A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial

The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. The objective of our study was to investigate wheth...

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Published in:	Journal of medical Internet research Vol. 23; no. 4; p. e24316
Main Authors:	Zheng, Yingfeng, Wang, Wei, Zhong, Yuxin, Wu, Fengchun, Zhu, Zhuoting, Tham, Yih-Chung, Lamoureux, Ecosse, Xiao, Liang, Zhu, Erta, Liu, Haoning, Jin, Ling, Liang, Linyi, Luo, Lixia, He, Mingguang, Morgan, Ian, Congdon, Nathan, Liu, Yizhi
Format:	Journal Article
Language:	English
Published:	Canada JMIR Publications 30-04-2021
Subjects:	Adolescent Anxiety - prevention & control Anxiety - psychology Anxiety - therapy Asthenopia - prevention & control China - epidemiology COVID-19 - epidemiology Education, Distance Exercise Female Humans Male Original Paper Pandemics Peer Group Self Report Students - psychology China app homeschooling live streaming health information physical activity COVID-19 anxiety, digital eye strain digital health children mobile phone peer to peer behavior intervention online learning
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Summary:	The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children's anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root-transformed self-reported anxiety scores was greater in the intervention (-0.23, 95% CI -0.27 to -0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference -0.36, 95% CI -0.63 to -0.08; P=.02). There was a significant reduction in square-root-transformed eye strain in the intervention group (-0.08, 95% CI -0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference -0.15, 95% CI -0.26 to -0.03; P=.02). Change in sleep quality was similar between the two groups. This digital behavior change intervention reduced children's anxiety and eye strain during COVID-19-associated online schooling. ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	1438-8871 1439-4456 1438-8871
DOI:	10.2196/24316