Abstract
BackgroundEach year, over 15,000 preschoolers die from unintentional injuries in China. Many interventions proven to work in other nations have not been implemented nationwide in China. The rapid popularity of smartphones offers an opportunity to overcome this limitation and disseminate evidence-based interventions to the large population of China. This study aims to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among young Chinese children.MethodA single-blinded, 6-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be conducted in Changsha, China. In total, 2626 caregivers of preschoolers ages 3–6 years old who own a smartphone will be recruited from 20 preschools. Clusters will be randomized at the preschool level and allocated to either the control group (routine education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (routine education plus app-based parenting education including unintentional injury prevention). The app-based injury prevention program was developed based on the Theory of Planned Behavior, the Haddon Matrix, the Mobile Learning framework, and a needs assessment. Data collection will be conducted at baseline, 3-month, and 6-month follow-up via app-based survey plus printed questionnaire survey. The primary outcome measure is unintentional injury incidence among preschoolers in the past 3 months. Secondary outcome measures include economic losses due to unintentional injury in the past 3 months, the Incremental Cost-Effectiveness Ratios (ICERs), and parent’s attitudes and behaviors concerning supervision to prevent preschooler unintentional injury in the past week. An intention-to-treat approach will be used to evaluate outcome measures. Chi-square tests will examine differences for outcome measures between groups at each time point and generalized estimation equations (GEE) will test the overall effectiveness of the app-based intervention. Missing outcome data will be imputed using the Expectation Maximization algorithm (EM).DiscussionThis trial will examine evidence concerning the effectiveness of an innovative app-based intervention for caregivers of Chinese preschoolers. If effective, the app-based intervention could offer an effective population-based intervention option to cost-effectively promote unintentional injury prevention in countries and regions where injury control is under-supported.Trial registrationChiCTR-IOR-17010438. Registered 15 January 2017.
Highlights
Each year, over 15,000 preschoolers die from unintentional injuries in China
Poor caregiver perception of child injury risk, and risky child behaviors are reported as major risk factors for preschooler unintentional injury [2,3,4]
The present study extends the field to a middleincome country [18] and includes injury morbidity as a primary outcome
Summary
Over 15,000 preschoolers die from unintentional injuries in China. Many interventions proven to work in other nations have not been implemented nationwide in China. This study aims to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among young Chinese children. Interventions that have proven effective in other countries – including both multifaceted home-based interventions as well as other programs (e.g., child restraint legislation [6]; providing safe places away from water for young children; installing barriers controlling access to water [7]) – have not been widely implemented in China, largely due to lack of governmental support for injury control [8,9,10]. The rapid development of mobile health (mHealth) strategies, plus extensive smartphone penetration among Chinese parents, offers an opportunity to overcome barriers to child injury prevention in China since empiricallysupported parenting interventions could be delivered broadly and cost-effectively to caregivers using mobile health technology. A recent systematic review by Omaki et al [12] provides evidence of the effectiveness of computer-based communication in conveying information and influencing risk perception and safety behaviors; the review is support by empirical research from an RCT that concluded an intervention with web-based, tailored, safety advice combined with personal counseling is more effective than generic written materials to promote parents’ safety behavior for safe staircases, storage of cleaning products, bathing, drinking hot fluids, and cooking [13]
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