JMIR Publications

ABSTRACT

Background:

Unintentional injury is a leading cause of childhood morbidity and mortality worldwide. In China, real-world implementation of child injury prevention efforts remains inadequate due to constrained workforce capacity and a lack of operational frameworks.

Objective:

This study aims to assess the effectiveness of a mobile health (mHealth) intervention, the Intelligent Child Unintentional-injury Reduction & Education (iCURE) project, embedded within China’s National Basic Public Health Service Program. The intervention relies on a WeChat service account for caregivers and a web-based platform for healthcare providers to deliver standardized unintentional injury prevention strategies for young children. Key features of the program include interactive Q&A, injury risk assessment with instant feedback, a tailored injury prevention knowledge disseminator, and regular reminders to caregivers.

Methods:

A double-blind, 12-month follow-up, cluster randomized controlled trial will be implemented in Changsha, Hunan Province, China. At least 5,600 caregivers of children aged 5 and below will be recruited. Randomization will be conducted at the street/town level. The control group will receive traditional safety education, while the intervention group will receive both traditional safety education and the iCURE mHealth intervention focused on unintentional injury prevention and delivered via WeChat. Data will be collected at baseline and every 3 months during the study period. The primary outcome is 12-month incidence of unintentional injuries among children, including minor injuries and as reported by caregivers. Secondary outcomes include children's injury risk level and caregiver supervision behaviors assessed using a standard questionnaire. Data analysis will be conducted using generalized linear mixed models with a Poisson link function and generalized estimating equations to assess the effectiveness of the iCURE intervention, following intention-to-treat principles. Sensitivity analyses will be conducted with per-protocol principles and excluding participants with missing primary outcomes.

Results:

As of April 2025, a total of 6,704 participants have been successfully enrolled, and baseline data were collected for all participants. Of those enrolled, 82% completed the first follow-up assessment.

Conclusions:

This trial will examine the effectiveness of an intelligent mHealth intervention for child unintentional injury prevention building on China’s National Basic Public Health Service Program. If successful, the iCURE intervention may provide a cost-effective strategy for child injury prevention in low- and middle-income countries. Clinical Trial: The protocol of iCURE trial was retrospectively registered with Chinese Clinical Trial Registry (No. ChiCTR2400092698). Date of registration: November 21, 2024. Date of first participant enrollment: August 7, 2024.