Combining Technology and Research to Prevent Scald Injuries (the Cool Runnings Intervention): Randomized Controlled Trial

Abstract

BackgroundNew technologies, internet accessibility, social media, and increased smartphone ownership provide new opportunities for health researchers to communicate and engage target audiences. An innovative burn prevention intervention was developed using these channels.ObjectiveThe aim of this study was to evaluate the efficacy of Cool Runnings, an app-based intervention to increase knowledge of childhood burn risk (specifically hot beverage scalds) and correct burn first aid among mothers of young children.MethodsThis was a 2-group, parallel, single-blinded randomized controlled trial (RCT). Participants were women aged 18 years and above, living in Queensland, Australia, with at least 1 child aged 5-12 months at time of enrollment. The primary outcome measures were change in knowledge about risk of burns and correct burn first aid assessed via 2 methods: (1) overall score and (2) categorized as adequate (score=4) versus inadequate (score<4). Efficacy of gamification techniques was also assessed.ResultsIn total, 498 participants were recruited via social media and enrolled. At the 6-month follow-up, 244 participants completed the posttest questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those lost to follow-up on any characteristics except education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge posttest than control group participants on both primary outcome measures (overall knowledge intervention: mean [SD] of overall knowledge 2.68 [SD 1.00] for intervention vs 2.13 [SD 1.03] for control; 20.7% [25/121] adequate in intervention vs 7.3% [2/123] in control). Consequently, the number needed to treat was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage had 7.3 times higher odds of improved overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between gamification techniques and knowledge change (P<.001). In addition, odds of knowledge improvement between baseline and 6-month follow-up was higher in participants with low-moderate app activity compared with no app activity (odds ratio [OR] 8.59, 95% CI 2.9-25.02) and much higher in participants with high app activity (OR 18.26, 95% CI 7.1-46.8).ConclusionsDespite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about risks of hot beverage scalds and burn first aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to and engage with targeted populations, the results from this RCT provide important information on how smartphone apps can be used for widespread injury prevention campaigns and public health campaigns generally.Trial RegistrationAustralian New Zealand Clinical Trials Registry...

Factors Associated With Dropout of Participants in an App-Based Child Injury Prevention Study: Secondary Data Analysis of a Cluster Randomized Controlled Trial

“…Attrition in our study was quite similar to that reported at 6-month follow up for an educational app on car seat use [ 25 ] (34.3%, 387/1129), but was significantly lower than the rate of 51% (254/498) reported in an app-based study of scald burn prevention [ 22 ]. A wide range of factors likely explain participant attrition from engagement in an app-based intervention, including design of the app, assessment measures for participant compliance, individual characteristics of participants, and cultural differences across countries.…”

“…We hypothesized that a more active and attractive type of intervention would result in greater engagement and thus a lower attrition rate in the intervention arm compared with the control arm. Replicating Burgess et al [ 22 ] and others, we also hypothesized that greater education might be related to higher retention in the intervention study. We used data collected from a cluster randomized controlled trial (RCT) examining an app intervention to prevent unintentional child injury in China to test our hypotheses.…”

“…Based on our study hypotheses and previous studies [ 17 , 22 ], we considered demographic factors and engagement with the app-based intervention as potential factors that would predict dropout attrition of study participants. We also considered previous training experience on unintentional injury prevention, as we hypothesized that participants might engage in the intervention or study only if they valued parenting education and if they were receiving new information that they had not learned in the past.…”

“…Previous research examining predictors of dropout attrition from app-based intervention studies in reducing alcohol intake [ 19 ], improving health-related behavior [ 20 ], and weight loss [ 21 ] focused primarily on the demographic characteristics of individuals who are more likely to fail to complete follow-up surveys and therefore are not retained in the research study. For example, in an evaluation of the efficacy of an app-based child burn prevention program, Burgess et al [ 22 ] reported a higher proportion of university degree holders among participants who remained in the study (28.7%, 70/244) than those who were lost to follow up (16.5%, 42/254). Despite the value of this line of research, it is equally important to explore relationships between attrition and other indicators such as engagement with the app-based intervention.…”

An App-Based Intervention for Caregivers to Prevent Unintentional Injury Among Preschoolers: Cluster Randomized Controlled Trial

“…To date, however, only a few mobile phone app interventions are available to assist parents in preventing unintentional child injuries, and most are not based in theory or are insufficiently tested in rigorous randomized trials [11]. Tests of these interventions were conducted in HICs [12-15] and generally involved assessments of knowledge, perception, and behavioral outcomes with relatively small sample sizes [12,14] (eg, the sample sizes in studies by Gielen et al [12] and Burgess et al [14] were 498 and 742, respectively). None have used actual injury events as the primary outcome indicator [12-15].…”