John Jacob

Micro Data Videos (mDVs) are up to one-minute data-driven vertical video clips for mobile devices. Widely adopted on social media platforms, mDVs hold significant potential for disseminating information. Despite their growing prevalence, little is known about their components and how they are designed. Thus, two studies were conducted. Study 1 analyzed 40 mDVs and revealed their narrative components. Study 2 examined, through design sessions with design experts, how such components are assembled to craft storyboards for mDVs. The diverse narrative styles of mDVs render them flexible and suitable for multiple topics and purposes. Further, many include a “Linker" directing viewers to external online resources. Participants approached their design in a structural yet iterative manner with emphasis on setting up a “hook” in the opening seconds to capture attention. We summarize and share common design practices used in creating mDVs, an increasingly important medium in data storytelling.

Background and aim: Patient- and family-centered care in pediatrics is associated with improved outcomes and cost-effectiveness, yet current models often overlook the needs of diverse and racialized families. Digital health innovations offer new opportunities to address inequities and tailor care to the needs of racialized patients and their families. This study explores gaps in pediatric patient experience and examines how emerging digital health technologies can support more equitable, effective care by engaging diverse communities through semi-structured interviews with caregivers. Methods: We conducted a retrospective qualitative study using quota-based sampling at BC Children's Hospital. Caregivers of children with complex healthcare experiences—including surgery, rehabilitation, chronic conditions, or hospital stays over 14 days—were recruited and interviewed through semi-structured interviews conducted via Zoom. Transcripts were thematically analyzed and categorized using the BC Health Quality Matrix to identify key gaps and opportunities in pediatric care. Results: Interviews revealed gaps in pediatric care, including inconsistent shared decision-making, pre-procedural patient anxiety, barriers to access, misdiagnoses, and long wait times. We identified digital health solutions such as mobile health apps, telehealth, and artificial intelligence as opportunities to address these solutions, but found that many of these solutions have not yet been implemented within a pediatric population or may exacerbate disparities. Discussion: Digital health technologies show potential to improve pediatric care by addressing gaps in racialized patient experience as identified in the current study. Incorporating diverse patient and caregiver perspectives is essential to ensure innovations are equitable and responsive to the diverse needs of British Columbia residents. Achieving digital health equity remains critical to realizing the broader benefits of patient-centered innovation and advancing the Quadruple Aim.

Penicillin allergy de-labeling: Adaptation of risk stratification tool for patients and families To the Editor,Penicillin allergy is a common drug allergy diagnosis reported in 10% of the population . However, over 90% of patients are found to be non-allergic upon allergist assessment . This discrepancy is often due to misclassification of symptoms in patients who receive penicillin-based antibiotics . Erroneous penicillin allergy labeling is a public health problem associated with use of alternative antibiotics that are generally less effective, more toxic, or more costly .We previously developed and validated a decision support tool to assess penicillin allergy risk. It has been adapted into a mobile version that can be administered by various healthcare professionals. The goal of this study is to adapt the existing mobile tool into a patient-friendly version and validate it against the gold standard (allergist) assessment. If effective, this will empower lay individuals to conduct their own assessments and gain knowledge about levels of allergy risk. With this knowledge, patients can better advocate for themselves, potentially increasing efficiency of healthcare visits and reducing wait times for subspecialist assessments.Between April and September 2023, 127 pediatric patients ages 6 months to 17 years and pregnant adults referred to the BC Children’s and Women’s Hospital for assessment of penicillin allergy were invited to use the patient tool to complete a self-assessment, resulting in the assignment of a risk category: (1) allergic; (2) high risk, possible allergy; (3) low risk, unlikely to be allergic; and (4) not allergic. Informed consent was obtained. 84 patients completed the self-assessment prior to their appointments and at their appointments the allergist conducted an assessment using the validated tool. Construct validity (ability of the patient tool to measure penicillin allergy risk) was captured by comparing the patient-oriented tool and the allergist assessment using intra-class correlation (ICC), where ICC = 0 (no agreement) to 1 (excellent agreement).The primary outcome was the reliability of the patient tool to measure penicillin allergy risk compared with the gold standard allergist assessment. The secondary outcomes were to monitor potential safety risks and determine patient satisfaction with the tool.The patient tool and allergist assessment demonstrated agreement in 57/84 (67.9%, Figure 1) assessments. Of these, 45/57 (78.9%) patients were stratified as low risk or not allergic by both the patient and the allergist. 33 of these 45 patients have undergone an oral penicillin challenge; 33/33 (100%) passed, de-labeling the allergy.

Introduction Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)—virtual reality (VR-MRI) and a certified Child Life Program (CLP). Methods A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs. Results VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged from CAN$190.69 to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91–$426.64) to CAN$3843.41 (CAN$3196.59–$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20–$188.76) to CAN$283.85 (CAN$283.71–$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient. Conclusions While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes of pediatric patients scheduled for MRI at their facilities.

Background: Outdoor play is critical to children’s healthy development and well-being. Early learning and childcare centers (ELCCs) are important venues for increasing children’s outdoor play opportunities, and early childhood educators’ (ECE) perception of outdoor play can be a major barrier to outdoor play. The OutsidePlay-ECE risk-reframing intervention is a fully automated and open access web-based intervention to reframe ECEs’ perceptions of the importance of outdoor play and risk in play and to promote a change in their practice in supporting it in ELCC settings. We grounded the intervention in social cognitive theory and behavior change techniques. Objective: The aim of this study is to evaluate the effectiveness of the OutsidePlay-ECE web-based risk-reframing intervention. Methods: We conducted a single-blind randomized controlled trial in Canada between December 2020 and June 2021 to test the OutsidePlay-ECE risk-reframing intervention for ECEs. We recruited participants using social media and mass emails through our partner and professional networks. We invited ECEs and administrators working in an ELCC, who can speak, read, and understand English. We randomized consented participants to the intervention or control condition. The participants allocated to the intervention condition received a link to the OutsidePlay-ECE intervention. Participants allocated to the control condition read the Position Statement on Active Outdoor Play, a 4-page document on research and recommendations for action in addressing barriers to outdoor play. The primary outcome was a change in tolerance of risk in play. The secondary outcome was goal attainment. We collected data on the web via REDCap (Vanderbilt University) at baseline and 1 week and 3 months after intervention. Results: A total of 563 participants completed the baseline survey, which assessed their demographics and tolerance of risk in play. They were then randomized: 281 (49.9%) to the intervention and 282 (50.1%) to the control condition. Of these, 136 (48.4%) and 220 (78%) participants completed the baseline requirements for the intervention and control conditions, respectively. At 1 week after intervention, 126 (44.8%) and 209 (74.1%) participants completed follow-up assessments, respectively, and at 3 months after intervention, 119 (42.3%) and 195 (69.1%) participants completed the assessments, respectively. Compared with participants in the control condition, participants in the intervention group had significantly higher tolerance of risk in play at 1 week (β=.320; P=.001) and 3 months after intervention (β=.251; P=.009). Intention-to-treat analyses replicated these findings (β=.335; P<.001 and β=.271; P=.004, respectively). No significant intervention effect was found for goal attainment outcomes (odds ratio 1.124, 95% CI 0.335-3.774; P=.85). Conclusions: The results of this randomized controlled trial demonstrated that the OutsidePlay-ECE intervention was effective and had a sustained effect in increasing ECEs’ and administrators’ tolerance of risk in play. It was not effective in increasing goal attainment. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): RR2-10.2196/31041

BACKGROUND Outdoor play is critical to children’s healthy development and well-being. Early learning and childcare centers (ELCCs) are important venues for increasing children’s outdoor play opportunities, and early childhood educators’ (ECE) perception of outdoor play can be a major barrier to outdoor play. The OutsidePlay-ECE risk-reframing intervention is a fully automated and open access web-based intervention to reframe ECEs’ perceptions of the importance of outdoor play and risk in play and to promote a change in their practice in supporting it in ELCC settings. We grounded the intervention in social cognitive theory and behavior change techniques. OBJECTIVE The aim of this study is to evaluate the effectiveness of the OutsidePlay-ECE web-based risk-reframing intervention. METHODS We conducted a single-blind randomized controlled trial in Canada between December 2020 and June 2021 to test the OutsidePlay-ECE risk-reframing intervention for ECEs. We recruited participants using social media and mass emails through our partner and professional networks. We invited ECEs and administrators working in an ELCC, who can speak, read, and understand English. We randomized consented participants to the intervention or control condition. The participants allocated to the intervention condition received a link to the OutsidePlay-ECE intervention. Participants allocated to the control condition read the Position Statement on Active Outdoor Play, a 4-page document on research and recommendations for action in addressing barriers to outdoor play. The primary outcome was a change in tolerance of risk in play. The secondary outcome was goal attainment. We collected data on the web via REDCap (Vanderbilt University) at baseline and 1 week and 3 months after intervention. RESULTS A total of 563 participants completed the baseline survey, which assessed their demographics and tolerance of risk in play. They were then randomized: 281 (49.9%) to the intervention and 282 (50.1%) to the control condition. Of these, 136 (48.4%) and 220 (78%) participants completed the baseline requirements for the intervention and control conditions, respectively. At 1 week after intervention, 126 (44.8%) and 209 (74.1%) participants completed follow-up assessments, respectively, and at 3 months after intervention, 119 (42.3%) and 195 (69.1%) participants completed the assessments, respectively. Compared with participants in the control condition, participants in the intervention group had significantly higher tolerance of risk in play at 1 week (β=.320; P=.001) and 3 months after intervention (β=.251; P=.009). Intention-to-treat analyses replicated these findings (β=.335; P<.001 and β=.271; P=.004, respectively). No significant intervention effect was found for goal attainment outcomes (odds ratio 1.124, 95% CI 0.335-3.774; P=.85). CONCLUSIONS The results of this randomized controlled trial demonstrated that the OutsidePlay-ECE intervention was effective and had a sustained effect in increasing ECEs’ and administrators’ tolerance of risk in play. It was not effective in increasing goal attainment. CLINICALTRIAL ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 INTERNATIONAL REGISTERED REPORT RR2-10.2196/31041

Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs’ and ELCC administrators’ perceptions and practices in support of children’s outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children’s play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041