Interactive media for parental education on managing children chronic condition: a systematic review of the literature

Annaim et al. BMC Pediatrics (2015) 15:201 DOI 10.1186/s12887-015-0517-2 RESEARCH ARTICLE Open Access Interactive media for parental education on managing children chronic condition: a systematic review of the literature Ali Annaim1*, Mia Lassiter1, Anthony J. Viera2 and Maria Ferris1 Abstract Background: Although some research has examined the use of games for the education of pediatric patients, the use of technology for parental education seems like an appropriate application as it has been a part of the popular culture for at least 30 years. The main objective of this systematic review is to examine the literature for research evaluating the use of interactive media in the education of parents of children with chronic conditions. Methods: We searched the MEDLINE, PSYCHINFO, CINAHL, Cochrane database of systematic reviews and EMBASE databases from 1986 to 2014 seeking original investigations on the use of interactive media and video games to educate parents of children with chronic conditions. Cohort studies, randomized control trials, and observational studies were included in our search of the literature. Two investigators reviewed abstracts and full texts as necessary. The quality of the studies was assessed using the GRADE guidelines. Overall trend in the results and the degree of certainty in the results were considered when assessing the body of literature pertaining to our focused questions. Results: Our initial search identified 4367 papers, but only 12 fulfilled the criterion established for final analysis, with the majority of the studies having flaws that reduced their quality. These papers reported mostly positive results supporting the idea that parent education is possible through interactive media. Conclusion: We found limited evidence of the effectiveness of using serious games and or interactive media to educate parents of children with chronic conditions. Keywords: Parent education, Interactive media, Chronic condition Background The estimated number of children with chronic health conditions in the United States is 15 to 18 million [1]. These large numbers of children rely on their caregivers for the majority of their care and health management by virtue of them being dependents. The parent/caregiver roles include learning about their child’s condition, giving medications, ensuring that the child performs procedures, and providing transportation to appointments with health care providers [2]. * Correspondence: 1 Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, 7021 Burnett-Womack, Chapel Hill, NC 27599, USA Full list of author information is available at the end of the article The number of adults, who have grown up with technology, in particular interactive media such as computerdelivered education and video games, has been rising with each successive generation. Although the use of computer-based technology and video games has been described as a means to teach children to self-manage conditions such as cancer, asthma, and diabetes, the state of the literature on the use of interactive technology and/ or video games to teach parents about their children’s conditions has not been well characterized [3–9]. Such interventions have been described in the literature as “serious games” [10]. The goal of this systematic review of the literature was to identify and evaluate research that had used interactive media approaches to educate parents © 2015 Annaim et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Annaim et al. BMC Pediatrics (2015) 15:201 of pediatric patients with chronic conditions and their relative effectiveness. Methods We conducted a review of publications using the following databases: MEDLINE, PsychINFO, CINAHL, and EMBASE, and we reported the findings based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria [11]. The search terms used are presented in Table 1. Additionally, the Cochrane database of systematic reviews was accessed, and an review focused on interactive health communication applications acted as a source for additional articles that the reviews examined [12]. To be included in the review, an article had to report data evaluating an educational intervention using either interactive media or interactive games for parents. Any original research design was eligible. The titles of the articles were scanned to identify pertinent studies for abstract evaluation based on the presence of an educational intervention in the title. Two authors independently examined abstracts from the most relevant articles; any disagreement between the authors was settled by a senior advisor. They also performed reference chaining using the discovered studies as a starting point. They focused on the following research question (see Table 2). The primary research question was: Does the use of “serious games” (games intended to educate) and/or interactive media for parents improve health outcomes in children with chronic conditions (e.g. asthma, diabetes, chronic kidney disease, cystic fibrosis, and cardiac abnormalities)? They determined internal validity, potential for biases, accuracy and appropriateness of the analysis and applicability used in each study. The overall quality of the study was determined through an application of the GRADE guidelines [13–19]. They also determined the literacy level of the tools used in these the studies using the FleshKincaid methodology. Inclusion/exclusion criteria Only observational studies, cohort studies, and randomized control trials were included in the final review. They included studies that went as far as 1986, the earliest year that this topic was introduced in the literature [20]. For cohort and randomized trials, they did not differentiate studies on the basis of time between intervention and post-testing, when applicable. The participants for the studies needed to include parents in the exposure group. Data extraction The studies were examined and basic information was extracted from each study. For quantitative studies data was collected on: (1) the sample size in the study; (2) the composition of the study population; (3) the Page 2 of 13 measurement tool that used in the study; and (4) outcomes. Further information on the potential for biases and analysis performed in each of the quantitative studies is presented in Additional file 1 as an evidence (...truncated)