JMIR Pediatrics and Parenting最新文献

{"title":"An Electronic Health Record-Based Intervention to Facilitate Primary Care Referrals to the Special Supplemental Nutrition Program for Women, Infants, and Children: Retrospective Cohort Study.","authors":"Kimberly Montez, Melissa C Kay, Alysha J Taxter, Kristina H Lewis","doi":"10.2196/87608","DOIUrl":"10.2196/87608","url":null,"abstract":"<p><strong>Background: </strong>Despite the benefits of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), many eligible children remain unenrolled.</p><p><strong>Objective: </strong>This study evaluated responses to an electronic health record (EHR)-embedded federal nutrition program (FNP) participation screening and WIC referral tool implemented within 8 clinics during well-child visits for children younger than 5 years of age.</p><p><strong>Methods: </strong>Structured EHR data from July 2020 to October 2023 were extracted to summarize screening, referral acceptance, WIC enrollment outcomes, and patient demographics. Multivariable logistic regression was used to examine patient-level predictors of WIC nonenrollment at the first screening, referral acceptance, and enrollment among those accepting a referral, with analyses stratified by clinic type.</p><p><strong>Results: </strong>Among 5385 children, 51.8% (n=2785) were newborn-aged, 36.6% (n=1969) were Hispanic, and 87.8% (n=4726) were Medicaid-insured. The mean age at the initial screening was 10.7 (SD 14.2) months. Among screened patients (n=3606), 34% (n=1235) were not enrolled in WIC at the first screening. Medicaid coverage, an academic clinic setting, non-Hispanic Black or Hispanic race, and ethnicity were associated with lower odds of WIC nonenrollment. Among those not enrolled with a documented response to referral (n=819), 59% (n=488) accepted the referral. Acceptance was higher among non-Hispanic Black and Hispanic patients, newborn-aged patients, those with Medicaid coverage, and those seen in academic clinics. Among referral acceptors with follow-up (n=438), 61% (n=265) were enrolled at the last screening, with higher odds among newborn-aged patients and those in academic clinics.</p><p><strong>Conclusions: </strong>An EHR-based automated intervention can facilitate screening and referral to WIC. WIC participation at the first screening, referral acceptance, and enrollment after referral varied by sociodemographic characteristics, suggesting opportunities to improve equitable access through health care system-based approaches.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e87608"},"PeriodicalIF":2.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Lifestyle Support for Adolescents Undergoing Metabolic and Bariatric Surgery: Pilot Prospective Cohort Study.","authors":"Sarah E Messiah, Jackson M Francis, Folefac D Atem, Matthew Sunil Mathew, Alicia Wheelington, Maral Misserian, Sitapriya Neti, Rashon Braxton, Bethany R Cartwright, Faisal G Qureshi, Sarah E Barlow, Marlyn A Alicock","doi":"10.2196/86816","DOIUrl":"https://doi.org/10.2196/86816","url":null,"abstract":"<p><strong>Background: </strong>Metabolic and bariatric surgery (MBS) is a safe and effective treatment for adolescents with severe obesity, yet no standardized lifestyle interventions exist to support sustained behavior change after MBS.</p><p><strong>Objective: </strong>This pilot study assessed the feasibility and acceptability of TeenLyft, an online lifestyle support program for adolescents undergoing MBS, and explored preliminary clinical and safety outcomes to inform the design of a future randomized trial.</p><p><strong>Methods: </strong>Adolescents aged 13 to 18 years were recruited from a tertiary care MBS center and enrolled in TeenLyft. The study was not powered or designed as a randomized controlled trial but rather as a pilot to guide future randomized controlled trial development. Feasibility domains included recruitment, retention, data completeness, intervention fidelity, and engagement, with predefined progression criteria of ≥80% enrollment, ≥70% retention, ≥70% data completeness, and ≥90% fidelity. Exploratory clinical and safety measures (weight, BMI, and cardiometabolic markers) were collected descriptively to confirm that participation was not associated with harm.</p><p><strong>Results: </strong>Twenty-nine adolescents (mean age 15.9 years, SD 1.1; n=22, 75.9% female; n=13, 44.8% Hispanic; mean BMI 47.8, SD 7.3 kg/m²) were enrolled, representing 145% of the recruitment target (n=20), with 72.4% retention at 6 months. All feasibility progression criteria were met. Descriptive trends showed expected post-MBS reductions in weight and BMI and improvements in blood pressure and hemoglobin A_1c, with no adverse cardiometabolic effects observed.</p><p><strong>Conclusions: </strong>TeenLyft demonstrated high feasibility, acceptability, and safety as an adjunct to adolescent MBS care. Findings support progression to a fully powered randomized trial to evaluate long-term effectiveness and sustainability.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e86816"},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Social Media Intervention to Increase Caregiver Knowledge of Early Infant Communication: Multiple Methods Intervention Development and Pilot Study.","authors":"Mollie Romano, Aliya Junaideen, Frances Baehman, Katherine Dale, Arienne Ferchaud, Diana Lucia Abarca Sasser, Ashley Sellers","doi":"10.2196/93171","DOIUrl":"10.2196/93171","url":null,"abstract":"<p><strong>Background: </strong>Greater caregiver knowledge of early language development may support more reciprocal interactions with infants and improved child language outcomes. Short-form video interventions on social media platforms like Instagram and TikTok could be a scalable, cost-effective way to increase caregiver knowledge.</p><p><strong>Objective: </strong>The objective of this investigation is to describe the development and testing of a version of the BabyTok Project, a social media-based intervention for caregivers of very young infants under 3 months of age.</p><p><strong>Methods: </strong>We used a multiple-method, pre-post quasi-experimental design to examine the feasibility, acceptability, and initial evidence of effectiveness of the BabyTok Project through a knowledge measure called the SPEAK-R (Survey of Parent/Provider Expectations and Knowledge-Research).</p><p><strong>Results: </strong>Engagement metrics, participants' postintervention surveys, and feedback support the feasibility and acceptability of the intervention. Statistically significant scores on the SPEAK-R offer initial indications of change in caregiver knowledge.</p><p><strong>Conclusions: </strong>The BabyTok Project has multiple demonstrations of its feasibility and acceptability and shows promise as a means to increase caregiver knowledge of early infant communication development and strategies to enhance children's learning. Interventions like the BabyTok Project could be a scalable way to promote optimal child language outcomes.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e93171"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human-Centered Baby Massage Mobile App for Low Birth Weight Infants: Usability Testing and a Pre-Post Pilot Intervention Study in Indonesia.","authors":"Supriatin Supriatin, Regidor Iii Dioso, Hafizah Che Hassan","doi":"10.2196/73153","DOIUrl":"10.2196/73153","url":null,"abstract":"<p><strong>Background: </strong>Low birth weight (LBW) is associated with increased risks of neonatal morbidity, developmental delays, and long-term health problems. Although baby massages have been shown to improve growth and neurodevelopmental outcomes in LBW infants, access to suitable training and adherence to massage protocols remain challenging, particularly in low-resource settings. Mobile health interventions may help address these gaps by providing scalable and standardized education on infant massage.</p><p><strong>Objective: </strong>This study aimed to design and evaluate a human-centered baby massage mobile app to support the growth and development of LBW infants in Indonesia.</p><p><strong>Methods: </strong>A human-centered iterative design approach was used to develop the mobile app. Usability was assessed using the System Usability Scale among 42 caregivers of LBW infants. Qualitative data were collected through semistructured interviews and analyzed thematically to understand user experience. A pilot pre-post intervention study was conducted to evaluate the impact of the app on caregivers' knowledge, confidence, adherence to baby massage practices, and infant growth outcomes. Pre- and postintervention measures were compared.</p><p><strong>Results: </strong>The app demonstrated high usability, with a mean System Usability Scale score of 78.6 (SD 8.2), indicating good usability (≥68). Most participants rated the app as \"excellent\" or \"good.\" Qualitative findings highlighted improved caregiver confidence and ease of learning massage techniques. Statistically significant improvements were observed in caregiver knowledge (mean difference 20.5 points; P=.002), confidence (21.6 points; P=.001), and adherence to recommended massage practices (20.3 points; P=.02). Infant outcomes also improved, including weight gain (mean increase 330 g; P=.003) and head circumference (mean increase 1.3 cm; P=.004).</p><p><strong>Conclusions: </strong>The human-centered baby massage mobile app showed promising feasibility and effectiveness in improving caregiver knowledge, confidence, and adherence to infant massage practices. The app provides a culturally appropriate and user-friendly tool to support early interventions for LBW infants in resource-limited settings.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e73153"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Immersive Virtual Reality to Prevent Child Injuries in the Home: Proof-of-Concept Study.","authors":"Melissa C Osborne, Lei Zhang, Allison Garefino, Reece Freeman","doi":"10.2196/90006","DOIUrl":"https://doi.org/10.2196/90006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Injury is the leading cause of death among US children, with over 2700 deaths due to unintentional injuries among children aged &lt;6 years in 2023. Many of these deaths occur in the home and involve addressable safety hazards. Evidence-based parenting programs (EBPPs), in which parents work with a provider to learn parenting skills, offer an infrastructure for disseminating home safety content. However, few programs have structured modules on home safety, with most home safety education coming from printed materials or websites. Immersive virtual reality (IVR) allows participants to engage in activities in a simulated, risk-free environment. IVR's technological affordances create a training environment that supports experiential learning and helps learners internalize and transfer knowledge more effectively to real-world situations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to (1) design an IVR home safety program for parents of children aged &lt;6 years in line with our conceptual model, (2) obtain feedback from parents and EBPP providers on the initial design, and (3) test an initial prototype of the program with parents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The prototype was developed using human-centered design principles. The team first identified key components for program content using existing research and theory. Qualitative data were then collected from EBPP provider interviews (n=5) and focus groups with parents (n=7) regarding implementation constraints, program content, barriers/facilitators for engagement, and feedback on the use of IVR. Thematic analysis was used to identify themes from the qualitative data. The initial prototype was then pilot tested with parents of children aged &lt;6 years (n=5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The IVR program addresses knowledge and skill enhancement in three key areas: (1) home safety hazard identification, (2) hazard removal/mitigation, and (3) parental supervision. Using surveillance data, we identified leading causes of unintentional injuries in the home environment among US children aged &lt;6 years, including sleep-related deaths, firearm injuries, and drowning. Hazards and corresponding tasks in the IVR program were developed for these leading causes. Findings from interviews with providers indicate that they are open to the use of IVR in EBPPs and envision uses for both group and individual settings. They expressed concerns about the cost of incorporating IVR into their usual programs. Parents were interested in IVR, especially if presented in brief sessions. They also noted a desire for the virtual environment to look realistic and \"lived in.\"&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Currently, home safety information is delivered in a didactic or pamphlet-driven format in most EBPPs, which is not ideal for behavior change. This IVR home safety program will provide unique benefits in training, including (1) real-world simulations, (2) hands-on learning, (3) a risk-f","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e90006"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Stepwise Animated Video Modeling App With Token-Based Reinforcement for Toilet Training in Children With Autism Spectrum Disorder: Pilot Study Using Multiple-Baseline and Single-Case Designs.","authors":"Inyoung Son, Younglae Kim, Yearin Kim, Jungmin Kim, Dongwon Kang, Sojung Lee, Jungsang Min, Bung-Nyun Kim","doi":"10.2196/92147","DOIUrl":"10.2196/92147","url":null,"abstract":"<p><strong>Background: </strong>Toilet training is a major challenge for children with autism spectrum disorder. While mobile health offers accessible support, few apps specifically address the complex chaining required for independent toileting routines.</p><p><strong>Objective: </strong>This pilot study evaluated the feasibility and preliminary effectiveness of a caregiver-mediated mobile app using stepwise animated video modeling with token-based reinforcement support for toilet training in young children with autism spectrum disorder.</p><p><strong>Methods: </strong>A multiple-baseline design across participants (urination training) and a single-case AB design (defecation training) were used. Ten children (aged 3-6 years) were enrolled, and 4 (40%) were included in the final analyses. The tablet-based intervention guided a 16-step toileting routine using animation and token reinforcement. Primary outcomes were caregiver-recorded in-toilet elimination success (percentage) and routine completion (percentage). Secondary outcomes included standardized adaptive behavior scores (Korean Scales of Independent Behavior-Revised) and social validity.</p><p><strong>Results: </strong>Four children completed the study, whereas 6 were not included in the final analyses for heterogeneous reasons, including child engagement, caregiver implementation burden, and postenrollment ineligibility. Among completers, in-toilet elimination success improved substantially from baseline, reaching 100% for all participants at the limited 3-day follow-up observation window conducted 3 months after the intervention. Notably, one participant showed marked improvement from a stable 0% at baseline to 93.8% (30/32) of elimination events during the intervention. Routine completion also increased across all participants, suggesting improvements in independence. Caregivers reported favorable treatment adherence and social validity.</p><p><strong>Conclusions: </strong>The app showed preliminary feasibility and was associated with improvements in toileting outcomes among families who maintained engagement. However, the high attrition rate suggests that successful implementation may depend on child engagement readiness and caregiver resources. Future research should prioritize defining readiness criteria to identify families most likely to benefit from digital toileting interventions.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e92147"},"PeriodicalIF":2.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Family-Centered Patient Portals for Childhood Asthma Management Among Black Primary Caregivers: Qualitative Interview Study.","authors":"Aviv Y Landau, Anthonia Odarkor Odartei, Levia Airall Sutton, Leila Azari, Jamie Flores, Hita Kambhamettu, Sonya Sanders, Andrew Head, Kenrick Cato","doi":"10.2196/100502","DOIUrl":"10.2196/100502","url":null,"abstract":"<p><strong>Background: </strong>Childhood asthma places substantial burdens on caregivers, particularly in communities facing structural barriers to health care access. Patient portals, the patient-facing component of electronic health record systems, are primarily designed for clinical workflows, limiting their usefulness for caregivers managing their child's asthma.</p><p><strong>Objective: </strong>This qualitative study aimed to elicit primary caregivers' perspectives on managing childhood asthma and their experiences with patient portals to inform the development of a community-centered and family-centered medical platform.</p><p><strong>Methods: </strong>The authors conducted a qualitative study using in-depth, semistructured interviews between July and October 2024 with 15 Black primary caregivers of children with asthma living in the Greater Philadelphia area. Participants were recruited through purposive sampling in partnership with Philly Thrive, a community-based organization. Interviews were conducted both in person and virtually and lasted 30 to 90 minutes. A semistructured guide with 3 core questions explored experiences with managing childhood asthma, interactions with medical documentation and patient portals, and recommendations for redesigning patient portals. The number of interviews was determined by data richness and fulfillment of study aims. Data were analyzed using reflexive thematic analysis, guided by the Standards for Reporting Qualitative Research.</p><p><strong>Results: </strong>Two themes were generated. Theme 1, lived experiences of managing childhood asthma in families and communities, revealed that caregiving involves profound emotional work, daily routines, and community knowledge sharing that health systems largely do not recognize or support. Theme 2, caregivers' perceptions and experiences of navigating patient portals for childhood asthma, revealed that caregivers used portals selectively at key care moments rather than routinely. Persistent barriers included confusing medical terminology, outdated medication records, and limited communication channels. Caregivers recommended direct provider messaging, integration of environmental trigger data, streamlined medication refill processes, and age-appropriate portal features to support children's gradual self-management.</p><p><strong>Conclusions: </strong>Effective childhood asthma management requires information systems that honor caregiver expertise, provide transparent and accurate documentation, and actively work to reduce epistemic injustice. Community-centered platform design should integrate caregiver knowledge, environmental data, and child-appropriate tools to support equitable asthma care.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e100502"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13606335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents' Experiences From Participating in an Online Peer Support Child Feeding Intervention: The \"PICNIC Sweden\" Explanatory Sequential Mixed Methods Feasibility Study.","authors":"Kerith Duncanson, Anna Jörnvi, Sara Ask, Malin Högman, Erica Belestam Vikman, Richard Ball, Maria Henström Engblom","doi":"10.2196/93565","DOIUrl":"10.2196/93565","url":null,"abstract":"<p><strong>Background: </strong>Parents' feeding practices play a role in shaping children's dietary patterns, which influence chronic disease risk. Feeding children is challenging, so parents need guidance and support. Parents In Child Nutrition Informing Community (PICNIC) is an Australian program that promotes responsive child feeding using dietitian-led training and online communication, then facilitates peer-to-peer information sharing within parents' social networks.</p><p><strong>Objective: </strong>This pilot study aimed to test the feasibility, acceptability, appropriateness, and perceived impact of PICNIC with Swedish parents.</p><p><strong>Methods: </strong>This explanatory sequential mixed methods study involved 47 parents of children aged 0 to 24 months. Parents attended a 2-hour online dietitian-led workshop, followed by 2 months of child nutrition and feeding support in a moderated, closed Facebook group. Quantitative data from digital questionnaires (n=43) were analyzed and integrated with qualitative findings from thematic analysis of semistructured interviews (n=15).</p><p><strong>Results: </strong>Parents attended 1 of 10 workshops, and 4 to 5 posts per week (of which 20% were participants' questions) were shared in the project's Facebook group. Both quantitative and qualitative data indicated parents' child feeding knowledge and parental self-efficacy increased after participation. Parents reported that the intervention filled a gap in the existing support from child health services, strengthening their confidence in child feeding, while providing a sense of recognition and community. PICNIC information was described as trustworthy, shareable, and something to \"lean on.\" Parents valued the social interaction during the workshops but also suggested providing recorded content for easier access.</p><p><strong>Conclusions: </strong>This pilot study demonstrated high acceptability and appropriateness of the PICNIC intervention model among parents in Sweden. This study will inform the design of an adapted version of PICNIC to be offered through child health services.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e93565"},"PeriodicalIF":2.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Is (Not) Engaging With a Digital Parenting Intervention in Tanzania? Analysis of Predictors Using Data From a Factorial Randomized Trial.","authors":"Roselinde Janowski, Lucie D Cluver, Joyce Wamoyi, G J Melendez-Torres, Jamie M Lachman, David Stern, Lauren-Jayne van Niekerk, Yulia Shenderovich","doi":"10.2196/86129","DOIUrl":"10.2196/86129","url":null,"abstract":"<p><strong>Background: </strong>Digital interventions offer a promising avenue for scalable parenting support in low- and middle-income countries, where in-person coverage remains limited. However, engagement disparities may reduce their potential for population-level impact.</p><p><strong>Objective: </strong>This study examined caregiver-level predictors of engagement with ParentApp, a smartphone-based adaptation of the Parenting for Lifelong Health (PLH) for Teens program for caregivers of adolescents aged 10 to 17 years.</p><p><strong>Methods: </strong>This study was nested within a cluster-randomized factorial trial of ParentApp in Mwanza, Tanzania, implemented according to the optimization phase of the Multiphase Optimization Strategy. Clusters (n=16), comprising 614 caregivers (n=205, 33.4% men), were randomized to 3 components: guidance (guided vs self-guided), app design (unstructured vs structured), and digital support (enhanced vs basic). Digitally tracked app engagement outcomes included the number of modules completed, the first module not started, and the first module not completed. Baseline candidate predictors included demographic, socioeconomic, behavioral, and psychological factors assessed via an app-embedded questionnaire. Poisson generalized linear mixed-effects models with random effects for clusters assessed associations between predictors and each outcome. Interaction terms were specified to test whether associations differed by caregiver gender.</p><p><strong>Results: </strong>Among 614 caregivers, 596 (97.1%) completed the first module; however, engagement declined rapidly thereafter, with only 281 (45.8%) completing module 2 and 49 (7.9%) completing all 12 modules. Overall, mean content completion was 35.6% (SD 33.1%) of the program. Women completed approximately 15% more modules than men (incidence rate ratio 1.15, 95% CI 1.05-1.27, <i>P</i>=.003), despite reporting higher levels of financial stress, food insecurity, child maltreatment, and depressive symptoms at baseline (all <i>P</i>≤.02; Cohen <i>d</i>=0.19-0.37). No other caregiver characteristics were significantly associated with engagement.</p><p><strong>Conclusions: </strong>This is the first known study to investigate caregiver-level predictors of engagement with a digital parenting intervention in a low- and middle-income country. Engagement with ParentApp was broadly consistent across caregiver subgroups, with the exception that women completed significantly more modules than men. To equitably engage men and fathers, future studies should pair father-inclusive, identity-affirming content with implementation strategies that reduce social and economic barriers to participation.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e86129"},"PeriodicalIF":2.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Performance of Assistant Teachers Supporting Children With Autism in the United Arab Emirates: Mixed Methods Observational Study.","authors":"Fawaz Habbal, Abdulla Abdulalee Alhumaidan, Hajar Aljaberi, Fadi Nayef Bani Mostafa, Suzan Almali, Afaf Almenhali","doi":"10.2196/86784","DOIUrl":"10.2196/86784","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Assistant teachers play a central role in supporting children with autism spectrum disorder in United Arab Emirates inclusive classrooms. Despite this importance, no prior study has used validated observational instruments to systematically evaluate assistant teachers' competency profiles across classroom practice and parent interaction domains simultaneously in this cultural context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This program evaluation study assessed the professional performance of assistant teachers supporting children with autism spectrum disorder, examining classroom instructional competencies and parental engagement behaviors within a single United Arab Emirates diploma training program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A convergent mixed methods design was used. Ten assistant teachers who completed a national diploma training program were assessed by 3 independent expert evaluators across 50 site visits (n=25, 50% classroom observations; n=25, 50% parent meeting observations) conducted in January 2025 and March 2025. Tool 1 assessed 11 standardized classroom competency criteria, and tool 2 assessed 8 parent interaction criteria, both using a 5-point Likert scale. Mean scores were calculated by averaging all evaluator ratings across observation sessions per criterion. Internal consistency was assessed using the Guttman λ (λ=0.79 for tool 2). Formal interrater reliability was not computed; consensus-based resolution was used in cases in which evaluator ratings differed, which is acknowledged as a methodological limitation. Qualitative field notes were analyzed using the 6-phase thematic analysis by Braun and Clarke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Classroom performance means were 4.56 (SD 0.19; very high) in phase 1 (January 2025) and 4.55 (SD 0.23; very high) in phase 2 (March 2025). All teachers (10/10, 100%) achieved ceiling scores for daily living skill support and cultural adherence (mean 5.00, SD 0.00) across both phases. Safety and hygiene criteria scores were in the high range (mean 4.00, SD 0.00 to 4.10, SD 0.32). In parent interaction assessments (tool 2), the overall mean was 4.75 (SD 0.20; very high). The highest-ranked criteria were empathetic family treatment (mean 4.92, SD 0.28) and meeting preparation (mean 4.88, SD 0.33). The lowest-ranked criterion was clarity of structured communication (mean 4.48, SD 0.51; very high). Qualitative themes identified culturally responsive communication, emotional attunement, and individualized education plan-aligned practice. Repeated SD values of 0.00 and the absence of formal interrater reliability statistics are limitations that should be considered when interpreting these findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Within this program-specific evaluation, assistant teachers demonstrated consistently high professional competence. These preliminary findings suggest that diploma-based training can support culturally aligned and technically proficient inc","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"9 ","pages":"e86784"},"PeriodicalIF":2.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}