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

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.

Strategies to optimize the information provision for parents of children with developmental dysplasia of the hip

Aims

The aim of this study was to identify the information topics that should be addressed according to the parents of children with developmental dysplasia of the hip (DDH) in the diagnostic and treatment phase during the first year of life. Second, we explored parental recommendations to further optimize the information provision in DDH care.

Methods

A qualitative study with semi-structured interviews was conducted between September and December 2020. A purposive sample of parents of children aged younger than one year, who were treated for DDH with a Pavlik harness, were interviewed until data saturation was achieved. A total of 20 interviews with 22 parents were conducted. Interviews were audio recorded, transcribed verbatim, independently reviewed, and coded into categories and themes.

Results

Interviews revealed four fundamental information topics that should be addressed in the different phases of the DDH healthcare trajectory: general information (screening phase), patient-specific information (diagnostic and treatment phase), practical information (treatment phase), and future perspectives (treatment and follow-up phase). To further optimize the information provision in DDH care, parents wished for more accessible and trustworthy general information prior to the first hospital visit to be better prepared for the diagnosis. Furthermore, parents wanted more personalized and visually supported information for a better understanding of the nature of the disease and the reason for treatment.

Conclusion

This study offers novel insights to optimize the information provision in DDH care. The main finding is the shift in information need from general information in the screening phase to patient-specific information in the diagnostic and treatment phase of DDH. Parents prefer visually-supported information, provided in a timely fashion, and tailored to their child's situation. These recommendations potentially decrease parental anxiety, insecurity, confusion, and increase parental empowerment and treatment adherence throughout the diagnostic and treatment phase of DDH.

Preparation of children for elective surgery and hospitalisation: A parental perspective

Parents play a central role in the preparation of their child for hospitalisation and surgery. This research examined the parental perspective on educating their child for an elective admission to hospital for surgery. The study employed a qualitative descriptive design and sampled eight parents from a private hospital in Dublin, Ireland, prior to their child's discharge, after ear, nose and throat surgery. A thematic analysis revealed four themes: how parents educate themselves about surgery and hospital, factors influencing parent's decisions on the quantity of information to share, sources of education about hospitalisation and aspects of hospitalisation not discussed by parents. Findings indicated that although the internet was used as a general source of information, parents relied more on information provided by the hospital. Parents used their child's age, individual needs and level of autonomy to determine what information to communicate. Specific areas that parents found difficult to communicate included pain and fasting. This research highlights the need for hospitals to invest and support the delivery of parental education for children prior to surgery. Clarification of the children's nurses' role in the development, implementation and evaluation of education programmes that support education delivery in the home by parents is also warranted.

Profile of the Users and the Most Visited Topics of a Pediatric eHealth Website

Parents need information about their children's health, and the Internet has become an essential repository for this information. However, there is almost no information about which topics are the most searched, consulted, or shared, or about the main characteristics of pediatric website users. The main aim of this research was to describe the profile of the users of a pediatric website, which topics they searched for, which topics were the most consulted, and which were the most shared. Users' demographic data were analyzed regarding their use of the Internet to search for information about health. A pediatric website for parents was analyzed. A 26-item questionnaire collected demographical features of the users of the website. Descriptive and analytical analyses were performed. Most participants used general search engines for their health searches, and the most searched keywords were prurigo, barking cough, and laryngitis. The most visited topics were unexplained fever, snots, and laryngitis. The most shared were snots, lipotomy, and dizziness. The users were mainly women (67.8%), with an average age of 38.8 years, and one or two children (89%) with a mean age of 4.6 years. The users who mainly used the Internet for health purposes were women of younger age, and with a higher educational level.

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.

A Study of eHealth from the Perspective of Social Sciences

The field of social sciences has become increasingly important in eHealth. Patients currently engage more proactively with health services. This means that eHealth is linked to many different areas of Social Sciences. The main purpose of this research is to analyze the state-of-the-art research on eHealth from the perspective of social sciences. To this end, a bibliometric analysis was conducted using the Web of Science database. The main findings show the evolution of publications, the most influential countries, the most relevant journals and papers, and the importance of the different areas of knowledge. Although there are some studies on eHealth within social sciences, most of them focus on very specific aspects and do not develop a holistic analysis. Thus, this paper contributes to academia by analyzing the state-of-the-art of research, as well as identifying the most relevant trends and proposing future lines of research such as the potential of eHealth as a professional training instrument, development of predictive models in eHealth, analysis of the eHealth technology acceptance model (TAM), efficient integration of eHealth within public systems, efficient budget management, or improvement in the quality of service for patients.

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.

Mobile and Online Health Information: Exploring Digital Media Use among Austrian Parents

In today’s digitalized world, most parents are Internet-savvy and use online sources for child health information, mainly due to the 24/7 availability of advice. However, parents are often not specifically trained to identify reliable, evidence-based sources of information. In this cross-sectional online survey among a purposive, non-probabilistic sample of Austrian parents (n = 90, 81.1% females), we assessed aspects of health app use and family policy benefits-related and scenario-based Internet seeking behavior. We found that the surveyed parents showed a high health app use. The participants indicated that they prefer online information seeking to any other option in a scenario describing that their child would be sick at after-work hours, with social media channels being the least preferred source of online information. Mothers and younger parents were more likely to retrieve online information on family policy benefits. With the smartphone in everybody’s pocket, parents seemed to rely on mobile and online content when searching for child health information. Pediatricians are best suited to decide what treatment fits the child or their current medical condition, but nowadays they face increasing numbers of pre-informed parents seeking health information online. Provision of targeted parental education and guidance through the online information jungle could effectively empower parents and smooth personal and digital contacts in the delicate doctor–parent–child triangle.

Parental internet search in the field of pediatric orthopedics

Parents whose children are affected by systemic diseases, anomalies, deformities, or further orthopedic defective positions use the Internet to increase their knowledge. However, there have been few studies that focus, as this one does, on Internet enquiries done before the parents contact the pediatric orthopedic surgeon. This study analyzed data gathered through a standardized questionnaire on general habits of Internet use, parents' hardware, age, and educational background of the parents. A total of 521 questionnaires were completed for a response rate of 96%. One-quarter of parents (n = 127) attended the consultation because of a gait anomaly or foot deformity, followed by children with DDH (20%, n = 99), clubfoot (9%, n = 47), and scoliosis (6%, n = 29). Parents of children with clubfoot were especially likely to look for health information online (84%, n = 38), followed by parents of children with scoliosis (69%, n = 20), with DDH (67%, n = 66), and with foot deformity/gait anomaly (49%, n = 62). Most people (97%, n = 295) using the Internet for health research purposes made use of a search engine. Concerning use of social media, respondents with clubfoot children were the most numerous (38%, n = 18). There were 35 parents who intended to discuss the results of their Internet research with the pediatric orthopedic surgeon. Most (84%, n = 254) of the respondents who used the Internet for health research planned to do so again.Conclusion: This study documented that the Internet is an important and popular source of information for parents or caregivers in the field of pediatric orthopedics.Level of evidence: Level II; prospective study What is known: •Parents and caregivers often search the Internet for information, particularly before an upcoming operation in the field of orthopedic disorders. What is new: •This study provides recent data on parental Internet research in a large study population.

INFORMATION NEEDS OF FAMILIES ON THE HEALTH/DISEASE OF PRETERM INFANTS IN A NEONATAL INTENSIVE CARE UNIT

ABSTRACT Objective: to identify the information needs of the families of preterm infants hospitalized to the Neonatal Intensive Care Unit on health/disease. Method: exploratory study, with a qualitative approach, performed with 33 relatives of preterm infants admitted to the Neonatal Intensive Care Unit, through a semi-structured interview, recorded in audio, transcribed and analyzed with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software. Results: two categories were identified, which are called: Reality versus expectation of obtaining information about the preterm infant; and Information on health/disease on-line: useful, positive and unattractive aspects. Conclusion: it has been found that the information needs of family members are wide, and different means are employed to satisfy them, ranging from the traditional and every day to the use of technological means to find data and used for different purposes.

Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study

Background

Pediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians.

Objective

Our aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers’ questions, and whether further face-to-face medical contact was needed.

Methods

In September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later.

Results

The age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers’ questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians’ answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers’ main concern was infection was not found to be associated with whether caregivers considered physicians’ answers helpful or not. However, physicians felt more capable of answering caregivers’ questions when the main concern was infection.

Conclusions

Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child’s health or illness.

The Gobbledygook in Online Parent-Focused Information about Child and Adolescent Mental Health

Online parent-focused informational resources play a vital step in parent decision-making about initiating child and adolescent mental health care, but their usefulness may depend on how easily the resource content can be understood. The purpose of this cross-sectional study was to examine the readability and reliability of parent-focused mental health resources provided on Canadian websites. After meeting inclusion criteria, 50 documents retrieved during the search in September 2016 from websites using online health information searching strategies that would be typically employed by parents underwent analysis. Document readability was assessed using Health Canada recommended instruments: Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level, and the Flesch Reading-Ease scale. Reliability was assessed using Health on the Net Foundation Code of Conduct (HONcode). Our analysis revealed that all included documents exceeded the 8th grade reading level. The mean ± SD readability scores were SMOG 11.65 ± 1.10 and FKGL 10.03 ± 1.49. Reading-ease scores showed that 42% (n = 21) of the documents were "Difficult" to read. Factorial ANOVA revealed no significant difference in readability across mental health topic areas or organizational sectors (p = > 0.05). Twenty-four percent of documents came from sites with HONcode certification. Findings suggest that almost all child and adolescent mental health information that would typically be found online by parents in Canada had readability scores that were too high for average parents to read and exceeded Health Canada recommended reading levels. Being able to locate resources online can be significantly precluded if a parent cannot understand and use information to mobilize them to accessing mental health care for their families.

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.