Mothers "Google It Up:" Extending Communication Channel Behavior in Diffusion of Innovations Theory

A meta-Ethnography on Parents' Experiences of the Internet As a Source of Health Information

The Internet is increasingly being used as a health information resource. This meta-ethnography aimed to synthesize the literature on how parents of children aged below 5 years' experienced using the Internet for health information purposes. We employed an interpretive meta-synthesis approach-meta-ethnography-according to Noblit & Hare's seven phases. A total of 22 articles met the inclusion criteria, representing four continents and with 650 participants, mainly mothers. We analysed and synthesized the primary studies into the following lines-of-argument synthesis representing a novel conceptual understanding of the phenomenon: Parents experience the Internet as "A cyber partner for child caring" being a 24/7 available "go-to" among other confined sources. Parents find ways of "patching together" trustworthy information in solicitude for their child's health while navigating between trust and anxiety. They relate online and share their experiences and secrets without being rejected. Clinicians and parents may benefit from "partnering" with this resource.

How Resources Combining Expertise and Social Support Help Breastfeeding Women Address Self-Doubt and Increase Breastfeeding Self-Efficacy: A Mixed-Methods Study

Existing research on parental information literacy focuses on parents' ability to evaluate information. This approach does not account for conflicting or unwanted information and obscures the emotional impact of unsought information. We aimed to (1) document the sources women use most frequently for accessing breastfeeding information, (2) explore the reasons women choose some sources over others, (3) test the relationship between source characteristics and breastfeeding self-efficacy, and (4) determine the extent to which four source characteristics - competence, trustworthiness, goodwill, and social support - predict breastfeeding self-efficacy. This study was conducted in two phases. The first phase consisted of interviews and focus groups, which we analyzed inductively using a grounded theory approach. In phase two, we conducted a cross-sectional survey of women who were currently breastfeeding, collecting data on the source credibility and social support associated with the source they use most frequently and the participants' breastfeeding self-efficacy. We used multiple regression to analyze our survey data. The frequency with which our participants encountered conflicting and unsought prompted them to view sources that combine expertise and social support as ideal. However, these sources are often difficult to access, leading to a reliance on online sources. This compromise has implications for breastfeeding tenure, as both competence and social support predicted breastfeeding self-efficacy. This study demonstrates how emotional aspects of information seeking shape women's preferred sources, how accessibility limits the use of preferred sources, and how source competence and social support influence breastfeeding self-efficacy.

Development and Effects of Mobile-Application-Based Parenting Support Program for Premature Infants' Mothers

BACKGROUND

Premature infants are separated from their parents after birth and are admitted to the neonatal intensive care unit. Separation of babies from mothers causes various problems. Therefore, as the number of premature infants increases every year, educational programs to continuously support baby care are needed.

METHODS

In this study, a nonequivalent control group non-synchronized design was employed. The subjects of the study were 52 mothers of premature infants (16 in the app-based program group, 18 in the electronic document group, and 18 in the control group) using a portal site for parents from February to April 2023. The app-based program and electronic document group followed a parenting support program for two weeks.

RESULTS

There were significant differences in maternal confidence between the app-based, electronic document, and control groups (F = 7.354, p = 0.002).

CONCLUSIONS

Providing necessary information and emotional support through professional counseling centers' app-based programs for premature infants' mothers, and providing interaction through member community bulletin boards, are proposed to form an effective educational program.

From one to five stars: An exploratory study of how consumer reviews and digital brand identity shape maternal pediatrician selection

Digital media initiated a paradigm shift of the doctor-patient relationship in which prospective patients "shop" for physicians as they do other goods and services: using search engines' results, aggregated review websites, and star ratings as cues. These are processed centrally or peripherally in accordance with the Elaboration Likelihood Model (ELM). Electronic word of mouth (EWOM) in conjunction with a pediatrician's digital brand management strategy impacts practice revenue through patient recruitment and retention. This exploratory study found that a pediatrician's placement on a review website and overall digital brand image leads to increased or decreased trust in expertise, competence, and likability.

Impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review

OBJECTIVE

The objective of this review was to determine whether electronic health (eHealth) educational interventions about infant procedural pain and pain management impact parental outcomes (eg, mental health, knowledge uptake), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response).

INTRODUCTION

Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, such as immunizations, yet infants often receive little to no pain management. Parents are an essential component of effective pain management, although they may not be aware of the roles they play. Despite the increased number of eHealth resources available to educate parents about infant pain management, their impact has yet to be synthesized.

INCLUSION CRITERIA

This review considered studies that evaluated eHealth educational interventions targeted at parents during pregnancy and up to 1 year postpartum. Interventions included, but were not limited to, mobile applications, web-based applications, websites, videos, interactive training, hands-on direct simulation, short message service (SMS), and desktop applications. Primary outcomes included parental outcomes (eg, stress or anxiety, self-efficacy, knowledge, attitudes), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). Experimental, quasi-experimental, and observational study designs were included.

METHODS

MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO were searched for studies published in English up to June 14, 2021. Citation lists of relevant reviews and included studies were also searched for additional peer-reviewed articles. Two independent reviewers conducted critical appraisal using standardized tools from JBI, and data extraction, using a data extraction form designed by the authors. Statistical pooling of quantitative data was not possible due to heterogeneity; thus, the findings were reported narratively.

RESULTS

A total of 4163 unique studies were screened, with 11 studies ultimately included for synthesis. Five articles were randomized controlled trials, 5 articles were analytical cross-sectional studies, and 1 article was quasi-experimental. Studies reported on 4 unique eHealth educational interventions, all of which used video format and primarily targeted the postnatal period. The findings for all primary outcomes were mixed but suggested either improvements in outcomes or no impact. The certainty of evidence was determined as low or very low across primary outcomes for reasons related to imprecision, risk of bias, and indirectness.

CONCLUSIONS

Although heterogeneity of findings limited quantitative synthesis of data, this review suggests that short and engaging educational videos have the potential to positively impact parents' knowledge, confidence, and desire to be involved in procedural pain management for their children. Most of the interventions presented in this review describe evidence-based information about procedural pain management strategies that are known to be effective for infant populations. Thus, it is reasonable to assume that infant pain response should be lower when parents appropriately apply the strategies. However, the findings of this review were not able to confirm this assumption. More research is needed to evaluate the impact of parent-targeted pain management education on infant pain response.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020151569.

The Importance of Social Networks for Support and Health Beliefs throughout Pregnancy

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

You Have Options: Implementing and evaluating a contraceptive choice social marketing campaign

Background:

Up to two-thirds of pregnancies among young, unmarried women in the United States are unintended, despite increased access to highly effective contraceptive options.

Aim:

This study implemented and evaluated a social marketing campaign designed to increase access to a full range of contraceptive methods among women aged 18–24 years on a southeastern university campus.

Methods:

Researchers partnered with Choose Well and Student Health Services to design, implement, and evaluate You Have Options, a 10-week multi-media social marketing campaign. The campaign aimed to raise awareness, increase knowledge, and improve access to contraceptive options, including long-acting reversible contraception (LARC) methods among college women. A pretest-posttest web-based survey design measured campaign awareness and recognition, as well as attitudes, subjective norms, and behavior.

Results:

Participants demonstrated a significant increase in knowledge about intrauterine devices (IUDs) between pretest ( M = 2.66, SD = 1.30) and posttest ( M = 3.06; SD = 1.96); t(671) = −2.60, p < .01). Analysis revealed that frequent exposure to the campaign prompted participants to engage in discussions about LARC with friends ( p < .05). In addition, 20- to 24-year-olds who reported seeing the campaign messages were more likely to seek out information ( p < .01) and adopt a LARC method ( p = .001) than 18- or 19-year-olds who saw the campaign messages.

Conclusion:

Findings from the study offer practical recommendations for implementing social marketing campaigns aimed at increasing access to LARC and reducing unintended pregnancy.

The impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review protocol

OBJECTIVE

The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes).

INTRODUCTION

Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated.

INCLUSION CRITERIA

This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response.

METHODS

PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.

Evaluation of Mobile Apps Targeted to Parents of Infants in the Neonatal Intensive Care Unit: Systematic App Review

Background

Parents of preterm infants increasingly use their mobile phone to search for health information. In a recent review, websites targeted toward parents with infants in the neonatal intensive care unit (NICU) were found to have poor to moderate quality educational material; however, there is a dearth of literature regarding mobile apps for NICU parents.

Objective

This study aimed to identify and evaluate apps targeting parents of infants in the NICU for quality of information, usability, and credibility.

Methods

We systematically searched the Apple App Store and Google Play using 49 key terms (eg, “preterm infant”) from July 26 to August 18, 2017. English apps targeting NICU parents that cost less than $20 were included. Apps for health care professionals, e-books/magazines, or nonrelevant results were excluded. In total, 3 tools were used for evaluation: Mobile Application Rating Scale (MARS) to measure quality; Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) to measure the app’s content usability; and Trust it or Trash It to measure credibility.

Results

The initial search yielded 6579 apps, with 49 apps eligible after title and description screening. In total, 27 apps met the eligibility criteria with 9 apps available in both app stores; of those, the app with the most recent update date was chosen to be included in the analysis. Thus, 18 unique apps were included for final analysis. Using MARS, 7 apps (7/18, 39%) received a good score on overall quality (ie, 4.0 out of 5.0), with none receiving an excellent score. In addition, 8 apps (8/18, 44%) received a PEMAT-AV score between 51% and 75% on the understandability subscale, and 8 apps (8/18, 44%) scored between 76% and 100% on the actionability subscale. Trust It or Trash It deemed 13 apps (13/18, 72%) as trash for reasons including no identification of sources or lack of current information, with only 5 (5/18, 28%) deemed trustworthy. Reviewer’s expert evaluation found 16 apps contained content that matched information provided by multiple sources; however, most apps did not meet other objective measurement items to support credibility. When comparing the MARS overall quality and subjective quality scores with trustworthiness of apps, there was no statistically significant difference. A statistically significant difference was found between the 2 MARS quality scores, indicating that, on average, apps were ranked significantly lower on subjective quality compared with overall quality measures.

Conclusions

This evaluation revealed that of the available apps targeting NICU parents, less than half should be considered as acceptable educational material. Over two-thirds of the apps were found to have issues regarding credibility and just over a quarter were considered good quality. The apps currently available for NICU parents are lacking and of concern in terms of quality and credibility.

Digital Presence of a Research Center as a Research Dissemination Platform: Reach and Resources

BACKGROUND

Web-based platforms can be powerful tools for research dissemination. By leveraging the advantages of mass media and interpersonal channels of communication, Web-based dissemination platforms may improve awareness about, and subsequent adoption of, evidence-based practices (EBPs). Digital dissemination strategies can augment traditional dissemination models, improving stakeholder access to digestible and actionable information and promoting translation of EBPs.

OBJECTIVE

This study aimed to describe the reach and content of the Web presence of a National Institute on Drug Abuse Center of Excellence and how it is used to disseminate research related to digital behavioral health approaches.

METHODS

The Center for Technology and Behavioral Health (CTBH) has a website and regularly updated Facebook and Twitter accounts. The website features include summaries of digital behavioral health approaches and related empirical literature, a blog feed focused on the state of the science and technology concerning digital health care approaches, and a newsletter about Center activities. We extracted website usage metrics from Google Analytics and follower counts from social media accounts for the period from March 1, 2013, to July 17, 2018.

RESULTS

Since the implementation of analytic tracking, 70,331 users have initiated 96,995 sessions on the CTBH website. The website includes summaries of 86 digital therapeutic programs, encompassing 447 empirical articles. There are 1160 posts in the CTBH blog feed, including 180 summaries of scholarly articles. The Twitter and Facebook accounts have 577 and 1500 followers, respectively. The newsletter has reached a growing subscriber network and has a high open rate relative to industry standards.

CONCLUSIONS

The CTBH Web presence serves as a model for how to leverage accessible and easily updatable digital platforms as research dissemination channels. Digital dissemination tools can augment traditional dissemination strategies to promote awareness about evidence-based digital therapeutic approaches for behavioral health and health care more broadly.

The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review

Background

Pregnancy apps are a booming global industry, with most pregnant women in high-income countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability, and quality control.

Objective

This review provides an overview of current literature on pregnancy apps and aims at describing (1) the ways in which apps are used by women, in general, and by those of a culturally and linguistically diverse (CALD) background; (2) the utility and quality of information provided; and (3) areas where more research, development, and oversight are needed.

Methods

We chose a narrative review methodology for the study and performed a structured literature search including studies published between 2012 and 2017. Searches were performed using MEDLINE, EMBASE, and CINAHL databases. Studies were identified for inclusion using two separate search criteria and strategies: (1) studies on pregnancy apps and pregnant women’s use of these apps and (2) studies on CALD pregnant women and their use of technology for accessing information on and services for pregnancy. Overall, we selected 38 studies.

Results

We found that pregnancy apps were principally used to access pregnancy health and fetal development information. Data storage capability, Web-based features or personalized tools, and social media features were also popular app features sought by women. Lower rates of the pregnancy app uptake were indicated among lower-income and non-English-speaking women. Preliminary evidence indicates that a combination of technological, health literacy, and language issues may result in lower uptake of pregnancy apps by these groups; however, further investigation is required. A marked limitation of the health app industry is lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of the information being presented. Health professionals and users alike indicate that given the choice, they would prefer using pregnancy apps that are relevant to their local health care context and come from a trusted source. Evidence indicates a need for greater health professional and institutional engagement in the app development, as well as awareness of and guidance for women’s use of these resources.

Conclusions

This is the first review of pregnancy app use, types of information provided, and features preferred by pregnant women in general and by those of a CALD background in particular. It indicates the demand for access to accurate information that is relevant to users, their community, and their associated health services. Given the popularity of pregnancy apps, such apps have enormous potential to be used for the provision of accurate, evidence-based health information.

eHealth versus equity: Using a feminist poststructural framework to explore the influence of perinatal eHealth resources on health equity

AIMS AND OBJECTIVES

To explore whether and how eHealth resources targeted to families during the perinatal period effectively reach a diverse population or further oppress marginalised groups.

BACKGROUND

eHealth is often intended to reach a broad population, thus health content must be relatively generalised which limits the ability to tailor health education and interventions to individual needs. Generalisation of health information has historically represented a hegemonic depiction of the health consumer, especially within the perinatal period, often disregarding the diversity that exists in the world and perpetuating heteronormative constructs within healthcare systems as a result.

DESIGN

A critical review of the literature regarding perinatal eHealth resources was conducted using a feminist poststructuralist approach for analysis. Included literature addresses the development, implementation and/or evaluation of perinatal eHealth resources.

DISCUSSION

This approach uncovered hegemonic discourses related to the current state of perinatal eHealth resources. Nurses and midwives have the unique advantage of interacting and understanding diverse populations. Thus, nurses and midwives are integral to the development, implementation and evaluation of eHealth resources to reduce social health inequity.

RELEVANCE TO CLINICAL PRACTICE

This paper acts as an exemplar on how to apply feminist poststructuralism to highlight inequities that exist and identifies strategies for nurses and midwives to become involved in the development of eHealth resources or advocate for greater visibility within current resources.

Learning to parent from Google? Evaluation of available online health evidence for parents of preterm infants requiring neonatal intensive care

The study aim was to identify and evaluate the reliability and quality of online resources for parents of preterm infants seeking health information about their infant using the DISCERN tool and Health on Net code. An Internet search ( www.google.com ) was used to identify websites for parents of preterm infants on their infants' health and health issues. For each search, the top 100 "hits" were downloaded, yielding 1200 websites. After reviewing websites for exclusion criteria and duplicates, 197 websites remained and were analyzed. According to the DISCERN tool, the websites had a moderate reliability score (mean = 29.88, standard deviation = 4.88, range: 18-40), moderate treatment score (mean = 24.15, standard deviation = 5.79, range: 10-35), and moderate overall quality score (mean = 3.41, standard deviation = 0.89, range: 1-5). Only 24 (12.2%) websites had current Health on Net code approval and no other websites met full eligibility for certification. Overall, the reliability and quality of information available online to parents of preterm infants is lacking.

e-Health and new moms: Contextual factors associated with sources of health information

OBJECTIVE

Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors.

DESIGN AND SAMPLE

Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample.

MEASURES

Use of online media about mother-baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education.

RESULTS

Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother-baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messaging (χ² statistics, p < .001). Stress and race/ethnicity were among factors associated with preferences.

CONCLUSIONS

Mothers widely used e-Health related media, but use was associated with contextual factors. In public health efforts to reach new mothers, partnering with mother-favored Web sites, focusing on audience-relevant media, and adopting attributes of successful sites are recommended strategies.

The Power of a Parent's Touch: Evaluation of Reach and Impact of a Targeted Evidence-Based YouTube Video

Despite strong evidence that skin-to-skin contact and breast-feeding are effective pain-relieving interventions for infants undergoing painful procedures, they remain underutilized in clinical practice. Given the important contribution of parents, there is a need to find innovative ways to assist parents to become actively involved in their infant's care. We developed a YouTube video to disseminate evidence-based information on the effectiveness of skin-to-skin contact and breast-feeding for infant pain management. The 2-minute 39-second video launched on December 2, 2014, and was promoted through Web-based and in-person communication and YouTube advertisements. Data were collected using YouTube analytics and an online survey. Post-18 months from its launch, the video had a reach of 157 938 views from 154 countries, with most viewers watching an average of 73% of the video (1 minute 56 seconds). Parents (n = 32) and healthcare providers (n = 170) completed the survey. Overall, both reported that they liked the video, found it helpful, felt more confident, and were more likely to use skin-to-skin contact (16% and 12%) and breast-feeding (3% and 11%), respectively, during future painful procedures. Despite the high-viewing patterns, alternative methods should be considered to better evaluate the impact on practice change.