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Provision of anticipatory guidance for parents is recommended as an effective strategy to prevent injuries among young children. Technology-based anticipatory guidance has been suggested to reinforce the effectiveness of injury prevention and improve parents’ knowledge of child safety.
This study aims to examine the effectiveness of a technology-based injury prevention program with parental anticipatory guidance for enhancing mothers’ knowledge of child safety.
In this randomized controlled trial, 308 mothers will be recruited from the antenatal clinics and postnatal wards of two major public hospitals in Hong Kong. Participating mothers will be randomly assigned into intervention and control groups. Mothers in the intervention group will be given free access to a technology-based injury prevention program with anticipatory guidance, whereas mothers in the control group will be given a relevant booklet on parenting. The injury prevention program, available as a website or on a mobile app, includes behavioral components based on the Theory of Planned Behavior. The primary outcome measure will be the change in the mother’s knowledge of child safety. The secondary outcome measures will be age-appropriate domestic safety knowledge, attitudes, intentions, perceived behavioral control, and self-reported behavior related to home safety practice. We will also determine dose-response relationships between the outcome measures and the website and mobile app usage.
Enrolment of participants will begin in October 2016. Results are expected by June 2018.
Parents will be able to easily access the domestic injury prevention website to find information regarding child injury prevention. It is anticipated that the technology-based intervention will help parents improve their knowledge of child safety and raise their awareness about the consequences of domestic injuries and the importance of prevention.
Clinicaltrials.gov
Clinicaltrials.gov NCT02835768; http://clinicaltrials.gov/ct2/show/NCT02835768 (Archived by WebCite at http://www.webcitation/6lbXYM6b9)
Childhood injury is a major public health problem worldwide [
Parents are the primary caregivers and role models for their children’s behavior, and they should be given guidance regarding domestic injury prevention and how to modify the home to be a safe environment [
Technology-based interventions with anticipatory guidance information can be accessed anonymously, anytime, and anywhere. These systems can provide individualized and tailored interfaces enriched with interactive elements [
In this study, we propose to develop a new technology-based intervention that includes parental anticipatory guidance related to child injury prevention that is accessible on the web and as a mobile app. We will examine the effectiveness of the intervention in enhancing mothers’ knowledge of child safety. Using our new technology-based approach, we aim to motivate mothers to learn about pediatric unintentional domestic injury prevention to improve their knowledge of child safety, attitudes, and perceived behavioral control toward home safety practice. Website usage will be evaluated in terms of its reach and engagement statistics. User acceptance evaluations will be conducted at the end of the intervention period to collect feedback on the website interface.
This study will be a randomized controlled trial of the effectiveness of a technology-based injury prevention program for enhancing mothers’ knowledge of child safety (
Participants will be randomly allocated into the intervention and control groups in a 1:1 ratio. All participants will be given an information pack consisting of a parenting booklet from the Maternal and Child Health Centers (MCHC). This booklet is publicly available and provides brief and general home safety tips for mothers with children under 3 years of age. The intervention group will also be given an additional leaflet containing a brief introduction to the Internet-based domestic safety platform, and instructions on how to access the website. Mothers can easily access this practical online parenting resource through the website or a mobile app. The online resource contains information on various safety topics and educational materials, including general and age-appropriate injury prevention measures suitable for mothers with infants and children between 2 and 18 months of age. Participants in the intervention group will be periodically contacted by telephone and electronic messaging to encourage them to access and engage with the domestic safety website. The research team will provide technical support to all participants who encounter problems accessing the intervention website or mobile app. Apart from technical support, no other intervention will be provided to those accessing the website or mobile app by any therapist, nurse, care provider, or physician. The control group will receive only the MCHC parenting booklet.
All consenting participants will be asked to complete a general safety questionnaire at the antenatal clinic or postnatal ward of the two hospitals. Age-appropriate safety knowledge, attitudes, intentions, perceived behavioral control, and self-reported behavior related to home safety practice will be assessed at specific child developmental ages at 2, 6, 9, 12, and 18 months. Participants in the intervention group will be given immediate feedback on their specific injury prevention behaviors prompted by the
This study is registered with Clinicaltrials.gov (Identifier: NCT02835768) and has been approved by the Institutional Review Board of Hong Kong University and Hospital Authority Hong Kong West Cluster (Reference number: UW 15-465). All participants will provide written informed consent.
With reference to a computer-based parenting intervention for child injury prevention that reported a small to medium effect (d=0.42) for knowledge change [
Participants will be randomly assigned to the intervention group or the control group by stratified randomization within each hospital, using random numbers generated using R Statistical Software. Each participant will receive a sealed opaque envelope assigning them to either the intervention (website and mobile app access) or the control (no website or mobile app access) groups. The participant recruitment and randomization process will be independently carried out by different research assistants. Outcome assessors will be blinded to the allocation of participants in each group.
The technology-based intervention website will be developed using the existing injury prevention website designed by the Hong Kong Childhood Injury Prevention and Research Association (CIPRA), which provides informational, educational, and motivational support to parents [
The Injury Prevention Program (TIPP), an intervention website introduced by the American Academy of Pediatrics [
Flow diagram of study design.
Age-appropriate safety counseling topics adopted and modified based on The Injury Prevention Program (TIPP).
Age | Safety counseling topics |
1.5 to 2 months | |
Falls | |
Scalds | |
Sleeping safety | |
Suffocation | |
Drowning | |
6 months | |
Falls | |
Burns | |
Medicine poisoning | |
Drowning | |
Toy hazards | |
9 months | |
Concussion | |
Drowning | |
Driving hazards | |
Finger pinching | |
12 months | |
Poisoning | |
Falls | |
Sunburn | |
Driving hazards | |
18 months | |
Poisoning | |
Falls | |
Sunburn | |
Driving hazards |
The value of using a behavioral approach to design an injury prevention program is widely recognized by researchers [
Mothers can use the discussion forum to exchange opinions or ideas related to domestic safety, such as the usefulness of safety gadgets, uncommon domestic injury hazards, and home safety emergency plans. Concerned mothers can also use the forum for online consultation by asking questions about childhood injury, and can even upload photos, which will then be answered by safety experts. However, in an emergency, participants should contact emergency services and attend their nearest accident and emergency department. The forum can serve as a practical learning platform and provide parents or caregivers with additional social value through online interaction. Online discussion forums have been shown to enhance social support and the feeling of parental efficacy, and thus can improve one’s attitudes and intentions to adopt safer practices [
Additional interactive elements such as video demonstrations, games, and quizzes will be added to the website and mobile app. Two interactive games have been designed to deliver key information related to childhood safety and injury prevention. In the first game (named
The website will contain comprehensive injury prevention information and useful links and telephone numbers. All information contained in the website and the app will be consolidated and updated regularly, taking into account the changing patterns arising from local injury profiles, caregivers’ responses, and the physical environment. Reference and guidance materials such as injury-related publications of evidence-based good practices, statistical data, and frequently asked questions will be made available on the website to reinforce users’ perceived behavior control toward domestic injury prevention. In addition, the injury profiles of the 18 districts in Hong Kong, with infographic summaries, will be uploaded to the website for reference [
The existing CIPRA website will be redesigned to accommodate the intervention program in this study, and will be cohosted by CIPRA and the authors’ department. A mobile app will be made available for downloaded on Android phones and iPhones. The website will run on a Linux server located and managed under the authors’ department, and will have regular backups to prevent any accidental data loss.
This study aims to increase mothers’ knowledge of child domestic safety, and to improve their attitudes, intentions, perceived behavioral control, and actual behavior related to home safety practice. The following five evaluation components will be included to demonstrate the effectiveness of the technology-based intervention: general safety knowledge, age-appropriate safety questionnaire, injury prevention behavior checklist, website and mobile app usage statistics, and website and mobile app user acceptance.
This component aims to evaluate changes in mothers’ general knowledge related to domestic injury prevention [
This component examines age-appropriate domestic safety knowledge, attitudes, intentions, and perceived behavioral control toward home safety practice (
This component examines different age-appropriate injury prevention behaviors. The injury prevention behavior checklist serves as a behavioral measure for: (1) identifying hazards, and (2) implementing safety measures in a home environment (see
Participants will be required to register online as a
Towards the end of the intervention period, subjects will be reminded to complete a user acceptance evaluation (see
To enhance participation and minimize attrition in the follow-up months, incentives will be given to mothers who continue to complete evaluations. Proposed incentives include safety gadgets and cash coupons (valued at Hong Kong $50; approximately US $6.40) from companies that promote child domestic safety.
Changes in participants’ knowledge of child safety will be studied by comparing their knowledge before and after completing the injury prevention program, and by comparing the participants’ knowledge of child safety in the intervention and control groups. Regression analysis will be used to examine the intervention effectiveness, adjusted for participant demographics (eg, gender, age, and socioeconomic status of the parent). Data will be analyzed by an intent-to-treat approach to address loss of any follow-up data. Independent sample t-tests will be used to examine the between-group differences in age-appropriate safety knowledge, attitudes, intentions, perceived behavioral control, and actual behavior related to home safety practice. Dose-response relationships between the outcome measures and the website and mobile app usage will be determined by correlation analysis. Website and mobile app usage data will be summarized based on the number of users and their time spent using these resources during the entire intervention period. A summary of the user acceptance evaluation will be compiled to improve and develop the website and mobile app.
This project was successfully funded by the Health Care and Promotion Fund (Project No. 08150345) of the Food and Health Bureau, Hong Kong government, in March, 2016 after a stringent external review process. Enrolment of participants will start in October, 2016 and results are expected by June, 2018.
It is anticipated that the technology-based injury prevention intervention will yield a small to medium effect in terms of mothers’ child safety knowledge enhancement. It is estimated that intervention participants will spend more time on the mobile app than on the website. Dose-response relationships between the outcome measures and the website and mobile app usage will be examined. It is expected that intervention participants will have better age-appropriate safety knowledge, attitudes, intentions, perceived behavioral control, and actual behavior related to home safety practice compared to the control group participants.
This study examines the effectiveness of a technology-based intervention designed to improve mothers’ awareness of the severity and consequences of domestic injuries. Mothers can enhance their knowledge of child safety by accessing the online age-appropriate information related to child health, parenting, and safety. This technology-based platform can help users find available resources, services, providers, and relevant contact information.
A discussion forum will be available on the new website and mobile app as a means to facilitate communication between mothers and professionals. Mothers can also benefit from technology-mediated social support and chat rooms, and exchange lay knowledge. Safety experts and pediatricians will be invited to provide advice, professional support, and counseling through the website and the app, which will strengthen online services and promote engagement. The website will help to mobilize community stakeholders to address child safety concerns and other aspects of child health, and will allow stakeholders to raise their own concerns. The website will empower parents to take responsibility for their children’s health and safety, and to adopt good health practices.
The Internet is becoming widely accepted as an effective, low-cost platform for the dissemination of health and safety information. In comparison to traditional media, information on the Internet can be updated instantly and inexpensively [
This study will be carried out in collaboration with CIPRA by sharing resources, exchanging best practices, and combining efforts towards sustainability. Furthermore, this Web-based intervention will demonstrate a sustainable health promotion strategy that mobilizes local resources with cross-sectoral collaborations to engage the community by building partnerships between private, public, and nongovernmental organizations. Upon completion of the evaluation, the information leaflet with details of the domestic safety website will be disseminated to relevant public, private, and nongovernmental organizations that promote child health, and particularly child safety. This freely accessible safety platform will allow organizations to reinforce awareness and promote domestic injury prevention among target populations.
Information on the platform can be revised regularly to ensure that users have access to high quality, up-to-date, and accurate information. All safety information contained on the website and mobile app will be shared with interested nongovernmental organizations, MCHC, and postnatal clinics. All information associated with the platform can also be linked across sectors, including the government, academic institutions, nongovernmental organizations, and private sectors in Hong Kong. The CIPRA safety information website and mobile app are expected to be easily accessible for all users, including parents, caregivers, school teachers, social workers, children, and nonacademic medical and allied health professionals. This platform will serve as an information hub for the community and a learning platform for all relevant stakeholders. When disseminating the findings from the intervention study within the community, we will also compare the intervention with other services by collecting feedback from different users, interviewing relevant stakeholders, and conducting ecological and econometric studies to assess the long-term social impact on the intervention. We will further improve the intervention platform to meet the needs of the community.
Anticipatory guidance for injury prevention should be provided to parents along with routine medical care, such as well-child visits for infants and children. An important advantage of this Internet-based intervention, apart from providing anticipatory guidance, is its potential to reach a wide audience, which can be exploited by other electronic health services that utilize community-wide interventions with intersectoral collaborations between public, private, and nongovernment organizations. The use of technology-based interventions is increasing, and can be considered a powerful mobilization strategy for engaging various user groups. In the future, the online platform can be adapted to deliver preventive pediatric health care information in other learning areas, such as growth monitoring, nutrition, and vaccinations. All of these important child health-related areas would contribute to the establishment of a child health portal that will help to promote the well-being and optimal development of children in Hong Kong.
General safety knowledge questionnaire.
Age-appropriate safety questionnaire.
Injury prevention behavior checklist.
Website and mobile app user acceptance questionnaire.
The peer-review report from the Health Care and Promotion Fund.
CONSORT-EHEALTH checklist (V1.6.1) [
The Hong Kong Childhood Injury Prevention and Research Association
Maternal and Child Health Centers
The Injury Prevention Program
None declared.