Protocol for digital intervention for effective health promotion of small children-A cluster randomized trial.

AIM: This article introduces the protocol of a study aiming to evaluate the effectiveness of digital WellWe intervention in supporting the participation of families with small children in the promotion of their health. BACKGROUND: Early childhood is a meaningful period for building a strong base for good health. Parents play a key role in affecting the health behaviour and psychosocial development of their children. A family-centred approach makes it possible to support families' individual health literacy needs and empower them to take actions towards promoting healthier behaviour. However, there are a lack of family-centred digital health interventions intended for parents and their small children. DESIGN: The study is designed as a two-arm cluster, randomized, controlled trial with a 4-month follow-up. METHODS: The data are being collected from 200 families with a 4-year-old child. Cluster randomization is being performed at the municipality level. Municipalities (N = 4) located in Southwest Finland, comprising child health clinics (N = 15) with their family clients, were randomly allocated to either an intervention (WellWe intervention) or a control group (usual care). The outcome measures include parental self-efficacy for healthy behaviours, mindfulness in parenting and the family-centred approach of the extensive health examination. Data collection is being performed at baseline, after the intervention and at a 4-month follow-up. DISCUSSION: The results from this study will make it possible to determine whether this new method can be recommended for implementation in child health clinic settings to support the participation of families with small children in promoting their health.

Health game interventions to enhance physical activity self-efficacy of children: a quantitative systematic review.

AIM: To describe and explore health game interventions that enhance the physical activity self-efficacy of children and to evaluate the effectiveness of these interventions. BACKGROUND: Physical inactivity among children has increased globally. Self-efficacy is one of the key determinants of physical activity engagement in children. There is a need to explore new and innovative interventions to enhance physical activity self-efficacy that are also acceptable for today's children. DESIGN: Quantitative systematic review. DATA SOURCES: MEDLINE (Ovid), CINAHL, PsychInfo, EMBASE and the Cochrane Library between 1996-2016. REVIEW METHODS: A review was conducted in accordance with the Cochrane Collaboration guidelines. A systematic search was done in June 2016 by two independent reviewers according to the eligibility criteria as follows: controlled trial, comparison of digital game intervention with no game intervention control condition, participants younger than 18 years of age and reported statistical analyses of a physical activity self-efficacy outcome measure. RESULTS: Altogether, five studies met the eligibility criteria. Four game interventions, employing three active games and one educational game, had positive effects on children's physical activity self-efficacy. An intervention, employing a game-themed mobile application, showed no intervention effects. The variation between intervention characteristics was significant and the quality of the studies was found to be at a medium level. CONCLUSION: Although health game interventions seemingly enhance the physical activity self-efficacy of children and have potential as a means of increasing physical activity, more rigorous research is needed to clarify how effective such interventions are in the longer run to contribute to the development of game-based interventions.

Digital Information Management for Advanced Practice Nursing: Needs Assessment.

The aim of this pilot study was to explore needs related to a quality dashboard for advanced practice nursing to support quality management in a Finnish university hospital.

Videoconferencing Applications for Training Professionals on Nonverbal Communication in Online Clinical Consultations.

OBJECTIVES: The use of videoconferencing technologies for clinician-patient online consultations has become increasingly popular. Training on online communication competence through a videoconferencing application that integrates nonverbal communication detection with feedback is one way to prepare future clinicians to conduct effective online consultations. This case report describes and evaluates two such applications designed for healthcare professionals and students in healthcare-related fields. METHODS: We conducted a literature review using five databases, including the Web of Science, Scopus, PubMed, ACM, IEEE, and CINAHL in the spring of 2022. RESULTS: We identified seven studies on two applications, ReflectLive and EQClinic. These studies were conducted by two research groups from the USA and Australia and were published between 2016 and 2020. Both detected nonverbal communication from video and audio and provided computer-generated feedback on users' nonverbal communication. The studies evaluated usability, effectiveness in learning communication skills, and changes in the users' awareness of their nonverbal communication. The developed applications were deemed feasible. However, the feedback given by the applications needs improvement to be more beneficial to the user. The applications were primarily evaluated with medical students, with limited or no attention given to questions regarding ethics, information security, privacy, sustainability, and costs. CONCLUSIONS: Current research on videoconferencing systems for training online consultation skills is very limited. Future research is needed to develop more user-centered solutions, focusing on a multidisciplinary group of students and professionals, and to explore the implications of these technologies from a broader perspective, including ethics, information security, privacy, sustainability, and costs.

Feasibility of mobile health game "Fume" in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design.

OBJECTIVE: New interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10-13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website. METHODS: In total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests. RESULTS: Statistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P <  0.001). There were no statistically significant differences in opinions about Fume and those regarding the website. CONCLUSIONS: The intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

Designing a Health-Game Intervention Supporting Health Literacy and a Tobacco-Free Life in Early Adolescence.

OBJECTIVE: The purpose of this study was to explore the design of a health game that aims to both support tobacco-related health literacy and a tobacco-free life in early adolescence and to meet adolescents' expectations. MATERIALS AND METHODS: Data were collected from adolescents using an open-ended questionnaire (n = 83) and focus groups (n = 39) to obtain their view of a health game used for tobacco-related health education. The data were analyzed using thematic analysis. A group of experts combined the adolescents' views with theoretical information on health literacy and designed and produced the first version of the game. Adolescents (session 1, n = 16; session 3, n = 10; and session 4, n = 44) and health promotion professionals (session 2, n = 3) participated in testing the game. Feedback from testing sessions 3 and 4 was analyzed using descriptive statistics. RESULTS: Adolescents pointed out that the health game needs to approach the topic of tobacco delicately and focus on the adolescents' perspective and on the positive sides of a tobacco-free life rather than only on the negative consequences of tobacco. The adolescents expected the game to be of high quality, stimulating, and intellectually challenging and to offer possibilities for individualization. Elements from the adolescents' view and theoretical modelling were embedded into the design of a game called Fume. Feedback on the game was promising, but some points were highlighted for further development. CONCLUSION: Investing especially in high-quality design features, such as graphics and versatile content, using humoristic or otherwise stimulating elements, and maintaining sufficiently challenging gameplay would promote the acceptability of theory-based health games among adolescents.

Determinants of tobacco-related health literacy: A qualitative study with early adolescents.

BACKGROUND: Today's adolescents are used to a constant information flow, but many face difficulties in processing health-related information due to low health literacy. There is still need for deeper understanding on the determinants of health literacy in relation to adolescents to guide the development of health literacy instruments and interventions. PURPOSE: The purpose of this study was to explore, from the perspective of early adolescents, the determinants of health literacy in the context of tobacco-related health communication. DESIGN: A qualitative descriptive study. SETTING: Two schools located in the south of Finland. One school represented a typical Finnish public school with students following general curriculum and the other represented a Finnish public school with students with special educational needs. PARTICIPANTS: Purposively selected sample of 10-13-year-old early adolescents (n=39) from the two schools to obtain a varied group of early adolescents representing different kinds of literacy levels. METHODS: We conducted 10 focus groups with early adolescents and analyzed the data using the theoretical thematic analysis method. We used a combination of the determinants presented in three adolescent-specific health literacy models as the theoretical framework of deductive analysis. The remaining data extracts were coded inductively. We sorted the codes under sub-themes that represented different determinants of health literacy. These were further divided between three themes: "personal", "external", and "mediating" determinants. Finally, we named the themes with an expression that embodied the early adolescents' views and experiences. RESULTS: Early adolescents' descriptions revealed that the list of determinants presented in the three adolescent-specific health literacy models is not comprehensive enough. Early adolescents brought up how their motives, self-efficacy, and role expectations determine their health literacy in addition to the other personal determinants presented in the previous models. Their descriptions also suggest that external determinants include interpersonal relations with authorities, idols and random people, and the socio-cultural atmosphere as new factors. New mediating determinants that have a separate influence on health literacy were recognized based on early adolescents' descriptions as well. CONCLUSION: Our findings give a new, adolescent-oriented insight on the determinants of adolescents' health literacy. Based on the findings, there are additional personal, external, and mediating determinants that are not included in the current adolescent-specific health literacy models. These newly found determinants require attention and further exploration. The acquired knowledge can be used for strengthening existing adolescent-specific health literacy models, and as a basis of health literacy instrument and intervention development.

Promoting Children's Health with Digital Games: A Review of Reviews.

Effective, evidence-based, and interesting methods are needed for children's health promotion. Digital games can be such a method, but there is need for a summary of the evidence on the effectiveness of digital games in promoting children's health. The aim of this review of reviews was to evaluate the quality of systematic reviews, to summarize the evidence in systematic reviews and reviews related to the effectiveness of digital games in children's health promotion, and to identify gaps in knowledge. A systematic literature search was conducted in May-August 2013 from relevant databases, and 1178 references were found. In total, 15 systematic reviews and reviews met the inclusion criteria. Most of the systematic reviews were found to be medium quality on the AMSTAR checklist. Most commonly, systematic reviews and reviews evaluated active videogames. According to the results, evidence of the highest level and quality seems to support an increase in physical activity to light to moderate levels and energy expenditure, especially when playing active videogames that require both upper and lower body movements. In addition, sedentary games were shown to have potential in children's health education, especially in supporting changes in asthma- and diabetes-related behavior and in dietary habits. However, there are still several gaps in the knowledge. There is a need for further high-quality systematic reviews and research in the field of health games.