The comparison of access to an eHealth resource to current practice on mother and co-parent teamwork and breastfeeding rates: A randomized controlled trial.

BACKGROUND: Breastfeeding rates are suboptimal, putting mothers and their infants' health at risk. One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals has been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. OBJECTIVES: To compare two study conditions to determine: (1) which way is more effective to provide breastfeeding education to women and their co-parents on increasing breastfeeding rates and associated secondary outcomes, such as breastfeeding knowledge, attitude, self-efficacy and overcoming challenges; (2) the difference in co-parenting and partner support between the study groups; (3) how parents in both groups preferred to access breastfeeding information; and (4) the groups' satisfaction with the eHealth resource that was provided. DESIGN: This study used a randomized controlled trial design (Clinicaltrials.org #NCT03492411). Participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant. Participants in Study Condition #1 (SC1) accessed a previously created, online e-Health resource, in addition to other generally available resources they could access in the community; participants in Study Condition #2 (SC2) accessed only the generally available resources. SETTING: Participants were recruited in health care providers' offices and services for expectant parents in Ontario and via social media throughout Canada. PARTICIPANTS: Expectant women (n = 113) and their co-parents (n = 104) were enrolled. METHODS: After eligibility was determined, consents obtained and baseline surveys completed, group allocation was conducted. SC1 had a virtual meeting with a research assistant to review the eHealth resource. Weekly emails were sent to all participants for 6 weeks as reminders. Follow-up data were electronically collected from mothers and co-parents at 2 weeks post enrollment and 4, 12, 26 and 52-weeks postpartum. RESULTS: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% 'exclusive' 6 months) and (SC1 71% and SC2 78% 'any' 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly. CONCLUSION: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

The Development and piloting of an eHealth breastfeeding resource targeting fathers and partners as co-parents.

OBJECTIVE: Traditionally breastfeeding education programs target mothers solely. The objective of this study was to design and pilot test an interactive eHealth breastfeeding co-parenting resource developed to target both mothers and fathers. eHealth resources provide an accessible and engaging format on which to educate parents and assist them in meeting their breastfeeding goals. Best practices to design such resources are not currently known. DESIGN: A three phase pilot study was conducted. The three phases included conducting a needs assessment, creating the resource and pilot testing the resource with mother, father and health care professionals to determine their perspectives regarding the usability and design of the prototype resource. The interactive prototype resource was designed to provide information to parents on breastfeeding and co-parenting, which included suggestions on how fathers can be involved and support breastfeeding and how the couples can work as a team to meet their breastfeeding goals. Setting: Recruitment took place in a health region in Southern Ontario, Canada between June 2014 and March 2015. Online questionnaires were completed by participants in all phases of the study. PARTICIPANTS: Participants (n=149) were pregnant or new mothers and their partners in the health region who read and speak English and had access to the internet and health care professionals who work with breastfeeding families in Ontario, Canada. INTERVENTION: A prototype eHealth breastfeeding co-parenting resource was developed based on maternal and paternal feedback from Phase I and utilized an interactive interface which included games and multimodal information delivery. The prototype eHealth resource was provided to the parents in Phase II and health care professionals in Phase III. The final resource was created based on feedback from these participants. MEASUREMENTS AND FINDINGS: The resource was pilot tested with new and expectant parents using pre- and post-test questionnaires which included measures for breastfeeding self-efficacy (Breastfeeding Self-Efficacy Short Form), infant feeding attitude (Iowa Infant Feeding Attitude Scale), breastfeeding knowledge (Breastfeeding Knowledge Questionnaire) and co-parenting relationship (Co-parenting Relationship Scale). Maternal and paternal breastfeeding self-efficacy and knowledge and infant feeding attitude scores all increased from pre-test to post-test. However, there was no difference in the co-parenting relationship scores from pretest to post-test. KEY CONCLUSIONS: This study has used feedback from parents and health professionals to develop a prototype resource which appears to be effective in increasing parents' breastfeeding knowledge, attitude and self-efficacy. The prototype resource was rated positively by parents and health care providers. IMPLICATIONS FOR PRACTICE: An eHealth breastfeeding co-parenting resource designed with input from the target population is an effective way of providing information to mothers and fathers. Further research with a randomized controlled design and more diverse populations is needed to determine effectiveness of the resource on breastfeeding duration and exclusivity.

Developing a Game Interface to Assess Risk Perception with Respect to Two Key Dimensions of Risk (Frequency and Severity) in Contexts Where Risks Are Elevated from Their Accepted, "Typical" Values.

OBJECTIVE: This four-stage study culminated in a game interface designed to calibrate people's perceptions of net risk (combining frequency and severity), in contexts where risks are elevated from their accepted, "typical" values, as when avalanche threats elevate the risks of "skiing" above levels skiers normally accept. Risk prompts are displayed dynamically, in naturalistic language, and not, for example, as static displays of dollar amounts or probabilities. Individual differences are measured. MATERIALS AND METHODS: In Stage 1 (pilot), focus groups (n=9) piloted procedures, visual prompts, and examples of contexts where risks elevated from the "usual," for use in upcoming stages. In Stage 2 (exploratory), participants (primarily students; n=119; mean age, 20.1 years; 64 percent male) were assigned to risk contexts, answered demographic and risk-history questions, and then matched risk-description prompts to perceived "appropriate" levels along an ordinal risk scale. Descriptive measures and graphs showed response distributions; chi-squared analyses compared responses for different demographics. In Stage 3 (manipulating "cards"), participants (n=80; mean age, 37 years; 60 percent male) matched naturalistic risk prompts with ordinal risk positions. Regressions compared cards' placements with their "expected" (per exploratory Stage 2) placements. In Stage 4, the interface was coded in the Unity(®) (implemented at Business and IT Capstone, University of Ontario Institute of Technology, Oshawa, ON, Canada) development environment. RESULTS: In Stage 1, ambiguities in draft wordings/displays for Stage 2 were identified and corrected. Three risk contexts emerged: traffic/hidden intersection; skiing/avalanche; and swimming/drowning. In Stage 2, for traffic and skiing contexts, responses relating ordinal risk categories to realistic examples were observed to cluster around values potentially usable as markers. No associations appeared with demographic variables. In Stage 3, actual and "expected" ordinal-risk-category assignments for naturalistic risk markers were well correlated. "Approximate mappings" between markers and categories appeared stable. In Stage 4, the interface design incorporated the "approximate mappings"-yet also incorporated a "tuning phase," for measuring and recording individual differences. CONCLUSIONS: The interface can capture individual differences in risk perception on two key dimensions (frequency and severity)-viewed in dynamic, naturalistic scenarios, where risk levels are increased.

Health capabilities and diabetes self-management: the impact of economic, social, and cultural resources.

While the "social determinants of health" view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's "capabilities" framework and its derivative the "health capabilities" (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health.

Risk factors for increased severity of paediatric medication administration errors.

Patients' risks from medication errors are widely acknowledged. Yet not all errors, if they occur, have the same risks for severe consequences. Facing resource constraints, policy makers could prioritize factors having the greatest severe-outcome risks. This study assists such prioritization by identifying work-related risk factors most clearly associated with more severe consequences. Data from three Canadian paediatric centres were collected, without identifiers, on actual or potential errors that occurred. Three hundred seventy-two errors were reported, with outcome severities ranging from time delays up to fatalities. Four factors correlated significantly with increased risk for more severe outcomes: insufficient training; overtime; precepting a student; and off-service patient. Factors' impacts on severity also vary with error class: for wrong-time errors, the factors precepting a student or working overtime significantly increase severe-outcomes risk. For other types, caring for an off-service patient has greatest severity risk. To expand such research, better standardization is needed for categorizing outcome severities.

Said another way: asking the right questions regarding the effectiveness of simulations.

Applying simulations in healthcare practice and education is increasingly accepted, yet a number of recent authors have questioned the effectiveness of these technologies. The contention is that while high-fidelity simulators may contribute to educational gains, their gains compared to low-tech alternatives are often "not significant." That assessment, however, and the evidence it is based on, may be a consequence of asking the wrong questions. Typical studies often compare a measure for "average success" for one group's members versus another's on some criteria, but this can mask important information about the "tails" of the distribution for how trainees are performing. An alternative approach, adapted from quality control, compares error rates for each group in the experiment, in aggregate. The statistical results of evaluations can change if this method is used, as illustrated by a recent study showing that simulation training can significantly reduce the frequency of medication administration errors among student nurses on placement. The paper includes a case study to tangibly demonstrate how the way we frame our evaluation test question can reverse the apparent statistical finding of the significance test.

The relationship between simulation in nursing education and medication safety.

This experimental study examined whether the use of clinical simulation in nursing education could help reduce medication errors. Fifty-four student volunteers were randomly assigned to an experimental (treatment) group (24 students) or a clinical control group (30 students). The treatment replaced some early-term clinical placement hours with a simulated clinical experience. The control group had all normally scheduled clinical hours. Treatment occurred prior to opportunities for medication administration.