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A decline in routine vaccination was reported by some countries early in the COVID-19 pandemic. In the context of the pandemic, determinants of routine childhood vaccination may have changed. Changes over time in parents' perceptions of routine vaccines and intentions for their children during the pandemic have not been fully explored. Understanding changes provides opportunities to promote routine childhood vaccines and address factors that may compromise parents' acceptance.We conducted longitudinal analysis of two sequential national surveys during the pandemic (Dec 2020 and Oct/Nov 2021) to assess changes over time in Canadian parents' perceptions of routine childhood vaccines, intentions to vaccinate, access for their children ≤ 17 years, and differences among sociodemographic characteristics. McNemar-Bowker tests were used to determine changes in parents' responses collected at two time points.Of the 650 parents in the sample, 25.1% with a child ≤ 6 years and 20.5% with a child 7-17 years perceived that routine childhood vaccines were more important because of the pandemic. Between the two time points, parents' confidence in the safety (72.8% to 80.2%, p .001) and effectiveness (81.7% to 85.2%, p =.007) of routine vaccines increased, parents were more engaged in vaccine decision-making (73.4% to 79.8%, p =.006), and everyday stress preventing vaccination decreased (78.8% to 68.5%, p .001). Acceptance of routine vaccines increased (82.9% to 86.5%, p =.021), but more parents were undecided about influenza vaccination (12.6% to 20.3%, p =.002). Compared to parents with 1 child, those with 2 children reported increased vaccination acceptance (82.6% to 87.4%, p =.024).Under the spotlight of COVID-19, parents' confidence in routine vaccines, engagement in decision-making, and vaccination acceptance increased. Vaccination providers should support parents' decision-making as they navigate routine childhood vaccine uncertainties. Differences in parents' acceptance of routine and influenza vaccines for their children highlight the need for targeted communication strategies for specific vaccines.

Introduction: Children and adolescents have been shown to manifest COVID-19 differently than adults, frequently displaying less severe symptoms or appearing asymptomatic as well as presenting lower risk of death. However, the effects of the pandemic, declared in March 2020, stem beyond the immediate infectious risk for this population. Our aim was to conduct a scoping review of the scientific literature and produce an online Interactive Evidence Map (IEM) highlighting the trends and available evidence around the unintended effects of the COVID-19 pandemic on children’s and adolescents’ mental, psychosocial and physical health during the COVID-19 pandemic. Methods: In April 2021 a research librarian developed a broad search using key terms associated with “coronavirus” and “children”. The search was run monthly in Medline, PsycInfo, CENTRAL and the Cochrane COVID‐19 Study Register. Using pre-defined eligibility criteria, each month studies were screened by one reviewer, with all exclusions verified by a second reviewer. Eligible studies relating to the unintended mental, psychosocial and physical health consequences of the COVID-19 pandemic were categorized by focus, and data were extracted relating to study design, population characteristics (e.g., age, gender, race), and outcomes examined. Categorized studies and corresponding data were then uploaded into EPPI-Reviewer and transferred to EPPI-Mapper for visualization. Results: From May 1st 2021 through April 30th 2022, over 14,500 citations were screened; 1,445 were specifically related to the mental, psychosocial and physical health consequences of the COVID-19 pandemic on children and adolescents. Ultimately, 826 studies were included in this scoping review and IEM. The majority of studies were cross-sectional (n=528; 64%) and reported on mental health outcomes, particularly anxiety (n=309; 37%) and depression (n=294; 36%). Psychosocial outcomes related to lockdowns such as loneliness (n=120; 15%) and impact on adolescent relationships with others (n=149; 18%) were also reported. Fewer studies examined the physical consequences of the pandemic, but those that did mostly focused on child abuse (n=73; 9%). Conclusion: This scoping review used an innovative visualization tool to chart peer-reviewed articles and identify trends related to the unintended effects of the COVID-19 pandemic on the mental, psychosocial, and physical health consequences of the pandemic experienced by children and adolescents. The literature we mapped had a strong focus on mental health outcomes such as anxiety and depression. Children and adolescents have been significantly affected by the pandemic and future resources need to be directed towards ongoing mental health supports and management for this unique and vulnerable population.

Anaphylaxis, or anaphylactic reactions, are a severe allergic reaction with a rapid onset and can be fatal. Children are disproportionately at risk for hospitalization and emergency department visits due to anaphylaxis. A previously conducted mixed studies systematic review and qualitative descriptive study found that parents lacked confidence in recognizing and treating an anaphylactic reaction in their child, and were unsure of when to bring their child to the emergency department. This demonstrates that more effective knowledge translation (KT) tools are needed to satisfy parent information needs.The purpose of this research was to work with parents to develop and test the usability of an animated video and an interactive infographic about anaphylactic reactions in children. These tools merge the best available research evidence with narratives of parent experiences to respond to their information needs. Prototypes were evaluated by parents (video n=31; infographic n=30) through usability testing in an urban emergency department waiting room in Alberta. Parents viewed the tools on an iPad and answered questions via an electronic survey. The usability survey consisted of 9, 5-point Likert items, which assessed: 1) usefulness, 2) aesthetics, 3) length, 4) relevance, and 5) future use. Parents were also asked to provide their positive and negative opinions of the tool via two free text boxes. Overall, results were positive and the tools were highly rated across most usability items. Mean scores across usability items were 4.26 to 4.71 for the video and 3.83 to 4.43 for the infographic. The scores from the usability testing suggest arts-based digital tools are useful in sharing complex health information with parents about managing an anaphylactic reaction in their child and provide meaningful guidance on how to improve KT tools to better reflect the needs of parents.

Pediatric functional constipation (FC) is a common childhood problem that involves difficult or painful defecation and can be caused by a variety of different factors. In children, FC is often unrecognized and poorly treated, and has potential to cause abdominal pain, appetite suppression, loss of control over defecation, and family disruption. A recent interpretive description qualitative study found that parents who care for children with FC often experience a myriad of negative sentiments, including isolation and self-doubt. Furthermore, parents often have unanswered questions about the condition, particularly regarding the cause, symptoms, and treatment options. As such, more effective knowledge translation (KT) tools are needed to satisfy parental information needs.The purpose of this research was to collaborate with parents to develop and test the usability of two animated KT tools (video and interactive infographic) on FC in children. Prototypes were co-developed with parents, and then evaluated by parents through usability testing in a large Alberta emergency department waiting room. Usability was assessed based on nine items with responses on a five-point Likert scale from 1=strongly disagree to 5=strongly agree. Overall, results were positive and the tools were highly rated across most usability items. Mean scores across usability items were 4.20 to 4.59 for the video and 3.73 to 4.30 for the infographic. The scores from the usability testing suggest arts-based digital tools are useful in sharing complex health information with parents about FC and provide meaningful guidance on how to improve KT tools to better reflect the needs of parents of children with FC.

Asthma is the most common chronic condition in children with an estimated 15% of children and youth living with asthma in Canada. Acute asthma exacerbations, or asthma attacks, are the main reason for children to seek emergency care, contributing to financial burdens for families and healthcare systems. This burden highlights opportunities to reduce health system costs and improve patient and family education.We worked with parents of children with asthma to develop and evaluate two digital knowledge translation (KT) tools on asthma. These tools merge the best available research evidence with narratives of parent experiences, and use art and engaging media (video and interactive infographic) to optimize uptake and appeal. Following prototype completion, usability testing was conducted among 60 parents (30 parents per tool) in an urban Alberta emergency department waiting room. Parents viewed the tools on an iPad and answered questions via an electronic survey. Usability was assessed based on nine items with responses on a five-point Likert scale from 1=strongly disagree to 5=strongly agree. Overall, results were positive and the tools were highly rated across most usability items. Mean scores across usability items were 4.13 to 4.63 for the video and 4.10 to 4.43 for the infographic. The scores from the usability testing suggest arts-based digital tools are useful in sharing complex health information with parents about the care of a child with asthma and provide meaningful guidance on how to improve KT tools to better reflect the needs of parents of children with asthma.

IntroductionThe COVID-19 pandemic underlined that guidelines and recommendations must be made more accessible and more understandable to the general public, including adults, parents, and youth, to improve health outcomes. The objective of this study is to evaluate, quantify, and compare the public’s (youth, parents, and adult populations) understanding, usability, satisfaction, intention to implement, and preference for different ways of presenting COVID-19 health recommendations derived from the COVID-19 Living Map of Recommendations and Gateway to Contextualization (herein referred to as the RecMap).Methods and AnalysisThis is a protocol for a multi-method study. We will conduct pragmatic allocation-concealed, blinded superiority randomized controlled trials (RCT) in three populations to test alternative formats of presenting health recommendations: adults (21 years of age or older), parents (18 years or above and are a parent or legal guardian of a child under 18 years old), and youth (15 to 24 years old), with at least 240 participants in each population. The research will consist of a randomized online survey and an optional one-on-one interview. Prior to initiating the RCT, our interventions will have been refined with relevant stakeholder input. In each population group, the intervention arm will receive a plain language recommendation (PLR) format while the control arm will receive the corresponding original recommendation format as originally published by the guideline organizations (herein referred to as Standard Language Version). Our primary outcome is understanding, and our secondary outcomes are accessibility and usability, satisfaction, intended behavior, and preference for the two recommendation formats. Each population’s results will be analyzed separately. However, we are planning a meta-analysis of the results across populations, and will also explore potential interaction and subgroup effects within each population. At the end of each survey, participants will be invited to participate in a one-on-one, virtual semi-structured interview to explore their user experience and their learning preferences and future research. All interviews will be transcribed and analyzed using the principles of thematic analysis and a hybrid inductive and deductive approach. Iterative member checking, triangulation, interpretation, and saturation of themes will be sought to enhance reliability.Ethics and DisseminationThrough Clinical Trials Ontario (CTO), the Hamilton Integrated Research Ethics Board has reviewed and approved this protocol (Project ID: 3856). The University of Alberta has approved the parent portion of the trial (Project ID:00114894). All potential participants will be required to provide informed consent. The findings from this study will be disseminated through open-access publications in peer-reviewed journals and using social media.Strengths and limitations of this studyWe are following a multi-method approach: randomized controlled trials and qualitative interviews. The qualitative results will supplement and help explain our quantitative findings.This protocol is reported in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), which enhances transparency and completeness. The trials use previously validated outcomes from similar trials. This will strengthen the credibility of our results.Our study is testing an optimized plain language recommendation format, which makes our intervention relevant to our stakeholder groups, and is recruiting internationally, which ensures the inclusion of a diverse population. Recruitment will take place online using social media, and data will be collected using an online survey. This allows for self-selection and limits accessibility to those who have no or limited digital access, which in turn limits generalizability.While the recommendations are offered in multiple languages through the RecMap, the study is only testing English plain language recommendation summaries.

Despite the large number of immigrant adolescents in Canada, research on their knowledge of sexual and reproductive health and rights (SRHR) and information needs is nearly nonexistent. A scoping review was undertaken following the PRISMA-ScR statement to identify and assess the existing literature regarding SRHR needs of immigrant adolescents in Canada. Of the 1514 articles retrieved from our search strategy, 15 studies met our inclusion criteria. The results from our review identifies three unique themes related to immigrant adolescents’ SRHR needs: knowledge needs, access to SRHR education and services, and approaches to SRHR education and services. Immigrant adolescents’ knowledge needs includes needs on HIV/STI transmission and protection, unintended pregnancy, sexual activity, family planning, pubertal education, navigating the health care system, and confidentiality legislations. Our results revealed that immigrant adolescents’ access SRHR education and services through both school-based and community-based settings. Lastly, approaches to SRHR education and services for immigrant adolescents should include cultural sensitivity, an intersectional approach, interactive learning, a strength-based approach, and reassuring confidentiality rights. The multi-faceted SRHR needs of immigrant adolescents in Canada demonstrates that future research, program development, and policymaking requires careful consideration of these intersecting forces. Inclusive SRHR education and services can be achieved through the employment of a critical cultural approach and intersectional strategies.

BACKGROUND Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. OBJECTIVE The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. METHODS We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. RESULTS Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. CONCLUSIONS Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/45389

BACKGROUND Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video). OBJECTIVE The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value. METHODS A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged RESULTS A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; PP CONCLUSIONS The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents’ decision-making regarding their child’s health. CLINICALTRIAL ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s40814-018-0318-0

African immigrant children experience some of the poorest mental health outcomes in Canada, yet limited research has systematically mental health determinants among this growing demographic. Our participatory action research project (PAR) explored, from the perspectives of parents, the factors influencing the mental health of African immigrant children in Alberta, Canada. The project utilized an intersectionality theoretical lens to collect and analyze data from a sample of 81 African immigrant parents who participated in nine conversation cafes and five focus groups. This PAR approach provided an ideal structure to engage parents and generate knowledge on the factors influencing their children’s mental health. Parents identified racial discrimination, limited mental health awareness, limited access to mental health supports, changing family dynamics, parental absenteeism, and unresolved pre-migration trauma as factors influencing their children’s mental health. These factors were perceived as contributing to children’s experiences of material deprivation, social problems, and emotional difficulties. Our findings suggest that interventions to overcome these factors and enhance the mental health of African immigrant children must target transformation of the family, community, and cultural systems within which their lives are embedded, as well as the policies and institutions that produce and reproduce child mental health vulnerabilities.

Background Engaging youth throughout the research process improves research quality and outcomes. Youth advisory groups provide one way for youth to express their opinions on relevant issues. Objective This study aimed to identify research‐ and health‐related youth advisory groups (‘groups’) in Canada and understand the best practices of these groups. Methods Google searches and supplementary methods were used to identify relevant groups in Canada. Group information was extracted from websites or through interviews with key informants. Results We identified 40 groups. Groups were commonly part of a hospital/healthcare facility, nonprofit/health organization or research group. The majority focused on a specific content area, most commonly, mental health. Over half the groups advised on health services. Members' ages ranged from 9 to 35 years. The number of members ranged from 5 to 130. Interviews (n = 12) identified seven categories relating to group practices: (a) group purpose/objectives, (b) group development, (c) group operations, (d) group structure, (e) adult involvement, (f) membership and recruitment and (g) group access. Challenges and facilitators to the success of groups were described within the following themes: (a) retaining engagement, (b) creating a safe environment and (c) putting youth in positions of influence. Advice and recommendations were provided regarding the development of a new group. Conclusion This study provides a comprehensive overview of research‐ and health‐related youth advisory groups in Canada. This information can be used to identify groups that stakeholders could access as well as inform the development of a new group. Patient or Public Contribution Youth advisory group representatives were interviewed as part of the study.

Aim Ethical and logistical issues often exacerbate recruitment problems in child health studies. This study aims: (a) to provide new knowledge on how parents want to hear about child health research and (b) to inform the KidsCAN PERC iPCT initiative's re‐examination of recruitment and retention strategies for pediatric emergency department research studies. Design We employed a cross‐sectional, survey design. Methods An online survey was distributed to participants (i.e., parents) through partner organizations' advisory group mailing lists. Frequencies and measures of central tendency guided data analysis. Results Parents are interested in hearing about child health research opportunities, particularly during general practitioner, pediatrician or walk‐in clinic visits. Most parents wanted updates on the research team, progress and results and support to participate, such as reimbursement of travel and childcare costs. Results can inform research teams in the planning of communications to effectively share research opportunities, progress and results with parents.

IntroductionIn a recent child health research priority setting exercise conducted in Alberta (CA), youth identified “mental health” as a priority topic. Specifically, youth were interested in understanding what the early signs and symptoms of anxiety were, and when they should seek help.ObjectiveThe objective of this study was to understand what information is currently available online for Canadian youth about the signs and symptoms of anxiety, what resources are available for self-assessment, and what are youth’s behaviors, experiences and information needs around seeking help for anxiety.MethodsWe conducted a systematic environmental scan of Internet resources and academic literature. Internet and literature search results (Information Sources) were screened by one reviewer and verified by another. Relevant information (e.g., self-assessment resource features and population characteristics such as age, presence of anxiety, and education) were then extracted and verified. Information Sources were categorized relating to the research concepts regarding; signs and symptoms, self-assessments, information needs and experiences. We complimented our environmental scan with youth consultations to understand how anxiety resources are perceived by youth, and what if anything, could be improved about the information they are receiving. Consultations were conducted over Zoom with three Canadian Youth Advisory Groups (2 provincial, 1 national) and took a semi-structured focus group format.ResultsA total of 99 Information Sources (62 addressing signs and symptoms, 18 self-assessment resources, and 19 reporting on information and help-seeking behaviors) met the inclusion criteria. The majority of Information Sources on signs and symptoms were webpage-based articles, and 36 (58%) specifically stated that they were targeting youth. 72% of anxiety self-assessment resources were provided by private institutions. The resources varied markedly in the post-assessment support provided to youth according to their source (i.e. private, academic, governmental). Regarding information and help-seeking preferences, three main themes were apparent and related to 1) obtaining in-person professional help, 2) searching for online help, and 3) stigma associated with seeking help for anxiety disorders. The Youth Group consultations identified several areas that need to be considered when developing resources for youth. The key considerations highlighted by youth across the consultations suggested resources needed to be; youth friendly, align with a credible institute (e.g. University, Health Institution), and provide useful resources post online assessment and tangible action items to support help seeking.ConclusionAwareness of the information and resources available to youth, coupled with an understanding of their help-seeking behaviors and information needs can help support the development and dissemination of appropriate knowledge translation tools around youth anxiety.

Background Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video). Objective The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value. Methods A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged Results A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; P Conclusions The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents’ decision-making regarding their child’s health. Trial Registration ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777 International Registered Report Identifier (IRRID) RR2-10.1186/s40814-018-0318-0

Background In response to a growing movement to involve patients and community stakeholders in health research, we established a parent advisory group in 2016. The group meets regularly to act as advisors and partners for our research program. The purpose of this paper is to describe our experiences establishing the group, and results from parent evaluations. Methods We contacted 191 organizations to recruit parents and caregivers of children who wanted to contribute to child health research. Our initial goal was to recruit 8 to 10 parents who would meet regularly (approximately 8 times per year). We conducted an online baseline survey of members after the first two meetings to understand motivations for participating and early experiences. Sixteen months later we conducted another online survey to identify what was going well and areas for improvement. Results Twelve parents initially joined the group. The baseline survey (n = 9 complete) identified motivations for participation: wanting a patient/family voice in health research; personal experience accessing health system for child’s care; wanting to improve healthcare communications. Concerns about participation included: having sufficient time to attend meetings; whether contributions would be worthwhile; and uncertainty about how the group’s input would be used in practice. Parents identified aspects that were working well: opportunity to provide constructive feedback; diversity among parents involved; well-run and organized meetings (agenda and materials sent prior to meeting, skilled facilitation, adequate time for discussion). Items parents identified as not working well were: fluctuating attendance; not knowing others in the group; challenges if attending remotely. At follow-up, there were seven active members. The follow-up survey (n = 5 complete) identified positive feedback related to group dynamics (e.g., collegial, everyone participates) and organization of meetings. Suggestions for improvement included increasing membership, regular attendance, and providing adequate information/context to allow meaningful input. Conclusions Our experience establishing a parent advisory group and evaluation of the group by parent members have yielded tremendous insights around involving parents and patient proxies in health research. The parent advisory group is a dynamic entity requiring ongoing communication between researchers and members. Effective means of evaluating engagement is essential to ensure it is meaningful. Dedicated time, funding and resources are required for success. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00280-3., Plain English summary In 2016 we developed a parent advisory group to inform our research program in knowledge translation (i.e., sharing research in accessible ways to inform decision-making) for child health. The group provides input from a parent perspective. We conducted an online baseline survey of parent members and a follow-up online survey 16 months after the group had started. The surveys helped us understand reasons for parents’ participation, what they thought was working well with the group, and areas for improvement. Parents valued the opportunity to provide constructive feedback on research processes and outputs. They felt the meetings were well-organized and the group was open and welcoming. Parents felt that regular and ongoing communication with the researchers was critical for meaningful engagement. To this end, funding to support a dedicated coordinator was considered essential. Parents appreciated that the researchers organized the group around parents’ needs in terms of timing of meetings (evenings) and reimbursement for expenses to attend meetings (travel, childcare). Parents considered this type of group to be unique, particularly as it supports a research program over the long-term rather than for specific projects, and because of the relative maturity in terms of clearly defining group purpose, structure, and engagement approach. The ongoing involvement allows for benefits in terms of building relationships, providing many and varied opportunities to interact, and allowing parents to see how their input is implemented. Finally, an evaluation mechanism with communication of results and a commitment to implement findings is considered critical. Our parent advisory group can provide a model for other researchers or research organizations. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00280-3.

BACKGROUND Background - Our research groups have developed a number of parent knowledge translation (KT) tools to help families and caregivers understand common childhood illnesses and make informed decisions regarding when to seek urgent care. We have developed a series of videos to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency healthcare services. It is unclear whether the videos in their current form and language are useful for a wider scope of populations, including Indigenous groups. OBJECTIVE Objectives - The purpose of this study was to explore if and understand how our KT tools could be adapted for use with Indigenous communities. METHODS Methods - Healthcare providers (HCPs) serving Indigenous families in Alberta were asked to review two of our KT tools (one on croup and one on acute otitis media), complete a demographic survey, and participate in a one-on-one semi-structured interview. HCPs were asked to reflect on the usability of our KT tools within their practice, and what cultural adaptation considerations they felt would be needed to develop KT tools that meet the needs of Indigenous clients. Audio recordings from the interviews were transcribed verbatim and analyzed for relevant themes using thematic analysis. RESULTS Results - Eighteen HCPs (15 women and 3 men) from various health professions (e.g., doctor, registered nurse, licensed practical nurse, etc.) were interviewed. Seven HCPs self-identified as Indigenous. Four key overarching themes were identified as important when considering how to adapt KT tools for Indigenous communities: accessibility, relatability, KT design, and relationship building. Access to tangible resources and personal and professional connections were considered important. Accessibility impacts the types of KT tools that can be obtained or utilized by various individuals and communities, and the extent to which they can implement recommendations given in those KT tools. Additionally, the extent to which users relate to the depictions and content within KT tools must be considered. The environments, portrayals of characters, and cultural norms and values presented within KT tools should be relevant to users to increase relatability and uptake of recommendations. Most importantly, fostering genuine and sustainable relationships with users and communities is a vital consideration for KT tool developers. CONCLUSIONS Conclusion - These findings serve to cultivate a greater understanding of the various components to consider when developing and/or culturally adapting KT tools for Indigenous families. This information will help support the effective adaptation and distribution of KT tools for use by a broad audience. Careful consideration of the themes identified in this study highlights the importance of working together with the knowledge users when developing KT tools.

Background Our research groups have developed a number of parental knowledge translation (KT) tools to help families understand common childhood illnesses and make informed decisions regarding when to seek urgent care. We have developed a series of videos to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency health care services. It is unclear whether the videos in their current form and language are useful for a wider range of populations, including Indigenous groups. Objective The purpose of this study was to explore whether and understand how our KT tools could be adapted for use with Indigenous communities. Methods Health care providers (HCPs) serving Indigenous families in Alberta, Canada, were asked to review 2 of our KT tools (one on croup and one on acute otitis media), complete a demographic survey, and participate in a one-on-one semistructured interview. HCPs were asked to reflect on the usability of the KT tools within their practice and what cultural adaptation considerations they felt would be needed to develop KT tools that meet the needs of Indigenous clients. Audio recordings from the interviews were transcribed verbatim and analyzed for relevant themes using thematic analysis. Results A total of 18 HCPs (n=15, 83% women and n=3, 17% men) from various health professions (eg, physician, registered nurse, and licensed practical nurse) were interviewed. Of these 18 HCPs, 7 (39%) self-identified as Indigenous. Four overarching themes were identified as important when considering how to adapt KT tools for use by Indigenous communities: accessibility, relatability, KT design, and relationship building. Access to tangible resources and personal and professional connections were considered important. Accessibility affects the types of KT tools that can be obtained or used by various individuals and communities and the extent to which they can implement recommendations given in those KT tools. In addition, the extent to which users relate to the depictions and content within KT tools must be considered. The environments, portrayals of characters, and cultural norms and values presented within KT tools should be relevant to users to increase the relatability and uptake of recommendations. Most importantly, fostering genuine and sustainable relationships with users and communities is a vital consideration for KT tool developers. Conclusions These findings serve to cultivate a greater understanding of the various components that HCPs consider important when developing or culturally adapting KT tools for use by Indigenous families. This information will help support the effective adaptation and distribution of KT tools for use by a broad audience. Careful consideration of the themes identified in this study highlights the importance of working together with the knowledge users (health care consumers) when developing KT tools.

UNSTRUCTURED Childhood heart failure is a factor in many hospital admissions each year. It can impose a steep learning curve for parents who need to learn the key information to care for their child at home. In this study, we conducted an environmental scan to identify and assess web-based knowledge translation tools about childhood heart failure for parent audiences developed within North America. The aim of this study is to inventory tools publicly available to parents about childhood heart failure from popular web-based venues, assess how each tool communicates health information, and explore how they were developed. Our search strategy included two commonly used multimedia-based platforms: two app stores (Google Play and Apple App Store) and one search engine (Advanced Google Search). Common search terms were used, and results were uploaded to Microsoft Excel for screening between 2 reviewers. The inclusion criteria for the tools were as follows: content focused on educating parents about their child's heart failure, developed in the English language, and originating within Canada and the United States. A total of 2 reviewers screened the app store and internet search results for relevant tools. Each tool was assessed using the Suitability Assessment of Materials (SAM), a validated tool that objectively assesses the suitability of how health information is communicated to a particular audience. Key informants who were involved in tool development were identified and invited for a qualitative interview using a semistructured format to provide data about the development process. Key themes were identified in the semistructured interview process. Frequencies and SAM percent ratings of eligible tools were reported. No apps exist for parents relating to pediatric heart failure. Overall, 17 relevant internet tools were identified, and their suitability was assessed for the parent audience. Most tools scored well in layout and type, but they scored lower in readability and graphics. Qualitative interviews with key informants revealed three key themes: timely and introductory knowledge, credible and trustworthy knowledge, and challenges and evolution in knowledge. This is the first environmental scan looking for parent tools relating to childhood heart failure in Canada and the United States. Findings from this study reveal that there are no apps on this topic and there is a small number of tools for parents on the internet (n=17). Using the SAM, no tools scored in the superior range, and further work in knowledge translation strategies needs to be done in this area to improve more effective education to parents and caregivers who have a child with heart failure. These findings will inform the development of a new resource on children's heart failure that targets parents and caregiver audiences.

ObjectiveThe aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the Primary Care Asthma Paediatric Pathway.DesignQualitative semistructured focus groups following a randomised cluster-controlled design.Setting22 primary care practices in Alberta, Canada.Participants37 healthcare providers participated in four focus groups to discuss the barriers and facilitators of pathway implementation.InterventionAn electronic medical record (EMR) based paediatric asthma pathway, online learning modules, in-person training for allied health teams in asthma education, and a clinical dashboard for patient management.Main outcome measuresOur qualitative findings are organised into three themes using the core constructs of the normalisation process theory: (1) Facilitators of implementation, (2) Barriers to implementation, and (3) Proposed mitigation strategies.ResultsParticipants were positive about the pathway, and felt it served as a reminder of paediatric guideline-based asthma management, and an EMR-based targeted collection of tools and resources. Barriers included a low priority of paediatric asthma due to few children with asthma in their practices. The pathway was not integrated into clinic flow and there was not a specific process to ensure the pathway was used. Sites without project champions also struggled more with implementation. Despite these barriers, clinicians identified mitigation strategies to improve uptake including developing a reminder system within the EMR and creating a workflow that incorporated the pathway.ConclusionThis study demonstrated the barriers and facilitators shaping the asthma pathway implementation. Our findings highlighted that if team support of enrolment (establishing buy-in), legitimisation (ensuring teams see their role in the pathway) and activation (an ongoing plan for sustainability) there may have been greater uptake of the pathway.Trial registration numberThis study was registered at clinicaltrials.gov on 25 June 2015; the registration number is: NCT02481037, https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1

The COVID-19 pandemic heightened anti-Asian racism towards East Asian diasporas in North America. Experiences of racism encountered by East Asian communities have been documented to negatively impact their mental health.A scoping review was undertaken following Arksey and O'Malley's (2005) methodology to (a) map the foci of literature on racism and the mental health of East Asian diasporas in North America and (b) identify gaps in the current literature.A total of 1309 articles were identified in May 2021. Based on the inclusion criteria, 35 records were included. Two distinct mental health foci were found: mental health outcomes and mental healthcare access and utilization. The majority (The expanding knowledge base on COVID-19-related racial discrimination is reminiscent of previous literature examining the history of anti-Asian racism in North America. Greater attention is needed to navigate impactful anti-racism solutions for East Asian populations' mental health in North America.

Background Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. Objective The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. Methods We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. Results Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. Conclusions Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. International Registered Report Identifier (IRRID) PRR1-10.2196/45389

ObjectiveMapping literature on Indigenous families’ experiences seeking child health information and identifying barriers and facilitators to information access.DesignScoping review.Data sourcesWe searched Medline, EMBASE, PsycINFO, Scopus and CINAHL for peer-reviewed literature and Google Advanced for grey literature. We screened tables of contents of two Indigenous research journals not consistently indexed in online health databases and used snowball sampling to supplement searches.Eligibility criteriaWe included full-text, English-language articles, published from 2000 to the time of the search in April 2021, based on: participants (Indigenous families), concept (experiences of families seeking health information) and context (child health).Data extraction and synthesisTwo independent reviewers extracted: citation details, study purpose, country of study, publication type, study design, data collection method, Indigenous group, family member participants, home/healthcare setting, child health area, how health information was accessed, and information-seeking barriers and facilitators. Data were examined for patterns and trends, results and implications.ResultsAmong 19 papers (representing 16 research projects) included, nine described family/friends and 19 described healthcare professionals as sources of child health information. Barriers include racism/discrimination during healthcare visits, ineffective communication with healthcare providers and structural barriers (eg, transportation). Facilitators include easy access, improved communication and relationships with healthcare providers, and culturally safe healthcare.ConclusionIndigenous families perceive they do not have access to necessary child health information, which can lead to insensitive, ineffective and unsafe healthcare. A critical gap exists in understanding Indigenous families’ information needs and preferences when making decisions about children’s health.

Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents’ needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.

Objectives We compared the addition of iPad distraction to standard care, versus standard care alone, to manage the pain and distress of intravenous (IV) cannulation. Methods Eighty-five children aged 6 to 11 years requiring IV cannulation (without child life services present) were recruited for a randomized controlled trial from a paediatric emergency department. Primary outcomes were self-reported pain (Faces Pain Scale-Revised [FPS-R]) and distress (Observational Scale of Behavioral Distress-Revised [OSBD-R]), analyzed with two-sample t-tests, Mann–Whitney U-tests, and regression analysis. Results Forty-two children received iPad distraction and 43 standard care; forty (95%) and 35 (81%) received topical anesthesia, respectively (P=0.09). There was no significant difference in procedural pain using an iPad (median [interquartile range]: 2.0 [0.0, 6.0]) in addition to standard care (2.0 [2.0, 6.0]) (P=0.35). There was no significant change from baseline behavioural distress using an iPad (mean ± SD: 0.53 ± 1.19) in addition to standard care (0.43 ± 1.56) (P=0.44). Less total behavioural distress was associated with having prior emergency department visits (odds ratio [95% confidence interval]: −1.90 [−3.37, −0.43]) or being discharged home (−1.78 [−3.04, −0.52]); prior hospitalization was associated with greater distress (1.29 [0.09, 2.49]). Significantly more parents wished to have the same approach in the future in the iPad arm (41 of 41, 100%) compared to standard care (36 of 42, 86%) (P=0.03). Conclusions iPad distraction during IV cannulation in school-aged children was not associated with less pain or distress than standard care alone. The effects of iPad distraction may have been blunted by topical anesthetic cream usage. Clinical trials registration ClinicalTrials.gov: NCT02326623.

Background: Bronchiolitis is an acute lower respiratory infection, with significant impacts on children and families and strains on the health care system. Understanding parents’ experiences and information needs caring for a child with bronchiolitis is crucial to highlight misconceptions or issues contributing to the high burden. The objective of this qualitative study was to describe parents’ experiences caring for a child with bronchiolitis. Methods: Qualitative description guided this study. Participants were recruited from the Stollery Children’s Hospital emergency department (ED), a specialized pediatric ED in a major Canadian urban center. Semi-structured interviews were conducted with 15 parents. Results: Five major themes were identified: (a) their children’s symptoms and behaviors, (b) bronchiolitis affects the entire family, (c) factors influencing parent’s decision to go to ED, (d) ED experience for parents and their children, and (e) bronchiolitis treatment and management. Interviews revealed bronchiolitis has significant effects on both children and families and parents are generally unaware of bronchiolitis symptoms, treatment, and management. Conclusions: Our study highlights that parents have knowledge deficits when it comes to recognizing the presence and severity of bronchiolitis symptoms. Parents would benefit from having more evidence-based resources to enhance their knowledge about the nature of bronchiolitis.

Background: Health care providers (HCPs) report barriers to effective communication with adolescents with obesity when discussing lifestyle behavior change and may benefit from tailored health comm...

Aims and objectives To explore parents' experiences with paediatric fever to understand their needs for information and support. Background Paediatric fever is a normal part of childhood, and multiple episodes of fever are a common occurrence between infancy and adulthood. Despite this expectation, paediatric fever often sparks fear and anxiety amongst parents. Existing research has primarily focused on measuring parental deficits, so a more in-depth exploration is helpful to understand the complexities of caring for a febrile child. Design Qualitative descriptive study. Methods Purposive sampling of N = 15 parents from a paediatric emergency department presenting with a febrile child. Semi-structured interviews were conducted in-person or via telephone. Thematic analysis was used to understand the data in the light of our research question. Reporting follows the consolidated criteria for reporting qualitative research checklist. Results We found themes of (a) parental confidence through caregiving tasks, (b) emergent feelings of inadequacy, (i) referrals and limitations of community practice, (c) information needs and (d) information sources. Whereas parents were initially confident accessing information, providing care, making decisions and managing symptoms, new signs/symptoms sparked a change in parents' emotions, coping and behaviour. Parents routinely search for information about paediatric fever and value reliable, accessible resources. Conclusions Our findings highlight parents' strengths assessing fever and effectively managing symptoms. We are encouraged by the potential for these results to inform the development of empowering resources to help parents make child health decisions during paediatric fever. Relevance to clinical practice Findings provide an evidence base for researchers, clinicians and policymakers to improve care for paediatric patients and families. Parents want clear, reliable and accessible information about decision points associated with paediatric fever. Resources with an empowerment focus may help parents maintain a sense of control when caring for a febrile child.

BACKGROUND We have developed a series of knowledge translation (KT) tools that integrate parental experiences to communicate evidence-based information about acute childhood health conditions to parents and caregivers. While we created these tools with parent input, it is unclear if they are useful for diverse parent groups, including specific immigrant and refugee groups in Canada. OBJECTIVE This study aims to explore the usefulness of our preexisting KT tools within our local Somali community, and understand what cultural and linguistic adaptations could improve their usability. METHODS After viewing 4 KT tools (differing in design and format) about various acute child health conditions, health care providers (HCPs) and knowledge brokers (KBs) who work with Somali families were interviewed about the usability of these tools and discussed considerations for adapting KT tools for use within the Somali community. RESULTS A total of 13 HCPs and KBs participated and indicated that the Somali community values accessibility, representation, and the role of trusted others in delivering effective KT products. Understanding accessibility barriers, the power of adequate representation, and engaging meaningfully with prominent community leaders were key suggestions for ensuring relevance of KT products and uptake by community members. CONCLUSIONS This study represents an essential piece of understanding processes for adapting or developing KT products for culturally and linguistically diverse communities.

Background Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. Objective The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. Methods A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. Results A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=−0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=−5.083; P Conclusions Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents’ knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents’ confidence in managing their child’s concussion.

BACKGROUND Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. OBJECTIVE The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. METHODS A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. RESULTS A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=−0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=−5.083; P CONCLUSIONS Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents’ knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents’ confidence in managing their child’s concussion. CLINICALTRIAL

Digital storytelling aims to illuminate complex narratives of health and illness when used as a method in health research. Digital stories are three to five minute videos that integrate written and narrated stories with multiple aesthetic components. There is increasing interest in digital storytelling as a research method, yet there is limited synthesized knowledge about its use. A systematic review to advance methodological understanding was warranted. Our systematic review purpose was to identify and synthesize evidence on the use, impact, and ethical considerations of digital storytelling as a method in health research. Key databases and online sources were searched for qualitative, quantitative, and mixed methods studies using digital storytelling. Articles with pediatric or adult populations, family members, or healthcare professionals were included. The focus was on digital storytelling in health research, where it was used as a method, at any point in the research process. Two independent reviewers screened abstracts and full texts to confirm eligibility. We conducted a narrative synthesis of the extracted narrative data. The searches yielded 7285 articles. Following the removal of duplicates and screening, 46 articles met the inclusion criteria, which predominantly used qualitative methodology. An analysis of the extracted data resulted in seven descriptive themes which provided insight into the purpose, definition, process, context, impact and ethical considerations of this method. Digital storytelling is an empowering and disruptive method that captures voice through a process-oriented, flexible approach. It is particularly effective at honouring local and cultural knowledge, and evoking change. Researchers have used consistent facilitation approaches, but theoretical inconsistency, diverse positioning in analysis, and ethical complexity remain significant challenges. These findings provide methodological insight for applying digital storytelling in future research. Systematic review protocol registration: CRD42017068002.

Background Experimental designs for evaluating knowledge translation (KT) interventions can provide strong estimates of effectiveness but offer limited insight into how the intervention worked. Consequently, process evaluations have been used to explore the causal mechanisms at work; however, there are limited standards to guide this work. This study synthesizes current evidence of KT process evaluations to provide future methodological recommendations. Methods Peer-reviewed search strategies were developed by a health research librarian. Studies had to be in English, published since 1996, and were not excluded based on design. Studies had to (1) be a process evaluation of a KT intervention study in primary health, (2) be a primary research study, and (3) include a licensed healthcare professional delivering or receiving the intervention. A two-step, two-person hybrid screening approach was used for study inclusion with inter-rater reliability ranging from 94 to 95%. Data on study design, data collection, theoretical influences, and approaches used to evaluate the KT intervention, analysis, and outcomes were extracted by two reviewers. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). Results Of the 20,968 articles screened, 226 studies fit our inclusion criteria. The majority of process evaluations used qualitative forms of data collection (43.4%) and individual interviews as the predominant data collection method. 72.1% of studies evaluated barriers and/or facilitators to implementation. 59.7% of process evaluations were stand-alone evaluations. The timing of data collection varied widely with post-intervention data collection being the most frequent (46.0%). Only 38.1% of the studies were informed by theory. Furthermore, 38.9% of studies had MMAT scores of 50 or less indicating poor methodological quality. Conclusions There is widespread acceptance that the generalizability of quantitative trials of KT interventions would be significantly enhanced through complementary process evaluations. However, this systematic review found that process evaluations are of mixed quality and lack theoretical guidance. Most process evaluation data collection occurred post-intervention undermining the ability to evaluate the process of implementation. Strong science and methodological guidance is needed to underpin and guide the design and execution of process evaluations in KT science. Registration This study is not registered with PROSPERO.

Background In 2012, the Saskatchewan Ministry for Health mandated a system-wide Lean transformation. Research has been conducted on the implementation processes of this system-wide Lean implementation. However, no research has been done on the sustainability of these Lean efforts. We conducted a realist evaluation on the sustainability of Lean in pediatric healthcare. We used the context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic to explain under what contexts, for whom, how and why Lean efforts are sustained or not sustained in pediatric healthcare. Methods We employed a case study research design. Guided by a realist evaluation framework, we conducted qualitative realist interviews with various stakeholder groups across four pediatric hospital units ‘cases’ at one acute hospital. Interview data was analyzed using an integrated approach of CMOc categorization coding, CMOc connecting and pattern matching. Results We conducted thirty-two interviews across the four cases. Five CMOcs emerged from our realist interview data. These configurations illustrated a ‘ripple-effect’ from implementation outcomes to contexts for sustainability. Sense-making and staff engagement were prominent mechanisms to the sustainment of Lean efforts. Failure to trigger these mechanisms resulted in resistance. The implementation approach used influenced mechanisms and outcomes for sustainability, more so than Lean itself. Specifically, the language, messaging and training approaches used triggered mechanisms of innovation fatigue, poor ‘sense-making’ and a lack of engagement for frontline staff. The mandated, top-down, externally led nature of implementation and lack of customization to context served as potential pitfalls. Overall, there was variation between leadership and frontline staff’s perceptions on how embedded Lean was in their contexts, and the degree to which participants supported Lean sustainability. Conclusions This research illuminates important contextual factors and mechanisms to the process of Lean sustainment that can be applicable to those implementing systems changes. Future work is needed to continue to develop the science on the sustainability of interventions for healthcare improvement.

Background There is limited evidence to evaluate the sustainability of evidence-based interventions (EBIs) for healthcare improvement. Through an integrative review, we aimed to identify approaches to evaluate the sustainability of evidence-based interventions (EBIs) and sustainability outcomes. Methods Following Whittemore and Knafl’s methodological process: (1) problem identification; (2) literature search; (3) data evaluation; (4) data analysis; and (5) presentation, a comprehensive search strategy was applied across five databases. Included studies were not restricted by research design; and had to evaluate the sustainability of an EBI in a healthcare context. We assessed the methodological quality of studies using the Mixed Methods Appraisal Tool. Results Of 18,783 articles retrieved, 64 fit the inclusion criteria. Qualitative designs were most commonly used for evaluation (48%), with individual interviews as the predominant data collection method. Timing of data collection varied widely with post-intervention data collection most frequent (89%). Of the 64 studies, 44% used a framework, 26% used a model, 11% used a tool, 5% used an instrument, and 14% used theory as their primary approach to evaluate sustainability. Most studies (77%) did not measure sustainability outcomes, rather these studies focused on sustainability determinants. Discussion It is unclear which approach/approaches are most effective for evaluating sustainability and what measures and outcomes are most commonly used. There is a disconnect between evaluating the factors that may shape sustainability and the outcomes approaches employed to measure sustainability. Our review offers methodological recommendations for sustainability evaluation research and highlights the importance in understanding mechanisms of sustainability to advance the field.

Background Pet therapy, or animal-assisted interventions (AAI), have demonstrated positive effects for patients, families and health care providers (HCP) in inpatient settings. However, the evidence supporting AAI in emergency or ambulatory care settings is unclear. We conducted a systematic review to evaluate the effectiveness of AAI on patient, family, and HCP experience in these settings. Methods We searched (from inception to May 2020) Medline, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL, plus grey literature, for studies assessing AAI in emergency and ambulatory care settings on: 1) patient and family anxiety/distress or pain; and 2) HCP stress. Screening, data extraction and quality assessment were done in duplicate with conflicts adjudicated by a third party. Random-effects meta-analyses are reported as mean differences (MD) or standardized mean differences (SMDs) and 95% confidence intervals (CIs), as appropriate. Results We included 9 randomized controlled trials (RCTs; 341 patients, 146 HCP, 122 child caregivers), 4 before-after (before-after; 83 patients), and 1 mixed-method study (124 patients). There was no effect across three RCTs measuring patient-reported anxiety/distress (n=380; SMD: -0.36, 95% CI: -0.95 to 0.23; I2 =81%), while two before-after studies suggested a benefit (n=80; SMD: -1.95, 95% CI: -2.99 to -0.91; I2 =72%). Four RCTs found no difference in measures of observed anxiety/distress (n=166; SMD: -0.44; 95% CI: -1.01 to 0.13; I2 =73%) while one before-after study reported a significant benefit (n=60; SMD: -1.64, 95% CI: -2.23 to -1.05). Three RCTs found no difference in patient-reported pain (n=202; MD: -0.90; 95% CI: -2.01 to 0.22; I2 =68%). Two RCTs reported positive but non-significant effects on HCP stress. Conclusions Limited evidence is available on the effectiveness of AAI in emergency and ambulatory care settings. Rigorous studies using global experience-oriented (or patient-identified) outcome measures are required.

Primary Subject area Technology Background Providing resources that aid in detection and identification of serious childhood illness helps parents feel better equipped to assess their child’s health and significantly changes parental health-seeking behaviours. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access health information about their child. Mobile health (mHealth) apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. Objectives To systematically identify all Canadian and US child health apps for parents. Design/Methods We used an environmental scan approach – a review designed to summarize information for decision makers. The Android and Apple app marketplaces were used as search platforms. We built a list of search terms and used these platforms to search for apps targeted at parents, related to pediatric illnesses in US and Canada. Then once we determined that the app met the inclusion criteria, each included app was assessed using the Mobile App Rating Scale (MARS), a validated tool for assessing health apps. The MARS examines apps on five domains: engagement, functionality, aesthetics, information quality, and subjective quality. Results 650 unique apps were screened and 53 apps were included. On a scale of 1-5, the 53 apps assessed had an average Engagement score of 2.82/5 (θ = 0.86), Functionality of 3.98/5 (θ = 0.72), Aesthetics of 3.09/5 (θ = 0.87), Information quality of 2.73/5 (θ = 1.32), and Subjective quality of 2.2 (θ = 0.79). App scores ranged from 2.2/5 to 4.5/5 (µ= 3.2, θ =0.6).The top three apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top three apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces. In addition, published evidence of the included apps’ impact was poor: only 5/53 apps had an evidence base showing the app had been trialed. Conclusion There is a need for evidence-based apps of Canadian origin related to childhood illnesses. The results of this scan created a picture of the health app landscape by examining trends in apps related to pediatric health that are readily available to parents, and by identifying gaps in app design that can be addressed.

Background Childhood heart failure is a factor in many hospital admissions each year. It can impose a steep learning curve for parents who need to learn the key information to care for their child at home. In this study, we conducted an environmental scan to identify and assess web-based knowledge translation tools about childhood heart failure for parent audiences developed within North America. Objective The aim of this study is to inventory tools publicly available to parents about childhood heart failure from popular web-based venues, assess how each tool communicates health information, and explore how they were developed. Methods Our search strategy included two commonly used multimedia-based platforms: two app stores (Google Play and Apple App Store) and one search engine (Advanced Google Search). Common search terms were used, and results were uploaded to Microsoft Excel for screening between 2 reviewers. The inclusion criteria for the tools were as follows: content focused on educating parents about their child’s heart failure, developed in the English language, and originating within Canada and the United States. A total of 2 reviewers screened the app store and internet search results for relevant tools. Each tool was assessed using the Suitability Assessment of Materials (SAM), a validated tool that objectively assesses the suitability of how health information is communicated to a particular audience. Key informants who were involved in tool development were identified and invited for a qualitative interview using a semistructured format to provide data about the development process. Key themes were identified in the semistructured interview process. Results Frequencies and SAM percent ratings of eligible tools were reported. No apps exist for parents relating to pediatric heart failure. Overall, 17 relevant internet tools were identified, and their suitability was assessed for the parent audience. Most tools scored well in layout and type, but they scored lower in readability and graphics. Qualitative interviews with key informants revealed three key themes: timely and introductory knowledge, credible and trustworthy knowledge, and challenges and evolution in knowledge. Conclusions This is the first environmental scan looking for parent tools relating to childhood heart failure in Canada and the United States. Findings from this study reveal that there are no apps on this topic and there is a small number of tools for parents on the internet (n=17). Using the SAM, no tools scored in the superior range, and further work in knowledge translation strategies needs to be done in this area to improve more effective education to parents and caregivers who have a child with heart failure. These findings will inform the development of a new resource on children’s heart failure that targets parents and caregiver audiences.

BACKGROUND Childhood heart failure is a factor in many hospital admissions each year. It can impose a steep learning curve for parents who need to learn the key information to care for their child at home. In this study, we conducted an environmental scan to identify and assess web-based knowledge translation tools about childhood heart failure for parent audiences developed within North America. OBJECTIVE The aim of this study is to inventory tools publicly available to parents about childhood heart failure from popular web-based venues, assess how each tool communicates health information, and explore how they were developed. METHODS Our search strategy included two commonly used multimedia-based platforms: two app stores (Google Play and Apple App Store) and one search engine (Advanced Google Search). Common search terms were used, and results were uploaded to Microsoft Excel for screening between 2 reviewers. The inclusion criteria for the tools were as follows: content focused on educating parents about their child’s heart failure, developed in the English language, and originating within Canada and the United States. A total of 2 reviewers screened the app store and internet search results for relevant tools. Each tool was assessed using the Suitability Assessment of Materials (SAM), a validated tool that objectively assesses the suitability of how health information is communicated to a particular audience. Key informants who were involved in tool development were identified and invited for a qualitative interview using a semistructured format to provide data about the development process. Key themes were identified in the semistructured interview process. RESULTS Frequencies and SAM percent ratings of eligible tools were reported. No apps exist for parents relating to pediatric heart failure. Overall, 17 relevant internet tools were identified, and their suitability was assessed for the parent audience. Most tools scored well in layout and type, but they scored lower in readability and graphics. Qualitative interviews with key informants revealed three key themes: timely and introductory knowledge, credible and trustworthy knowledge, and challenges and evolution in knowledge. CONCLUSIONS This is the first environmental scan looking for parent tools relating to childhood heart failure in Canada and the United States. Findings from this study reveal that there are no apps on this topic and there is a small number of tools for parents on the internet (n=17). Using the SAM, no tools scored in the superior range, and further work in knowledge translation strategies needs to be done in this area to improve more effective education to parents and caregivers who have a child with heart failure. These findings will inform the development of a new resource on children’s heart failure that targets parents and caregiver audiences. CLINICALTRIAL

Background Stories can be a powerful tool to increase uptake of health information, a key goal of knowledge translation (KT). Systematic reviews demonstrate that storytelling (i.e. sharing stories) can be effective in changing health-promoting behaviours. Though an attractive KT strategy, storytelling is a complex approach requiring careful planning and consideration of multiple factors. We sought to develop a framework to assist KT researchers and practitioners in health contexts to consider and develop effective KT interventions that include stories or storytelling. Methods We conducted a broad search of the literature to identify studies that used storytelling as a KT intervention across different disciplines: health research, education, policy development, anthropology, organizational development, technology research, and media. We extracted purposes, theories, models, mechanisms, and outcomes and then mapped the theoretical and practical considerations from the literature onto the Medical Research Council guidance for complex interventions. The theoretical and practical considerations uncovered comprised the basis of the storytelling framework development. Through discussion and consensus, methodological experts refined and revised the framework for completeness, accuracy, nuance, and usability. Results We used a complex intervention lens paired with existing behaviour change techniques to guide appropriate theory-based intervention planning and practical choices. An intentional approach to the development of story-based KT interventions should involve three phases. The theory phase specifies the goal of the intervention, mechanisms of action, and behaviour change techniques that will achieve the intended effects. The modelling phase involves development and testing using an iterative approach, multiple methods and engagement of end-users. Finally, formal evaluation using multiple methods helps determine whether the intervention is having its intended effects and value added. Conclusions This framework provides practical guidance for designing story-based KT interventions. The framework was designed to make explicit the requisite considerations when determining the appropriateness and/or feasibility of storytelling KT, clarify intervention goals and audience, and subsequently, support the development and testing of storytelling interventions. The framework presents considerations as opposed to being prescriptive. The framework also offers an opportunity to further develop theory and the KT community’s understanding of effectiveness and mechanisms of action in storytelling interventions.

BACKGROUND A number of evidence-based knowledge translation (KT) tools for parents of children with acute health conditions have been developed. These tools were created and tested with parental input and disseminated to groups proficient in English. Therefore, it is unclear whether they are useful for populations that are more diverse. To enhance the reach of our current and future KT tools, language translation and cultural adaptations may promote relevance for previously underserved knowledge users. OBJECTIVE This study aims to explore and understand considerations for the cultural and linguistic adaptation of a KT tool in French and Filipino communities. METHODS A KT tool (whiteboard animation video) describing the signs and symptoms of croup was originally developed in English to provide parents with evidence-based information couched within a narrative reflecting parents’ experiences with the condition. This KT tool was adapted (linguistics and imagery) for French- and Tagalog-speaking parents and caregivers through feedback from key stakeholders. The videos were presented to the respective language speakers for usability testing and discussion. Participants were asked to view the KT tool, complete a usability survey, and participate in semistructured interviews. Audio recordings from the interviews were transcribed verbatim, translated into English, and analyzed for relevant themes by using thematic analysis. RESULTS French- (n=13) and Tagalog-speaking (n=13) parents completed the usability survey and were interviewed. Although analyzed separately, both data sets produced similar findings, with key themes relating to understanding, relatability, and accessibility. Both the French and Tagalog groups reported that the video and other KT tools were useful in their adapted forms. Participants in both groups cautioned against using verbatim vocabulary and suggested that cultural competency and understanding of health languages were essential for high-quality translations. Parents also discussed their preference for videos with diverse visual representations of families, home environments, and health care workers, as such videos represent their communities more broadly. CONCLUSIONS French and Filipino parents appreciated having KT tools in their first language; however, they were also supportive of the use of English KT products. Their suggestions for improving the relatability and communication of health messages are important considerations for the development and adaptation of future KT products. Understanding the needs of the intended end users is a crucial first step in producing relevant tools for health evidence dissemination.

Youth are vulnerable to mental health challenges. Social media presents an opportunity to evaluate disinhibited mental health discourse and self-disclosure. The objective of this study was to explore reported experiences and information needs related to youth seeking support for mental health on the social media platform, Reddit.com. We searched two subreddits: r/mental health and r/teenagers on Reddit.com for posts made by youth (13–24 years) relating to mental health help-seeking behaviors and information needs. Posts were screened and relevant data were extracted, coded, and analyzed using thematic analysis. Thematic analysis of relevant posts yielded four themes: (1) navigating mental health issues, (2) disclosing to others, (3) barriers to seeking care, and (4) experiences seeking care. Youth may have a diverse range of mental health help-seeking-related information needs and may face several barriers throughout the process of seeking care.

ObjectiveTo develop a reporting guideline for overviews of reviews of healthcare interventions.DesignDevelopment of the preferred reporting items for overviews of reviews (PRIOR) statement.ParticipantsCore team (seven individuals) led day-to-day operations, and an expert advisory group (three individuals) provided methodological advice. A panel of 100 experts (authors, editors, readers including members of the public or patients) was invited to participate in a modified Delphi exercise. 11 expert panellists (chosen on the basis of expertise, and representing relevant stakeholder groups) were invited to take part in a virtual face-to-face meeting to reach agreement (≥70%) on final checklist items. 21 authors of recently published overviews were invited to pilot test the checklist.SettingInternational consensus.InterventionFour stage process established by the EQUATOR Network for developing reporting guidelines in health research: project launch (establish a core team and expert advisory group, register intent), evidence reviews (systematic review of published overviews to describe reporting quality, scoping review of methodological guidance and author reported challenges related to undertaking overviews of reviews), modified Delphi exercise (two online Delphi surveys to reach agreement (≥70%) on relevant reporting items followed by a virtual face-to-face meeting), and development of the reporting guideline.ResultsFrom the evidence reviews, we drafted an initial list of 47 potentially relevant reporting items. An international group of 52 experts participated in the first Delphi survey (52% participation rate); agreement was reached for inclusion of 43 (91%) items. 44 experts (85% retention rate) completed the second Delphi survey, which included the four items lacking agreement from the first survey and five new items based on respondent comments. During the second round, agreement was not reached for the inclusion or exclusion of the nine remaining items. 19 individuals (6 core team and 3 expert advisory group members, and 10 expert panellists) attended the virtual face-to-face meeting. Among the nine items discussed, high agreement was reached for the inclusion of three and exclusion of six. Six authors participated in pilot testing, resulting in minor wording changes. The final checklist includes 27 main items (with 19 sub-items) across all stages of an overview of reviews.ConclusionsPRIOR fills an important gap in reporting guidance for overviews of reviews of healthcare interventions. The checklist, along with rationale and example for each item, provides guidance for authors that will facilitate complete and transparent reporting. This will allow readers to assess the methods used in overviews of reviews of healthcare interventions and understand the trustworthiness and applicability of their findings.

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.

Acute otitis media (AOM) is the most common bacterial ear infection affecting up to 80% of children before the age of three. Despite the common occurrence of the illness and the wide range of material available at clinics and online, parents are not always aware of these resources and they are often difficult to understand. We worked with parents to develop and assess the usability of a whiteboard animation video and interactive infographic for AOM in children. Parents rated the tools highly across all usability items, suggesting that creative tools developed using multi-method development processes can be useful, relevant, understandable, and will be used by the intended audience.Following the completion of the English-language products, our team culturally adapted the tools for the Pakistan context and evaluated the usability of these adapted tools. During usability testing, parents indicated that they felt the tools were useful, demonstrating that culturally adapted version of knowledge translations tools are effective in ensuring that parents could understand complex health information.

Bronchiolitis is an acute infection of the lower respiratory tract that predominantly affects children less than two years old. Although self-limiting, symptoms of bronchiolitis can be distressing for young children. Research has demonstrated that parents may not have the necessary information to be able to identify bronchiolitis symptoms, resulting in emergency department (ED) visits and hospitalizations. Parents have expressed that they feel unprepared, afraid, and that they lack information on their child’s condition. Digital knowledge translation (KT) tools have the potential to convey complex health information to parents to support their healthcare decision-making needs.We worked with parents of children with bronchiolitis to develop and evaluate three digital tools on bronchiolitis (whiteboard animation video, infographic, and e-Book). Following prototype completion, usability testing was conducted using iPads in two Alberta ED waiting rooms. Parents were randomized to one out of the three tools. Overall, the tools were highly rated, suggesting that arts-based digital tools are useful in delivering complex health information to parents.