapping N2 - Background: To limit students? medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students? autonomy regarding their situation. Objective: This study aimed to identify professionals? and students? perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. Methods: Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. Results: Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. Conclusions: Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism. UR - https://formative.jmir.org/2021/6/e24659 UR - http://dx.doi.org/10.2196/24659 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152275 ID - info:doi/10.2196/24659 ER - TY - JOUR AU - Nicolaidou, Iolie AU - Stavrou, Evi AU - Leonidou, Georgia PY - 2021/6/9 TI - Building Primary-School Children?s Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study JO - JMIR Pediatr Parent SP - e27958 VL - 4 IS - 2 KW - COVID-19 KW - interactive learning environment KW - internet-based cognitive behavioral therapy KW - parents KW - prevention intervention KW - primary school children KW - psychological resilience KW - teachers N2 - Background: Resilience is a person?s mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children?s resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program ?Friends,? to overcome accessibility issues associated with delivering cognitive behavioral therapy?based interventions in formal and informal education settings. Objective: This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment?s usability. Methods: A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children?s anxiety symptoms, namely the Greek translation of the original Spence Children?s Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. Results: In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students? reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=?6.99; P<.001), identification of somatic symptoms of stress (t19=?7.31; P<.001), and identification of stress management techniques (t19=?6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. Conclusions: This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access. UR - https://pediatrics.jmir.org/2021/2/e27958 UR - http://dx.doi.org/10.2196/27958 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106080 ID - info:doi/10.2196/27958 ER - TY - JOUR AU - Norris, E. Anne AU - Thalasinos, Delcampo Roxana AU - Hecht, L. Michael PY - 2021/6/2 TI - Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups JO - JMIR Form Res SP - e24937 VL - 5 IS - 6 KW - implementation science KW - mobile apps KW - peer influence KW - early intervention KW - adolescent health N2 - Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program?s behavior change potency. UR - https://formative.jmir.org/2021/6/e24937 UR - http://dx.doi.org/10.2196/24937 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076578 ID - info:doi/10.2196/24937 ER - TY - JOUR AU - Sweeney-Reed, M. Catherine AU - Wolff, Doreen AU - Niggel, Jakob AU - Kabesch, Michael AU - Apfelbacher, Christian PY - 2021/5/28 TI - Pool Testing as a Strategy for Prevention of SARS-CoV-2 Outbreaks in Schools: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e28673 VL - 10 IS - 5 KW - SARS-CoV-2 KW - COVID-19 KW - schools KW - pool testing KW - gargle test KW - test strategy KW - monitoring KW - surveillance KW - PCR N2 - Background: School closures are a widely implemented strategy for limiting infection spread in the current COVID-19 pandemic. The negative impact of school closures on children and young people is increasingly apparent, however. Objective: We aim to evaluate the feasibility of an infection monitoring program in schools to enable targeted quarantining to replace school closures. The program is currently being implemented in two model schools in Magdeburg, Germany, within the framework of the Study of Coronavirus Outbreak Prevention in Magdeburg Schools (Studie zur Ausbruchsvermeidung von Corona an Magdeburger Schulen [STACAMA]). Methods: Five pupils per class are pseudorandomly selected twice a week and asked to provide a gargle sample over a 16-week evaluation period. RNA is extracted from each sample individually in a laboratory and pooled according to school class for real-time reverse transcription polymerase chain reaction (rRT-PCR) analysis. Immediate individual sample testing will be carried out in the case of a positive pool test. Individual RNA extraction prior to pooling and application of rRT-PCR result in high test sensitivity. Testing will be performed in strict adherence to data protection standards. All participating pupils will receive a 16-digit study code, which they will be able to use to access their test Results: When the study commenced on December 2, 2020, 520 (52%) pupils and their families or guardians had consented to study participation. The study was suspended after four test rounds due to renewed school closures resulting from rising regional infection incidence. Testing resumed when schools reopened on March 8, 2021, at which time consent to participation was provided for 54% of pupils. We will quantitatively and qualitatively evaluate the logistics and acceptability of the program. Conclusions: The findings from this study should inform the design of infection surveillance programs in schools based on gargle samples and a PCR-based pool testing procedure, enabling the identification of aspects that may require adaptation before large-scale implementation. Our focus on each step of the logistics and on the experiences of families should enable a robust assessment of the feasibility of such an approach. International Registered Report Identifier (IRRID): DERR1-10.2196/28673 UR - https://www.researchprotocols.org/2021/5/e28673 UR - http://dx.doi.org/10.2196/28673 UR - http://www.ncbi.nlm.nih.gov/pubmed/33979297 ID - info:doi/10.2196/28673 ER - TY - JOUR AU - Cui, Shu AU - Zhang, Chao AU - Wang, Shijiang AU - Zhang, Xingong AU - Wang, Lei AU - Zhang, Ling AU - Yuan, Qiuyu AU - Huang, Cui AU - Cheng, Fangshuo AU - Zhang, Kai AU - Zhou, Xiaoqin PY - 2021/5/19 TI - Experiences and Attitudes of Elementary School Students and Their Parents Toward Online Learning in China During the COVID-19 Pandemic: Questionnaire Study JO - J Med Internet Res SP - e24496 VL - 23 IS - 5 KW - attitude KW - elementary school students KW - parents KW - online learning KW - COVID-19 N2 - Background: Due to widespread SARS-CoV-2 infection, an emergency homeschooling plan was rigorously implemented throughout China. Objective: This study aimed to investigate the experiences and attitudes of elementary school students and their parents (two generations from the same family) toward online learning in China during the pandemic. Methods: A 16-item questionnaire was distributed at the 10-day and 40-day marks after the start of the first online course to 867 parent-child pairs and 141 parent-child pairs, respectively. The questionnaire was comprised of questions pertaining to course and homework completeness, effectiveness, reliability, and abundance as well as the students? enthusiasm for taking part in online classes and their satisfaction with the courses. Results: Our findings indicate that 90.7% (786/867) of students exhibited high or moderate enthusiasm for participating in online classes. However, most students performed poorly in online learning classes and after-school homework. With regard to satisfaction, parents' and students' average scores were 7.35 and 7.25, respectively (10-point scoring system). During the second stage of this study, parents' positive evaluations for online learning declined, including those for the effectiveness and reliability of the courses. Furthermore, the proportion of students who completed the courses and homework on time decreased; this difference proved statistically significant (P=.047). The parents? and students? overall satisfaction with online learning also declined during the second stage (parents: 7.21; students: 7.23); however, the difference in overall satisfaction between the two stages was not statistically significant (parents: P=.53; students: P=.60). Several of the parents (315/867, 36.2%) indicated that assisting with and supervising the students? online learning resulted in increased stress. Further, 36% of parents expressed dissatisfaction with or provided suggestions for online learning; most parents and students hoped to return to face-to-face classes (parents: 823/867, 94.9%; students: 811/867, 93.5%). Finally, our results presented the following six main issues that parents were the most concerned about: (1) disappointment regarding timely interaction in courses; (2) apprehensiveness about students? understanding of the course; (3) the increased burden of annoying adult responsibilities; (4) concern about children's eyesight; (5) the idea that teachers? explanations were not detailed enough; and (6) concerns about the decline of students' interest in and attention toward online courses. Conclusions: Online learning can prevent the spread of infectious diseases while still allowing elementary school students to attain knowledge. However, in our study, children?s completion of the courses and homework were not satisfactory. Furthermore, their parents often experienced stress and had many concerns and complaints. Measures such as increasing the interactivity of the courses and prohibiting teachers from assigning tasks to parents could improve the effectiveness of these courses and the mental health of parents and students. UR - https://www.jmir.org/2021/5/e24496 UR - http://dx.doi.org/10.2196/24496 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878022 ID - info:doi/10.2196/24496 ER - TY - JOUR AU - Milton, C. Alyssa AU - Stewart, Elizabeth AU - Ospina-Pinillos, Laura AU - Davenport, Tracey AU - Hickie, B. Ian PY - 2021/4/12 TI - Participatory Design of an Activities-Based Collective Mentoring Program in After-School Care Settings: Connect, Promote, and Protect Program JO - JMIR Pediatr Parent SP - e22822 VL - 4 IS - 2 KW - participatory design KW - children KW - after school care KW - health KW - well-being KW - program development KW - community consultation N2 - Background: Out of school hours care (OSHC) services provide a unique opportunity to deliver early intervention programs to enhance primary school?aged children?s social, emotional, physical, and cognitive well-being; however, such programs are currently lacking. Objective: This study aims to address the lack of well-being programs for children accessing OSHC services in the research literature by using participatory design (PD) to collaboratively develop and test an OSHC well-being program?the connect, promote, and protect program (CP3). Methods: The study employed methods of PD, user (acceptance) testing, and iterative knowledge translation to develop a novel well-being program framework?CP3?with key stakeholders (eg, children, OSHC staff, volunteers, families, clinicians, educators, and researchers). Thematic techniques were used to interpret and translate the qualitative information obtained during the research and design cycles. Results: The co-design process generated the CP3 model, which comprises a group-based mentoring approach to facilitate enhanced activities in OSHC settings. Activities are underpinned by 4 key principles of program delivery: build well-being and resilience, broaden horizons, inspire and engage, and connect communities. Conclusions: To our knowledge, the CP3 program is the first co-designed well-being program developed specifically for OSHC services. This co-design process is key to ensuring local community needs?particularly those of young people accessing OSHC?are met and that these individuals are meaningfully and actively involved in all stages of the research and design process, from conception to implementation, evaluation, and continuous improvement. UR - https://pediatrics.jmir.org/2021/2/e22822 UR - http://dx.doi.org/10.2196/22822 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843603 ID - info:doi/10.2196/22822 ER - TY - JOUR AU - Kuriyan, Aparajita AU - Kinkler, Grace AU - Cidav, Zuleyha AU - Kang-Yi, Christina AU - Eiraldi, Ricardo AU - Salas, Eduardo AU - Wolk, Benjamin Courtney PY - 2021/2/8 TI - Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e26567 VL - 10 IS - 2 KW - teams KW - Team Strategies and Tools to Enhance Performance and Patient Safety KW - school mental health KW - school health N2 - Background: Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. Objective: The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. Methods: Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. Results: Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. Conclusions: This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. Trial Registration: ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228 International Registered Report Identifier (IRRID): DERR1-10.2196/26567 UR - https://www.researchprotocols.org/2021/2/e26567 UR - http://dx.doi.org/10.2196/26567 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555258 ID - info:doi/10.2196/26567 ER - TY - JOUR AU - Sauch Valmaña, Glòria AU - Vidal-Alaball, Josep AU - Garcia Furió, Victoria AU - Testoni, Giorgia AU - Espelt, Albert AU - Exposito, Katarin AU - Saigí-Rubió, Francesc AU - Carré, Núria AU - Sanz, Ikuska AU - Vicens, Victor PY - 2021/2/3 TI - An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study JO - JMIR Res Protoc SP - e25062 VL - 10 IS - 2 KW - mHealth KW - telehealth KW - teenager KW - health promotion and sexual health KW - health promotion KW - sexual health N2 - Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients? safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 UR - https://www.researchprotocols.org/2021/2/e25062 UR - http://dx.doi.org/10.2196/25062 UR - http://www.ncbi.nlm.nih.gov/pubmed/33533729 ID - info:doi/10.2196/25062 ER - TY - JOUR AU - Knight, Louise AU - Atuhaire, Lydia AU - Allen, Elizabeth AU - Namy, Sophie AU - Anton-Erxleben, Katharina AU - Nakuti, Janet AU - Mirembe, Faridah Angel AU - Nakiboneka, Mastula AU - Seeley, Janet AU - Weiss, A. Helen AU - Parkes, Jenny AU - Bonell, Chris AU - Naker, Dipak AU - Devries, Karen PY - 2020/12/7 TI - Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study JO - JMIR Res Protoc SP - e20940 VL - 9 IS - 12 KW - violence KW - long-term follow-up KW - whole-school KW - intervention KW - adolescents KW - Uganda KW - resilience KW - non-randomised N2 - Background: Violence against children in schools is a global public health problem. There is growing evidence that school-based interventions can be effective in reducing violence against children in schools. However, there is little evidence on the long-term impact of such interventions. The Good School Toolkit, developed by Raising Voices, a Uganda-based nonprofit organization, is a whole-school violence prevention intervention that aims to change the operational culture of primary schools. In 2014, the Good School Toolkit was evaluated through a cluster randomized controlled trial (Good Schools Study) and found to reduce teacher-to-student and student-to-student violence. Objective: This protocol describes quantitative analyses to explore long-term outcomes of the Good School Toolkit intervention among adolescents in Uganda, including the extent to which it is associated with peer-violence victimization (primary outcome) and peer-violence perpetration, intimate-partner violence, acceptance of teacher-violence, equitable gender attitudes, agency, self-regulation, peer connectedness, social assets, psychological assets, and retention in school (secondary outcomes). Methods: This is a nonrandomized quasi-experimental 4-year follow-up study of adolescents who attended the 42 Good Schools Study primary schools in 2014; 21 schools initiated the Good School Toolkit intervention during the trial from 2012, and 19 schools initiated the intervention after the trial (during the later delivery phase) from 2015; 2 schools did not implement the intervention. Students in the final school grade (Primary 7) during 2014 of the 19 primary schools in the later delivery phase are expected to have left school prior to toolkit delivery in 2015. Wave 1 data were collected in 2014 from 3431 grade Primary 5 to Primary 7 school students aged 11-14 years; these students were followed up in 2018-2019 when aged 16-19 years and invited to participate in the Wave 2 survey. Data were collected in face-to-face interviews by trained Ugandan field researchers. Toolkit exposure groups are defined as exposed during the Good Schools Study trial (from 2012), as exposed during later delivery (from 2015), or not exposed including those expected to have completed Primary 7 prior to later delivery or from the 2 schools that did not implement the toolkit. Associations between outcomes at Wave 2 and toolkit exposure groups will be analyzed using mixed-effect multivariable logistic and linear regression models for binary and continuous outcomes, respectively. This analysis is exploratory and aims to generate hypotheses on if, and under what circumstances, the toolkit influences later adolescent outcomes. Results: Data collection was completed in August 2019. Conclusions: To our knowledge, this is the first long-term follow-up study of adolescents exposed to a school-based violence-prevention intervention in sub-Saharan Africa. If the intervention reduces violence and improves other outcomes in later adolescence, then this study supports primary school interventions as key to achieving long-term population impacts. The pattern of effects will inform where reinforced or additional interventions are needed. International Registered Report Identifier (IRRID): DERR1-10.2196/20940 UR - https://www.researchprotocols.org/2020/12/e20940 UR - http://dx.doi.org/10.2196/20940 UR - http://www.ncbi.nlm.nih.gov/pubmed/33283762 ID - info:doi/10.2196/20940 ER - TY - JOUR AU - Fisher, Dominic AU - Louw, Quinette AU - Thabane, Lehana PY - 2020/11/30 TI - Sedentariness and Back Health in Western Cape Primary School Students: Protocol for a Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e18522 VL - 9 IS - 11 KW - sitting KW - standing KW - postural dynamism KW - sit-stand desks KW - classroom KW - school KW - sedentary KW - children N2 - Background: Despite growing evidence of deleterious health outcomes associated with sedentary behavior, prolonged static sitting in classrooms remains ubiquitous in primary schools. Sedentary behavior is associated with the development of cardio-metabolic conditions and poor back health. Preventative strategies to reduce sedentary behavior and its negative health effects may be required in a resource-constrained environment such as South Africa. Objective: The primary objective of this study is to assess the feasibility of conducting a full trial to evaluate the effects of a multifaceted intervention comprising novel multifunctional classroom furniture and a video-based curriculum versus usual care on sedentary behavior among students aged 10-11 years in primary schools. The secondary objective is to assess the preliminary effects of the intervention on sedentary behavior and postural dynamism. Methods: Eighty grade 5 or 6 students, aged 10 and 11 years, in mixed-gender schools within the Western Cape metropolitan urban area in Cape Town, South Africa are eligible to participate in this pilot cluster stepped-wedge trial design with classroom as the unit of randomization. Data will be collected at the schools. The intervention will comprise multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum on sedentary behavior. Usual practice is the absence of the intervention. The primary outcomes assessed will be (1) adherence to the intervention and (2) project pragmatics. The secondary outcomes will be (1) sedentariness measured using activPAL3 microsensors and (2) postural dynamism measured using Noraxon Myomotion inertial measurement units. We randomized the school to the first or second start of the intervention. This is an open-label trial and therefore blinding will not be possible for any group. Descriptive analysis of the feasibility and physiological outcomes will be presented. We will report the preliminary estimates of the effects of the intervention on sedentariness and postural dynamism using the mean difference and 95% CI. Results: At the time of submission, two classrooms have been recruited into the study. Baseline physical activity and postural dynamism data have been collected from 10 participants from each class. Conclusions: The results of this feasibility stepped-wedge cluster randomized controlled trial will be useful in informing the design of the main trial to assess whether this multifaceted intervention of multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum versus usual care has any effect on sedentary behavior in low-resource-setting primary schools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR1-10.2196/18522 UR - http://www.researchprotocols.org/2020/11/e18522/ UR - http://dx.doi.org/10.2196/18522 UR - http://www.ncbi.nlm.nih.gov/pubmed/33089783 ID - info:doi/10.2196/18522 ER - TY - JOUR AU - Galanti, Rosaria Maria AU - Pulkki-Brännström, Anni-Maria AU - Nilsson, Maria PY - 2020/10/29 TI - Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation JO - JMIR Res Protoc SP - e21100 VL - 9 IS - 10 KW - tobacco use KW - prevention KW - school KW - social influence KW - public commitment KW - cluster randomized trial KW - observational study N2 - Background: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent?s commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. Objective: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program?s implementation. Methods: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. Results: The study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. Conclusions: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID): DERR1-10.2196/21100 UR - http://www.researchprotocols.org/2020/10/e21100/ UR - http://dx.doi.org/10.2196/21100 UR - http://www.ncbi.nlm.nih.gov/pubmed/33000762 ID - info:doi/10.2196/21100 ER - @Article{info:doi/10.2196/21155, author="Katapally, Reddy Tarun", title="Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health", journal="JMIR Pediatr Parent", year="2020", month="Sep", day="25", volume="3", number="2", pages="e21155", keywords="Indigenous youth", keywords="mental health", keywords="school policies", keywords="health policy", keywords="digital health interventions", keywords="mHealth", keywords="systems integration", keywords="land-based learning", keywords="physical activity", doi="10.2196/21155", url="http://pediatrics.jmir.org/2020/2/e21155/", url="http://www.ncbi.nlm.nih.gov/pubmed/32975527" } TY - JOUR AU - Wang, Bo AU - Deveaux, Lynette AU - Lunn, Sonja AU - Dinaj-Koci, Veronica AU - Ghosh, Samiran AU - Li, Xiaoming AU - Marshall, Sharon AU - Rolle, Glenda AU - Forbes, Nikkiah AU - Stanton, Bonita PY - 2020/8/21 TI - Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting JO - JMIR Res Protoc SP - e14816 VL - 9 IS - 8 KW - adolescent KW - HIV prevention KW - implementation KW - sustainability KW - evidence-based intervention N2 - Background: Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs. Objective: This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time. Methods: This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5. Results: It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023. Conclusions: The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy. International Registered Report Identifier (IRRID): PRR1-10.2196/14816 UR - http://www.researchprotocols.org/2020/8/e14816/ UR - http://dx.doi.org/10.2196/14816 UR - http://www.ncbi.nlm.nih.gov/pubmed/32821065 ID - info:doi/10.2196/14816 ER - TY - JOUR AU - Kliem, Sören AU - Krieg, Yvonne AU - Lohmann, Anna AU - Mößle, Thomas PY - 2020/8/20 TI - Evaluation of the Universal Prevention Program Klasse2000 in Fourth Grade Primary School Children: Protocol for a Propensity Score-Matching Approach JO - JMIR Res Protoc SP - e14371 VL - 9 IS - 8 KW - Klasse2000 KW - prevention program KW - student survey KW - propensity score matching KW - evaluation N2 - Background: Klasse2000 is the most widely adopted school-based prevention program in Germany. It addresses health promotion, addiction, and violence prevention in primary schools. As a universal prevention program, it has reached more than 1.4 million German children in the past 25 years. Objective: The effectiveness of Klasse2000 will be evaluated with a large representative survey among students. Students who have participated in the prevention program (intervention group) will be compared with students who did not participate (control group). The comparison will cover the following outcome domains: well-being, self-esteem, emotion regulation, food habits, behavioral problems, and school and classroom atmosphere. Furthermore, victimization and perpetration regarding bullying, alcohol consumption, smoking, and media consumption are assessed. Methods: To control for potential group differences, treatment effects will be estimated using propensity score-matching, which matches students from the intervention and control groups based on an identical propensity score or a propensity score that does not differ by more than a previously defined distance. The treatment effect will then be estimated in the matched sample taking the matching process into account. Results: Enrollment of schools began in March 2017. A total of 6376 students participated in the survey (n=4005 in control group; n=2371 in Klasse2000). The parent survey was returned by 52.13% (3324/6376) of parents. Results are expected in mid-2020. Conclusions: The results on the effectiveness of the Klasse2000 prevention program will form an empirical basis for legitimizing universal prevention programs and for planning future prevention approaches. Trial Registration: German Clinical Trials Register DRKS00014332; https://tinyurl.com/y2trvq4p International Registered Report Identifier (IRRID): DERR1-10.2196/14371 UR - https://www.researchprotocols.org/2020/8/e14371 UR - http://dx.doi.org/10.2196/14371 UR - http://www.ncbi.nlm.nih.gov/pubmed/32815524 ID - info:doi/10.2196/14371 ER - TY - JOUR AU - Sun, Jiangang AU - Liu, Yang PY - 2020/8/5 TI - Using Smart Bracelets to Assess Heart Rate Among Students During Physical Education Lessons: Feasibility, Reliability, and Validity Study JO - JMIR Mhealth Uhealth SP - e17699 VL - 8 IS - 8 KW - physical education KW - heart rate KW - validation KW - feasibility KW - reliability KW - Fizzo KW - Polar KW - wrist-worn devices KW - physical education lesson KW - monitoring N2 - Background: An increasing number of wrist-worn wearables are being examined in the context of health care. However, studies of their use during physical education (PE) lessons remain scarce. Objective: We aim to examine the reliability and validity of the Fizzo Smart Bracelet (Fizzo) in measuring heart rate (HR) in the laboratory and during PE lessons. Methods: In Study 1, 11 healthy subjects (median age 22.0 years, IQR 3.75 years) twice completed a test that involved running on a treadmill at 6 km/h for 12 minutes and 12 km/h for 5 minutes. During the test, participants wore two Fizzo devices, one each on their left and right wrists, to measure their HR. At the same time, the Polar Team2 Pro (Polar), which is worn on the chest, was used as the standard. In Study 2, we went to 10 schools and measured the HR of 24 students (median age 14.0 years, IQR 2.0 years) during PE lessons. During the PE lessons, each student wore a Polar device on their chest and a Fizzo on their right wrist to measure HR data. At the end of the PE lessons, the students and their teachers completed a questionnaire where they assessed the feasibility of Fizzo. The measurements taken by the left wrist Fizzo and the right wrist Fizzo were compared to estimate reliability, while the Fizzo measurements were compared to the Polar measurements to estimate validity. To measure reliability, intraclass correlation coefficients (ICC), mean difference (MD), standard error of measurement (SEM), and mean absolute percentage errors (MAPE) were used. To measure validity, ICC, limits of agreement (LOA), and MAPE were calculated and Bland-Altman plots were constructed. Percentage values were used to estimate the feasibility of Fizzo. Results: The Fizzo showed excellent reliability and validity in the laboratory and moderate validity in a PE lesson setting. In Study 1, reliability was excellent (ICC>0.97; MD<0.7; SEM<0.56; MAPE<1.45%). The validity as determined by comparing the left wrist Fizzo and right wrist Fizzo was excellent (ICC>0.98; MAPE<1.85%). Bland-Altman plots showed a strong correlation between left wrist Fizzo measurements (bias=0.48, LOA=?3.94 to 4.89 beats per minute) and right wrist Fizzo measurements (bias=0.56, LOA=?4.60 to 5.72 beats per minute). In Study 2, the validity of the Fizzo was lower compared to that found in Study 1 but still moderate (ICC>0.70; MAPE<9.0%). The Fizzo showed broader LOA in the Bland-Altman plots during the PE lessons (bias=?2.60, LOA=?38.89 to 33.69 beats per minute). Most participants considered the Fizzo very comfortable and easy to put on. All teachers thought the Fizzo was helpful. Conclusions: When participants ran on a treadmill in the laboratory, both left and right wrist Fizzo measurements were accurate. The validity of the Fizzo was lower in PE lessons but still reached a moderate level. The Fizzo is feasible for use during PE lessons. UR - http://mhealth.jmir.org/2020/8/e17699/ UR - http://dx.doi.org/10.2196/17699 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663136 ID - info:doi/10.2196/17699 ER - TY - JOUR AU - Champion, Elizabeth Katrina AU - Gardner, Anne Lauren AU - McGowan, Cyanna AU - Chapman, Cath AU - Thornton, Louise AU - Parmenter, Belinda AU - McBride, Nyanda AU - Lubans, R. David AU - McCann, Karrah AU - Spring, Bonnie AU - Teesson, Maree AU - AU - Newton, Clare Nicola PY - 2020/7/28 TI - A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program JO - JMIR Form Res SP - e19485 VL - 4 IS - 7 KW - primary prevention KW - schools KW - eHealth KW - chronic disease KW - mobile phone KW - health promotion N2 - Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. UR - http://formative.jmir.org/2020/7/e19485/ UR - http://dx.doi.org/10.2196/19485 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720898 ID - info:doi/10.2196/19485 ER - TY - JOUR AU - Davidson, Rosemary AU - Randhawa, Gurch PY - 2020/6/30 TI - The Sign 4 Little Talkers Intervention to Improve Listening, Understanding, Speaking, and Behavior in Hearing Preschool Children: Outcome Evaluation JO - JMIR Pediatr Parent SP - e15348 VL - 3 IS - 1 KW - sign language KW - early years KW - intervention KW - disadvantage N2 - Background: Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances; however, a significant proportion of children fail to meet the expected standards in these early years outcomes when they start school. Factors influencing the development of language and communication include low income, gender, and having English as an additional language (EAL). Objective: This study aimed to determine whether the Sign 4 Little Talkers (S4LT) program improves key developmental outcomes in hearing preschool children. S4LT was developed to address gaps in the attainment of vocabulary and communication skills in preschool children, identified through routine monitoring of outcomes in early years. Signs were adapted and incorporated into storybooks to improve vocabulary, communication, and behavior in hearing children. Methods: An evaluation of S4LT was conducted to measure key outcomes pre- and postintervention in 8 early years settings in Luton, United Kingdom. A total of 118 preschool children were tested in 4 early years outcomes domains?listening, speaking, understanding, and managing feelings and behavior?as well as Leuven well-being scales and the number of key words understood and spoken. Results: Statistically significant results were found for all measures tested: words spoken (P<.001) and understood (P<.001), speaking (P<.001), managing feelings and behavior (P<.001), understanding (P<.001), listening and attention (P<.001), and well-being (P<.001). Approximately two-thirds of the children made expected or good progress, often progressing multiple steps in educational attainment after being assessed as developmentally behind at baseline. Conclusions: The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development and become school ready by improving their command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support. UR - https://pediatrics.jmir.org/2020/1/e15348 UR - http://dx.doi.org/10.2196/15348 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452813 ID - info:doi/10.2196/15348 ER - TY - JOUR AU - Mationg, S. Mary Lorraine AU - Williams, M. Gail AU - Tallo, L. Veronica AU - Olveda, M. Remigio AU - Aung, Eindra AU - Alday, Portia AU - Reñosa, Donald Mark AU - Daga, Mae Chona AU - Landicho, Jhoys AU - Demonteverde, Paz Maria AU - Santos, Dianne Eunice AU - Bravo, Andrea Thea AU - Angly Bieri, A. Franziska AU - Li, Yuesheng AU - Clements, A. Archie C. AU - Steinmann, Peter AU - Halton, Kate AU - Stewart, E. Donald AU - McManus, P. Donald AU - Gray, J. Darren PY - 2020/6/25 TI - Determining the Impact of a School-Based Health Education Package for Prevention of Intestinal Worm Infections in the Philippines: Protocol for a Cluster Randomized Intervention Trial JO - JMIR Res Protoc SP - e18419 VL - 9 IS - 6 KW - soil-transmitted helminths KW - school-based health educational intervention KW - Magic Glasses KW - integrated control KW - randomized controlled trial KW - Philippines N2 - Background: Repeated mass drug administration (MDA) of antihelminthics to at-risk populations is still the main strategy for the control of soil-transmitted helminth (STH) infections. However, MDA, as a stand-alone intervention, does not prevent reinfection. Accordingly, complementary measures to prevent STH reinfection, such as health education and improved sanitation, as part of an integrated control approach, are required to augment the effectiveness of MDA for optimal efficiency and sustainability. Objective: The aim of this study is to determine the impact and generalizability of a school-based health education package entitled The Magic Glasses for STH prevention in the Philippines. Methods: We conducted a cluster randomized controlled intervention trial, involving 2020 schoolchildren aged 9-10 years, in 40 schools in Laguna Province, Philippines, to evaluate the impact of the school-based health education package for the prevention of STHs. The trial was conducted over the course of 1 year (June 2016 to July 2017). A total of 20 schools were randomly assigned to the intervention arm, in which The Magic Glasses Philippines health education package was delivered with the standard health education activities endorsed by the Philippines Department of Health (DOH) and the Department of Education (DepEd). The other 20 schools comprised the control arm of the study, where the DOH/DepEd?s standard health education activities were done. At baseline, parasitological assessments and a knowledge, attitude, and practice survey were carried out in all schools. In addition, height, weight, and hemoglobin levels were obtained from each child (after parental consent), and their school attendance and academic performance in English and mathematics were accessed from the school records. The baseline and 2 follow-up surveys were completed using the same study measurements and quality-control assessments. Results: Key results from this cluster randomized intervention trial will shed light on the impact that The Magic Glasses health education package will have against STH infections in schoolchildren in the province of Laguna, located on the Island of Luzon, in the Calabarzon Region of the Philippines. Conclusions: The results of the trial will be used to assess the generalizability of the impact of The Magic Glasses health education package in different epidemiological and cultural settings, providing evidence for translation of this health education package into public health policy and practice in the Asian region and beyond. Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12616000508471; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368849 International Registered Report Identifier (IRRID): DERR1-10.2196/18419 UR - https://www.researchprotocols.org/2020/6/e18419 UR - http://dx.doi.org/10.2196/18419 UR - http://www.ncbi.nlm.nih.gov/pubmed/32584263 ID - info:doi/10.2196/18419 ER -