Hiba Al-Hakeem

Background: Youth with persisting symptoms after concussion (PSaC) can experience ongoing physical, cognitive, and emotional challenges, and their caregivers experience increased stress. There are currently limited interventions that support youth with PSaC or their caregivers. Move&Connect is a virtual group program with 2 parallel interventions: Move&Connect-Youth ( M&C-Y ) and Move&Connect-Caregivers ( M&C-C ). M&C-Y includes concussion education, active rehabilitation, and goal setting. M&C-C uses psychoeducation and practical tools to promote family communication and problem solving. Objective: Within the context of a broader pilot study of M&C-Y and M&C-C , we completed a fidelity and engagement evaluation with the objectives of (1) evaluating intervention fidelity and (2) exploring facilitators and barriers to youth and caregiver engagement. Methods: M&C-Y and M&C-C were delivered virtually using Zoom Healthcare and ran in parallel. Youth with PSaC and caregivers were recruited from a children’s rehabilitation hospital in Ontario, Canada. Intervention fidelity was evaluated according to the 5 principles of fidelity from Bellg et al: design, training, delivery, receipt, and enactment. Intervention delivery, attendance, and engagement ratings were monitored through weekly logs and field notes. Participants completed exit satisfaction surveys, and a subset of youth and caregivers completed semistructured interviews to understand facilitators and barriers to engagement. Descriptive statistics were used to analyze logs and surveys. Directed content analysis, guided by a motivational framework, and inductive coding to identify barriers and facilitators to engagement were applied to qualitative data. Results: A total of 34 youth (age: mean 15.1, SD 2.28 years) and 36 caregivers (age: mean 48.9, SD 5.92 years) participated in 10 M&C-Y and 9 M&C-C groups, respectively. Most youth identified as girls (24/34, 71%), and most caregivers identified as mothers (30/36, 83%). Clinician facilitators adhered to the components of the intervention protocols between 92% and 97% of the time in M&C-Y and 82% and 93% of the time in M&C-C . The majority of youth (22/34, 65%) and caregivers (24/36, 67%) attended 5 or more sessions. In addition, 82% (28/34) of youth and 94% (34/36) of caregivers agreed they would recommend the interventions to others. Qualitative findings revealed youth engagement was supported by motivation, comfort in the virtual setting, interactive intervention components, feelings of trust, and diverse and modifiable exercises. Barriers to youth engagement included ongoing symptoms, discrepancies between exercises and physical abilities, and previous knowledge of education. Caregiver engagement was facilitated by perceived benefits of M&C-C , emotional connection and validation, and comfort and convenience of the virtual setting. Barriers to caregiver engagement included stress, competing scheduling demands, and limited reminders or access to intervention materials. Conclusions: The pilot study of M&C-Y and M&C-C was conducted with high delivery adherence. Exit satisfaction surveys combined with qualitative data revealed high levels of caregiver satisfaction and engagement, whereas youth satisfaction and engagement had some variability, particularly related to the exercise. Findings demonstrate important implications for delivering virtual group interventions for youth with PSaC and their caregivers.

BACKGROUND Youth with persisting symptoms after concussion (PSaC) can experience ongoing physical, cognitive, and emotional challenges, and their caregivers experience increased stress. There are currently limited interventions that support youth with PSaC or their caregivers. Move&Connect is a virtual group program with two parallel interventions: Move&Connect-Youth (M&C-Y) and Move&Connect-Caregivers (M&C-C). M&C-Y includes concussion education, active rehabilitation, and goal setting. M&C-C uses psychoeducation and practical tools to promote family communication and problem solving. OBJECTIVE We will examine a pilot study of M&C-Y and M&C-C with the objectives of: (1) evaluating intervention fidelity and (2) exploring facilitators and barriers to youth and caregiver engagement. METHODS M&C-Y and M&C-C were delivered virtually using Zoom Healthcare and ran in parallel. Youth with PSaC and caregivers were recruited from a children’s rehabilitation hospital in Ontario, Canada. Intervention fidelity was evaluated according to Bellg’s five principles of fidelity: design, training, delivery, receipt, and enactment. Intervention delivery, attendance and engagement ratings were monitored through weekly logs and fieldnotes. Participants completed exit satisfaction surveys and a subset of youth and caregivers completed semi-structured interviews to understand facilitators and barriers to engagement. Descriptive statistics were used to analyze logs and surveys. Directed content analysis, guided by a motivational framework, and inductive coding to identify barriers and facilitators to engagement was applied to qualitative data. RESULTS A total of 34 youth (M=15.1 years; SD=2.28) and 36 caregivers (M=48.9 years; SD=5.92) completed ten M&C-Y and nine M&C-C groups. Most youth identified as girls (n=24; 71%) and caregivers as mothers (n=30; 83%). Clinician facilitators adhered to the components of the intervention protocols between 97-92% of the time in M&C-Y and 93-82% in M&C-C. The majority of youth (n=22; 65%) and caregivers (n=24; 67%) attended 5 or more sessions. Youth satisfaction was more variable than caregivers’, with 82% of youth and 94% of caregivers agreeing they would recommend the interventions to others. Qualitative findings revealed examples of cognitive, affective, and behavioral engagement. Youth engagement was supported by motivation, comfort in the virtual setting, interactive intervention components, feelings of trust, and diverse and modifiable exercises. Barriers to youth engagement included ongoing symptoms, discrepancies between exercises and physical abilities, and previous knowledge of education. Caregiver engagement was facilitated by perceived benefits of M&C-C, emotional connection and validation, and comfort and convenience of the virtual setting. Barriers to caregiver engagement included high stress, competing scheduling demands, and a lack of reminders or access to intervention materials. CONCLUSIONS The pilot study of M&C-Y and M&C-C was delivered with high fidelity. Exit satisfaction surveys combined with qualitative data revealed high levels of participant satisfaction and engagement with the interventions. Findings demonstrate important implications for delivering virtual group interventions for youth with PSaC and their caregivers. CLINICALTRIAL Trial Registration: NCT05631301

Move&Connect-Youth (M&C-Y) is an interdisciplinary virtual group intervention for youth experiencing persisting symptoms after concussion (PSAC) that includes psychoeducation, active rehabilitation, and goal-setting. Using an intervention mapping framework, this paper describes the iterative development of M&C-Y and findings from initial feasibility testing. Ten youth participated in M&C-Y completing pre-intervention demographic questionnaires and semi-structured exit interviews to understand participants' experience and gather feedback. M&C-Y was feasible based on apriori criteria and findings from interviews provided insights related to: (1) intervention structure, (2) intervention engagement, and (3) intervention takeaways. M&C-Y is a meaningful, feasible, and engaging intervention for youth with PSAC.

Background: Acquired brain injury (ABI) is a leading cause of death and disability in children and can lead to lasting cognitive, physical, and psychosocial outcomes that affect school performance. Students with an ABI experience challenges returning to school due in part to lack of educator support and ABI awareness. A lack of knowledge and training contribute to educators feeling unprepared to support students with ABI. Teach-ABI, an online professional development module, was created to enhance educators’ ABI knowledge and awareness to best support students. Using a case-based approach, Teach-ABI explains what an ABI is, identifies challenges for students with ABI in the classroom, discusses the importance of an individualized approach to supporting students with ABI, and describes how to support a student with an ABI in the classroom. Objective: This study aims to assess the usability of and satisfaction with Teach-ABI by elementary school educators. The following questions were explored: (1) Can elementary school teachers use and navigate Teach-ABI?, (2) Are the content and features of Teach-ABI satisfactory?, and (3) What modifications are needed to improve Teach-ABI? Methods: Elementary school educators currently employed or in training to be employed in Ontario elementary schools were recruited. Using Zoom, individual online meetings with a research team member were held, where educators actively reviewed Teach-ABI. Module usability was evaluated through qualitative analysis of think-aloud data and semistructured interviews, direct observation, user success rate during task completion, and the System Usability Scale (SUS) scores. The usability benchmark selected was 70% of participants performing more than half of module tasks independently. Results: A total of 8 female educators participated in the study. Educators were classroom (n=7) and preservice (n=1) teachers from public (n=7) and private (n=1) school boards. In terms of task performance, more than 85% of participants (ie, 7/8) independently completed 10 out of 11 tasks and 100% of participants independently completed 7 out of 11 tasks, demonstrating achievement of the module usability goal. The average overall SUS score was 86.25, suggesting a high satisfaction level with the perceived usability of Teach-ABI. Overall, participants found Teach-ABI content valuable, useful, and aligned with the realities of their profession. Participants appreciated the visual design, organization, and varying use of education strategies within Teach-ABI. Opportunities for enhancement included broadening content case examples of students with ABI and enhancing the accessibility of the content. Conclusions: Validated usability measures combined with qualitative methodology revealed educators’ high level of satisfaction with the design, content, and navigation of Teach-ABI. Educators engaged with the module as active participants in knowledge construction, as they reflected, questioned, and connected content to their experiences and knowledge. This study established strong usability and satisfaction with Teach-ABI and demonstrated the importance of usability testing in building online professional development modules.

BACKGROUND Acquired brain injury (ABI) is a leading cause of death and disability in children and can lead to lasting cognitive, physical, and psychosocial outcomes that affect school performance. Students with an ABI experience challenges returning to school due in part to lack of educator support and ABI awareness. A lack of knowledge and training contribute to educators feeling unprepared to support students with ABI. Teach-ABI, an online professional development module, was created to enhance educators’ ABI knowledge and awareness to best support students. Using a case-based approach, Teach-ABI explains what an ABI is, identifies challenges for students with ABI in the classroom, discusses the importance of an individualized approach to supporting students with ABI, and describes how to support a student with an ABI in the classroom. OBJECTIVE This study aims to assess the usability of and satisfaction with Teach-ABI by elementary school educators. The following questions were explored: (1) Can elementary school teachers use and navigate Teach-ABI?, (2) Are the content and features of Teach-ABI satisfactory?, and (3) What modifications are needed to improve Teach-ABI? METHODS Elementary school educators currently employed or in training to be employed in Ontario elementary schools were recruited. Using Zoom, individual online meetings with a research team member were held, where educators actively reviewed Teach-ABI. Module usability was evaluated through qualitative analysis of think-aloud data and semistructured interviews, direct observation, user success rate during task completion, and the System Usability Scale (SUS) scores. The usability benchmark selected was 70% of participants performing more than half of module tasks independently. RESULTS A total of 8 female educators participated in the study. Educators were classroom (n=7) and preservice (n=1) teachers from public (n=7) and private (n=1) school boards. In terms of task performance, more than 85% of participants (ie, 7/8) independently completed 10 out of 11 tasks and 100% of participants independently completed 7 out of 11 tasks, demonstrating achievement of the module usability goal. The average overall SUS score was 86.25, suggesting a high satisfaction level with the perceived usability of Teach-ABI. Overall, participants found Teach-ABI content valuable, useful, and aligned with the realities of their profession. Participants appreciated the visual design, organization, and varying use of education strategies within Teach-ABI. Opportunities for enhancement included broadening content case examples of students with ABI and enhancing the accessibility of the content. CONCLUSIONS Validated usability measures combined with qualitative methodology revealed educators’ high level of satisfaction with the design, content, and navigation of Teach-ABI. Educators engaged with the module as active participants in knowledge construction, as they reflected, questioned, and connected content to their experiences and knowledge. This study established strong usability and satisfaction with Teach-ABI and demonstrated the importance of usability testing in building online professional development modules.