Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jan 28, 2019
Date Accepted: Jun 16, 2019
(closed for review but you can still tweet)
Evaluating an app-based intervention to prevent unintentional injury among caregivers of preschoolers: A cluster randomized controlled trial
ABSTRACT
Background:
App-based interventions have potential to reduce child injury in countries with limited injury prevention resources, but their effectiveness has not been rigorously examined.
Objective:
To assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers.
Methods:
A 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. 2920 caregivers of preschoolers aged 3-6 years old from 20 preschools in Changsha, China were recruited offline, and 1980 completed the 6-month follow-up. Schools were randomly allocated to either the control (app-based parenting education excluding unintentional injury prevention) or intervention group (app-based parenting education including unintentional injury prevention). The primary outcome was unintentional injury incidence among preschoolers in the past 3 months that were surveyed online at baseline, 3-month, and 6-month follow-up visits through online self-assessed questionnaires. Secondary outcome measures included caregivers’ attitudes and behaviors concerning child supervision during the last week. Generalized Estimation Equation (GEE) was used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for socio-demographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat and a per-protocol sensitivity analysis was also conducted.
Results:
In total, 1980 of the 2920 caregivers completed the study (mean age=32.0 years; 69.0% female). During the 6-month follow-up, changes were not statistically significant across groups in unintentional injury incidence (intervention group: 8.8% to 8.1%; control group: 9.4% to 7.5%; OR=1.14, 95% CI: 0.80, 1.62) or the average attitude score towards unintentional injury prevention (B=0.05, 95% CI: -0.03, 0.13). Changes in parenting behavior toward unintentional injury prevention were greater in the intervention group than the control group after intervention (B=0.87, 95% CI: 0.33, 1.42). Isolated-behavior analyses showed that the intervention reduced three risky behaviors [(unsafely feeding children (OR=0.73, 95% CI: 0.60, 0.89); incorrectly placing children in a car (OR=0.73, 95% CI: 0.57, 0.93); and allowing children to ride a bicycle, electric bicycle, or motorcycle unsupervised (OR=0.80, 95% CI: 0.64, 0.99)] and improved three safe behaviors [testing water temperature before giving child a bath (OR=1.26, 95% CI: 1.05, 1.52); properly storing sharp objects (OR=1.24, 95% CI: 1.01, 1.52); and safely storing medicines, detergents, and pesticides (OR=1.24, 95% CI: 1.02, 1.51)].
Conclusions:
The app-based intervention did not reduce unintentional injury incidence among preschoolers but substantially improved caregivers’ safety behaviors. This intervention approach is readily to be used in broad population to improve patenting behaviors of preschooler caregivers. Clinical Trial: Chinese Clinical Trial Registry: ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84)
Citation
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