RESUMO
BACKGROUND: Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. OBJECTIVE: This study aims to evaluate a behavior theory-informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. METHODS: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. RESULTS: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. CONCLUSIONS: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app.
RESUMO
BACKGROUND: Falls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. OBJECTIVE: The objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. METHODS: Online parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into "precursor events" and "influencing factors" for infant falls. RESULTS: We identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant's rapid motor development, lapses in caretaker attention, and trip hazards. CONCLUSIONS: The findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior.
RESUMO
BACKGROUND: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory-informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. OBJECTIVE: This study aims to develop a behavior theory- and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. METHODS: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. RESULTS: The target behaviors identified in phase 1 were adequate rest for the newborn's mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. CONCLUSIONS: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory-informed mobile intervention for injury prevention refined using the person-based approach.
RESUMO
AIM: Falls are the most common injury mechanism of children <12 months in Australia. We aimed to determine the prevalence of hospital admission following a fall among New South Wales (NSW) infants and changes in admission rate over time. Secondary aims were to examine demographics, nature of injury and trends by age groups associated with developmental milestones and fall mechanism. METHODS: This was a retrospective, population-based study across NSW from 2002 to 2013 using the NSW Admitted Patient Data collection. Infants with recorded falls, external causes of morbidity and mortality and activity codes were assessed. Main outcome measures were absolute numbers, rates and proportions by year, age group, socio-demographics, fall mechanism, injury type, body region affected and admission outcome. RESULTS: A total of 4380 cases were identified. Numbers increased over years (342 in 2002 to 469 in 2013). Rate of admissions per 10 000 population were 40.37 in 2002 and 47.18 in 2013 (average increase 0.9% per year, P = 0.25). 76% resided in a major city, 23% resided in the least disadvantaged areas and 18% in the most disadvantaged. Falls from furniture and falls while being carried were most common. 85% suffered a head injury, 70% of which had a traumatic brain injury (TBI). There were seven deaths and one quarter of surviving infants were admitted for 2 or more days. CONCLUSIONS: Hospital admission following a fall is a long-standing problem with no improvement among infants in NSW, commonly leading to head injury and traumatic brain injury. Effective prevention interventions are needed.
