Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery.

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.

What do hospital-based health professionals need and expect from an mHealth app to support the first 1000 days of life? Results from a cross sectional study.

BACKGROUND: Several attempts have been made to introduce mHealth solutions to support maternal, newborn, and child health (MNCH). However, most of the available apps do not meet the needs of end-users, underscoring the urgency of involving them in the co-design of telehealth interventions. OBJECTIVE: With this in mind, we investigated the needs and expectations of hospital-based health professionals (i.e., secondary users) providing care to pregnant women and new mothers with their babies for a hypothetical mHealth app to support the first 1000 days of life. METHODS: From November 2021 to March 2022, we surveyed health professionals using a questionnaire that explored the perceived importance of specific content, functionalities, and technical features of the proposed app. We also collected sociodemographic information from secondary users. We performed descriptive analysis and then used Ward hierarchical clustering method to classify respondents according to their response patterns. RESULTS: We recorded the needs and expectations of 145 hospital-based health professionals from obstetrics/gynecology, nursery/neonatology, and pediatrics. We found general agreement with the proposed content of the app, particularly general information about health during pregnancy (92%) and potential risky infections during pregnancy (91%). Three clusters emerged from the analysis, with the high and medium demanding clusters rating the importance of app content and technical features as very high and high, respectively, while low demanding cluster expressing more skepticism, especially about some of the proposed functionalities of the app. CONCLUSIONS: Assessing the needs and expectations of end-users is an essential process for developing tailored and effective mHealth solutions. This study has shown that hospital-based health professionals generally recognize the value of the proposed app, suggesting their propensity to integrate such a telehealth solution into mainstream clinical practice.

Exploring the Needs and Expectations of Expectant and New Parents for an mHealth Application to Support the First 1000 Days of Life: Steps toward a Co-Design Approach.

To improve maternal and child health, it is essential to adhere to health-promoting and preventive measures. However, reliable information as well as effective tools are not easy to identify in this field. Our cross-sectional study investigated the needs and expectations of expectant and new mothers and fathers as potential primary users of a hypothetical application supporting the first 1000 days of life. Between May and August 2022, we recruited expectant and new parents by administering an 83-item 5-point Likert scale questionnaire related to the content, functionalities, and technical features of the hypothetical app. We stratified responses using sociodemographic characteristics and then performed ward hierarchical clustering. The 94 women and 69 men involved in our study generally agreed with the proposed content, but expressed low interest in certain app functionalities or features, including those related to the interaction mechanism and interactivity. Women were generally more demanding than men. Our findings, resulting from the engagement of end-users, may be useful for designers and technology providers to implement mHealth solutions that, in addition to conveying reliable information, are tailored to the needs and preferences of end-users in the first 1000 days of life.

With a little help from our pediatrician: An intervention to promote mathematics-related home activities through regular well-child visits.

Introduction: Children's involvement in mathematics-related activities in the home environment is associated with the development of their early numeracy over the preschool years. Intervention studies to promote parents' awareness and provision of mathematics-related home activities are however scant. In this study we developed and tested the effectiveness of a non-intensive intervention program delivered by community pediatricians to promote mathematics-related activities in the home environment. Methods: Parents of 204 Italian children were invited to report on the frequency of mathematics-related home activities when children attended the first preschool year (3 years, 8 months of age on average) and, subsequently, the third preschool year (5 years, 6 months of age on average). At both waves, children were also assessed on their early numeracy. In occasion of the routine well-child visit at age 5, parents who were randomly allocated to the intervention condition (vs. a business-as-usual control condition) received guidance on age-appropriate home mathematics-related practices to sustain children's numerical development. Results: Results revealed that parents in the intervention group improved their provision of home mathematics-related activities at the post-intervention assessment (relative to baseline) to a greater extent than parents in the control condition. No effect was observed on children's early numeracy. Discussion: Overall, results are promising in suggesting that community pediatricians may be a resource to promote home mathematics-related activities though non-intensive low-cost interventions.

Numerical Training Videos and Early Numerical Achievement: A Study on 3-Year-Old Preschoolers.

Early numerical abilities predict later math achievement and could be improved in children by using various training methods. As the literature on the use of training videos to develop numerical abilities is still surprisingly scant, the aim of the present study was to test the efficacy of a numerical training video on the development of counting and number line knowledge in 3-year-old preschoolers. Far transfer effects to cardinality and working memory were also examined. The study involved 86 children randomly assigned to two intervention groups: a numerical training group exposed to videos on counting and number lines; and a control group exposed to videos on colors and animal names in a foreign language. After the video training, there was an improvement in the numerical training group's counting skills, but not in their number line knowledge, and this improvement persisted six months later. The numerical training group also showed a far-transfer enhancement of cardinality six months after the intervention. Based on our results, numerical training videos could be effective in helping to enhance early numeracy skills in very young preschoolers.

The contributions of working memory domains and processes to early mathematical knowledge between preschool and first grade.

Working Memory (WM) plays a crucial role in supporting children's mathematical learning. However, there is no consensus on the relative contributions of different WM domains (i.e., verbal, visuo-spatial, and numerical-verbal) and processes (i.e., low-control and high-control) to mathematical performance, specifically before and after the onset of formal education. This cross-sectional study examined the relations between WM domains and processes and early mathematical knowledge, comparing a group of children in the second year of preschool (N = 66) to a group of first graders (N = 110). Results of multigroup path analysis showed that whereas visuo-spatial low-control WM significantly predicted early mathematical knowledge only among preschoolers, verbal low-control WM was a significant predictor only among first graders. Instead, the contribution of visuo-spatial high-control WM emerged as significant for both age groups, as well as that of numerical-verbal WM, although the latter to a greater extent among preschoolers. These findings provide new insights into the WM domains and processes most involved in early mathematical knowledge at different developmental stages, with potential implications for the implementation of age-appropriate training interventions targeting specific WM skills before and after the onset of formal education.

Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores.

BACKGROUND: Despite the availability of thousands of health apps worldwide, when considering those addressing children's first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. OBJECTIVE: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health-related field. METHODS: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. RESULTS: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). CONCLUSIONS: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion.

Math anxiety and math achievement: The effects of emotional and math strategy training.

Math anxiety (MA) is a specific feeling of tension generated by the manipulation of numerical stimuli in daily life and academic situations (Richardson & Suinn, 1972). This condition has significant repercussions on the individual's life at personal, social, and economic level. Literature on the topic of MA alleviation, however, is still scarce. This study aims at contributing to this field by addressing MA prevention in school-age children. We have developed two different training methods administered to two groups of fourth graders: (a) MA training focusing on identifying and copying with MA-related feelings (N = 76); and (b) Math strategy training focusing on supplementary exercises to enhance calculation strategies (N = 76). We also carried out a Control training involving a range of activities, such as reading comic strips, describing characters in the story, and combining text and images to obtain an original narrative text (N = 72). We evaluated the differential effects of these training methods on MA, general anxiety, and math achievement before and after the training. Results indicate that MA training contributes to a decrease in MA level, although it does not appear to affect math achievement; Math strategy training, on the other hand, results in far transfer on a reduction of MA level as well as near transfer on the improvement of math achievement. Data are discussed in terms of specific mechanisms underlying each type of training method, and with specific focus on the evaluation of educational and developmental opportunities linked to MA prevention and improvement of math abilities in school-age children.

Exploring EFs and Math Abilities in Highly Deprived Contexts.

Executive functions (EFs)' development is critically affected by childhood adversity exposure. Although recent studies underlined the deleterious effects of early life stresses on working memory (WM) and inhibitory control, they were scarcely investigated in war context especially in relation with learning abilities. In order to fill this gap, we designed a research with the aim to evaluate EFs together with early math skills. In particular, we conducted a study involving 150 children divided into three groups: 48 Yazidis (M age = 71 months, SD = 6.59), 47 Syrian refugees (M age = 68.77 months, SD = 7, age), and 55 Italians (M age = 68.65 months, SD = 2.88) attending the third year of kindergarten in Italy or inserted in Psyco-Social-Support activities in Iraq. The children were evaluated with a variety of tasks assessing WM, inhibitory control, counting, digit-quantity mapping, and digit naming skills. The results indicated substantial differences both in EFs and early numerical abilities between the deprived groups and the Italian children. Data are discussed in terms of implications for children both exposed to mainstream school environments and living in socio-economically disadvantaged and deprived contexts.

Evaluation and training of Executive Functions in genocide survivors. The case of Yazidi children.

Executive Functions (EFs) development is critically affected by stress and trauma, as well as the socioeconomic context in which children grow up (Welsh, Nix, Blair, Bierman, & Nelson, 2010, Journal of Educational Psychology, 102, 43-53). Research in this field is surprisingly lacking in relation to war contexts. This study represents a first attempt at addressing this topic by evaluating EFs in Yazidi children. The Yazidi community is an ethnic and religious minority living in Iraq. From August 2014 onwards, the Yazidi community has been the target of several atrocities perpetrated by ISIS and described as genocide by the international community at large. The University of Trieste, thanks to a program financed by the Friuli Venezia Giulia Region, developed a study aimed at (a) evaluating hot and cool EFs in children living in a war context and (b) developing a specific training method to enhance hot and cool EFs in Yazidi children of preschool age (N = 53). Data related to this group of children were compared with a sample of typically developing Italian children randomly assigned to either an EFs training group (N = 55) or a passive control group (N = 51). Results indicate different baselines in EFs in Yazidi and Italian samples and a significant effect of the program on both trained groups, especially in tasks measuring hot EFs. Data are discussed in terms of hot and cool EFs in children growing in adverse environments, as well as the evaluation of educational and developmental opportunities to prevent children who survived genocide from becoming a 'lost generation'. A video abstract of this article can be viewed at https://youtu.be/7t_08TbxR_8.