TY  - JOUR
AU  - Zheng, Yingfeng
AU  - Wang, Wei
AU  - Zhong, Yuxin
AU  - Wu, Fengchun
AU  - Zhu, Zhuoting
AU  - Tham, Yih-Chung
AU  - Lamoureux, Ecosse
AU  - Xiao, Liang
AU  - Zhu, Erta
AU  - Liu, Haoning
AU  - Jin, Ling
AU  - Liang, Linyi
AU  - Luo, Lixia
AU  - He, Mingguang
AU  - Morgan, Ian
AU  - Congdon, Nathan
AU  - Liu, Yizhi
PY  - 2021
DA  - 2021/4/30
TI  - 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
JO  - J Med Internet Res
SP  - e24316
VL  - 23
IS  - 4
KW  - homeschooling
KW  - children
KW  - anxiety, digital eye strain
KW  - peer to peer
KW  - live streaming
KW  - digital health
KW  - intervention
KW  - health information
KW  - physical activity
KW  - COVID-19
KW  - online learning
KW  - behavior
KW  - app
KW  - mobile phone
AB  - Background: 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. Trial Registration: ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097 
SN  - 1438-8871
UR  - https://www.jmir.org/2021/4/e24316
UR  - https://doi.org/10.2196/24316
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33882021
DO  - 10.2196/24316
ID  - info:doi/10.2196/24316
ER  -