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

dc.contributor.authorZheng, Yingfeng
dc.contributor.authorWang, Wei
dc.contributor.authorZhong, Yuxin
dc.contributor.authorWu, Fengchun
dc.contributor.authorZhu, Zhuoting
dc.contributor.authorTham, Yih-Chung
dc.contributor.authorLamoureux, Ecosse
dc.contributor.authorXiao, Liang
dc.contributor.authorZhu, Erta
dc.contributor.authorLiu, Haoning
dc.contributor.authorJin, Ling
dc.contributor.authorLiang, Linyi
dc.contributor.authorLuo, Lixia
dc.contributor.authorHe, Mingguang
dc.contributor.authorMorgan, Ian
dc.contributor.authorCongdon, Nathan
dc.contributor.authorLiu, Yizhi
dc.description.abstractBackground: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: This digital behavior change intervention reduced children's anxiety and eye strain during COVID-19-associated online schooling.en_AU
dc.description.sponsorshipThis study was supported by the Construction Project of High-Level Hospitals in Guangdong Province (303020107, 303010303058); the National Natural Science Foundation of China (81530028, 81721003); the Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory (2018GZR0201001); the research units of Ocular Development and Regeneration, Chinese Academy of Medical Sciences (2019-I2M-5-005); the Local Innovative and Research Teams Project of the Guangdong Pearl River Talents Program (2017BT01S138); and the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University. NC is supported by the Ulverscroft Foundation (United Kingdom).en_AU
dc.provenanceOriginally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.04.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.en_AU
dc.publisherJournal of medical Internet Researchen_AU
dc.rights©Yingfeng Zheng, Wei Wang, Yuxin Zhong, Fengchun Wu, Zhuoting Zhu, Yih-Chung Tham, Ecosse Lamoureux, Liang Xiao, Erta Zhu, Haoning Liu, Ling Jin, Linyi Liang, Lixia Luo, Mingguang He, Ian Morgan, Nathan Congdon, Yizhi Liu.en_AU
dc.rights.licenseCreative Commons Attribution Licenseen_AU
dc.sourceJournal of Medical Internet Researchen_AU
dc.subjectdigital eye strainen_AU
dc.subjectpeer to peeren_AU
dc.subjectlive streamingen_AU
dc.subjectdigital healthen_AU
dc.subjecthealth informationen_AU
dc.subjectphysical activityen_AU
dc.subjectonline learningen_AU
dc.subjectmobile phoneen_AU
dc.titleA 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 trialen_AU
dc.typeJournal articleen_AU
dcterms.accessRightsOpen Accessen_AU
local.contributor.affiliationZheng, Yingfeng, Sun Yat-Sen Universityen_AU
local.contributor.affiliationWang, Wei, Sun Yat-sen Universityen_AU
local.contributor.affiliationZhong, Yuxin, Sun Yat-sen Universityen_AU
local.contributor.affiliationWu, Fengchun, Guangzhou Medical Universityen_AU
local.contributor.affiliationZhu, Zhuoting, Sun Yat-sen Universityen_AU
local.contributor.affiliationTham, Yih-Chung, Singapore Eye Research Instituteen_AU
local.contributor.affiliationLamoureux, Ecosse, Singapore Eye Research Instituteen_AU
local.contributor.affiliationXiao, Liang, Zhaoqing Education Bureauen_AU
local.contributor.affiliationZhu, Erta, Zhaoqing Education Bureauen_AU
local.contributor.affiliationLiu, Haoning, Duanzhou District Education Bureauen_AU
local.contributor.affiliationJin, Ling, Sun Yat-Sen Universityen_AU
local.contributor.affiliationLiang, Linyi, Sun Yat-sen Universityen_AU
local.contributor.affiliationLuo, Lixia, Sun Yat-sen Universityen_AU
local.contributor.affiliationHe, Mingguang, Sun Yat-Sen Universityen_AU
local.contributor.affiliationMorgan, Ian, College of Science, ANUen_AU
local.contributor.affiliationCongdon, Nathan, Queen's University Belfasten_AU
local.contributor.affiliationLiu, Yizhi, Sun Yat-sen Universityen_AU
local.contributor.authoruidMorgan, Ian, u7401805en_AU
local.description.notesImported from ARIESen_AU
local.identifier.absfor321201 - Ophthalmologyen_AU
local.identifier.absfor321203 - Optometryen_AU
local.identifier.absseo200412 - Preventive medicineen_AU
local.type.statusPublished Versionen_AU


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