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BackgroundPerinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. ObjectiveThe aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. MethodsPerinatal women were recruited from a large Midwest Children’s Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention–Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants’ perceptions of voice technology as a means to support perinatal health in the future. ResultsIn total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). ConclusionsOur findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions.

BackgroundChildren are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. ObjectiveThe purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. MethodsFifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. ResultsSelf-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. ConclusionsUtilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.

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. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

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. (Contains 3 tables and 1 figure.)

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent diabetes outcomes remain poor despite increased use of diabetes technologies such as insulin pump therapy. Meaningful research examining adolescent insulin pump self‐management has been done, however, a summary of these self‐management findings has not been published. The aim of this literature review is to map, evaluate, and summarize existing adolescent insulin pump self‐management research. Method: A scoping review of three databases was conducted to comprehensively report and synthesize relevant literature published before September 2019. Results: Of the 1295 titles identified, 18 articles met the inclusion criteria and were included in this scoping review. Key insulin pump self‐management behaviors were featured in the literature, most notably self‐monitoring of blood glucose (SMBG) and bolus frequency. Several factors were found to influence pump self‐management including psychological factors, parental support and self‐management transition, insulin pump education and knowledge acquisition, and environmental factors. We uncovered five gaps in the literature including: an unclear delineation of adolescent age; limited minority representation; variability in the definitions and reporting of self‐management behaviors; the role of data sharing and remote monitoring was not addressed; and there remains limited inquiry into diabetes burden and distress associated with insulin pump self‐management. Practice Implications: There exists a consensus that well‐established behaviors, such as bolus and SMBG frequency, influence glycemic outcomes for adolescent insulin pump users, however, full insulin pump utilization and self‐management is poorly understood. Diabetes clinicians should work to support adolescent insulin pump self‐management practices by reinforcing bedrock behaviors while fostering supportive factors found to influence pump self‐management. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Engaging in positive healthy lifestyle behaviors continues to be a public health challenge, requiring innovative solutions. As the market for voice assistants (Amazon Alexa, Google Assistant, and Apple Siri) grows and people increasingly use them to assist their daily tasks, there is a pressing need to explore how voice assistant (VA) technology may be used in behavioral health interventions. A scoping review of literature was conducted to address a PICO (Population, Intervention, Comparison, and Outcome) question: across populations, how does the use of voice assistants in behavioral health research/interventions influence healthy lifestyle behaviors versus control or comparison interventions? To inform the science, a secondary aim of this review was to explore characteristics of VAs used in behavioral health research. The review was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines with scoping review extension (PRISMA-ScR). Ten studies satisfied the inclusion criteria, representing research published through February 2019. Studies spanned pediatric to elderly populations, covering a vast array of self-management and healthy lifestyle behaviors. The majority of interventions were multicomponent, involving more than one of the following behavior change techniques grouped by cluster: shaping knowledge, self-belief, repetition and substitution, feedback and monitoring, goals and planning, antecedents, natural consequences, comparison of behavior, and identification. However, most studies were in early stages of development, with limited efficacy trials. VA technology continues to evolve and support behavioral interventions using various platforms (e.g. Interactive Voice Response [IVR] systems, smartphones, and smart speakers) which are used alone or in conjunction with other platforms. Feasibility, usability, preliminary efficacy, along with high user satisfaction of research adapted VAs, in contrast to standalone commercially available VAs, suggest a role for VAs in behavioral health intervention research. [ABSTRACT FROM AUTHOR]

Lebanon has the highest per-capita concentration of refugees worldwide. There is an urgent need to offer psychosocial interventions to vulnerable groups such as Syrian refugee adolescents. To assess the feasibility, acceptability, and preliminary effects of a cognitive–behavioral intervention (Creating Opportunities for Patient Empowerment [COPE]) on depression, anxiety, and quality of life (QOL) in a sample of adolescent refugees (13-17 years) living in Lebanon. A preexperimental study design was used. COPE 7-Session was delivered to 31 adolescent Syrian refugees. Participants were assessed for depression (Personal Health Questionnaire–9), anxiety (General Anxiety Disorders Scale), and QOL (Pediatric Quality of Life Inventory). Feasibility and acceptability findings indicated that the COPE program was a positive experience for teens. Significant decreases in depression and anxiety, and increases in QOL were also reported. COPE is an effective cognitive–behavioral intervention that can be delivered in an Arabic/Middle-Eastern setting for teen refugees to improve mental health and QOL. [ABSTRACT FROM AUTHOR]

• The population of children is growing along with an increase in complexity and diversity of health care needs. • The number of pediatric nurse scientists is inadequate to meet the demand for research underlying evidence-based care for this growing pediatric population. • Pediatric nurse scientists develop from pediatric nurses, and the number of pediatric nurses is steadily decreasing. • Nursing leaders in academia, practice, and public policy must act to support and build pediatric nursing and 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and purpose Little is known about the physical health, lifestyle beliefs and behaviors, and mental health among first-year health professional graduate students. Therefore, the purpose of this study was to describe these attributes as well as to explore the relationships among them. Methods A descriptive correlational study was conducted on the baseline data from a wellness onboarding intervention study with 93 health sciences students from seven different colleges within a large public land grant university in the Midwest United States. Findings Nearly 40% of the sample was overweight/obese, and 19% of students had elevated total cholesterol levels. Only 44% met the recommended 30 min of exercise 5 days per week. Forty-one percent reported elevated depressive symptoms and 28% had elevated anxiety. Four students reported suicidal ideation. Inverse relationships existed among depression/anxiety and healthy lifestyle beliefs/behaviors. Conclusions Students entering health professional schools are at high risk for depression, anxiety, and unhealthy behaviors, which could be averted through screening and early evidence-based interventions. Implications for practice Assessing the physical health, lifestyle behaviors, and mental health of first-year health sciences professional students is important to identify health problems and modifiable at-risk behaviors so that early interventions can be implemented to improve outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 (β =.32, 95% CI =.11,.52, P =.003) and autonomous motivation (β =.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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Pokémon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families. Objective: The aims of this study were (1) to explore the Pokémon GO user experience from a family perspective and (2) to investigate Pokémon GO within the context of family health. Methods: Between January and February 2017, congruent with one of the largest anticipated Pokémon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pokémon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pokémon GO. Results: Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. "Spending time together" was the most cited reason for gameplay by both parents (122/160, 76.3%) and children (24/31, 77%), followed by "it helped me go outdoors" for parents (113/160, 70.1%) and "I am a Pokémon fan" by children (21/31, 68%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t97=3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t130=4.70, P<.001) PA per week after playing Pokémon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (rs=.514, P=.003) and after (rs=.536, P=.003) Pokémon GO uptake. Conclusions: Pokémon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach. [ABSTRACT FROM AUTHOR]

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., (©Emre Sezgin, A Baki Kocaballi, Millie Dolce, Micah Skeens, Lisa Militello, Yungui Huang, Jack Stevens, Alex R Kemper. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 19.07.2024.)

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., (© 2024 The Author(s). Research in Nursing & Health published by Wiley Periodicals LLC.)

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., Competing Interests: The authors have no conflicts of interest to declare., (© The Author(s) 2023.)

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., (©Lisa Militello, Michael Sobolev, Fabian Okeke, Daniel A Adler, Inbal Nahum-Shani. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.03.2022.)

Background: Pokémon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families., Objective: The aims of this study were (1) to explore the Pokémon GO user experience from a family perspective and (2) to investigate Pokémon GO within the context of family health., Methods: Between January and February 2017, congruent with one of the largest anticipated Pokémon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pokémon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pokémon GO., Results: Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. "Spending time together" was the most cited reason for gameplay by both parents (122/160, 76.3%) and children (24/31, 77%), followed by "it helped me go outdoors" for parents (113/160, 70.1%) and "I am a Pokémon fan" by children (21/31, 68%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t 97 =3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t 130 =4.70, P<.001) PA per week after playing Pokémon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (r s =.514, P=.003) and after (r s =.536, P=.003) Pokémon GO uptake., Conclusions: Pokémon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach., (©Lisa K Militello, Nathan Hanna, Claudio R Nigg. Originally published in JMIR Pediatrics and Parenting (http://pediatrics.jmir.org), 03.10.2018.)