1.

Alcohol consumption and other mental health problems up during COVID‐19: Study
https://onlinelibrary.wiley.com/doi/abs/10.1002/adaw.32867

ABSTRACT
A study published in JAMA Network Open last month found that the frequency of alcohol consumption
increased 14% overall during the beginning of the pandemic in March 2020 compared to the same
period a year earlier (baseline); this was an increase of 17% over the 2019 baseline for women, an
increase of 19% for adults age 30 to 59 years and an increase of 10% for non‐Hispanic whites over the
2019 baseline. On average, alcohol was consumed one day more per month by three of four adults.
Heavy drinking also went up for women. In addition, there was a 39% increase in the Short Inventory of
Problems scale for women, which indicates increased alcohol‐related problems independent of
consumption for almost one in 10 women. “These data provide evidence of changes in alcohol use and
associated consequences during the COVID‐19 pandemic,” the researchers wrote. “In addition to a
range of negative physical health associations, excessive alcohol use may lead to or worsen existing
mental health problems, such as anxiety or depression, which may themselves be increasing during
COVID‐19.” The study, “Changes in Adult Alcohol Use and Consequences During the COVID‐19 Pandemic
in the U.S.,” is by Michael S. Pollard, Ph.D., of the RAND Corporation and colleagues.

Purpose: The study aims to determine if there are changes in adult alcohol use and consequences
during the COVID-19 Pandemic in the U.S.

Procedure: A comparison was conducted on the frequency of alcohol consumption during the
beginning of the pandemic in March 2020 to the same period a year earlier(baseline) with the addition
to a comparison on the alcohol-related problems independent of consumption during the Pandemic to
the results of the same period a year earlier.

Data: An increase of 17% over the 2019 baseline for women, an increase of 19% for adults age 30 to 59
years and an increase of 10% for non‐Hispanic whites over the 2019 baseline. On average, alcohol was
consumed one day more per month by three of four adults. Heavy drinking also went up for women. In
addition, there was a 39% increase in the Short Inventory of Problems scale for women, which indicates
increased alcohol‐related problems independent of consumption for almost one in 10 women.

Conclusion: These data provide evidence of changes in alcohol use and associated consequences during
the COVID‐19 pandemic. In addition to a range of negative physical health associations, excessive
alcohol use may lead to or worsen existing mental health problems, such as anxiety or depression, which
may themselves be increasing during COVID‐19.

2. A review of caffeine’s effects on cognitive, physical and occupational performance by Tom M.

McLellana, et. al.

ABSTRACT

Caffeine is consumed by over 80% of U.S. adults. This review examines the effects caffeine has on
cognitive and physical function, since most real-world activities require complex decision making, motor
processing and movement. Caffeine exerts its effects by blocking adenosine receptors. Following low
(∼40 mg or ∼0.5 mg kg−1) to moderate (∼300 mg or 4 mg kg−1) caffeine doses, alertness, vigilance,
attention, reaction time and attention improve, but less consistent effects are observed on memory and
higher-order executive function, such as judgment and decision making. Effects on physical performance
on a vast array of physical performance metrics such as time-to-exhaustion, time-trial, muscle strength
and endurance, and high-intensity sprints typical of team sports are evident following doses that exceed
about 200 mg (∼3 mg kg−1). Many occupations, including military, first responders, transport workers
and factory shift workers, require optimal physical and cognitive function to ensure success, workplace
safety and productivity. In these circumstances, that may include restricted sleep, repeated
administration of caffeine is an effective strategy to maintain physical and cognitive capabilities.

Purpose: This review examines the effects caffeine has on cognitive and physical function, since most
real-world activities require complex decision making, motor processing and movement.
Procedure: In this paper, the procedure can be understood from the data. Procedure was embedded in
the discussion of the data. Procedure is underlined below

Data: Caffeine exerts its effects by blocking adenosine receptors. Following low (∼40 mg or ∼0.5 mg
kg−1) to moderate (∼300 mg or 4 mg kg−1) caffeine doses, alertness, vigilance, attention, reaction time
and attention improve, but less consistent effects are observed on memory and higher-order executive
function, such as judgment and decision making. Effects on physical performance on a vast array of
physical performance metrics such as time-to-exhaustion, time-trial, muscle strength and endurance,
and high-intensity sprints typical of team sports are evident following doses that exceed about 200 mg
(∼3 mg kg−1).

Conclusion: Many occupations, including military, first responders, transport workers and factory shift
workers, require optimal physical and cognitive function to ensure success, workplace safety and
productivity. In these circumstances, that may include restricted sleep, repeated administration of
caffeine is an effective strategy to maintain physical and cognitive capabilities.

3. Smartphone-Based Self-Monitoring, Treatment, and Automatically Generated Data in Children,

Adolescents, and Young Adults With Psychiatric Disorders: Systematic Review
Sigurd Melbye1, MD ;
Lars Vedel Kessing1, MD, DSMc ;
Jakob Eyvind Bardram2, MSc, PhD ;
Maria Faurholt-Jepsen1, MD, DMSc
1 The Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen,
Rigshospitalet, Kobenhavn, Denmark
2 Department of Applied Mathematics and Computer Science, The Technical University of Denmark,
Lyngby, Denmark

ABSTRACT

Psychiatric disorders often have an onset at an early age, and early identification and intervention help
improve prognosis. A fine-grained, unobtrusive, and effective way to monitor symptoms and level of
function could help distinguish severe psychiatric health problems from normal behavior and potentially
lead to a more efficient use of clinical resources in the current health care system. The use of
smartphones to monitor and treat children, adolescents, and young adults with psychiatric disorders has
been widely investigated. However, no systematic review concerning smartphone-based monitoring and
treatment in this population has been published.

This systematic review aims at describing the following 4 features of the eligible studies: (1) monitoring
features such as self-assessment and automatically generated data, (2) treatment delivered by the app,
(3) adherence to self-monitoring, and (4) results of the individual studies.

We conducted a systematic literature search of the PubMed, Embase, and PsycInfo databases. We
searched for studies that (1) included a smartphone app to collect self-monitoring data, a smartphone
app to collect automatically generated smartphone-based data, or a smartphone-based system for
treatment; (2) had participants who were diagnosed with psychiatric disorders or received treatment for
a psychiatric disorder, which was verified by an external clinician; (3) had participants who were younger
than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported
in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
The risk of bias in each individual study was systematically assessed.

A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria
for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders,
depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-
monitoring was used in all but 1 study, and 11 of them reported on the participants’ adherence to self-
monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive
attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data
were collected. Three studies were randomized controlled trials investigating the effectiveness of
smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2
randomized controlled trials, the researchers were blinded for randomization, but the participants were
not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas.

Smartphones hold great potential as a modern, widely available technology platform to help diagnose,
monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of
homogeneity and rigor among studies regarding their methodology and reporting of adherence would
facilitate future reviews and meta-analyses.

Purpose: This systematic review aims at describing the following 4 features of the eligible studies: (1)
monitoring features such as self-assessment and automatically generated data, (2) treatment delivered
by the app, (3) adherence to self-monitoring, and (4) results of the individual studies.

Procedure: We conducted a systematic literature search of the PubMed, Embase, and PsycInfo
databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a
smartphone app to collect automatically generated smartphone-based data, or a smartphone-based
system for treatment; (2) had participants who were diagnosed with psychiatric disorders or received
treatment for a psychiatric disorder, which was verified by an external clinician; (3) had participants who
were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review
was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses guidelines. The risk of bias in each individual study was systematically assessed.

Data: A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the
criteria for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders,
depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-
monitoring was used in all but 1 study, and 11 of them reported on the participants’ adherence to self-
monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive
attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data
were collected. Three studies were randomized controlled trials investigating the effectiveness of
smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2
randomized controlled trials, the researchers were blinded for randomization, but the participants were
not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas.

Conclusions: Smartphones hold great potential as a modern, widely available technology platform to

help diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher
level of homogeneity and rigor among studies regarding their methodology and reporting of adherence
would facilitate future reviews and meta-analyses.

4. Public Access and Use of Health Research: An Exploratory Study of the National Institutes of
Health (NIH) Public Access Policy Using Interviews and Surveys of Health Personnel by Jamie
O'Keeffe1, MEd; John Willinsky1, PhD; Lauren Maggio2, MS(LIS)

ABSTRACT
In 2008, the National Institutes of Health (NIH) Public Access Policy mandated open access for
publications resulting from NIH funding (following a 12-month embargo). The large increase in access to
research that will take place in the years to come has potential implications for evidence-based practice
(EBP) and lifelong learning for health personnel.

This study assesses health personnel’s current use of research to establish whether grounds exist for
expecting, preparing for, and further measuring the impact of the NIH Public Access Policy on health
care quality and outcomes in light of time constraints and existing information resources.
In all, 14 interviews and 90 surveys of health personnel were conducted at a community-based clinic and
an independent teaching hospital in 2010. Health personnel were asked about the research sources they
consulted and the frequency with which they consulted these sources, as well as motivation and search
strategies used to locate articles, perceived level of access to research, and knowledge of the NIH Public
Access Policy.
In terms of current access to health information, 65% (57/88) of the health personnel reported being
satisfied, while 32% (28/88) reported feeling underserved. Among the sources health personnel
reported that they relied upon and consulted weekly, 83% (73/88) reported turning to colleagues, 77%
(67/87) reported using synthesized information resources (eg, UpToDate and Cochrane Systematic
Reviews), while 32% (28/88) reported that they consulted primary research literature. The dominant
resources health personnel consulted when actively searching for health information were Google and
Wikipedia, while 27% (24/89) reported using PubMed weekly. The most prevalent reason given for
accessing research on a weekly basis, reported by 35% (31/88) of survey respondents, was to help a
specific patient, while 31% (26/84) were motivated by general interest in research.

The results provide grounds for expecting the NIH Public Access Policy to have a positive impact on EBP
and health care more generally given that between a quarter and a third of participants in this study (1)
frequently accessed research literature, (2) expressed an interest in having greater access, and (3) were
aware of the policy and expect it to have an impact on their accessing research literature in the future.
Results also indicate the value of promoting a greater awareness of the NIH policy, providing training
and education in the location and use of the literature, and continuing improvements in the organization
of biomedical research for health personnel use.

Purpose: This study assesses health personnel’s current use of research to establish whether grounds
exist for expecting, preparing for, and further measuring the impact of the NIH Public Access Policy on
health care quality and outcomes in light of time constraints and existing information resources.

Procedure: In all, 14 interviews and 90 surveys of health personnel were conducted at a community-
based clinic and an independent teaching hospital in 2010. Health personnel were asked about the
research sources they consulted and the frequency with which they consulted these sources, as well as
motivation and search strategies used to locate articles, perceived level of access to research, and
knowledge of the NIH Public Access Policy.

Data: In terms of current access to health information, 65% (57/88) of the health personnel reported
being satisfied, while 32% (28/88) reported feeling underserved. Among the sources health personnel
reported that they relied upon and consulted weekly, 83% (73/88) reported turning to colleagues, 77%
(67/87) reported using synthesized information resources (eg, UpToDate and Cochrane Systematic
Reviews), while 32% (28/88) reported that they consulted primary research literature. The dominant
resources health personnel consulted when actively searching for health information were Google and
Wikipedia, while 27% (24/89) reported using PubMed weekly. The most prevalent reason given for
accessing research on a weekly basis, reported by 35% (31/88) of survey respondents, was to help a
specific patient, while 31% (26/84) were motivated by general interest in research.

Conclusion: The results provide grounds for expecting the NIH Public Access Policy to have a positive
impact on EBP and health care more generally given that between a quarter and a third of participants
in this study (1) frequently accessed research literature, (2) expressed an interest in having greater
access, and (3) were aware of the policy and expect it to have an impact on their accessing research
literature in the future. Results also indicate the value of promoting a greater awareness of the NIH
policy, providing training and education in the location and use of the literature, and continuing
improvements in the organization of biomedical research for health personnel use.

5. Using Virtual Reality to Provide Health Care Information to People With Intellectual Disabilities:
Acceptability, Usability, and Potential Utility by Valerie Hall1, MSc, DPhil; Suzanne Conboy-Hill2,
BA(Hons), MSc, MPhil, PhD; Dave Taylor3, BSc, MSc

ABSTRACT
People with intellectual disabilities have poor access to health care, which may be further compromised
by a lack of accessible health information. To be effective, health information must be easily understood
and remembered. People with intellectual disabilities learn better from multimodal information sources,
and virtual reality offers a 3-dimensional (3D) computer-generated environment that can be used for
providing information and learning. To date, research into virtual reality experiences for people with
intellectual disabilities has been limited to skill-based training and leisure opportunities within the young
to mid age ranges.
This study assessed the acceptability, usability, and potential utility of a virtual reality experience as a
means of providing health care-related information to people with intellectual disabilities. We designed
a prototype multimodal experience based on a hospital scenario and situated on an island in the Second
Life 3D virtual world. We wanted to know how people of different ages and with varying levels of
cognitive function would participate in the customized virtual environment, what they understood from
being there, and what they remembered a week later.

The study drew on qualitative data. We used a participatory research approach that involved working
alongside people with intellectual disabilities and their supporters in a community setting. Cognitive
function was assessed, using the Matrix Analogies Test and the British Picture Vocabulary Scale, to
describe the sample. Participants, supported by facilitators, were video recorded accessing and engaging
with the virtual environment. We assessed recall 1 week later, using a specialized interview technique.
Data were downloaded into NVivo 8 and analyzed using the framework analysis technique.

Study participants were 20 people aged between 20 and 80 years with mild to severe intellectual
disabilities. All participants were able to access the environment and voluntarily stayed there for
between 23 and 57 minutes. With facilitator support, all participants moved the avatar themselves.
Participants engaged with the scenario as if they were actually there, indicating cognitive presence.
Some referred back to previous medical experiences, indicating the potential for experiential knowledge
to become the foundation of new learning and retention of knowledge. When interviewed, all
participants remembered some aspects of the environment.

A sample of adults with intellectual disabilities of all ages, and with varying levels of cognitive function,
accessed and enjoyed a virtual-world environment that drew on a health care-related scenario, and
remembered aspects of it a week later. The small sample size limits generalizability of findings, but the
potential shown for experiential learning to aid retention of knowledge on which consent is based
appears promising. Successfully delivering health care-related information in a non-National Health
Service setting indicates potential for delivery in institutional, community, or home settings, thereby
widening access to the information.

Purpose: This study assessed the acceptability, usability, and potential utility of a virtual reality
experience as a means of providing health care-related information to people with intellectual
disabilities. We designed a prototype multimodal experience based on a hospital scenario and situated
on an island in the Second Life 3D virtual world. We wanted to know how people of different ages and
with varying levels of cognitive function would participate in the customized virtual environment, what
they understood from being there, and what they remembered a week later.

Procedure: The study drew on qualitative data. We used a participatory research approach that involved
working alongside people with intellectual disabilities and their supporters in a community setting.
Cognitive function was assessed, using the Matrix Analogies Test and the British Picture Vocabulary
Scale, to describe the sample. Participants, supported by facilitators, were video recorded accessing and
engaging with the virtual environment. We assessed recall 1 week later, using a specialized interview
technique. Data were downloaded into NVivo 8 and analyzed using the framework analysis technique.

Data: Study participants were 20 people aged between 20 and 80 years with mild to severe intellectual
disabilities. All participants were able to access the environment and voluntarily stayed there for
between 23 and 57 minutes. With facilitator support, all participants moved the avatar themselves.
Participants engaged with the scenario as if they were actually there, indicating cognitive presence.
Some referred back to previous medical experiences, indicating the potential for experiential knowledge
to become the foundation of new learning and retention of knowledge. When interviewed, all
participants remembered some aspects of the environment.

Conclusion: A sample of adults with intellectual disabilities of all ages, and with varying levels of
cognitive function, accessed and enjoyed a virtual-world environment that drew on a health care-related
scenario, and remembered aspects of it a week later. The small sample size limits generalizability of
findings, but the potential shown for experiential learning to aid retention of knowledge on which
consent is based appears promising. Successfully delivering health care-related information in a non-
National Health Service setting indicates potential for delivery in institutional, community, or home
settings, thereby widening access to the information.

6. Digital Dashboard Design Using Multiple Data Streams for Disease Surveillance With Influenza
Surveillance as an Example by Calvin KY Cheng, MMedSc; Dennis KM Ip, MBBS, MPhil; Benjamin J
Cowling, PhD; Lai Ming Ho, PhD; Gabriel M Leung, MD, MPH; Eric HY Lau, PhD

ABSTRACT

Great strides have been made exploring and exploiting new and different sources of disease surveillance
data and developing robust statistical methods for analyzing the collected data. However, there has
been less research in the area of dissemination. Proper dissemination of surveillance data can facilitate
the end user's taking of appropriate actions, thus maximizing the utility of effort taken from upstream of
the surveillance-to-action loop.

The aims of the study were to develop a generic framework for a digital dashboard incorporating
features of efficient dashboard design and to demonstrate this framework by specific application to
influenza surveillance in Hong Kong.

Based on the merits of the national websites and principles of efficient dashboard design, we designed
an automated influenza surveillance digital dashboard as a demonstration of efficient dissemination of
surveillance data. We developed the system to synthesize and display multiple sources of influenza
surveillance data streams in the dashboard. Different algorithms can be implemented in the dashboard
for incorporating all surveillance data streams to describe the overall influenza activity.

We designed and implemented an influenza surveillance dashboard that utilized self-explanatory figures
to display multiple surveillance data streams in panels. Indicators for individual data streams as well as
for overall influenza activity were summarized in the main page, which can be read at a glance. Data
retrieval function was also incorporated to allow data sharing in standard format.

The influenza surveillance dashboard serves as a template to illustrate the efficient synthesization and
dissemination of multiple-source surveillance data, which may also be applied to other diseases.
Surveillance data from multiple sources can be disseminated efficiently using a dashboard design that
facilitates the translation of surveillance information to public health actions.

Purpose: The aims of the study were to develop a generic framework for a digital dashboard
incorporating features of efficient dashboard design and to demonstrate this framework by specific
application to influenza surveillance in Hong Kong.

Procedure: Based on the merits of the national websites and principles of efficient dashboard design, we
designed an automated influenza surveillance digital dashboard as a demonstration of efficient
dissemination of surveillance data. We developed the system to synthesize and display multiple sources
of influenza surveillance data streams in the dashboard. Different algorithms can be implemented in the
dashboard for incorporating all surveillance data streams to describe the overall influenza activity.

Data: We designed and implemented an influenza surveillance dashboard that utilized self-explanatory
figures to display multiple surveillance data streams in panels. Indicators for individual data streams as
well as for overall influenza activity were summarized in the main page, which can be read at a glance.
Data retrieval function was also incorporated to allow data sharing in standard format.

Conclusions: The influenza surveillance dashboard serves as a template to illustrate the efficient
synthesization and dissemination of multiple-source surveillance data, which may also be applied to
other diseases. Surveillance data from multiple sources can be disseminated efficiently using a
dashboard design that facilitates the translation of surveillance information to public health actions.

7. Evaluating a Web-Based Social Anxiety Intervention Among Community Users: Analysis of Real-
World Data by Hugh Cameron McCall1, BA ; Fjola Dogg Helgadottir2,3,4, PhD ; Ross G Menzies5,
PhD; Heather D Hadjistavropoulos1, PhD ; Frances S Chen6, PhD
ABSTRACT
Social anxiety is both harmful and prevalent. It also currently remains among the most undertreated
major mental disorders, due, in part, to socially anxious individuals’ concerns about the stigma and
expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions
may render them particularly helpful in addressing these concerns, and they are also highly scalable, but
most tend to be only somewhat effective without therapist support. However, a recent evaluation of a
new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called
Overcome Social Anxiety found that it was highly effective.

The initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in
symptom severity among university undergraduates. The aim of this study was to extend the results of
the initial study and investigate their generalizability by directly evaluating the intervention’s
effectiveness among a general community sample.

While signing up for Overcome Social Anxiety, users consented to the usage of their anonymized
outcome data for research purposes. Before and after completing the intervention, users completed the
Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure.
Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke
questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors
(Avoidance Questionnaire).

Participants who completed the intervention (102/369, 27.7%) experienced significant reductions in the
severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the
depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen
d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001;
Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42).

Our results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety
symptoms among those who complete it and suggest that its effectiveness extends to the general
community. The completion rate is the highest documented for a fully automated intervention for
anxiety, depression, or low mood in a real community sample. In addition, our results indicate that
Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of
anxiety, and stress in addition to symptoms of social anxiety.

Purpose: The initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions
in symptom severity among university undergraduates. The aim of this study was to extend the results
of the initial study and investigate their generalizability by directly evaluating the intervention’s
effectiveness among a general community sample.

Procedure: While signing up for Overcome Social Anxiety, users consented to the usage of their
anonymized outcome data for research purposes. Before and after completing the intervention, users
completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome
measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2
bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance
behaviors (Avoidance Questionnaire).

Data: Participants who completed the intervention (102/369, 27.7%) experienced significant reductions
in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the
depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen
d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001;
Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42).

Conclusion: Our results provide further evidence that Overcome Social Anxiety reduces the severity of
social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the
general community. The completion rate is the highest documented for a fully automated intervention
for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that
Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of
anxiety, and stress in addition to symptoms of social anxiety.

8. An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of

Preschool-Aged Children: Randomized Controlled Trial by Megan L Hammersley1, PhD ; Anthony D
Okely1, EdD ; Marijka J Batterham2, PhD ; Rachel A Jones1, PhD.

ABSTRACT

Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have
shown promise in improving obesity-related behaviors in children.

This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for
preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index
(BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-
efficacy.

The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017.
Participants were recruited both online and through more traditional means within the community.
Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison
group. Intervention participants received an 11-week internet-based healthy lifestyle program,
underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter.
Intervention participants set goals and received individual feedback from a dietitian. They were also
encouraged to access and contribute to a closed Facebook group to communicate with other
participants and the dietitian. Comparison participants received email communication only. Objectively
measured child BMI was the primary outcome. Secondary outcomes included objectively measured
physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary
intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at
face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors.
Randomization was conducted using a computerized random number generator post baseline data
collection.

A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the
comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up
and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range.
Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses
found no significant outcomes for change in BMI between groups. Compared with children in the
comparison group, those in the intervention group showed a reduced frequency of discretionary food
intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child
feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43,
95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes.

The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can
provide support to improve dietary-related practices and self-efficacy but was not successful in reducing
BMI. The target sample size was not achieved, which would have affected statistical power.

Purpose: This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle
program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body
mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and
parent self-efficacy.

Procedure: The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to
2017. Participants were recruited both online and through more traditional means within the
community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or
comparison group. Intervention participants received an 11-week internet-based healthy lifestyle
program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter.
Intervention participants set goals and received individual feedback from a dietitian. They were also
encouraged to access and contribute to a closed Facebook group to communicate with other
participants and the dietitian. Comparison participants received email communication only. Objectively
measured child BMI was the primary outcome. Secondary outcomes included objectively measured
physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary
intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at
face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors.
Randomization was conducted using a computerized random number generator post baseline data
collection.

Data: A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the
comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up
and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range.
Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses
found no significant outcomes for change in BMI between groups. Compared with children in the
comparison group, those in the intervention group showed a reduced frequency of discretionary food
intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child
feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43,
95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes.

Conclusions: The trial demonstrated that a parent-focused eHealth childhood obesity prevention
program can provide support to improve dietary-related practices and self-efficacy but was not
successful in reducing BMI. The target sample size was not achieved, which would have affected
statistical power.

9. A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for
Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized
Controlled Trial by Marie Bee Hui Yap1,2, MPsych (Clin), PhD ; Shireen Mahtani1, DPsych (Clin) ;
Ronald M Rapee3, PhD; Claire Nicolas1, BSocSc, GradDipPsych ; Katherine A Lawrence1, DPsych
(Clin) ; Andrew Mackinnon2,4, PhD ; Anthony F Jorm2, PhD, DSc

ABSTRACT
Depression and anxiety disorders in young people are a global health concern. Parents have an
important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions
for parents that can be widely disseminated are lacking.

This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on
parenting risk and protective factors for adolescent depression and anxiety, and on adolescent
depression and anxiety symptoms.

A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited
primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3
months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-
based parenting intervention designed following Persuasive Systems Design (PSD) principles to target
parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a
tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a
set of interactive modules (up to nine) that is specifically recommended for the parent based on
individually identified areas for improvement. Parents in the active-control condition received a
standardized package of five Web-based factsheets about adolescent development and well-being.
Parents in both conditions received a 5-min weekly call to encourage progress through their allocated
program to completion. Both programs were delivered weekly via the trial website. The primary
outcome measure at postintervention was parent-reported changes in parenting risk and protective
factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale
(PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-
report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report
Spence Children’s Anxiety Scale (anxiety symptoms).
Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP
program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the
postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of
variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a
medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were
found at postintervention on any of the secondary outcome measures, with adolescent depressive
(parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly
from baseline to postintervention in both conditions.

The fully automated PiP intervention showed promising short-term effects on parenting behaviors that
are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to
ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The
intervention may be useful as a low-cost universal public health program to increase parenting practices
believed to benefit adolescents’ mental health.

Purpose: This study aimed to examine the postintervention effects of the Partners in Parenting (PiP)
program on parenting risk and protective factors for adolescent depression and anxiety, and on
adolescent depression and anxiety symptoms.

Procedure: A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads,
recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline
and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored
Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to
target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP
comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement,
followed by a set of interactive modules (up to nine) that is specifically recommended for the parent
based on individually identified areas for improvement. Parents in the active-control condition received
a standardized package of five Web-based factsheets about adolescent development and well-being.
Parents in both conditions received a 5-min weekly call to encourage progress through their allocated
program to completion. Both programs were delivered weekly via the trial website. The primary
outcome measure at postintervention was parent-reported changes in parenting risk and protective
factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale
(PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-
report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report
Spence Children’s Anxiety Scale (anxiety symptoms).

Data: Parents in the intervention condition completed a mean of 73.7% of their intended personalized
PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed
the postintervention assessment. Attrition was handled using mixed model of repeated measures
analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the
PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between
conditions were found at postintervention on any of the secondary outcome measures, with adolescent
depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing
significantly from baseline to postintervention in both conditions.

Conclusions: The fully automated PiP intervention showed promising short-term effects on parenting
behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is
required to ascertain whether these effects translate into reduced adolescent depression and anxiety
problems. The intervention may be useful as a low-cost universal public health program to increase
parenting practices believed to benefit adolescents’ mental health.

10. Challenges and Recommendations for the Deployment of Information and Communication
Technology Solutions for Informal Caregivers: Scoping Review

Alhassan Yosri Ibrahim Hassan1,2, BEng, MSc, MPH

1Centre for Socio-Economic Research on Ageing, Italian National Institute of Health & Science on
Ageing, Ancona, Italy
2Department of Economics and Social Sciences, Faculty of Economics “Giorgio Fuà”, Università
Politecnica delle Marche, Ancona, Italy

ABSTRACT
Information and communication technology (ICT)–based solutions have the potential to support
informal caregivers in home care delivery. However, there are many challenges to the deployment of
these solutions.

The aim of this study was to review literature to explore the challenges of the deployment of ICT-based
support solutions for informal caregivers and provide relevant recommendations on how to overcome
these challenges.

A scoping review methodology was used following the Arksey and O’Malley methodological framework
to map the relevant literature. A search was conducted using PubMed, IEEE library, and Scopus.
Publication screening and scrutiny were conducted following inclusion criteria based on inductive
thematic analysis to gain insight into patterns of challenges rising from deploying ICT-based support
solutions for informal caregivers. The analysis took place through an iterative process of combining,
categorizing, summarizing, and comparing information across studies. Through this iterative process,
relevant information was identified and coded under emergent broader themes as they pertain to each
of the research questions.

The analysis identified 18 common challenges using a coding scheme grouping them under four
thematic categories: technology-related, organizational, socioeconomic, and ethical challenges. These
range from specific challenges related to the technological component of the ICT-based service such as
design and usability of technology, to organizational challenges such as fragmentation of support
solutions to socioeconomic challenges such as funding of technology and sustainability of solutions to
ethical challenges around autonomy and privacy of data. For each identified challenge,
recommendations were created on how to overcome it. The recommendations from this study can
provide guidance for the deployment of ICT-based support solutions for informal caregivers.

Despite a growing interest in the potential offered by ICT solutions for informal caregiving, diverse and
overlapping challenges to their deployment still remain. Designers for ICTs for informal caregivers
should follow participatory design and involve older informal caregivers in the design process as much as
possible. A collaboration between designers and academic researchers is also needed to ensure ICT
solutions are designed with the current empirical evidence in mind. Taking actions to build the digital
skills of informal caregivers early in the caregiving process is crucial for optimal use of available ICT
solutions. Moreover, the lack of awareness of the potential added-value and trust toward ICT-based
support solutions requires strategies to raise awareness among all stakeholders—including policy
makers, health care professionals, informal caregivers, and care recipients—about support opportunities
offered by ICT. On the macro-level, policies to fund ICT solutions that have been shown to be effective at
supporting and improving informal caregiver health outcomes via subsidies or other incentives should
be considered.

Purpose: The aim of this study was to review literature to explore the challenges of the deployment of
ICT-based support solutions for informal caregivers and provide relevant recommendations on how to
overcome these challenges.

Procedure: A scoping review methodology was used following the Arksey and O’Malley methodological
framework to map the relevant literature. A search was conducted using PubMed, IEEE library, and
Scopus. Publication screening and scrutiny were conducted following inclusion criteria based on
inductive thematic analysis to gain insight into patterns of challenges rising from deploying ICT-based
support solutions for informal caregivers. The analysis took place through an iterative process of
combining, categorizing, summarizing, and comparing information across studies. Through this iterative
process, relevant information was identified and coded under emergent broader themes as they pertain
to each of the research questions.

Data: The analysis identified 18 common challenges using a coding scheme grouping them under four
thematic categories: technology-related, organizational, socioeconomic, and ethical challenges. These
range from specific challenges related to the technological component of the ICT-based service such as
design and usability of technology, to organizational challenges such as fragmentation of support
solutions to socioeconomic challenges such as funding of technology and sustainability of solutions to
ethical challenges around autonomy and privacy of data. For each identified challenge,
recommendations were created on how to overcome it. The recommendations from this study can
provide guidance for the deployment of ICT-based support solutions for informal caregivers.

Conclusions: Despite a growing interest in the potential offered by ICT solutions for informal caregiving,
diverse and overlapping challenges to their deployment still remain. Designers for ICTs for informal
caregivers should follow participatory design and involve older informal caregivers in the design process
as much as possible. A collaboration between designers and academic researchers is also needed to
ensure ICT solutions are designed with the current empirical evidence in mind. Taking actions to build
the digital skills of informal caregivers early in the caregiving process is crucial for optimal use of
available ICT solutions. Moreover, the lack of awareness of the potential added-value and trust toward
ICT-based support solutions requires strategies to raise awareness among all stakeholders—including
policy makers, health care professionals, informal caregivers, and care recipients—about support
opportunities offered by ICT. On the macro-level, policies to fund ICT solutions that have been shown to
be effective at supporting and improving informal caregiver health outcomes via subsidies or other
incentives should be considered.