ABSTRACT
Introduction: Obesity is a major public health problem worldwide and the prevalence of childhood obesity is of particular concern. Effective interventions for preventing and treating childhood obesity aim to change behaviour and exposures at the individual, community, and societal levels. However, monitoring and evaluating such changes is challenging. Development in the fields of behaviour change science, public health, clinical paediatrics, technology, citizen science and Big Data analytics can be harnessed to implement multidisciplinary research addressing the prevention and treatment of child and adolescent obesity at a population level. The H2020 project “BigO: Big Data Against Childhood Obesity” (http://bigoprogram.eu) is one example of such research efforts. Following the emergence of the COVID-19 pandemic, the BigO research team in Ireland adapted study procedures to ensure collection of Big Data could continue with modified procedures. Aim: To present the approach used for BigO data collection in Ireland during the COVID-19 pandemic and to explore changes in data collection over time. Methods: Step 1 reviewed and sought approval for ethical and regulatory procedures relevant to the collection, monitoring, and storage of personal data collected during the COVID-19 pandemic in children from the general population and those attending a multidisciplinary clinical service for severe obesity. Step 2 explored recruitment strategies and the informed consent and assent process. Step 3 explored the collection of anonymized data including: photographs of meals, beverages and advertisements, physical activity metrics, and masked GPS data using geo-hash representing geographical area rather than detailed coordinates. Following aggregation, analysis, and visualization of collected data descriptive statistics were used to explore patterns of behaviour in the population over time in order to better understand whether the system could be used to monitor behaviours through a period of significant societal change. Results: New ethical approval was granted for the updated methods. From 88 secondary schools approached to participate in the study, five agreed to commence an online consent process with parents and students. In the school setting, 700 children were eligible for study inclusion and 178 consented to participate, respectively. For the clinical study, images of outdoor advertisements collected from participants in Ireland changed during lock-down periods as children had less access to outdoor space and use of study smartwatches was discontinued to adhere to local infection control policies. Please see Table 1 for further details on results of the clinical study. Conclusions: Real-time collection of Big Data was possible through a period of societal upheaval though the expected volume of data was reduced. Such data may prove an important tool for monitoring interventions at the level of the individual child or at the population level for this vulnerable group.
ABSTRACT
Introduction: COVID-19 has brought to the fore an urgent need for secure information and communication technology (ICT) supported healthcare delivery, as the pertinence of infection control and social distancing continues. Telehealth for pediatric care incorporates additional layers of complexity compared with adult services for a variety of reasons including logistical, privacy, parental consent, child assent, child welfare, and quality concerns. There is no systematic evidence synthesis available that outlines the implementation issues for incorporating telehealth to pediatric services generally, or how users perceive these issues. Methods: We conducted a rapid mixed-methods evidence synthesis to identify barriers, facilitators, and documented stakeholder experiences of implementing pediatric telehealth, to inform the pandemic response. A systematic search was undertaken by a research librarian in MEDLINE for relevant studies. All identified records were blind double-screened by two reviewers. Implementation-related data were extracted, and studies quality appraised using the Mixed-Methods Appraisal Tool. Qualitative findings were analyzed thematically and then mapped to the Consolidated Framework for Implementation Research. Quantitative findings about barriers and facilitators for implementation were narratively synthesized. Results: We identified 27 eligible studies (19 quantitative;5 mixed-methods, 3 qualitative). Important challenges highlighted from the perspective of the healthcare providers included issues with ICT proficiency, lack of confidence in the quality/reliability of the technology, connectivity issues, concerns around legal issues, increased administrative burden and/ or fear of inability to conduct thorough examinations with reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout planning and implementation, sufficient training, and cultivation of telehealth champions. Families often expressed preference for in-person visits but those who had tried tele-consultations, lived far from clinics, or perceived increased convenience with technology considered telemedicine more favorably. Concerns from parents included the responsibility of describing their child's condition in the absence of an examination. Conclusion: Healthcare providers and families who have experienced tele-consultations generally report high satisfaction and usability for such services. The use of ICT to facilitate pediatric healthcare consultations is feasible for certain clinical encounters and can work well with appropriate planning and quality facilities in place.