Improving pediatric prevention via the internet: a randomized, controlled trial

Perceptions of Pediatric Residents Regarding Counseling About Use of Social Networking Sites

Increasing use of social networking sites (SNS) among youth prompted professional organizations to urge pediatricians to promote healthy media use. Electronic questionnaires were distributed to 76 pediatric residents at one academic center measuring attitudes, practices, and familiarity with SNS. Of 43 respondents (response rate = 57%), most reported personal SNS use (98%) and familiarity with SNS used by youth (72%), and 88% agreed that pediatricians should provide counseling on SNS use. Only 5% felt they had adequate training on SNS use in children, and just 26% felt comfortable advising families. Residents were less likely to discuss SNS use than general media use (19% vs 56%, P = .007). Media counseling was correlated with SNS counseling ( r = .38, P = .01). Pediatric residents recognize the importance of guiding families on SNS use, yet do not routinely provide counseling despite high levels of personal SNS use and familiarity. Focused training is necessary for pediatricians to prioritize practical guidance.

Six Questions for Well-Child Care Redesign

In the United States, well-child care has the goal of providing comprehensive care to children by addressing developmental, behavioral, psychosocial, and health issues through visits at recommended intervals. The preventive care needs of families can outpace the capacity of clinics and practices to provide it, necessitating a redesign of our well-child care system that aligns the structure of preventive care delivery with the needs of families. Here we focus on 6 questions (the what, when, who, why, how, and where) for well-child care redesign for infants and young children. By addressing these key questions and providing recommendations for advancing well-child care redesign in the clinical and research arenas, we hope to accelerate the process of well-child care redesign. In the current political and socioeconomic environment, continuing with well-child care "as usual" will mean that many families will find that their well-child care visits do not fully address the most pressing needs impacting children's health and well-being. It is time to implement and sustain real change in our system for preventive care.

Results of an RCT in Two Pediatric Emergency Departments to Evaluate the Efficacy of an m-Health Educational App on Car Seat Use

INTRODUCTION

The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting.

STUDY DESIGN

This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted.

SETTING/PARTICIPANTS

Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area.

INTERVENTION

A theory-based, stage-tailored educational program, Safety in Seconds v2.0^TM, delivered on a mobile app.

MAIN OUTCOME MEASURES

Four car seat behaviors: (1) having the correct restraint for the child's age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child's restraint inspected by a child passenger safety technician.

RESULTS

At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p<0.01) for using the correct car seat; 2.37 (p<0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p<0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p<0.01) and having the car seat inspected (OR=1.73, p<0.01).

CONCLUSIONS

Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education.

TRIAL REGISTRATION

Clinical Trial Registration # NCT02345941.

Knowledge translation tools for parents on child health topics: a scoping review

BACKGROUND

An emerging field of knowledge translation (KT) research has begun to focus on health consumers, particularly in child health. KT tools provide health consumers with research knowledge to inform health decision-making and may foster 'effective consumers'. Thus, the purpose of this scoping review was to describe the state of the field of previously published effectiveness research on child health-related KT tools for parents/caregivers to understand the evidence-base, identify gaps, and guide future research efforts.

METHODS

A health research librarian developed and implemented search strategies in 8 databases. One reviewer conducted screening using pre-determined criteria. A second reviewer verified 10% of screening decisions. Data extraction was performed by one reviewer. A descriptive analysis was conducted and included patient-important outcome classification, WIDER Recommendation checklist, and methodological quality assessment.

RESULTS

Seven thousand nine hundred fifty two independent titles and abstracts were reviewed, 2267 full-text studies were retrieved and reviewed, and 18 articles were included in the final data set. A variety of KT tools, including single- (n = 10) and multi-component tools (n = 10), were evaluated spanning acute (n = 4), chronic (n = 5) and public/population health (n = 9) child health topics. Study designs included: cross-sectional (n = 4), before-after (n = 1), controlled before-after (n = 2), cohort (n = 1), and RCTs (n = 10). The KT tools were evaluated via single primary outcome category (n = 11) and multiple primary outcome categories (n = 7). Two studies demonstrated significant positive effects on primary outcome categories; the remaining studies demonstrated mixed effects (n = 9) and no effect (n = 3). Overall, methodological quality was poor; studies lacked a priori protocols (n = 18) and sample size calculations (n = 13). Overall, intervention reporting was also poor; KT tools lacked description of theoretical underpinnings (n = 14), end-user engagement (n = 13), and preliminary research (n = 9) to inform the current effectiveness evaluation.

CONCLUSIONS

A number of child health-related knowledge translation tools have been developed for parents/caregivers. However, numerous outcomes were used to assess impact and there is limited evidence demonstrating their effectiveness. Moreover, the methodological rigor and reporting of effectiveness studies is limited. Careful tool development involving end-users and preliminary research, including usability testing and mixed methods, prior to large-scale studies may be important to advance the science of KT for health consumers.

Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Background

Unintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.

Aim

To increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.

Methods

Six work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.

Results

Modifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.

Limitations

Our case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.

Conclusions

Our studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.

Future work

Further randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.

Trial registration

Current Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.

Funding

The National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour

BACKGROUND

Although proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents' use of child restraints and smoke alarms.

METHODS

SIS is a multisite randomised controlled trial. Participants are parents of children aged 4-7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child's age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan.

DISCUSSION

Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use.

TRIAL REGISTRATION NUMBER

NCT02345941; Pre-results.

A systematic review of technology-based interventions for unintentional injury prevention education and behaviour change

OBJECTIVE

The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps.

METHODS

Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990.

RESULTS

Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention.

CONCLUSIONS

There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.

A smartphone app to communicate child passenger safety: an application of theory to practice

Child passenger safety remains an important public health problem because motor vehicle crashes are the leading cause of death for children, and the majority of children ride improperly restrained. Using a mobile app to communicate with parents about injury prevention offers promise but little information is available on how to create such a tool. The purpose of this article is to illustrate a theory-based approach to developing a tailored, smartphone app for communicating child passenger safety information to parents. The theoretical basis for the tailoring is the elaboration likelihood model, and we utilized the precaution adoption process model (PAPM) to reflect the stage-based nature of behavior change. We created assessment items (written at ≤6th grade reading level) to determine the child's proper type of car seat, the parent's PAPM stage and beliefs on selected constructs designed to facilitate stage movement according to the theory. A message library and template were created to provide a uniform structure for the tailored feedback. We demonstrate how messages derived in this way can be delivered through new m-health technology and conclude with recommendations for the utility of the methods used here for other m-health, patient education interventions.

Preventing childhood scalds within the home: Overview of systematic reviews and a systematic review of primary studies

OBJECTIVE

To synthesise and evaluate the evidence of the effectiveness of interventions to prevent scalds in children.

METHODS

An overview of systematic reviews (SR) and a SR of primary studies were performed evaluating interventions to prevent scalds in children. A comprehensive literature search was conducted covering various resources up to October 2012. Experimental and controlled observational studies reporting scald injuries, safety practices and safety equipment use were included.

RESULTS

Fourteen systematic reviews and 39 primary studies were included. There is little evidence that interventions are effective in reducing the incidence of scalds in children. More evidence was found that inventions are effective in promoting safe hot tap water temperature, especially when home safety education, home safety checks and discounted or free safety equipment including thermometers and thermostatic mixing valves were provided. No consistent evidence was found for the effectiveness of interventions on the safe handling of hot food or drinks nor improving kitchen safety practices.

CONCLUSION

Education, home safety checks along with thermometers or thermostatic mixing valves should be promoted to reduce tap water scalds. Further research is needed to evaluate the effectiveness of interventions on scald injuries and to disentangle the effects of multifaceted interventions on scald injuries and safety practices.

Automated conversation system before pediatric primary care visits: a randomized trial

BACKGROUND AND OBJECTIVES

Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical settings via spoken language. The objective of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians.

METHODS

English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were randomly assigned to groups by the system at the time of the call. Parents' spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit. Data were transferred to the electronic health records for review during visits. The study occurred in an urban hospital-based pediatric primary care center. Participants were called after the visit to assess (1) comprehensiveness of screening and counseling, (2) assessment of medications and their management, and (3) parent and clinician satisfaction.

RESULTS

PHP was able to identify and counsel in multiple areas. A total of 9.7% of parents responded to the mailed invitation. Intervention parents were more likely to report discussing important issues such as depression (42.6% vs 25.4%; P < .01) and prescription medication use (85.7% vs 72.6%; P = .04) and to report being better prepared for visits. One hundred percent of clinicians reported that PHP improved the quality of their care.

CONCLUSIONS

Systems like PHP have the potential to improve clinical screening, counseling, and medication management.

Well-child care clinical practice redesign for serving low-income children

Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called "Community Advisory Boards" [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non-face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.

Culturally competent transplant program improves Hispanics' knowledge and attitudes about live kidney donation and transplant

CONTEXT

Hispanics receive disproportionately fewer live donor kidney transplants than non-Hispanic whites. Increasing Hispanics' knowledge and changing attitudes about live kidney donation may reduce these disparities.

OBJECTIVE

To evaluate the effectiveness of culturally and linguistically competent educational sessions delivered through Northwestern University's Hispanic Transplant Program.

DESIGN

Baseline and postsession questionnaires were used to evaluate changes in patients' and family members' knowledge and attitudes toward live kidney donation and program satisfaction. Knowledge items related to live kidney donation were scaled, and changes in scores were evaluated via a paired t test. Multiple regression analysis of follow-up knowledge scores controlled for baseline scores was used to estimate the effects of patients' and families' sociodemographic characteristics. Changes in attitude items, including comfort with exploring live kidney donation, were analyzed with χ2 tests.

RESULTS

One-hundred thirteen patients and family members completed surveys before and after an education session. Respondents' knowledge about live kidney donation and transplant increased significantly (P<.001) between baseline and after the session. Patients' attitudes toward live kidney donation became more favorable (P< .02), as did family members' attitudes toward being a donor (P < .001) after participating in the program. All respondents reported high levels of satisfaction with the program and preferences for culturally congruent care.

CONCLUSIONS

The educational sessions provided by the Hispanic Transplant Program effectively addressed commonly shared Hispanic concerns about live kidney donation. Culturally congruent education increased Hispanic patients' and family members' knowledge and improved attitudes about live donor kidney transplants.

Well-child care clinical practice redesign at a community health center: provider and staff perspectives

BACKGROUND

Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery.

OBJECTIVE

To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years.

METHODS

Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions.

RESULTS

The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non-face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non-face-to-face (eg, phone) parent communication, and group visits.

CONCLUSION

CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.

Impact of an internet-based intervention on Finnish mothers' perceptions of parenting satisfaction, infant centrality and depressive symptoms during the postpartum year

OBJECTIVE

this study evaluates how an internet-based intervention affects mothers' parenting satisfaction, infant centrality and depressive symptoms.

DESIGN

a quasi-experimental design and repeated measures were used.

SETTINGS

this study was conducted in two Finnish public maternity hospitals (intervention/control).

PARTICIPANTS

a convenience sample (N=1300) of primiparous and multiparous Finnish-speaking mothers were invited to participate. Multiple-birth and early discharge mothers receiving home visits were excluded. The analysis included 760 mothers.

INTERVENTION

the intervention offered online support for parenting, breast feeding and infant care beginning from the middle of pregnancy. It consisted of an information database, a peer discussion forum and expert advice.

MEASUREMENTS

Outcomes were measured by the Evaluation and Infant Centrality subscales of the What Being the Parent of a New Baby is Like-Revised, and the Edinburgh Postnatal Depression Scale after childbirth, and six weeks, six months and 12 months post partum. Age, parity, parenting self-efficacy, and perception of infant and family functioning were used as the covariates.

FINDINGS

during the first postpartum year, mothers' parenting satisfaction increased significantly, whereas infant centrality and depressive symptoms decreased within groups. However, these changes were not linear. The mean difference between groups in parenting satisfaction and depressive symptoms was not significant within any of the four assessments. The mean difference in infant centrality between control and intervention mothers was significant only at six weeks post partum. Primiparas scored significantly higher in infant centrality and significantly lower in depressive symptoms than multiparas.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

an internet-based intervention did not significantly affect mothers' perceptions of parenting satisfaction and depressive symptoms, but intervention mothers experienced higher infant centrality compared with control mothers at six weeks. Parenting self-efficacy was a significant covariate for all measures. Parity needs to be taken into account when infant centrality and depressive symptoms are used as outcome variables in intervention studies. More research is needed to study the potential of information data bank, professional, and peer online support. This study also highlights the need to pay more attention to the selection of the target population, the selection of outcome measures, and implementation issues in intervention research.

Well-child care clinical practice redesign for young children: a systematic review of strategies and tools

BACKGROUND AND OBJECTIVE

Various proposals have been made to redesign well-child care (WCC) for young children, yet no peer-reviewed publication has examined the evidence for these. The objective of this study was to conduct a systematic review on WCC clinical practice redesign for children aged 0 to 5 years.

METHODS

PubMed was searched using criteria to identify relevant English-language articles published from January 1981 through February 2012. Observational studies, controlled trials, and systematic reviews evaluating efficiency and effectiveness of WCC for children aged 0 to 5 were selected. Interventions were organized into 3 categories: providers, formats (how care is provided; eg, non-face-to-face formats), and locations for care. Data were extracted by independent article review, including study quality, of 3 investigators with consensus resolution of discrepancies.

RESULTS

Of 275 articles screened, 33 met inclusion criteria. Seventeen articles focused on providers, 13 on formats, 2 on locations, and 1 miscellaneous. We found evidence that WCC provided in groups is at least as effective in providing WCC as 1-on-1 visits. There was limited evidence regarding other formats, although evidence suggested that non-face-to-face formats, particularly web-based tools, could enhance anticipatory guidance and possibly reduce parents' need for clinical contacts for minor concerns between well-child visits. The addition of a non-medical professional trained as a developmental specialist may improve receipt of WCC services and enhance parenting practices. There was insufficient evidence on nonclinical locations for WCC.

CONCLUSIONS

Evidence suggests that there are promising WCC redesign tools and strategies that may be ready for larger-scale testing and may have important implications for preventive care delivery to young children in the United States.

Media education in pediatric residencies: a national survey

BACKGROUND

Little is known about the current state of residency education with respect to counseling parents about media usage and whether trainees consider it to be adequate.

METHODS

A national survey of graduating pediatric residents was conducted in the United States to determine the amount of training they receive on traditional and new media, their perceptions of its quality, and their self-reported practices regarding talking to families about media usage.

RESULTS

A 58% response rate was achieved with no evidence of response bias based on age or gender. Only 38% rated their residency program as "very good" or "excellent" in preparing them to provide anticipatory guidance on the effects of media on children and adolescents. In logistic regression analyses, controlling for demographic characteristics, more training on media issues was a significant predictor for usually/always advising families on traditional, passive media (adjusted odds ratio = 3.29; 95% confidence interval 2.26-4.81) and usually/always advising families on new, interactive media use (adjusted odds ratio = 3.96; 95% confidence interval 2.61-6.00) during well-child visits.

CONCLUSIONS

The majority of residents believe their training on children in media is inadequate. Enhanced training on media is needed in US pediatric residencies.

A world wide web guide to pediatric infectious diseases

Pediatric infectious disease is a subspecialty constantly evolving in terms of scientific information. A novel means of attaining medical information that has emerged in recent years is the World Wide Web (WWW). The authors sought to assess availability and content of sites offering information on pediatric infectious diseases in the WWW. Websites chosen by two authors were evaluated by a specialist in pediatrics and a specialist in infectious diseases, and a representative list was constructed. A sub-search was performed for immunization-related websites. Websites from national and international institutions focusing on pediatrics in general or pediatric infectious diseases in particular offer ample information for health professionals and parents/public. There is an over-representation of vaccination-related material in the WWW, whereas no sites related to bioterrorism and children were considered as significant for inclusion during the process. Free access to related research remains a controversial issue.

Using technology to improve adolescent healthcare

PURPOSE OF REVIEW

To provide an overview of current technologies available for use in a primary healthcare setting, common indications for their use, and their effects on clinical practice.

RECENT FINDINGS

Technologies such as the internet and cell phones are an integral part of the daily lives of most adolescents. Many young people are comfortable using technology as part of their healthcare visits, especially when addressing sensitive issues. Over the past 5 years, a significant body of research has emerged introducing a variety of technologic modalities that screen for health-risk behaviors, educate patients about chronic diseases, promote preventive efforts, and provide interventions in the adolescent population. Findings suggest that integrating technology with clinical practice can improve quality of patient care.

SUMMARY

Technology can be used as an effective medium for the delivery of health information and interventions in an efficient, organized, and effective manner. Sharing knowledge of innovative tools, systems and programs will help develop further interventions and strategies to ensure optimal healthcare in young people.

e-Health in pediatric palliative care

e-Health has the potential to improve pediatric palliative care. e-Health initiatives use the Internet or health information technology to improve quality of care and have the potential to decrease costs by reducing medical errors, reducing duplication of services, improving access to diagnostic and laboratory results, and improving communication between providers and patients, and so on. The majority of e-health initiatives are for adults and only a limited amount of evidence exists in the literature on e-health interventions in palliative care that are focused on pediatrics. To explore what role e-health could play in pediatric palliative care programs, this article aims to describe the Internet use in general in the United States and in palliative care, describe the use of health information technology in general in the United States and in palliative care, and suggest areas in pediatric palliative care that might benefit from e-health interventions.

Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy

BACKGROUND

The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness.

OBJECTIVES

The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes.

METHODS

We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention.

RESULTS

We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d(+) = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d(+) = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages.

CONCLUSIONS

The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery.

The Internet as an adjunct for pediatric primary care

PURPOSE OF REVIEW

This review highlights recent publications on the use of the Internet as it relates to pediatric primary care, including its application to the pediatrician, teen, pediatric patient, and patients' parents. A brief overview of early work is introduced.

RECENT FINDINGS

The Internet has become a tool to expand the reach of preventive interventions, including school-based online pediatric health education. Although research continues to describe barriers to the adoption of online resources, recent reports highlight newer applications, including user-generated content (i.e. social networking sites), and the impact on teens and their health. There are concerns and benefits of Web 2.0 and the teen population, with adolescents at risk online yet also learning about their health online. Internet referrals, prescriptions for information, and online assessment methods have had varied success to date. There have been some studies of e-learning and online continuing medical education having an impact on clinical decision making, but there is a need for more research on the electronic medical record as it relates to the practicing pediatrician and the Internet at the point of care.

SUMMARY

The Internet is more than an information repository and continues to affect the lives and health of the pediatric population, parents, and providers. The growth of and changes to the Internet over time bring online innovations that have yet to be studied.

Enquiring minds want to know: topics requested by users of a children's health information website

OBJECTIVE

To investigate health information needs of users of a health information website for children and young people.

METHODS

A prospective analysis was conducted of unsolicited information requests to the Children First for Health (www.childrenfirst.nhs.uk) website, an NHS-run health and hospital online information resource for children, young people and families. All specific and general enquiries were recorded prospectively and coded according to health topic, age of the enquirer and web pages accessed.

RESULTS

There were 2865 (62%) general health information and 924 (21%) specific enquiries received over an 18-month period (6.3 enquiries per day). More general enquiries were received about adolescent (64%) than children's (36%) health issues. The most common topics were psychosocial issues, hospital and health services, and normal growth and development. Only 1% of requests for information related to smoking, alcohol and drugs.

CONCLUSION

Children and adolescents are active users of the Internet for health information. The results of this study highlight the health topics that are of greatest interest to children and young people.

PRACTICE IMPLICATIONS

The findings provide objective data on health information topics of interest to UK children and young people and can be used to guide development of health information aimed at UK youth.

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.

Parent use of touchscreen computer kiosks for child health promotion in community settings

OBJECTIVES

The goals were to evaluate the use of touchscreen computer kiosks, containing only child health-promoting information, in urban, low-income, community settings and to characterize the users of these kiosks.

METHODS

Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonald's restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data.

RESULTS

In total, there were 1846 kiosk sessions. Almost one half occurred at McDonald's. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to > or = 1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their child's doctor about what they had learned.

CONCLUSIONS

User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.