An App-Based Intervention for Caregivers to Prevent Unintentional Injury Among Preschoolers: Cluster Randomized Controlled Trial
An App-Based Intervention for Caregivers to Prevent Unintentional Injury Among Preschoolers: Cluster Randomized Controlled Trial
复制标题
基于应用程序的护理人员预防学龄前儿童意外伤害的干预措施：集群随机对照试验。
DOI：
10.2196/13519
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发表时间：
2019-08-09
影响因子：
5
通讯作者：
Hu, Guoqing
中科院分区：
文献类型：
--
作者：
Ning, Peishan;Cheng, Peixia;Hu, Guoqing
背景：在预防资源有限的国家，基于应用程序的干预措施有可能减少儿童伤害，但其有效性尚未得到严格审查。目的：本研究旨在评估基于app的学龄前儿童照顾者预防中国学龄前儿童意外伤害的干预效果。方法：于2017年12月至2018年6月进行为期6个月的整群随机对照试验。招募通过幼儿园进行，随机分为对照组（即基于app的育儿教育，不包括意外伤害预防）和干预组（即基于app的育儿教育，包括意外伤害预防）。通过学校线下招募长沙市20所幼儿园3-6岁幼儿保育员2920人。主要结局是过去3个月内学龄前儿童的意外伤害发生率；这项措施是通过基线访问和3个月和6个月随访时的在线护理人员报告来评估的。次要结果测量包括照顾者自我报告的上周对儿童监督的态度和行为。在调整了社会人口变量、结果变量的基线水平和指定组的干预措施后，使用广义估计方程（GEEs）来评估基于应用程序的干预措施对3个月和6个月的反应的有效性。所有分析均为意向治疗。还进行了每个方案的敏感性分析。结果：2920名护理人员中，共有1980人完成了研究。参与者的平均年龄为32.0岁（SD 5.5），女性占68.99%（1366/1980）。6个月随访期间，两组意外伤害发生率无显著变化：干预组意外伤害发生率从8.76%（94/1073）上升至8.11% (87/1073)，P= 0.59；对照组发病率由9.4%(85/907)降至7.5% (69/907)，P= 0.15。两组间的变化无差异（优势比[OR] 1.14, 95% CI 0.80-1.62）。两组间预防意外伤害态度平均得分的变化也相似(B。0.05, 95% CI -0.03至0.13)。干预后，干预组预防意外伤害行为的变化大于对照组(B。87, 95% ci 0.33-1.42)。个体伤害预防行为分析显示，干预减少了三种危险行为：儿童不安全喂养（OR 0.73, 95% CI 0.60-0.89）；错误地将儿童放在车内（OR 0.73, 95% CI 0.57-0.93）；允许儿童在无人监督的情况下骑自行车、电动自行车或摩托车（or 0.80, 95% CI 0.64-0.99）。干预还提高了三项以安全为重点的行为的得分：在给儿童洗澡前测试水温（OR 1.26, 95% CI 1.05-1.52）；妥善存放尖锐物品（OR 1.24, 95% CI 1.01-1.52）；以及安全储存药品、洗涤剂和农药（OR 1.24, 95% CI 1.02-1.51）。结论：基于app的干预并未降低学龄前儿童意外伤害发生率，但显著改善了照顾者的安全行为。这种基于应用程序的干预方法改善照顾者围绕儿童伤害风险的行为，有望得到修改，并最终得到广泛传播。
Background: App-based interventions have the potential to reduce child injury in countries with limited prevention resources, but their effectiveness has not been rigorously examined.Objective: This study aimed to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers.Methods: A 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. Recruitment was conducted through preschools, which were randomly allocated to either the control group (ie, app-based parenting education excluding unintentional injury prevention) or the intervention group (ie, app-based parenting education including unintentional injury prevention). A total of 2920 caregivers of preschoolers aged 3-6 years from 20 preschools in Changsha, China, were recruited offline through the schools. The primary outcome was unintentional injury incidences among preschoolers in the past 3 months; this measure was assessed through an online caregiver-report at the baseline visit and at 3-month and 6-month follow-up visits. Secondary outcome measures included caregivers' self-reported attitudes and behaviors concerning child supervision during the last week. Generalized estimating equations (GEEs) were used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for sociodemographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat. A per-protocol sensitivity analysis was also conducted.Results: In total, 1980 of the 2920 caregivers completed the study. The mean age of participants was 32.0 years (SD 5.5) and 68.99% (1366/1980) of them were female. During the 6-month follow-up visit, unintentional injury incidence did not change significantly in either group: incidence in the intervention group went from 8.76% (94/1073) to 8.11% (87/1073), P=.59; incidence in the control group went from 9.4% (85/907) to 7.5% (69/907), P=.15. The changes did not differ between the groups (odds ratio [OR] 1.14, 95% CI 0.80-1.62). Changes in the average score in attitude concerning unintentional injury prevention were also similar between the groups (B .05, 95% CI -0.03 to 0.13). Changes in unintentional injury prevention behaviors were greater in the intervention group than in the control group after the intervention (B .87, 95% CI 0.33-1.42). Analyses of individual injury prevention behaviors showed that the intervention reduced three risky behaviors: unsafe feeding of children (OR 0.73, 95% CI 0.60-0.89); incorrectly placing children in cars (OR 0.73, 95% CI 0.57-0.93); and allowing children to ride bicycles, electric bicycles, or motorcycles unsupervised (OR 0.80, 95% CI 0.64-0.99). The intervention also improved scores on three safety-focused behaviors: testing water temperature before giving children a bath (OR 1.26, 95% CI 1.05-1.52); properly storing sharp objects (OR 1.24, 95% CI 1.01-1.52); and safely storing medicines, detergents, and pesticides (OR 1.24, 95% CI 1.02-1.51).Conclusions: The app-based intervention did not reduce unintentional injury incidence among preschoolers but significantly improved caregivers' safety behaviors. This app-based intervention approach to improve caregiver behaviors surrounding child injury risk offers promise to be modified and ultimately disseminated broadly.