Internet health information use and e-mail access by parents attending a paediatric emergency department

Video Tutorials to Empower Caregivers of Ill Children and Reduce Health Care Utilization: A Randomized Clinical Trial

Importance

Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services.

Objective

To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children.

Design, Setting, and Participants

Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022.

Intervention

The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage.

Main outcomes and measures

The primary outcome was caregivers' self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period.

Results

In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.67; 95% CI, 0.55-0.82). Randomization to video tutorials did not increase adverse outcomes.

Conclusions and relevance

In this randomized clinical trial, offering caregivers video tutorials significantly and safely increased self-efficacy and reduced use of telephone triage. Children had fewer hospital assessments when caregivers watched videos. This suggests a future potential of health care information to empower caregivers and reduce health care utilization.

Trial Registration

ClinicalTrials.gov Identifier: NCT04301206.

Caregivers of children feel confident about using the internet for health information

BACKGROUND

Caregivers of children may rely on internet sources, health care providers, peers or family for health information.

OBJECTIVE

To examine the impact of sociodemographic factors on the use of the internet for health information by caregivers of children, and the impact on self-efficacy, effort and frustration.

METHODS

Using data from the 2019 Health Information National Trends Survey, the effects of information source on self-efficacy, effort and frustration was examined using the complex samples module of SPSS.

RESULTS

The internet was the most common source of health information for caregivers of children (n = 247), with high confidence, low frustration and effort reported. Younger, higher educated and higher income caregivers were significantly more likely to use the internet for health information. Information from Health Care Providers (HCPs) was associated with greater confidence, and information from peers associated with lesser effort and frustration. No significant effects on self-efficacy, effort or frustration for online health information was noted compared to other sources.

CONCLUSIONS

Efforts to reduce barriers to online health information may be required for some groups of caregivers, and health care providers may have a role to play in this.

From physician’s authority to patient expertise: the effects of e-health technology use on patient’s behavior and physician-patient relationship

Purpose

This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources.

Design/methodology/approach

An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study’s objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach.

Findings

The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources.

Originality/value

The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers.

The Content and Quality of Publicly Available Information About Congenital Diaphragmatic Hernia: Descriptive Study

BACKGROUND

Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making.

OBJECTIVE

We aimed to examine the content and quality of publicly available, internet-based CDH information.

METHODS

We conducted internet searches across 2 popular search engines (Google and Bing). Websites were included if they contained CDH information and were publicly available. We developed a coding instrument to evaluate websites. Two coders (FS and KS) were trained, achieved interrater reliability, and rated remaining websites independently. Descriptive statistics were performed.

RESULTS

Searches yielded 520 websites; 91 met inclusion criteria and were analyzed. Most websites provided basic CDH information including describing the defect (86/91, 95%), need for neonatal intensive care (77/91, 85%), and surgical correction (79/91, 87%). Few mentioned palliative care, decisions about pregnancy termination (13/91, 14%), or support resources (21/91, 23%).

CONCLUSIONS

Findings highlight the variability of information about CDH on the internet. Clinicians should work to develop or identify reliable, comprehensive information about CDH to support parents.

Influence of education and residence on the parental search for pediatric surgical information on the internet

BACKGROUND

The internet is a valuable tool for access to health-related information. There is limited literature regarding its use by parents of children with surgical conditions.

AIM

To investigate internet usage by parents seeking information about the surgical conditions of their offspring in relation to epidemiological factors such as family residential area and parental educational level and to subsequently review the literature regarding this topic.

METHODS

An anonymous questionnaire about internet usage was completed by eligible parents of children who were admitted to our clinic for minor surgical procedures during a six-month period.

RESULTS

Our results demonstrated that the internet has been mostly used by mothers for children’s health information. Google was the most commonly used search engine, while pediatricians were the first parental choice for ‘live’ information. Only one-quarter of the parents informed their doctor about the information found online. Nine of ten parents had a positive opinion of an official website managed by the doctors of our clinic. Our results mostly agreed with the international literature.

CONCLUSION

In conclusion, the establishment of official websites (designed and managed by specialists) that parents can access to receive appropriate health information is mandatory in the internet era.

Support Seeking in the Postpartum Period: Content Analysis of Posts in Web-Based Parenting Discussion Groups

Background

The transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time.

Objective

This study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed.

Methods

A leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines.

Results

In total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes.

Conclusions

Engagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices.

Online health information seeking behaviours of parents of children undergoing surgery in a pediatric hospital in Rome, Italy: a survey

Background

People increasingly search online for health information. Particularly, parents of patients often use the Internet as a source for health information. We conducted a survey to investigate the online searching behavior of parents of patients < 18 years, admitted for surgery in an Italian pediatric hospital.

Methods

The cross-sectional survey was nested in a prospective cohort study on surgical procedures. Parents of patients undergoing surgical procedures at Bambino Gesù Children’s Hospital, Rome, Italy, were enrolled and contacted by phone after the procedure. We recorded socio-demographic data, sex, length of stay following surgery, proximity of residence to the hospital, use of the internet to search for information on the surgery before and after the intervention and effect of information found online.

Results

The majority (91%) of parents of children undergoing surgical intervention used the internet. Of these, 74.3% of parents searched for information before surgery, and 26.1% searched for information after. Most parents searched for information on the care provider’s website. Two thirds of parents reported that information found online had increased their understanding of the child’s condition. Multivariate analyses indicated that families living far from the hospital (> 43 km) were more likely to search for health information (OR 2.3; 95% CI 1.34–4.00), as were families of patients undergoing a major surgery (OR = 2.1; 95% CI 1.04–4.11).

Conclusions

Parents of children undergoing surgery often search online for information on their child’s intervention, in particular those whose child is scheduled for a major surgery and those living far from the hospital. A survey like the present one allows to understand parents’ information needs, to better guide them in online information seeking and to better tailor information provided on the care provider’s website.

Development of an Instrument to Assess Parents' Excessive Web-Based Searches for Information Pertaining to Their Children's Health: The "Children's Health Internet Research, Parental Inventory" (CHIRPI)

Background

People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children’s health.

Objective

This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children’s Health Internet Research, Parental Inventory (CHIRPI).

Methods

A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents’ perception of their children’s health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child’s Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS−).

Results

CHIRPI’s internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as r_tt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one’s child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η²=0.053) and each subscale (Symptom Focus η²=0.012; Distress η²=0.113; and Implementing Advice η²=0.018).

Conclusions

The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child’s health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children.

Quality analysis of publicly available videos for pediatric strabismus surgery

YouTube.com is a popular, free video platform that parents are increasingly using for medical information. This analysis of pediatric strabismus surgery videos found that many videos lack useful information, and some provide disinformation that may be harmful to pediatric eye care.

A pilot study comparing parent and adolescent online health information seeking behaviours in elective pediatric surgical situations

PURPOSE

Little is known of how children seek health information. This study evaluates online health information (OHI) seeking behaviours in adolescents undergoing major elective surgical procedures and compares responses within parent-child dyads.

METHODS

With institutional approval, we prospectively surveyed parents of children admitted to our institution for major elective operations between November 2017 and November 2018, using convenience sampling. Patients aged 12 years and above were also invited. Each respondent completed an anonymized modification of a previously published survey on Internet usage. Chi squared tests were used for categorical data, with significance at P value < 0.05.

RESULTS

Ninety-one parents and 19 patients (median age 15 years, range 12-18) responded, with 13 parent-child pairs. Daily Internet access was reported by 84 (93%) parents and 18 (95%) children, but OHI was sought in 77% of parents and 74% of children. Six (32%) children could not name their admitting condition, compared to 10 (11%) parents. Nine (50%) children consulted family and friends for information compared to 27 (30%) parents. Parents were more likely to access hospital websites (n = 15, 44%) compared to no children (p = 0.01), while most children (n = 7, 70%) accessed non-health websites (e.g. Wikipedia). In the 13 parent-child pairs, only one parent accurately assessed what their child understood of their condition. Most patients (63.6%) did not understand the aspects of their condition that their parents deemed important.

CONCLUSIONS

This study highlights the differences in parental and child behaviours. Children are equally important to include when counselling. Surgeons can guide both parties to reliable Internet sources for health information.

SUFE and the internet: are healthcare information websites accessible to parents?

BACKGROUND

Slipped upper femoral epiphysis is an adolescent hip disorder requiring rapid surgical intervention. Faced with the prospect of their child undergoing surgery, many fearful parents will turn to the internet to provide information and reassurance. Previous studies have shown the orthopaedic information can be difficult to comprehend.

OBJECTIVE

Assess the readability of healthcare websites regarding slipped upper femoral epiphysis.

METHODS

The term Slipped Upper Femoral Epiphysis was searched in Google, Bing and Yahoo. The websites were evaluated using readability software with seven specialised readability tests including the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index and the Gunning Fog Index. The reading grade level (RGL) was also calculated.A Flesich Read Ease Score (FRES) score above 65 and an RGL of sixth grade and under was considered acceptable. Websites were also assessed for translation services.

RESULTS

21 unique websites were assessed. The average FRES was 52.5±15.4. Only 3 websites scored 65 or higher (14%). There was a statistically significant difference between website scores based on affiliation, with physician websites having the overall highest mean(p=0.004).The average RGL was 8.67±1.8. Only two websites met the accepted RGL criteria (9.5%) while five websites were marked as extremely difficult to understand (23.8%). Only five websites offered translations (23.8%). There was no statistically significant difference in readability scores between websites which offered translation and those which did not.One-sample t-tests showed that both the RGL (p<0.001; CI 1.83 to 3.49) and the FRES (p<0.001, CI -19.4 to -5.4) scores were significantly different from the accepted standard.

CONCLUSION

Most websites reviewed were above the recommended RGL, making content inaccessible. Improving readability and translation services would enhance the internet's usability as a healthcare tool for parents.

Opportunities for and Barriers to Using Smartphones for Health Education Among Families at an Urban Primary Care Clinic

Mobile technology is omnipresent in society. Though studies suggest increased rates of smartphone accessibility, current access and barriers to smartphone usage at urban primary care clinics remains unclear. A self-administered survey was distributed to families presenting to an urban, underserved pediatric primary care clinic in spring 2017. Survey questions related to smartphone ownership and barriers to usage. A total of 273 parents completed the survey. Ninety-five percent of participants owned a smartphone. Fifty-eight percent of participants identified no barriers to smartphone usage. Among those who identified one or more barriers (n = 108), difficulties were primarily related to Wi-Fi access (46%), available phone memory (45%), existing phone data (28%), and discomfort with technology (11%). The majority of parents (59%) were interested in using a smartphone to learn about their child's health. In conclusion, there is opportunity to transform health education utilizing mobile devices, though disparities to usage should be considered.

Health Information Preferences of Parents in a Pediatric Emergency Department

Parents of children seeking nonurgent care in the emergency department completed surveys concerning media use and preferences for health education material. Results were compiled using descriptive statistics, compared by health literacy level with logistic regression, adjusting for race/ethnicity and income. Semistructured qualitative interviews to elicit reasons for preferences, content preference, and impact of health information were conducted and analyzed using content analysis. Surveys (n = 71) showed that despite equal access to online health information, parents with low health literacy were more likely to use the internet less frequently than daily ( P < .01). Surveys and interviews (n = 30) revealed that health information will be most effective when distributed by a health care professional and must be made available in multiple modalities. Parents requested general information about childhood illness, including diagnosis, treatment, and signs and symptoms. Many parents believed that appropriate health information would change their decision-making regarding seeking care during their child's next illness.

Internet Usage by Parents Prior to Seeking Care at a Pediatric Emergency Department: Observational Study

BACKGROUND

Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit.

OBJECTIVE

The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child's illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED.

METHODS

A 40-question interview was conducted with parents presenting to an ED within a freestanding children's hospital. If parents reported IPED, the number and names of websites were documented. Parents indicated the helpfulness of Web-based content using a 100-mm visual analog scale and the degree to which it contributed to the decision to visit the ED using 5-point Likert-type responses.

RESULTS

About 11.8 % (31/262) reported IPED (95% CI 7.3-5.3). Parents who reported IPED were more likely to have at least some college education (P=.04), higher annual household income (P=.001), and older children (P=.04) than those who did not report IPED. About 35% (11/31) could not name any websites used. Mean level of helpfulness of Web-based content was 62 mm (standard deviation, SD=25 mm). After Internet use, some parents (29%, 9/31) were more certain they needed to visit the ED, whereas 19% (6/31) were less certain. A majority (87%, 195/224) of parents who used the Internet stated that they would be somewhat likely or very likely to visit a website recommended by a physician.

CONCLUSIONS

Nearly 1 out of 8 parents presenting to an urban pediatric ED reported using the Internet in the 24 hours prior to the ED visit. Among privately insured, at least one in 5 parents reported using the Internet prior to visiting the ED. Web-based medical information often influences decision making regarding ED utilization. Pediatric providers should provide parents with recommendations for high-quality sources of health information available on the Internet.

Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population.

Objective

The objective of this study was to describe where, what, and when people search online for topics related to ADHD.

Methods

Data were collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods.

Results

Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis.

Conclusions

The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD.

Mobile Health Technology to Communicate Discharge and Follow-Up Information to Adolescents From the Emergency Department

OBJECTIVE

Adolescents are the largest users of mobile technology; yet, there are little data regarding their receptivity to the use of mobile health technology (mHealth) from the emergency department (ED). The objective of this study was to determine adolescents' preferences for receiving ED discharge and follow-up information via mHealth and factors associated with those preferences.

METHODS

We administered an anonymous self-reporting survey to patients aged 14 to 19 years discharged from an urban pediatric ED. We conducted exploratory bivariate analyses to evaluate differences in communication preferences based on patient characteristics. We used multivariable logistic regression to determine whether preference for health information via mHealth is associated with frequent information technology (IT) use, adjusting for age, sex, ethnicity, and insurance status.

RESULTS

Four hundred thirty-nine adolescents completed the survey. Most were female (n = 279, 64%), 14 to 17 years old (n = 247, 57%), Hispanic (n = 359, 86%), and insured (n = 388, 88%). Adolescents used IT often, texting more than 30 times a day (58%) and emailing more than once a day (61%). Most (n = 335, 78%) were interested in electronic communication from the ED. Teens expressed particular interest in using email for discharge instructions (n = 196, 47%), physician referrals (n = 197, 48%), and test results (n = 201, 48%) and using texting for medication (n = 155, 38%) and appointment reminders (n = 170, 41%). Individuals tended to prefer communication with IT modes that they typically used, although only email was independently associated with preference for this mode (adjusted odds ratio, 2.8; 95% confidence interval, 1.5-5.3).

CONCLUSIONS

Adolescent patients are interested in receiving health information from the ED, mainly via email and texting. Future ED interventions should evaluate the effectiveness of these modalities to communicate with patients after discharge.

E-health and consultation rates for respiratory illnesses in infants: a randomised clinical trial in primary care

BACKGROUND

It is assumed that clear and complete information on the internet can reduce healthcare consumption.

AIM

We assessed in a randomised clinical trial whether a personalised online parent information program on infant respiratory symptoms can reduce primary care utilisation.

DESIGN AND SETTING

Randomised clinical trial in primary healthcare centres in a new residential area in the Netherlands.

METHOD

A web-based program (WHISTLER-online) was developed for parents that offered general information on childhood respiratory disease and personalised risk assessments. Parents of infants who enrolled from June 2009 to June 2012 in WHISTLER, an ongoing population-based birth cohort, were randomly allocated to 'WHISTLER-online' or 'usual care'. Information about, first, consultations and, second, associated prescriptions for respiratory symptoms during the first year of life was collected from the electronic patient files.

RESULTS

A total of 323 infants were randomly assigned to WHISTLER-online and 322 to usual care, and 314 and 305, respectively, were analysed. Of the parents, 70% used WHISTLER-online, and 99% of them judged it to be clear and useful information. There were differences neither in consultation rates for respiratory symptoms (incidence rate ratio 0.96 [95% CI = 0.85 to 1.09, P = 0.532]) nor in associated drug prescriptions.

CONCLUSION

Although parents greatly appreciate the provided facilities, a personalised e-support program on respiratory illnesses in infants does not substantially reduce healthcare utilisation.

The effects of informal carers' characteristics on their information needs: The information needs state approach

BACKGROUND

There has been little research that provides a comprehensive account of the nature and aspects of information needs of informal carers. The authors have previously developed and validated a framework that accounts for major underlying states of information need. This paper aims to apply this framework to explore whether there are common demographic and socioeconomic characteristics that affect the information needs states of carers. A questionnaire about the information needs states was completed by 198 carers above 18 years old. We use statistical methods to look for similarities and differences in respondents' information needs states, in terms of the demographic and socioeconomic variables. At least one information needs state varies among carers, in terms of seven demographic and socioeconomic variables: the age of the patient(s) that they are caring for; the condition(s) of the patient(s) that they are caring for; the number of patients that they are caring for; their length of time as a carer; their gender; the country that they live in; and the population of the area that they live in. The findings demonstrate the utility of the information needs state framework. We outline some practical implications of the framework.

Internet use of parents before attending a general pediatric outpatient clinic: does it change their information level and assessment of acute diseases?

Background

Before seeing a pediatrician, parents often look online to obtain child health information. We aimed to determine the influence of IUC (internet use regarding the reason for consultation) on their subjective information level, their assessment of acute diseases and the change in this assessment. Secondary objectives were to identify the most commonly used online resources and factors with an influence on IUC.

Methods

This cross-sectional observational study was conducted at a general pediatric outpatient clinic located in Vienna, Austria. An anonymous, voluntary and 14-items-containing questionnaire served to gather all data. A total number of 500 questionnaires were collected.

Results

Of the parents attending the outpatient clinic, 21 % use the internet before the appointment (= IUC). Most common online resources utilized for this purpose are websites run by doctors (61.3 %), the outpatient clinic’s homepage (56.3 %), Google (40 %), Wikipedia (32.5 %), health advisory services provided by doctors (28.7 %), health portals (21.3 %) and health forums and communities (18.8 %). The information level in terms of the reason for consultation is rated as good by 50.6 %, as average by 46.7 % and as insufficient by 2.7 % (internet users: 42.7 %, 55.3 %, 1.9 %). Acute diseases of the children are estimated to be mild by 58.4 %, to be moderate by 41.1 % and to be severe by 0.5 % (internet users: 54.9 %, 45.1 %, 0 %). After having used any source of information, this assessment is unchanged in 82.8 %, acute diseases are rated as more severe in 13.8 % and as less severe in 3.4 % (internet users: 79.2 %, 16.7 %, 4.2 %). Internet users and non-users do not differ with respect to their information level (p = 0.178), the assessment of acute diseases (p = 0.691) and the change in this assessment (p = 0.999). A higher education level of parents (mothers: p = 0.025, fathers: p = 0.037), a young age of their children (p = 0.012) and acute diseases of their children (p = 0.046) predispose to IUC.

Conclusions

Against the common perception that online health information might fuel panic-mongering, we could not determine a link between IUC and the assessment of acute diseases. The information level of internet users and non-users does not differ either. Further research is needed to clarify causes for high and low IUC.

Health-Related Internet Use by Informal Caregivers of Children and Adolescents: An Integrative Literature Review

Background

Internet-based health resources can support informal caregivers who are caring for children or adolescents with health care needs. However, few studies discriminate informal caregivers’ needs from those of their care recipients or those of people caring for adults.

Objective

This study reviews the literature of health-related Internet use among informal caregivers of children and adolescents.

Methods

A total of 17 studies were selected from literature searches conducted in 6 electronic databases: PubMed, Cochrane, CINAHL, PsycINFO, ERIC, and EMBASE. All databases searches were limited to articles published in the years 2004 to 2014 in peer-reviewed publications. Search terms consisted of “health-related Internet use,” “eHealth,” “Internet use for health-related purpose(s),” “Web-based resource(s),” and “online resources,” combined with informal caregiver (or “parents”) of “child,” “adolescent,” “student,” “youth,” and “teen.” The age range of the children receiving care was limited to younger than 22 years. Their informal caregivers were defined as persons (parents) who provided unpaid care or assistance to a child or an adolescent with health problems.

Results

Among 17 empirical studies, the majority of informal caregivers of children with medical issues were the parents. Quantitative studies (14/17, 77%) reported prevalence and predictors of health-related Internet use, while mixed-methods and qualitative studies (3/17, 24%) investigated informal caregiver perceptions of helpful health-related Internet use and barriers of use. The prevalence of health-related Internet use varied (11%-90%) dependent upon how health-related Internet use was operationalized and measured. Disease-specific information was used for decision making about treatment, while social support via virtual communities and email were used for informal caregiver emotional needs. A digital divide of Internet access was identified in lower educated minorities. Most studies had methodological challenges resulting from convenience sampling, cross-sectional surveys, lack of theoretical frameworks, or no clear definitions of health-related Internet use.

Conclusions

This study provides an important understanding of how family members use Internet-based information and support systems during child caregiving. Healthcare providers and policy makers should integrate family needs into their current practices and policies. Further rigorous research is required to design efficient and effective nursing interventions.

Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study

INTRODUCTION

Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified.

METHODS

This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected.

RESULTS

Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p < 0.01) display a higher tendency to use the internet for child health information purposes. Mothers and fathers (p = 0.151) as well as parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour.

DISCUSSION

Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level.

Use of online health information to manage children's health care: a prospective study investigating parental decisions

BACKGROUND

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents' decisions to use online information to manage their child's health care, a behaviour which has not yet been explored systematically.

METHODS

Parents (N = 391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child's health care during the previous 2 months.

RESULTS

We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents' intentions to use online information to manage their child's health care, with further support found for intentions, but not PBC, in predicting parents' behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents' decisions to engage in this child health management behaviour.

CONCLUSIONS

This theory-based investigation to understand parents' motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

Use of online health information to manage children's health care: a prospective study investigating parental decisions

BACKGROUND

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents' decisions to use online information to manage their child's health care, a behaviour which has not yet been explored systematically.

METHODS

Parents (N = 391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child's health care during the previous 2 months.

RESULTS

We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents' intentions to use online information to manage their child's health care, with further support found for intentions, but not PBC, in predicting parents' behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents' decisions to engage in this child health management behaviour.

CONCLUSIONS

This theory-based investigation to understand parents' motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

Parent's information seeking in acute childhood illness: what helps and what hinders decision making?

CONTEXT

Acute illness is a universal experience in early childhood. Parents find it difficult to determine whether or not their child requires medical care and seek information to inform their decision making. Little is known about parents' information seeking behaviour and what helps or hinders their decision making.

OBJECTIVE

This study aimed to explore parents' use of information resources during decision making in acute childhood illness at home.

DESIGN/METHOD

This exploratory qualitative study used focus groups and interviews to collect data from parents of children under 5 years of age.

SETTING AND PARTICIPANTS

Twenty-seven parents were recruited in the East Midlands, UK, in South Asian and Gypsy/Travelling communities, a Children's Centre and a private sector day nursery.

FINDINGS

Parents' pre-consultation information seeking was dominated by the internet, albeit with limited success. Parents liked easy to access, professionally validated and simple messages with access to more detailed information. Some parents always sought information through personal contact, whilst others did so when independent information seeking failed. When consulting a healthcare professional, parents liked to be given information to refer to later, although the information received varied. Importantly, neither hard copy nor the internet was accessible for parents with low levels of literacy.

DISCUSSION AND CONCLUSIONS

Although there is a wealth of information parents can access independently, our findings indicate a need for easy access to clearly signposted, professionally validated resources and available in a range of formats provided through different delivery systems. One size does not fit all.

Online resources in pediatrics

QUESTION

In the past few years, parents of children seen in my clinic are frequently conducting online searches relating to medical questions. How reliable are online resources in pediatrics and what guidance can I provide parents when searching online about their children's health?

ANSWER

The use of the Internet to gather medical information has increased dramatically over the past decade, including in the field of pediatrics. The enormous amount of information is confusing to parents and providers alike, and general search engines have not done enough to distinguish reliable from biased information. Physicians can develop websites with reliable content, advise parents on how to identify reliable sources of information, and give examples of websites to review child health-related topics.

Parents' information needs, self-efficacy and influences on consulting for childhood respiratory tract infections: a qualitative study

BACKGROUND

Acute respiratory tract infection (RTI) is the most common reason why parents consult primary care in the UK. Little is known about parents' perceptions of what may help them to make an appropriate decision to consult when their child is ill and how to improve self-care.Using qualitative methods, this study aimed to explore parents' views on support and information needs prior to consulting when children have RTIs with cough, and identify the triggers and barriers to consulting primary care.

METHODS

7 focus groups and 30 semi-structured interviews were held with 60 parents (with children aged 5 months - 17 years) from a range of socio-economic backgrounds. Topics discussed were informed by the Health Belief Model, and explored parents' concerns and beliefs about susceptibility and severity of RTIs, beliefs about the triggers and barriers to consulting, and information and support seeking behaviour undertaken before consulting primary care. Discussions were audio-recorded, transcribed and analysed using thematic methods.

RESULTS

Parents from all socio-economic backgrounds sought information from a wide range of sources about RTIs in children in order to identify which of their child's symptoms should be of concern and trigger a visit to the doctor. The perception of threat to a child of RTI (with cough) was increased with more severe illness and by perceived susceptibility to illness of a particular child; whilst experience with other children increased parental efficacy to cope with childhood cough at home. Psychological models of health behaviour informed the understanding of cultural beliefs and attitudes that underpin health related behaviours.

CONCLUSION

A wide range of perceptions influence the likelihood that parents will seek help from primary care for a child with cough; these perceptions are similar across socio-economic groups. Parents' experience, confidence and efficacy influence the likelihood of consulting primary care for their child's RTI. Parents would value consistent advice from a trusted source that addresses common concerns and supports home care and decision making about help seeking.

Access to digital technology among families coming to urban pediatric primary care clinics

OBJECTIVE

Digital technologies offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting.

METHODS

A self-administered survey was given to a convenience sample of caregivers bringing their children to 2 urban pediatric primary care centers in spring 2012. The survey assessed access to home Internet, e-mail, smartphone, and social media (Facebook and Twitter). A "digital technology" scale (0-4) quantified the number of available digital technologies and connections. Frequency of daily use and interest in receiving medical information digitally were also assessed.

RESULTS

The survey was completed by 257 caregivers. The sample was drawn from a clinical population that was 73% African American and 92% Medicaid insured with a median patient age of 2.9 years (interquartile range 0.8-7.4). Eighty percent of respondents reported having Internet at home, and 71% had a smartphone. Ninety-one percent reported using e-mail, 78% Facebook, and 27% Twitter. Ninety-seven percent scored ≥1 on the digital technology scale; 49% had a digital technology score of 4. The digital technology score was associated with daily use of digital media in a graded fashion (P < .0001). More than 70% of respondents reported that they would use health care information supplied digitally if approved by their child's medical provider.

CONCLUSIONS

Caregivers in an urban pediatric primary care setting have access to and frequently use digital technologies. Digital connections may help reach a traditionally hard-to-reach population.

Treatments for neurodevelopmental disorders: evidence, advocacy, and the Internet

The Internet is a major source of health-related information for parents of sick children despite concerns surrounding quality. For neurodevelopmental disorders, the websites of advocacy groups are a largely unexamined source of information. We evaluated treatment information posted on nine highly-trafficked advocacy websites for autism, cerebral palsy, and fetal alcohol spectrum disorder. We found that the majority of claims about treatment safety and efficacy were unsubstantiated. Instead, a range of rhetorical strategies were used to imply scientific support. When peer-reviewed publications were cited, 20 % were incorrect or irrelevant. We call for new partnerships between advocacy and experts in developmental disorders to ensure better accuracy and higher transparency about how treatment information is selected and evidenced on advocacy websites.

Predictive modelling: parents' decision making to use online child health information to increase their understanding and/or diagnose or treat their child's health

BACKGROUND

The quantum increases in home Internet access and available online health information with limited control over information quality highlight the necessity of exploring decision making processes in accessing and using online information, specifically in relation to children who do not make their health decisions. The aim of this study was to understand the processes explaining parents' decisions to use online health information for child health care.

METHODS

Parents (N = 391) completed an initial questionnaire assessing the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as perceived risk, group norm, and additional demographic factors. Two months later, 187 parents completed a follow-up questionnaire assessing their decisions to use online information for their child's health care, specifically to 1) diagnose and/or treat their child's suspected medical condition/illness and 2) increase understanding about a diagnosis or treatment recommended by a health professional.

RESULTS

Hierarchical multiple regression showed that, for both behaviours, attitude, subjective norm, perceived behavioural control, (less) perceived risk, group norm, and (non) medical background were the significant predictors of intention. For parents' use of online child health information, for both behaviours, intention was the sole significant predictor of behaviour. The findings explain 77% of the variance in parents' intention to treat/diagnose a child health problem and 74% of the variance in their intentions to increase their understanding about child health concerns.

CONCLUSIONS

Understanding parents' socio-cognitive processes that guide their use of online information for child health care is important given the increase in Internet usage and the sometimes-questionable quality of health information provided online. Findings highlight parents' thirst for information; there is an urgent need for health professionals to provide parents with evidence-based child health websites in addition to general population education on how to evaluate the quality of online health information.

Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

Background

Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills.

Methods

The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training.

Results

Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two) did not have a significant effect on any outcomes.

Conclusions

There was no consistent evidence for the superiority of novel refreshers as compared with a traditional mailed brochure, but the low degree of actual exposure to the materials does not allow a definitive conclusion. An online web-based approach seems to have the most promise for future research on electronic CPR refreshers.

Email for communicating results of diagnostic medical investigations to patients

BACKGROUND

As medical care becomes more complex and the ability to test for conditions grows, pressure on healthcare providers to convey increasing volumes of test results to patients is driving investigation of alternative technological solutions for their delivery. This review addresses the use of email for communicating results of diagnostic medical investigations to patients.

OBJECTIVES

To assess the effects of using email for communicating results of diagnostic medical investigations to patients, compared to SMS/ text messaging, telephone communication or usual care, on outcomes, including harms, for health professionals, patients and caregivers, and health services.

SEARCH METHODS

We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting authors.

SELECTION CRITERIA

Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies of interventions using email for communicating results of any diagnostic medical investigations to patients, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data collection or analysis was possible.

MAIN RESULTS

No studies met the inclusion criteria, therefore there are no results to report on the use of email for communicating results of diagnostic medical investigations to patients.

AUTHORS' CONCLUSIONS

In the absence of included studies, we can draw no conclusions on the effects of using email for communicating results of diagnostic medical investigations to patients, and thus no recommendations for practice can be stipulated. Further well-designed research should be conducted to inform practice and policy for communicating patient results via email, as this is a developing area.

Internet access and electronic communication among families in an urban pediatric emergency department

BACKGROUND

The Internet may represent an opportunity for health care providers in the emergency department (ED) to deliver discharge instructions and after-care educational materials electronically to patients and their caregivers.

OBJECTIVES

The objectives of this study were to determine the prevalence of Internet access and use among caregivers of children who visit the ED and to evaluate their interest in receiving after-care communication and educational material electronically.

METHODS

We distributed a self-administered survey to a convenience sample of English-speaking caregivers of children who presented to the ED of an urban, academic, pediatric hospital during November and December 2009.

RESULTS

The survey was distributed to and completed by 509 English-speaking respondents. Of the participants, 423 (83.1%) of 509 identified themselves as black/African American, and 397 (77.9%) of 509 were publicly insured. Of the participants, 503 of 509 (98.9%; 95% confidence interval [CI], 97.9%-99.8%) reported that they have access to the Internet. Of the participants with Internet access, 312 of 503 (62.0%; 95% CI, 57.8%-66.3%) have access at home, 166 of 503 (33.0%; 95% CI, 28.9%-33.1%) have access at work, and 112 of 503 (22.3%; 95% CI, 18.6%-25.9%) have access by mobile phone. When asked about electronic communication and social networking, 483 of 503 (96.0%; 95% CI, 94.3%-97.7%) have an e-mail account, and 304 of 503 (60.4%; 95% CI, 56.2%-64.7%) have a Facebook account. Furthermore, 353 of 503 (70.1%; 95% CI, 66.2%-74.2%) reported accessing the Internet daily, whereas 128 of 503 (25.4%; 95% CI, 21.6%-29.3%) access the Internet at least 2 to 6 times per week. Among all respondents, interest in receiving communication from the ED only electronically was expressed by 259 of 509 participants (50.9%; 95% CI, 46.5%-55.2%). Approximately one third of the participants (173/509 [34%; 95% CI, 29.9%-38.1%]) expressed interest in an electronic channel for communication between the ED and their child's patient primary care provider.

CONCLUSIONS

In this predominantly minority and economically disadvantaged population of caregivers presenting to an urban pediatric ED, a large majority reported regular access to the Internet and willingness and ability to receive communication from the ED via electronic means.

Exploring digital divides: An examination of eHealth technology use in health information seeking, communication and personal health information management in the USA

Recent government initiatives to deploy health information technology in the USA, coupled with a growing body of scholarly evidence linking online heath information and positive health-related behaviors, indicate a widespread belief that access to health information and health information technologies can help reduce healthcare inequalities. However, it is less clear whether the benefits of greater access to online health information and health information technologies is equitably distributed across population groups, particularly to those who are underserved. To examine this issue, this article employs the 2007 Health Information National Trends Survey (HINTS) to investigate relationships between a variety of socio-economic variables and the use of the web-based technologies for health information seeking, personal health information management and patient-provider communication within the context of the USA. This study reveals interesting patterns in technology adoption, some of which are in line with previous studies, while others are less clear. Whether these patterns indicate early evidence of a narrowing divide in eHealth technology use across population groups as a result of the narrowing divide in Internet access and computer ownership warrants further exploration. In particular, the findings emphasize the need to explore differences in the use of eHealth tools by medically underserved and disadvantaged groups. In so doing, it will be important to explore other psychosocial variables, such as health literacy, that may be better predictors of health consumers’ eHealth technology adoption.

Health information seeking by parents in the Internet age

AIM

Studies have shown increasing Internet use for health information. We aimed to broadly examine parents' utilisation of information sources for their children's health, their trust in them and to define the role of the Internet for children's health information

METHODS

Interview of a convenience sample of parents of patients presenting to a tertiary paediatric emergency department (ED) (Royal Children's Hospital, Melbourne, Australia) in 2006/2007.

RESULTS

A total of 360 parents completed the interview. Parents had used on average five sources of health information for their children in the previous 6 months. In the previous 6 months and immediately prior to the ED visit, general practitioners were consulted for health information by 87% and 39%, chemists by 44% and 2%, the Internet by 43% and 6% and telephone advice health lines by 30% and 10%, respectively. Of these sources, parents 'greatly trusted' Royal Children's Hospital ED doctors and nurses 82% (n = 112) their regular general practitioners in 73% (n = 303), chemists in 45% (n = 160), telephone advice health lines (Nurse-On-Call) in 42% (n = 90) and the Internet in general in 10% (n = 112). Overall, 52% had sought health information for their children on the Internet. Only 20% knew and 11% had ever used the regional children's hospital web site (http://www.rch.org.au/kidsinfo), but 97% of the Internet users reported they would trust this information.

CONCLUSION

While using numerous different sources, parents in this study mostly use and trust traditional sources of health information. Scores of respondents use the Internet to seek health information for their children and would value easier access to Internet sources that they trust.

Interest in the use of computerized patient portals: role of the provider-patient relationship

BACKGROUND

Bioinformatics experts are developing interactive patient portals to help those living with diabetes and other chronic diseases to better manage their conditions. However, little is known about what influences patients' desires to use this technology.

OBJECTIVE

To discern the impact of the provider-patient relationship on interest in using a web-based patient portal.

DESIGN

Qualitative analysis of focus groups.

PARTICIPANTS

Ten focus groups involving 39 patients (range 2-7) recruited from four primary care practices.

APPROACH

A qualitative approach was used, which involved reading transcribed texts until a consensus was reached on data interpretation. An intercoder reliability kappa score (0.89) was determined by comparing the provider-patient relationship talk selected by the two coders. A conceptual framework was developed, which involved the development and refinement of a codebook and the application of it to the transcripts.

RESULTS

Interest in the portal was linked to dissatisfaction with the provider-patient relationship, including dissatisfaction with provider communication/responsiveness, the inability to obtain medical information, and logistical problems with the office. Disinterest in the portal was linked to satisfaction with the provider-patient relationship, including provider communication/responsiveness, difficulty in using the portal, and fear of losing relationships and e-mail contact with the provider. No patient identified encrypted e-mail communication through the portal as an advantage.

CONCLUSIONS

Promoting the use of computerized portals requires patient-based adaptations. These should include ease of use, direct provider e-mail, and reassurances that access and interpersonal relationships will not be lost. Education is needed about privacy concerns regarding traditional e-mail communication.

Breastfeeding outcomes for mothers with and without home access to e-technologies

AIM

To estimate the percentage of breastfeeding mothers with home access to e-technologies and to compare breastfeeding outcomes for mothers with and without access to e-technologies.

METHODS

We conducted a prospective observational study of 550 breastfeeding mothers discharged from nine maternity units in France.

RESULTS

Overall, 435 mothers (79%; 95% confidence interval [95% CI], 75-82) had home access to e-technologies. Mothers with access to e-technologies were less likely to be unemployed (6% vs. 15%, p = 0.004), to smoke during pregnancy (8% vs. 16%, p = 0.03), to have a breastfeeding assessment score <8 (39% vs. 59%, p < 0.001) and to use a pacifier (23% vs. 41%, p < 0.001). Although mothers with access to e-technologies had a longer median breastfeeding duration than those without home access to e-technologies (19 vs. 16 weeks, p = 0.02), adjusted hazard ratios for breastfeeding discontinuation (0.85; 95% CI, 0.60-1.21), overall satisfaction rates (73% vs. 67%, p = 0.19) and breastfeeding difficulties after discharge (58% vs. 61%, p = 0.60) were not different for the two groups.

CONCLUSION

A vast majority of breastfeeding mothers have home access to e-technologies in France. However, access to e-technologies was not independently associated with better breastfeeding outcomes in this study.