Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study

Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S

Background

Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs.

Methods

Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors.

Results

Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury.

Conclusion

SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.

Significant effects of childhood obesity treatment with a web-based component in a randomised controlled study (Web-COP)

AIM

We evaluated the effect on body mass index standard deviation score (BMI-SDS) of a combined treatment (Web-COP) for children with obesity, including a web-based component targeting their parents.

METHODS

This randomised controlled trial recruited children 5-12 years of age with obesity (International Obesity Task Force BMI [IOTF-BMI] ≥30 kg/m2 ) from school health care and outpatient paediatric clinics in in Northern Sweden from 1 June 2019 to 21 June 2020. The children were randomised to Web-COP, an intervention with group sessions and a 12-week web-based component, or standard care. The primary outcome was the change in IOTF BMI-SDS after 6 months.

RESULTS

In total, 75 children (33 girls), mean age 9.5 years, were randomised, and 65/75 (87%) children and their parents completed the study, 35/39 (90%) in the Web-COP intervention and 30/36 (83%) in the standard care group. BMI-SDS at 6 months was changed from 3.08 to 2.81 in the intervention group compared to an increase from 3.07 to 3.16 in the standard care group, representing a significant difference between groups (p < 0.001). In the intervention group, 14/30 (47%) reduced their BMI-SDS ≥0.25, compared to none in the standard care group.

CONCLUSION

The parent-focused intervention significantly improved BMI-SDS in children with obesity as compared to children in standard care.

Validation of remote assessment of preschool children's anthropometrics and motor skills

Introduction

Remotely delivered treatment and research procedures were rapidly adopted in response to the COVID-19 pandemic. However, it is unclear if these measures are valid. The purpose of this study was to compare the validity of anthropometry and motor skill proficiency measurements collected in a remote-setting to in-person setting among a sample of children ages 3-4 years.

Methods

Child anthropometry and motor skill performance were measured in-person by trained assessors and by parents at home with remote supervision via videoconference by trained assessors. The following measures from the National Institutes of Health Toolbox were collected: anthropometry (height and weight), manual dexterity/manipulation (9-hole pegboard), motor coordination and agility (supine timed up and go), lower body strength (standing long jump), and postural stability (one-leg standing balance). Differences in expert and parent-based measurements were assessed using Bland-Altman plots, paired samples t-tests, and Pearson correlations.

Results

A total of n = 14 children completed the assessments. No significant differences were observed between measurement locations for weight and motor skills (p > .05). Remote measurement of height (M = 101.1 cm, SD = 5.40) was significantly greater than in-person measurements (M = 98.2 cm, SD = 5.16); p < .0001.

Discussion

Remote measurements of motor skills and weight are valid assessments for researchers and clinicians to utilize in young children. Remote assessment with guidance offers comparable and valid estimates as in-person assessment, potentially offering a solution to resource-constricted barriers in research and access to care. There is an opportunity for researchers to fine-tune remote height and individual-level assessment strategies.

[Strategies and effects of digital interventions in overweight and obesity treatments in children and adolescents-a systematic review]

BACKGROUND

Rising obesity prevalence in childhood and adolescence are characterized by unhealthy lifestyles such as low physical activity due to high media use. Recent studies use the accessibility of this target group through digital media, whereby technologies represent new approaches in the intervention design of weight reduction. However, the question arises as to which digital combinations and methodological program concepts condition effective body mass index (BMI) changes.

AIM

To gain insights into effective program design and media use; digital intervention strategies for BMI reduction in overweight and obese children and adolescents will be analyzed and evaluated.

METHODS

A systematic review was conducted in the databases MEDLINE via PubMed, Science Direct, and Web of Science to analyze studies from 2016 to 2021 on changes in BMI and BMI z‑score of overweight and obese 6‑ to 18-year-olds. Methodological study quality was assessed according to the Cochrane Risk of Bias guidelines.

RESULTS

From 3974 studies, seven articles describing the use of fitness wristbands, smartphones, and computer-based programs were identified. All media achieved BMI reductions, with smartphone interventions via calls and messages causing the most significant changes.

DISCUSSION

Smartphones as providers of digital programs (e.g., apps) offer effective approaches to obesity reduction. Based on the data, the selection and combination of several media as well as the relevance of family involvement and the methodological foundation of the measures are confirmed. Due to the young age of the participants, media interventions must be made accessible to the target group.

Determining factors that influence parents' perceptions of telehealth provided in a pediatric gastroenterological practice: A quality improvement project

BACKGROUND

In response to the COVID-19 pandemic, local and institutional guidelines restricted non-emergent, in-person visits in outpatient specialty clinics. Nurse practitioners (NPs) in pediatric gastroenterology clinics immediately shifted their practice to telehealth (TH).

LOCAL PROBLEM

The shift to TH necessitated a change in practice. This quality improvement project was designed to define factors influencing family's perceptions of TH and secure feedback on the TH experience. TH is remaining an option for accessing care even as restrictions are being lifted. Feedback is necessary to ensure that quality of care and high patient satisfaction are maintained in a virtual environment.

METHODS

The Unified Theory of Acceptance and Use of Technology was used to frame the project. Surveys were collected from NPs related to services provided and complexities of each encounter. Post-visit surveys were conducted with families to assess their perceptions of the visit. Findings were discussed to identify and address gaps in service.

RESULTS

Parent/family surveys were consistent with NP feedback. Results indicated that parents were satisfied with care provided via TH, but that these visits were limited by incomplete assessments, lacked the intimacy of in-person encounters and were often difficult to access due to technological issues.

CONCLUSIONS

It is anticipated that TH will be used in the post pandemic era to provide routine and non-emergent acute care. Institutions and providers need to consider factors influencing the patient experience learned during the pandemic and implement evidenced-based strategies that ensure quality care that meets patients' needs.