Self-efficacy and autonomous motivation are associated with lower sugar-sweetened beverage consumption in low-income overweight and obese mothers of young children.

Sugar-sweetened beverage (SSB) consumption is strongly associated with obesity. Autonomous motivation and self-efficacy, key concepts of self-determination theory, may influence SSB consumption. Low-income mothers of young children experience disproportionate rates of obesity. Whether autonomous motivation and self-efficacy are associated with SSB consumption in low-income mothers of young children is unknown. This exploratory secondary data analysis explored whether autonomous motivation or self-efficacy were associated with SBB consumption using data from a lifestyle intervention for low-income, overweight or obese mothers with young children. Participants (N = 311) completed surveys assessing autonomous motivation, self-efficacy, and SSB consumption at baseline, after the 16-week intervention, and at 3-month follow-up. Using baseline data, we performed linear regression models to explore associations of self-efficacy and autonomous motivation with SSB consumption. We also performed mixed effects models to explore whether autonomous motivation or self-efficacy were associated with SSB consumption over time. At baseline, a one-point increase in autonomous motivation and self-efficacy were associated with 4.36 (p < 0.001) and 6.43 (p = 0.025) fewer ounces of SSB consumption per day, respectively. In longitudinal models, SSB consumption decreased over time. Change in SSB consumption was associated with self-efficacy (B = -4.88; p = 0.015) and autonomous motivation (B = -2.29; p = 0.008). Our findings suggest self-efficacy and autonomous motivation may influence SSB consumption among mothers of young children with overweight and obesity. Further investigation should explore if self-efficacy and autonomous motivation have long-term effects on SSB consumption.

Early childhood stress responses to psychosocial stressors: The state of the science.

The aim of this systematic review was to better understand whether and to what extent psychosocial stressors are associated with hypothalamic-pituitary-adrenal axis or autonomic nervous system stress responses in young children (1-6 years of age). Studies were classified by psychosocial stressors from the ecobiodevelopmental model: social and economic resources, maternal mental health, parent-child relationships, and the physical environment. Of the 2388 identified studies, 32 met full inclusion criteria, including over 9107 children. Child physiologic stress responses were measured as hair and urinary cortisol and cortisone, salivary diurnal and reactive cortisol, salivary reactive alpha-amylase, and respiratory sinus arrhythmia. There were 107 identified relations between psychosocial stressors and physiologic stress responses. Nearly two thirds of these relations suggested that children have dysregulated stress responses as either significantly blunted (n = 27) or increased (n = 37); 43 relations were not significant. Children most consistently had significantly dysregulated stress responses if they experienced postnatal maternal depression or anxiety. Some reasons for the mixed findings may be related to characteristics of the child (i.e., moderators) or stressor, how the stress response or psychosocial stressor was measured, unmeasured variables (e.g., caregiving buffering), researcher degrees of freedom, or publication bias.

Expect the unexpected: Adolescent and pre-teens' experience of diabetes technology self-management.

OBJECTIVE: Only 17% of adolescents with type 1 diabetes (T1D) are currently meeting their glycemic targets despite advances in diabetes technologies. Self-management behaviors and challenges specific to use of diabetes technologies are insufficiently studied in adolescents. We aimed to describe the experience of diabetes technology self-management, including facilitators and barriers, among preteens/adolescents with low and high A1C. RESEARCH DESIGN AND METHODS: Youth (10-18 years of age) with T1D who use insulin pump therapy were recruited from the larger quantitative cohort of a mixed methods study for participation in semi-structured qualitative interviews. Maximum variability sampling was used to recruit youth with A1C <7.5% (n = 5) and A1C >9% (n = 5). Participants' personal insulin pump and continuous glucose monitoring data were downloaded and served as a visual reference. Interviews were analyzed using a qualitative descriptive approach. RESULTS: Participants were 50% female with a median age of 14.9 years and 80% used CGM. The sample was predominantly white (90.0%). Analysis produced four major themes, Bad Day, Expect the Unexpected, Nighttime Dependence, and Unpredictability, It's Really a Team and interconnecting subthemes. Youth characterized ''Bad Days'' as those requiring increased diabetes focus and self-management effort. The unpredictability (''Expect the Unexpected'') of glucose outcomes despite attention to self-management behaviors was considerable frustration. CONCLUSIONS: Diabetes devices such as insulin pumps are complex machines that rely heavily on individual proficiency, surveillance, and self-management behaviors to achieve clinical benefit. Our findings highlight the dynamic nature of self-management and the multitude of factors that feed youths' self-management behaviors.

Self-management among pre-teen and adolescent diabetes device users.

OBJECTIVE: Despite increased diabetes device use, few adolescents with type 1 diabetes (T1D) meet glycemic targets. We examine associations between utilization of insulin pumps and continuous glucose monitoring (CGM) and glycemic control. RESEARCH DESIGN AND METHODS: This prospective cohort study included 80 youths (10-18 years of age) with T1D. Multiple linear regression and linear mixed models (LMM) were used to estimate the effects of device self-management on HbA1c and daily time in range (70-180 mg/dL), respectively. RESULTS: Every blood glucose (BG) input/day was associated with a 0.2% decrease in HbA1c (95% CI: -0.297, -0.013), each bolus/day was associated with a 0.2% decrease (-0.327, -0.057), and use of CGM was associated with a 0.5% decrease (-1.00, -0.075). Among CGM users (n = 45) every 10% increase in CGM use was associated with a 0.3% decrease in HbA1c (-0.390, -0.180). In LMM accounting for within subject and between subject variability, there was a negative association between BG input/day frequency (coefficient = -1.880, [-2.640, -1.117]) and time in range. Residual random effects for CGM users were large showing time in range varied between youth with a SD of 15.0% (3 hours and 36 minutes) (SE 2.029, [11.484, 19.530]). Time in range varied significantly from day-to-day with SD of 18.6% (4 hours and 40 minutes) (SE0.455, [17.690, 19.473]). CONCLUSIONS: Device self-management behaviors among youth are significantly associated with both HbA1c and time in range. Our findings showing an association between reduced time in range and increased self-management behaviors is novel and deserves further investigation.

Evaluating Feasibility of Personal Diabetes Device Data Collection for Research.

BACKGROUND: Diabetes devices, like insulin pumps and continuous glucose monitors (CGMs), capture and store patient adherence and utilization data that can be retrieved or downloaded providing objective information on self-management behaviors; yet, diabetes device data remain underutilized in research. OBJECTIVE: The aim of the study was to examine the usability and feasibility of personal diabetes device data collected using a clinical download platform retooled for research purposes. METHODS: Investigators evaluated the feasibility of raw diabetes device data collection. One hundred eight preteens and adolescents with Type 1 diabetes and their parents provided consent/assent. RESULTS: Data were successfully collected from the diabetes devices (insulin pumps and CGM) of 97 youth using a clinical download software adapted for research, including data from all three commercially available CGM systems and insulin pumps brands, which contained all current and previous models of each insulin pump brand. The time required to download, mode of connection, and process varied significantly between brands. Despite the use of an agnostic download software, some outdated device brands and cloud-based CGM data were unsupported during data collection. Within the download software, dummy clinical accounts were created for each study participant, which were then linked back to a master study account for data retrieval. Raw device data were extracted into seven to eight Excel files per participant, which were then used to develop aggregate daily measures. DISCUSSION: Our analysis is the first of its kind to examine the feasibility of raw diabetes device data using a clinical download software. The investigators highlight issues encountered throughout the research process, along with mitigating strategies to inform future inquiry. CONCLUSION: This study demonstrates the feasibility of raw data collection, from a wide variety of insulin pump and CGM brands, through the retooling of a clinical download software. Data from these personal devices provide a unique opportunity to study self-management behavior and the glycemic response of individuals in their everyday environments.

Sex Differences on Quality of Life and Mental Health Outcomes When Using a Brief Cognitive-Behavioral Skill Building Intervention with Adolescent Syrian Refugees: A Secondary Analysis.

Little is known about how sex as a biological variable may contribute to differences in quality of life (QOL) and mental health outcomes following a brief intervention among adolescent Syrian refugees. This paper explores the results of a secondary data analysis to investigate differences by sex on self-reported QOL and mental health outcomes among Syrian refugees who participated in a 7-session cognitive behavioral skills building intervention. A one group pretest-posttest design was used to deliver the intervention to 31 adolescent refugees (13-17 years; 15 male, and 16 female). At baseline, there were no significant differences between males and females on mean scores of depression, anxiety, or QOL. Post-intervention, self-reported scores for QOL and mental health were significantly different between sexes. Males demonstrated a significant decrease in anxiety scores compared to females. Among males only, significant decreases in depression and anxiety scores were observed with significant improvement in total QOL.

The future of pediatric nursing science.

The provision of safe and effective nursing care to children is dependent upon pediatric nurse scientists creating knowledge that guides and directs day-to-day nursing practice. Current trends demonstrating steady decreases of pediatric nurses and inadequate numbers of PhD-prepared pediatric nurse scientists put the health of our children at risk. The purposes of this paper are to (1) summarize current health care demands in pediatrics, (2) present our concern that the number of pediatric nurse scientists is inadequate to generate foundational knowledge to guide pediatric nursing practice, (3) present our perspectives on factors influencing the number of pediatric nurse scientists, and (4) recommend specific actions for nursing leaders, nursing faculty, and professional nursing organizations to increase the depth and breadth of pediatric nursing science to meet current and future pediatric care needs.

Systematic Review of Cyberbullying Interventions for Youth and Parents With Implications for Evidence-Based Practice.

BACKGROUND: Cyberbullying is a new risk factor for the well-being of pediatric populations. Consequences of cyberbullying include both physical and mental health concerns such as depression, anxiety, and somatic concerns. Adolescents who have been victims of cyberbullying and developed secondary symptoms are often recommended to visit a healthcare provider to obtain effective, evidence-based treatment. To date, no interventions exist in the healthcare setting for adolescents who are victims of cyberbullying. AIMS: The purpose of this project is to review interventional studies on cyberbullying that have components for adolescents who have been involved with cyberbullying and their parents and to provide recommendations on effective intervention components with the goal of guiding clinical practice. METHODS: A systematic review was conducted using the Institute of Medicine guidelines. A comprehensive electronic literature search was completed targeting interventions of cyberbullying in any setting. No date limits were used. Literature was searched in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Communication and Mass Media Complete, Education Information Resource Center (ERIC), and PsycINFO databases. The following search terms were applied "cyberbullying" + "intervention" or "treatment" or "therapy" or "program." Only articles with a pediatric population were selected for review. RESULTS: Seventeen cyberbullying intervention programs in 23 articles were found to meet the search criteria. The most frequently used intervention components included education on cyberbullying for the adolescent, coping skills, empathy training, communication and social skills, and digital citizenship. Parent education on cyberbullying was also found to be important and was included in programs with significant outcomes. LINKING EVIDENCE TO ACTION: As youth present to healthcare providers with symptoms related to cyberbullying, effective interventions are needed to guide evidence-based practice. This review supports educating the individual youth and parent on cyberbullying and teaching the youth skills in communication and social, empathy, coping with cyberbullying, and digital citizenship.

A systematic review of mediators of physical activity, nutrition, and screen time in adolescents: Implications for future research and clinical practice.

BACKGROUND: Adolescents are not meeting current recommendations for daily physical activity, nutrition, and screentime which has been associated with overweight and obesity. Understanding the mediators that facilitate teens in improving their healthy lifestyle behaviors may be helpful in halting this crisis. PURPOSE: The purpose of this systematic review was to assess published findings regarding mediators of adolescent energy balance behaviors. METHOD: We followed the Institute of Medicine guidelines for completing a systematic review. DISCUSSION: Fourteen analyses from 12 studies were included with mediating variables tested for nutrition, physical activity, and screen time. Mediators were identified for all three behaviors and were primarily on the individual level of the social ecological model. CONCLUSIONS: Combining findings from this and other reviews of mediators can help guide researchers in choosing mediating factors for specific target behaviors.

The Impact of Community Violence on School-Based Research.

Research conducted on youth exposure to violence has generally focused on documenting the prevalence of community violence and its emotional and behavioral implications. However, there is a dearth of information related to the impact of violence on the implementation and evaluation of community and school-based programs. This commentary examines the impact of community violence on a school-based research program. It is also a brief summary of the detrimental effects of exposure to community violence on psychological and academic functioning and health outcomes. An example of the impact of community violence on the implementation of a school-based asthma program will be addressed. Implications for school nurses will be discussed.

A methodological quality synthesis of systematic reviews on computer-mediated continuing education for healthcare providers.

BACKGROUND: Healthcare providers use continuing education (CE) to meet professional development requirements and to ensure optimal patient care. There has been a dramatic increase in computer-mediated CE (CMCE) programs. AIMS: To synthesize the literature regarding the current state of the science on the efficacy of CMCE for healthcare professionals, particularly as it relates to provider learning and patient outcomes. Specifically, this review assesses the methodological quality of existing systematic reviews and meta-analyses. METHODS: A literature search was conducted using Cochrane Library, PubMed, and CINAHL. Review articles evaluating the efficacy of CMCE for healthcare providers were included. Publications were searched between 2002 and 2013 and limited to those printed in English. An objective measurement tool, AMSTAR, was used to assess the methodological quality of each review. AMSTAR is an 11-item instrument, in which individual criteria were evaluated and a composite score of all 11 components was determined for each review. Outcomes of each review were also categorized based on Kirkpatrick's levels for summative evaluation: (i) Learner satisfaction, (ii) Learning outcomes, (iii) Performance improvement, (iv) Patient/health outcomes. RESULTS: Starting with 231 articles, 11 met the inclusion criteria for this evaluation. AMSTAR quality scores of the reviews ranged from 7 to 11, with 11 indicating the strongest quality. Although weak research design of many studies and heterogeneous topics covered make summative evaluations difficult, there were some common themes covered in the articles reviewed. Healthcare providers were largely satisfied with using CMCE programs. Overall, the studies comparing CMCE to traditional CE methods found the impact on learning outcomes to be comparable, with neither method necessarily superior. Additionally, all reviews lacked evaluation of practice outcomes. LINKING EVIDENCE TO ACTION: While results of this review show promise for CMCE, further evaluation and more rigorously conducted research is necessary. Particular focus is needed to determine the effects of CMCE on health outcomes.

Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study.

BACKGROUND: Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. OBJECTIVE: This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. METHODS: This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot's design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. RESULTS: Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot's capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. CONCLUSIONS: Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs.

Using the life course health development model to address pediatric mental health disparities.

TOPIC: Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. PURPOSE: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. SOURCES: Peer-reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. CONCLUSIONS: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children.

Efficacy of the I Can Control Asthma and Nutrition Now (ICAN) pilot program on health outcomes in high school students with asthma.

Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and Nutrition Now (ICAN) program is an innovative school-based program composed of (1) nutrition and weight management education, (2) asthma education, and (3) monthly reenforcement visits. This pilot study tested the initial effectiveness of the ICAN pilot program on a variety of asthma and nutrition outcomes in 25 urban minority students with asthma. Over the course of the pilot program, significant increases in asthma knowledge, asthma self-efficacy, asthma quality of life, asthma self-care, nutrition knowledge, nutrition self-efficacy, and asthma control were observed. The ICAN program has demonstrated promising preliminary results in improving nutrition and asthma health outcomes with urban minority high school students.

Mothers In Motion Program: Implementation Process and Acceptability by Community.

BACKGROUND: Implementing lifestyle behavior programs in real-world settings challenges researchers. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has implemented and sustained Mothers In Motion (MIM)'s client videos for clients to promote healthy lifestyle behaviors, and train-the-trainer videos, for personnel to enhance motivational interviewing techniques since 2015 and 2016, respectively. This paper describes the implementation processes and the results of client video implementation acceptability by WIC personnel. METHODS: To document the implementation process, we applied the Framework for Adaptation and Modifications to Evidence-Based Implementation Strategies (FRAME-IS). To evaluate implementation acceptability, we conducted semi-structured interviews with 15 WIC personnel. A qualitative analysis was conducted to identify the common themes. RESULTS: The facilitators for client video implementation were the inclusion of the target audience and family members addressing daily challenges, easy implementation, and compatibility with daily practice. While videos online facilitated implementation, videos in DVD format could challenge implementation. CONCLUSIONS: Future lifestyle intervention programs aimed for future implementation in community settings may consider the inclusion of the target audience and their family members and take into consideration easy implementation and compatibility.

The Ohio State University Dream Team: Innovation for Well-being fellowship and coaching program.

Background: Nearly 70% of faculty experience very high levels of stress. Integrative Nurse Coaching (INC) can help by assisting clients in establishing goals and embarking on new lifestyle behaviors that help to decrease perceived stress, achieve work life integration, and enhance life satisfaction. Our goal was to evaluate a faculty coaching and fellowship program to support faculty well-being while developing innovation competency. Methods: We employed an INC paradigm to coach five faculty to build confidence and competence in innovation and enhance well-being. We offered monthly group and individual coaching and used a qualitative research thematic analysis to determine themes important for the fellow and group experiences, identify outcomes, and create recommendations for the future. Results: We identified the following themes as outcomes for our program: (1) enhanced connection, comradery, and support; (2) increased confidence and competence in navigating academia; (3) shift from a fixed mindset to an innovation mindset; and (4) increased ability to identify and manage stress and burnout. Fellows also experienced a shift from focusing on individual needs to addressing the needs of the community at the college. Conclusion: Nurse coaching is an effective strategy to address faculty stress and burnout. Additional research is needed to evaluate the Innovation for Well-being faculty fellowship program and its impact on the academic community.

Psychosocial Factors Associated With Physical Activity Among Low-Income Overweight or Obese Mothers with Young Children.

PURPOSE: Investigate the associations between psychosocial factors and physical activity. DESIGN: Secondary data analysis utilizing baseline data of a large-scale community-based randomized controlled lifestyle behavior intervention. SETTING: The Special Supplemental Program for Women, Infants, and Children in Michigan, USA. SUBJECTS: Low-income overweight or obese mothers with young children (N = 740, 65% response rate). MEASURES: Survey data were collected via phone interview. Predictors included self-efficacy, autonomous motivation, emotional coping, and social support. Self-reported leisure physical activity was the outcome variable. Covariates were age, race, smoking, employment, education, body mass index, and postpartum status. ANALYSIS: A multiple linear regression model was applied. RESULTS: Self-efficacy (ß = .32, 95% CI = .11, .52, P = .003) and autonomous motivation (ß = .10, 95% CI = .03, .17, P = .005) were positively associated with physical activity. However, emotional coping and social support were not associated with physical activity. CONCLUSION: Future research should examine the longitudinal association of key psychosocial factors with physical activity.

Effects of coping-skills training in low-income urban African-American adolescents with asthma.

BACKGROUND: Minority teens with asthma are at particular risk for this life-threatening disease due to increased morbidity and mortality rates in addition to the normal challenges of adolescence. OBJECTIVE: The purpose of this randomized controlled trial (n = 137) was to determine the effects of a coping-skills training program (intervention) compared with standard asthma education (attention control) in African-American teens with asthma. METHODS: Adolescents were recruited from five African-American dominant high schools serving low-income areas of Chicago. Data were collected at baseline, 2 months (immediately following the intervention), 6 months, and 12 months. Results. Both groups improved over time, with significant increases in asthma-related quality of life, asthma knowledge, and asthma self-efficacy, accompanied by decreases in symptom days and asthma-related school absences. CONCLUSIONS: Findings suggest that coping-skills training as implemented in this study provided no additional benefit beyond that experienced in the control group. However, group-based interventions delivered in the school setting may be beneficial for low-income, minority teens with asthma.

Systematic review of text-messaging interventions to promote healthy behaviors in pediatric and adolescent populations: implications for clinical practice and research.

BACKGROUND: Unhealthy lifestyle behaviors are major public health problems. Promoting positive behavior change is an ongoing challenge that warrants innovative solutions. Mobile phone use is becoming widespread across populations and merits further exploration as a strategy to promote wellness and reduce health disparities. AIMS: The purpose of this paper is to review the evidence using text messaging as a tool to deliver healthy lifestyle behavior intervention programs in pediatric and adolescent populations. The following question was used to guide the systematic review, "In pediatric and adolescent populations, how does the use of text-message-based interventions versus control or comparison interventions affect healthy lifestyle behaviors?" METHODS: A systematic search for relevant literature was conducted in the following databases: MEDLINE, PubMed, Google Scholar, Cochrane Library, and PsycINFO, and by hand-searching bibliographies. Evidence was compiled from experimental studies in peer-reviewed journals published from 2004 to May 15, 2011. Data were extracted using guidelines set forth by the Centre for Reviews and Dissemination. RESULTS: Thirty-seven articles were identified from the comprehensive search. Eight articles representing seven studies (two articles were published describing different aspects of the outcomes from one study) met inclusion for this review. Mean age of participants in the study ranged from 8.7 to 17.9 years of age. Differences between groups on healthy lifestyle behaviors were significant in five studies. CONCLUSIONS: This review supports previous literature suggesting that mobile phones are uniquely positioned to bridge gaps in health disparities and reach across demographics. Interventions using short messaging service may be most effective as a reminder system to support disease management behaviors. Existing recommendations for tailored, interactive, and family-centered care are supported with mobile technology recommended to augment clinical practice and health behavior change efforts. However, more rigorous, theory-based intervention research using mobile technology is warranted in pediatric and adolescent populations.

Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study.

BACKGROUND: Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. OBJECTIVE: In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. METHODS: We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. RESULTS: Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%). CONCLUSIONS: Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health.