TY - JOUR AU - Grace, Rebekah AU - Baird, Kelly AU - Elcombe, Emma AU - Webster, Vana AU - Barnes, Jacqueline AU - Kemp, Lynn PY - 2019/11/21 TI - Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables JO - JMIR Pediatr Parent SP - e13023 VL - 2 IS - 2 KW - volunteer home visiting KW - randomized controlled trial KW - families KW - support services KW - social relationships KW - community KW - Volunteer Family Connect N2 - Background: Volunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children. Objective: This paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills. Methods: The RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group). Results: The intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the ?Guidance? subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable ?parenting sense of competence? and largely neutral findings for the primary outcome variable ?community connectedness,? the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving. Conclusions: The Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 UR - http://pediatrics.jmir.org/2019/2/e13023/ UR - http://dx.doi.org/10.2196/13023 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750834 ID - info:doi/10.2196/13023 ER - TY - JOUR AU - Bird, Marissa AU - Li, Lin AU - Ouellette, Carley AU - Hopkins, Kylie AU - McGillion, H. Michael AU - Carter, Nancy PY - 2019/11/21 TI - Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review JO - JMIR Pediatr Parent SP - e15106 VL - 2 IS - 2 KW - pediatrics KW - scoping review KW - digital health KW - children with special health care needs KW - asthma KW - congenital heart disease KW - palliative care KW - co-design N2 - Background: Use of synchronous digital health technologies for care delivery to children with special health care needs (having achronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. Objective: We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. Methods: A systematic scoping review of the literature was conducted, guided by the Arksey and O?Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. Results: A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. Conclusions: The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs. UR - http://pediatrics.jmir.org/2019/2/e15106/ UR - http://dx.doi.org/10.2196/15106 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750840 ID - info:doi/10.2196/15106 ER - TY - JOUR AU - Colby, Sarah AU - Moret, Lauren AU - Olfert, D. Melissa AU - Kattelmann, Kendra AU - Franzen-Castle, Lisa AU - Riggsbee, Kristin AU - Payne, Magen AU - Ellington, Ainsley AU - Springer, Cary AU - Allison, Chelsea AU - Wiggins, Sa'Nealdra AU - Butler, Rochelle AU - Mathews, Douglas AU - White, A. Adrienne PY - 2019/08/29 TI - Incorporating Technology Into the iCook 4-H Program, a Cooking Intervention for Adults and Children: Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e11235 VL - 2 IS - 2 KW - technology KW - videos KW - intervention KW - cooking KW - child health N2 - Background: Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed. Objective: The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program. Methods: Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum. Results: Only 78.6% (81/103) of children and 68.3% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement. Conclusions: Incorporating technological supports, such as cameras and websites, into children?s programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions. Trial Registration: ISRCTN Registry ISRCTN54135351; https://www.isrctn.com/ISRCTN54135351 UR - http://pediatrics.jmir.org/2019/2/e11235/ UR - http://dx.doi.org/10.2196/11235 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518323 ID - info:doi/10.2196/11235 ER - TY - JOUR AU - McGoron, Lucy AU - Ratner, Horn Hilary AU - Knoff, AG Kathryn AU - Hvizdos, Erica AU - Ondersma, J. Steven PY - 2019/11/29 TI - A Pragmatic Internet Intervention to Promote Positive Parenting and School Readiness in Early Childhood: Initial Evidence of Program Use and Satisfaction JO - JMIR Pediatr Parent SP - e14518 VL - 2 IS - 2 KW - child rearing KW - child development N2 - Background: Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them. Objective: This study aimed to evaluate engagement in the 5-a-Day Parenting program, a technology-based program designed with low-income families in mind, to promote daily use of 5 specific parenting activities conducive to children?s school readiness. Following earlier pilot data, the program was enhanced with an initial motivational e-intervention and tailored text messages designed to promote engagement. Methods: Parents were recruited from local childcare centers and through a participant registry. We examined rates of receipt of program text messages and use of video-based content on the program website, 3 factors that may affect website use, and satisfaction with key program elements. Results: A total of 360 parents of young children learned about the study and had the opportunity to use the 5-a-Day Parenting website. Of these, 94 parents participated in the study, and 33% (31/94) accessed the video-based content on the website at least once. No association was found between website use and program recruitment approach, program-affiliation message, sociocontextual risk, and baseline use of the five parenting activities. Satisfaction with text messages and video-based content was high. Conclusions: For some parents, technology-based programs appear useful; however, engagement could still be enhanced. Additional research should seek innovative strategies for promoting engagement in Web-based parenting programs. UR - http://pediatrics.jmir.org/2019/2/e14518/ UR - http://dx.doi.org/10.2196/14518 UR - http://www.ncbi.nlm.nih.gov/pubmed/31782739 ID - info:doi/10.2196/14518 ER - TY - JOUR AU - Parga-Belinkie, Joanna AU - Merchant, M. Raina PY - 2019/12/20 TI - Voices in Evidence-Based Newborn Care: A How-to-Guide on Developing a Parent-Facing Podcast JO - JMIR Pediatr Parent SP - e16335 VL - 2 IS - 2 KW - neonatology KW - social media KW - medical education KW - patient education UR - http://pediatrics.jmir.org/2019/2/e16335/ UR - http://dx.doi.org/10.2196/16335 UR - http://www.ncbi.nlm.nih.gov/pubmed/31859674 ID - info:doi/10.2196/16335 ER - TY - JOUR AU - Barwise, K. Amelia AU - Patten, A. Christi AU - Bock, J. Martha AU - Hughes, A. Christine AU - Brockman, A. Tabetha AU - Valdez Soto, A. Miguel AU - Wi, Chung-Il AU - Juhn, J. Young AU - Witt, R. Daniel AU - Sinicrope, Stephen AU - Kreps, R. Samantha AU - Saling, D. Henry AU - Levine, A. James AU - Balls-Berry, E. Joyce PY - 2019/07/31 TI - Acceptability of Robotic-Assisted Exercise Coaching Among Diverse Youth: Pilot Study JO - JMIR Pediatr Parent SP - e12549 VL - 2 IS - 2 KW - robotics KW - adolescents KW - exercise KW - coaching KW - physical activity KW - technology N2 - Background: Almost 80% of adolescents do not achieve 60 minutes or more of physical activity each day as recommended by current US national guidelines. There is a need to develop and promote interventions that increase physical activity among adolescents. With increased interest in digital technologies among adolescents, robotic-assisted platforms are a novel and engaging strategy to deliver physical activity interventions. Objective: This study sought to assess the potential acceptability of robotic-assisted exercise coaching among diverse youth and to explore demographic factors associated with acceptance. Methods: This pilot study used a cross-sectional survey design. We recruited adolescents aged 12-17 years at three community-based sites in Rochester, MN. Written informed consent was obtained from participants? parents or guardians and participants gave consent. Participants watched a brief demonstration of the robotic system-human interface (ie, robotic human trainer). The exercise coaching was delivered in real time via an iPad tablet placed atop a mobile robotic wheel base and controlled remotely by the coach using an iOS device or computer. Following the demonstration, participants completed a 28-item survey that assessed sociodemographic information, smoking and depression history, weight, and exercise habits; the survey also included the eight-item Technology Acceptance Scale (TAS), a validated instrument used to assess perceived usefulness and ease of use of new technologies. Results: A total of 190 adolescents participated in this study. Of the participants, 54.5% were (103/189) male, 42.6% (81/190) were racial minorities, 5.8% (11/190) were Hispanic, and 28.4% (54/190) lived in a lower-income community. Their mean age was 15.0 years (SD 2.0). A total of 24.7% (47/190) of participants met national recommendations for physical activity. Their mean body mass index (BMI) was 21.8 kg/m2 (SD 4.0). Of note, 18.4% (35/190) experienced depression now or in the past. The mean TAS total score was 32.8 (SD 7.8) out of a possible score of 40, indicating high potential receptivity to the technology. No significant associations were detected between TAS score and gender, age, racial minority status, participant neighborhood, BMI, meeting national recommendations for physical activity levels, or depression history (P>.05 for all). Of interest, 67.8% (129/190) of participants agreed that they and their friends were likely to use the robot to help them exercise. Conclusions: This preliminary study found that among a racially and socioeconomically diverse group of adolescents, robotic-assisted exercise coaching is likely acceptable. The finding that all demographic groups represented had similarly high receptivity to the robotic human exercise trainer is encouraging for ultimate considerations of intervention scalability and reach among diverse adolescent populations. Next steps will be to evaluate consumer preferences for robotic-assisted exercise coaching (eg, location, duration, supervised or structured, choice of exercise, and/or lifestyle activity focus), develop the treatment protocol, and evaluate feasibility and consumer uptake of the intervention among diverse youth. UR - https://pediatrics.jmir.org/2019/2/e12549/ UR - http://dx.doi.org/10.2196/12549 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518333 ID - info:doi/10.2196/12549 ER - TY - JOUR AU - McGar, Brook Ashley AU - Kindler, Christine AU - Marsac, Meghan PY - 2019/11/11 TI - Electronic Health Interventions for Preventing and Treating Negative Psychological Sequelae Resulting From Pediatric Medical Conditions: Systematic Review JO - JMIR Pediatr Parent SP - e12427 VL - 2 IS - 2 KW - telemedicine KW - children KW - caregivers KW - injury KW - chronic disease KW - wounds and injuries KW - depression KW - anxiety N2 - Background: Pediatric medical conditions have the potential to result in challenging psychological symptoms (eg, anxiety, depression, and posttraumatic stress symptoms [PTSS]) and impaired health-related quality of life in youth. Thus, effective and accessible interventions are needed to prevent and treat psychological sequelae associated with pediatric medical conditions. Electronic health (eHealth) interventions may help to meet this need, with the capacity to reach more children and families than in-person interventions. Many of these interventions are in their infancy, and we do not yet know what key components contribute to successful eHealth interventions. Objective: The primary objective of this study was to conduct a systematic review to summarize current evidence on the efficacy of eHealth interventions designed to prevent or treat psychological sequelae in youth with medical conditions. Methods: MEDLINE (PubMed) and PsycINFO databases were searched for studies published between January 1, 1998, and March 1, 2019, using predefined search terms. A total of 2 authors independently reviewed titles and abstracts of search results to determine which studies were eligible for full-text review. Reference lists of studies meeting eligibility criteria were reviewed. If the title of a reference suggested that it might be relevant for this review, the full manuscript was reviewed for inclusion. Inclusion criteria required that eligible studies (1) had conducted empirical research on the efficacy of a Web-based intervention for youth with a medical condition, (2) had included a randomized trial as part of the study method, (3) had assessed the outcomes of psychological sequelae (ie, PTSS, anxiety, depression, internalizing symptoms, or quality of life) in youth (aged 0-18 years), their caregivers, or both, (4) had included assessments at 2 or more time points, and (5) were available in English language. Results: A total of 1512 studies were reviewed for inclusion based on their title and abstracts; 39 articles qualified for full-text review. Moreover, 22 studies met inclusion criteria for the systematic review. Of the 22 included studies, 13 reported results indicating that eHealth interventions significantly improved at least one component of psychological sequelae in participants. Common characteristics among interventions that showed an effect included content on problem solving, education, communication, and behavior management. Studies most commonly reported on child and caregiver depression, followed by child PTSS and caregiver anxiety. Conclusions: Previous research is mixed but suggests that eHealth interventions may be helpful in alleviating or preventing problematic psychological sequelae in youth with medical conditions and their caregivers. Additional research is needed to advance understanding of the most powerful intervention components and to determine when and how to best disseminate eHealth interventions, with the goal of extending the current reach of psychological interventions. UR - http://pediatrics.jmir.org/2019/2/e12427/ UR - http://dx.doi.org/10.2196/12427 UR - http://www.ncbi.nlm.nih.gov/pubmed/31710299 ID - info:doi/10.2196/12427 ER - TY - JOUR AU - Ntalindwa, Theoneste AU - Soron, Rashid Tanjir AU - Nduwingoma, Mathias AU - Karangwa, Evariste AU - White, Rebecca PY - 2019/9/27 TI - The Use of Information Communication Technologies Among Children With Autism Spectrum Disorders: Descriptive Qualitative Study JO - JMIR Pediatr Parent SP - e12176 VL - 2 IS - 2 KW - autism spectrum disorders KW - information communication technologies KW - inclusive education N2 - Background: The prevalence of Autism Spectrum Disorder (ASD) appears to be increasing globally due to the complex interaction of multiple biopsychosocial and environmental factors. Mobile phones, tablets, and other electronic gadgets have transformed our means of communication, and have also changed both healthcare and how we learn. These technological enhancements may have a positive impact on the lives of children, but there is currently a global scarcity of information on how information technology influences the education of children with ASD. Objective: This study was conducted in Rwandan schools and communities, and aimed to understand the perceptions of students with ASD, their parents, and their teachers, on the use of Information and Communication Technology (ICT) in the education of those with ASD. Methods: This qualitative descriptive study was conducted from December 2017 to July 2018. Researchers conducted four focus group discussions (FGDs) with 54 participants from different backgrounds: teachers, parents, and students with ASD. Each of the FGDs took approximately two and a half hours. A predefined set of open-ended questions were selected to discover people?s perceptions regarding assistive technologies used in ASD, their effectiveness, the scope of using them in their context, and upcoming challenges during implementation. The interviews were recorded, transcribed, and analyzed. Results: The findings of the study revealed seven key themes: (1) the use of ICT for the education of children with ASD; (2) existing augmentative facilities for learning; (3) current patterns of use of ICT in education; (4) preferred areas of learning for ASD students; (5) integration of ICT into educational programs; (6) areas of interest outside the classroom; and (7) future opportunities and challenges in Rwanda. We found most of the study participants assumed that appropriate technology and related innovations might solve the challenges faced by learners with ASD in classrooms. Moreover, they thought that children with ASD more so enjoyed watching television, playing digital games, and drawing objects using gadgets than interacting with people or playing with other children. Conclusions: The use of various low-cost technical devices can aid with teaching and the education of children with autism in Rwanda. However, this area requires further research to discover the impact ICT can have on the education of children with ASD, so this study may become a starting point for further research in the area. UR - http://pediatrics.jmir.org/2019/2/e12176/ UR - http://dx.doi.org/10.2196/12176 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573940 ID - info:doi/10.2196/12176 ER - TY - JOUR AU - Barker, M. Kathryn AU - Subramanian, V. S. AU - Selman, Robert AU - Austin, Bryn S. PY - 2019/09/17 TI - Gender Perspectives on Social Norms Surrounding Teen Pregnancy: A Thematic Analysis of Social Media Data JO - JMIR Pediatr Parent SP - e13936 VL - 2 IS - 2 KW - teenage childbearing KW - teen pregnancy KW - adolescent sexual behavior KW - social media KW - social norms KW - gender N2 - Background: Social concern with teen pregnancy emerged in the 1970s, and today?s popular and professional health literature continues to draw on social norms that view teen pregnancy as a problem?for the teen mother, her baby, and society. It is unclear, however, how adolescents directly affected by teen pregnancy draw upon social norms against teen pregnancy in their own lives, whether the norms operate differently for girls and boys, and how these social norms affect pregnant or parenting adolescents. Objective: This research aims to examine whether and how US adolescents use, interpret, and experience social norms against teen pregnancy. Methods: Online ethnographic methods were used for the analysis of peer-to-peer exchanges from an online social network site designed for adolescents. Data were collected between March 2010 and February 2015 (n=1662). Thematic analysis was conducted using NVivo software. Results: American adolescents in this online platform draw on dominant social norms against teen pregnancy to provide rationales for why pregnancy in adolescence is wrong or should be avoided. Rationales range from potential socioeconomic harms to life-course rationales that view adolescence as a special, carefree period in life. Despite joint contributions from males and females to a pregnancy, it is primarily females who report pregnancy-related concerns, including experiences of bullying, social isolation, and fear. Conclusions: Peer exchange in this online forum indicates that American adolescents reproduce prevailing US social norms of viewing teen pregnancy as a social problem. These norms intersect with the norms of age, gender, and female sexuality. Female adolescents who transgress these norms experience bullying, shame, and stigma. Health professionals must ensure that strategies designed to prevent unintended adolescent pregnancy do not simultaneously create hardship and stigma in the lives of young women who are pregnant and parent their children. UR - http://pediatrics.jmir.org/2019/2/e13936/ UR - http://dx.doi.org/10.2196/13936 UR - http://www.ncbi.nlm.nih.gov/pubmed/31536963 ID - info:doi/10.2196/13936 ER - TY - JOUR AU - Stiles-Shields, Colleen AU - Garcia, Brittney AU - Villota, Kimberly AU - Wartman, Elicia AU - Winning, M. Adrien AU - Holmbeck, N. Grayson PY - 2019/10/10 TI - Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study JO - JMIR Pediatr Parent SP - e15153 VL - 2 IS - 2 KW - spina bifida occulta KW - mHealth KW - mobile apps KW - usability testing KW - adolescent KW - young adult KW - weight reduction programs KW - body weight maintenance N2 - Background: Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. Objective: This study aimed to evaluate the usability of a high-quality, publicly available, weight management?focused mobile BIT (smartphone app) for AYA-SBs. Methods: Overall, 28 AYA-SBs attending a Young Men?s Christian Association?based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. Results: The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. Conclusions: AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs. UR - https://pediatrics.jmir.org/2019/2/e15153 UR - http://dx.doi.org/10.2196/15153 UR - http://www.ncbi.nlm.nih.gov/pubmed/31603432 ID - info:doi/10.2196/15153 ER - TY - JOUR AU - Ravindran, Vijay AU - Osgood, Monica AU - Sazawal, Vibha AU - Solorzano, Rita AU - Turnacioglu, Sinan PY - 2019/9/30 TI - Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study JO - JMIR Pediatr Parent SP - e14429 VL - 2 IS - 2 KW - autism spectrum disorder KW - interpersonal skills KW - virtual reality, instructional N2 - Background: Advances in virtual reality (VR) technology offer new opportunities to design supports for the core behaviors associated with autism spectrum disorder (ASD) that promote progress toward optimal outcomes. Floreo has developed a novel mobile VR platform that pairs a user receiving instruction on target skills with an adult monitor. Objective: The primary objective of this pilot study was to explore the feasibility of using Floreo?s Joint Attention Module in school-aged children with autism in a special education setting. A secondary objective was to explore a novel joint attention measure designed for use with school-aged children and to observe whether there was a suggestion of change in joint attention skills from preintervention to postintervention. Methods: A total of 12 participants (age range: 9 to 16 years) received training with the Joint Attention Module for 14 sessions over 5 weeks. Results: No serious side effects were reported, and no participants dropped out of the study because of undesirable side effects. On the basis of monitor data, 95.4% (126/132) of the time participants tolerated the headset, 95.4% (126/132) of the time participants seemed to enjoy using Floreo?s platform, and 95.5% (128/134) of the time the VR experience was reported as valuable. In addition, scoring of the joint attention measure suggested a positive change in participant skills related to the total number of interactions, use of eye contact, and initiation of interactions. Conclusions: The study results suggest that Floreo?s Joint Attention Module is safe and well tolerated by students with ASD, and preliminary data also suggest that its use is related to improvements in fundamental joint attention skills. UR - http://pediatrics.jmir.org/2019/2/e14429/ UR - http://dx.doi.org/10.2196/14429 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573921 ID - info:doi/10.2196/14429 ER - TY - JOUR AU - Kumpfer, Linda Karol AU - Brown, Litster Jaynie PY - 2019/11/18 TI - A Parenting Behavior Intervention (the Strengthening Families Program) for Families: Noninferiority Trial of Different Program Delivery Methods JO - JMIR Pediatr Parent SP - e14751 VL - 2 IS - 2 KW - parenting KW - youth drug prevention KW - family skills KW - DVD KW - Strengthening Families Program KW - internet KW - noninferiority trial N2 - Background: The Strengthening Families Program (SFP) is an evidence-based parent training and youth life skills and drug prevention program traditionally delivered in group settings. Families attend parent and youth classes conducted by trained facilitators. Recently, a 2-disk home-use DVD series was created with the same SFP skills as the group classes for parents and the youth to watch together at home. Additional lesson material was added that included healthy brain development, school success, anger management, dangers of alcohol and drugs, and mindfulness. The SFP DVD reduces SFP delivery costs for agencies and logistic burdens to families. Creative applications of the DVD include holding SFP DVD family discussion groups of multiple families and using SFP DVD video clips as part of a shorter 10-week group class version for parents and the youth. Objective: This study aimed to examine three different DVD implementation scenarios using a noninferiority trial, contrasting target outcomes with an age-matched sample culled from a national norm database of families who completed a standard SFP 14-week class. Methods: The partial eta-square was used to compare effect sizes between the different delivery modalities for relevant programmatic outcomes. We adjusted the effect sizes by demographic measures to determine whether there were site-specific features influencing program outcomes. Results: For the unadjusted effect size comparisons, 13 of the 15 indicated that the home-use DVD outperformed group norms with an average 0.13 effect size estimate difference across the comparisons (28% improvement in the effect size for DVD condition). Comparisons of the home-use DVD condition with the mixed DVD use conditions showed no discernable pattern where one condition consistently outperformed another. Adjusted effect sizes still reinforced the superiority of the DVD conditions; however, there was some shrinkage in the effect sizes as expected with the inclusion of relevant covariates. Conclusions: The home-use DVD shows that it is possible to effectively deliver an affordable family-based intervention using alternative technology outside of the traditional group-based class format. In almost all of the comparisons, the DVD conditions outperformed the group norms, underscoring that low-cost DVDs or viewing the videos on the Web may provide a useful surrogate for costly group-based formats. Future studies may want to improve on the quasi-experimental design by examining programmatic differences based on delivery format using a randomized controlled trial, thus strengthening the causal framework regarding program effects. In addition, the assessment protocol relied on retrospective reporting, which, although this can limit response shift bias, does not separate data collection in time as with a true pre- and posttest design. UR - http://pediatrics.jmir.org/2019/2/e14751/ UR - http://dx.doi.org/10.2196/14751 UR - http://www.ncbi.nlm.nih.gov/pubmed/31738176 ID - info:doi/10.2196/14751 ER -