JMIR Publications

ABSTRACT

Background:

The increasing prevalence of pediatric atopic diseases in China poses significant risks to children’s physical health, psychological well-being, and cognitive development. Caregivers play a pivotal role in disease management, yet scalable interventions to strengthen their capacity remain underexplored.

Objective:

This study aimed to develop and evaluate a Protection Motivation Theory-based cognitive-behavioral online intervention (PMT-CBO) for caregivers of children with atopic diseases, assessing its effects on caregivers’ protective motivation, behavioral intentions, preventive practices, and child-level clinical outcomes.

Methods:

From May to December 2023, 243 caregivers were purposively recruited from three healthcare institutions in Hangzhou, China, and non-randomly assigned to a PMT-CBO group (n=127) or a control group (n=116) using a quasi-experimental design. The intervention group received a 4-week structured program comprising 16 interactive modules delivered via a WeChat mini-program, whereas controls received routine care with verbal education. Primary outcomes included caregivers’ Protection Motivation Theory (PMT) constructs (threat appraisal, coping appraisal), behavioral intentions, and preventive behaviors, and secondary outcomes involved children’s symptom severity and medication adherence. Intention-to-treat analysis was employed.

Results:

The PMT-CBO group demonstrated significant improvements in overall PMT scores (Z=-6.289, P<.001) and most sub-dimensions (response efficacy, self-efficacy, threat severity and response cost, with P values <.05), except susceptibility (Z=-1.321, P=.19) and reward appraisals (Z=-0.989, P=.32). Caregivers exhibited stronger intentions and partial behavioral optimization (e.g., environmental allergen control, with Z=-3.025, P=.002). Children in the intervention group showed improved medication adherence (Z=-4.457, P<.001) and alleviated eczema (Z=-3.112, P=0.002) and allergic rhinitis symptoms (Z=-3.277, P<.001) , though no significant differences emerged in asthma control (Z=-0.830, P=0.41) or food allergy-related caregiver burden (Z=-1.693, P=0.09).

Conclusions:

The PMT-CBO intervention effectively enhanced caregivers’ short-term protective motivation and behavioral intentions while moderately improving pediatric medication adherence and symptom management. Its integration with WeChat ensured accessibility and scalability, offering a replicable digital health strategy for atopic disease management. Future studies should validate long-term efficacy across diverse populations and address persistent gaps in asthma control and caregiver burden mitigation.