PEDIATRICS Vol. 119 No. 3 March 2007, pp. 427-434 (doi:10.1542/peds.2006-2669)
ARTICLE |
Parent Use of Touchscreen Computer Kiosks for Child Health Promotion in Community Settings
a Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
b Department of Pediatrics
c Child Health Institute, University of Washington, Seattle, Washington
d Center for Health Studies, Group Health Cooperative, Seattle, Washington
e Children's Hospital and Regional Medical Center, Seattle, Washington
 |
ABSTRACT |
|---|
 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
|---|
OBJECTIVES. The goals were to evaluate the use of touchscreen computer kiosks, containing only child health–promoting information, in urban, low-income, community settings and to characterize the users of these kiosks.
METHODS. Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonald's restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data.
RESULTS. In total, there were 1846 kiosk sessions. Almost one half occurred at McDonald's. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to 
1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their child's doctor about what they had learned.
CONCLUSIONS. User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.
Key Words: health promotion • computers • community pediatrics • prevention
Abbreviations: ADHD—attention-deficit/hyperactivity disorder • DMV—Department of Motor Vehicles
Given the limited success in promoting prevention via pediatricians' offices, alternative methods for delivering child health promotion information are needed.1–3 Although recommendations regarding age-appropriate topics to be covered at well-child visits are plentiful,4 parents report that many of the anticipatory guidance topics are not covered in their children's well-child visits and that, after their visits, they can still use more information.5 In addition, many parents have little interaction with health care providers. Children >2 years of age may visit a physician only once per year. Many families face access issues that make it difficult for them to keep up with well-child visits. Therefore, alternative methods for delivery of this information need to be explored.
Technological advances in the past 2 decades have led to a focus on the use of new technologies to assist in the delivery of health promotion messages.6,7 One technology now being used is the touchscreen computer kiosk containing health information. Many studies have evaluated the placement of such kiosks in physician office waiting rooms and medical facilities.8–12 Very few studies have focused on the pediatric population. Two studies found that kiosks containing child health promotion information had positive effects on parental knowledge of prevention topics.11,12 It is notable, however, that the content of the kiosks in both of those studies was limited; one focused on household safety topics and the other on topics relevant to infants <6 months of age.11,12
Because health promotion information must be provided outside medical facilities (for a variety of reasons), there has been a push to place health kiosks in the community.13–16 Two of the largest efforts are the Michigan Interactive Health Kiosk project and the United Kingdom-based In Touch With Health project, both of which placed >100 kiosks in community locations.15,17 The Michigan Interactive Health Kiosk project presented mainly adult-focused information, with very limited child-focused information.15 The In Touch With Health project covered a broader range of pediatric issues and found that pediatric topics were among the top 20 medical topics viewed.18 Evaluation of the general use of these community-based kiosks showed that the kiosks were well used, including use by low-income and diverse populations.13,14,16,17
To our knowledge, however, there has not been an evaluation of the use of community-based computer kiosks that contain only child health–promoting information. In addition, there has not been a detailed description of the users who seek child health–promoting information from community-based kiosks. The objectives of this study were therefore to evaluate the use of touchscreen computer kiosks containing only child health–promoting information, in urban, low-income, community settings, and to characterize the users of such kiosks.
|
METHODS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Setting
This was a descriptive study of community-based kiosk use. The study protocol was approved by the University of Washington institutional review board.
Between March 2005 and October 2005, we placed 3 touchscreen computer kiosks at sites in low-income urban neighborhoods in Seattle, Washington. Sites included a McDonald's restaurant, a Department of Motor Vehicles (DMV) office, and a public library. Data from the corresponding US Census tracts for these locations showed that 20% to 25% of the population in these communities is <14 years of age, 26% to 32% of parents are single, and 49% to 65% of adults have a high school education or less. The specific location of the kiosk at each site was decided by the site managers, in consultation with the investigators.
Kiosk Content and Design
Kiosks contained 17-inch, flat, touchscreen, cathode-ray tube monitors. Each computer kiosk, including computer, touchscreen, and kiosk, cost $2200. To decrease maintenance needs, the kiosks were configured to be rebootable and to reload automatically. We labeled the kiosks as containing child health information, both on the screen and on the sides of the kiosks. Beyond this, there was no advertising for the kiosks. We adapted software used in 2 clinic-based studies for use in this study.19,20 All content was written at the eighth-grade level. We used clearly readable font sizes and included pictures in most modules. All information presented was user-driven, interactive, and presented in stages. All screen touches were recorded. To initiate a kiosk session, users first indicated whether they were previous or new users. A kiosk session was defined as an event in which a person logged onto the kiosk by identifying himself or herself as a new or previous user. Both previous and new users indicated whether they were adults or children. Only data entered by self-identified adults were used for this study. Users selected the month and year of birth for the index child and entered it by tapping "okay." Kiosks then displayed a list of age-appropriate module topics, which users could enter and exit at any point, viewing as many modules as they wanted. A sample module topics page is shown in Fig 1.
|
There were 14 modules in total. Ten focused on prevention and safety, including television/media, gun injuries, bicycle injuries, car crashes, tobacco smoke exposure, flu shots, sudden infant death syndrome prevention, house fires, Head Start, and scald burn prevention. Three modules were screening tools for the following: developmental delay, tuberculosis, and attention-deficit/hyperactivity disorder (ADHD). The final module was a symptom assessment tool for children with asthma. Users were shown only modules that were age-appropriate for the child of interest. The number of module topics listed on the topics page ranged from 9 to 12, depending on the age of the child (Table 1).
|
Content was derived from age-specific recommendations obtained from 5 sources: (1) The United States Preventive Services Task Force Guide to Clinical Preventive Services,21 (2) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,4 (3) National Asthma Education and Prevention Program Expert Panel Report 2,22 (4) peer-reviewed systematic reviews of other preventive care interventions, and (5) high-quality randomized, controlled trials. We selected topics for which there were reasonable evidence bases and clear recommendations. None of the content was specific to the Seattle communities in which this study was performed.
In a subset of 9 modules, users were asked specific questions at the start of the module. An algorithm was applied to identify whether the index child was at risk with respect to the module topic. Users responded to questions to describe the risk level of their child with respect to 5 prevention topics, namely, television/media, tobacco smoke exposure, bicycle injuries, house fire prevention, and sudden infant death syndrome prevention, and all 4 of the screening/assessment modules. For example, in the bicycle injuries module, users were asked 3 questions, that is, whether the child rode a bike, (if yes) whether the child had a helmet, and (if yes) whether the child used the helmet when riding a bike. Children reported as not owning or not using a helmet were identified as at-risk children. At-risk criteria for the other 4 prevention topics are shown in Table 2. We used the Vanderbilt screening tool to identify children who warranted additional evaluation for ADHD.23 The Parents’ Evaluations of Developmental Status (PEDS) screening tool identified children at risk for developmental delays.24 Screening guidelines from the Centers for Disease Control and Prevention were used to identify children at risk for tuberculosis. We created questions to identify children with inadequately controlled asthma symptoms by using the National Asthma Education and Prevention Program Expert Panel Report 2 guidelines.22
|
After responding to the risk questions, users of these modules were shown messages that depended on their responses. In the majority of these modules, the messages were tailored to the previous responses of the users. For example, in the developmental screening module, if a child was found to be at high risk for a developmental delay, then users were informed of their child's risk and were encouraged to speak to their child's physician regarding the findings.
A large button labeled "Exit" was found in the top right corner of all screens and led users to an optional, 9-item, exit survey. The survey asked users to characterize their kiosk experience according to ease of use, newness and helpfulness of the information that was provided, and intent to take action because of the information they viewed (ie, the following yes/no questions: Do you plan to try any of the things that you read about here? Will you talk to your child's doctor about the things you read today?). The survey also asked the user's highest grade completed in school, frequency of Internet use, and rating of the child's health on a 5-point Likert scale (excellent to poor).
Analyses
The total number of adult sessions was summed. We then tabulated frequency distributions for identified categories. Statistical significance was determined by using the 
2 test unless cell values were 
5, in which case Fisher's exact test was used. To reduce the risk of double-counting users, the majority of our analyses were limited to first-time users; we indicate clearly when use by previous users was examined. We also performed multiple Poisson regression analyses with robust error variance to evaluate the relationship between characteristics of users and their ratings of their kiosk session. Poisson regression analysis with robust error variance was used because it is a better way to evaluate relative risk, compared with logistic regression analysis, when the outcome is common.25 All analyses were performed by using Intercooled Stata 9.1 for Windows (Stata, College Station, TX).
|
RESULTS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
During the 6-month study period, self-identified adults used the touchscreen computer kiosks for 1846 sessions. In 22% of those sessions, users identified themselves as previous users (n = 399). Almost one half (47%; n = 873) of all kiosk sessions occurred at the McDonald's restaurant location, with 35% (n = 642) occurring at the public library and the remaining 18% (n = 331) occurring at the DMV office. Users sought information for children of all ages (Table 3). Almost one half (48%; n = 117) of the first-time users who responded to the optional exit questions reported that they had a high school education or less, and one fourth (26%; n = 67) reported that they never used the Internet. Forty percent (n = 103) of first-time users reported their child's health as fair or poor.
|
First-time users showed interest in all of the modules presented (Fig 2). The television/media (16%; n = 235), smoke exposure (14%; n = 196), ADHD screening (12%; n = 180), and asthma assessment (11%; n = 155) modules were the most commonly visited modules. For the majority of first-time kiosk sessions, only 1 module was explored (n = 882; 61%); 13% of users viewed 2 modules, and 6% viewed
3 modules.
|
There were 712 first-time user sessions that explored and completed
1 of the 9 modules that identified at-risk groups. At-risk children were identified in 373 (52%) of these sessions. Table 2 shows, according to module, the number of sessions in which an at-risk child was identified. Of the 217 first-time users who explored the television/media module, 123 (57%) did not have rules to limit the amount of television their child watched. Of the 188 users who explored the tobacco smoke exposure module, 73 (39%) lived in homes without rules to limit secondhand smoke exposure from smokers in the home. Fifty-three (40%) of the 131 users who viewed the bicycle injuries module sought information for children who ride bicycles and either do not own a helmet or do not wear a helmet when biking. Of the 56 first-time sessions in which the asthma assessment module was completed, the assessment showed that the child's asthma was not well controlled in 49 (87%) of the sessions. Of the 95 sessions in which the ADHD screening was completed, 38 (40%) identified a child at risk for ADHD.
In the optional exit survey, first-time users rated their kiosk experience. Twenty-eight percent (n = 405) of first-time users responded to 1 question on this exit survey, and 11% (n = 163) completed all 9 questions. The majority (57%; n = 155) of those who responded found the kiosk easy to use. Thirty percent found it hard to use, with the rest responding that it was neither hard nor easy. Fifty-five percent (n = 138) rated the information as easy to understand. One fourth (26%; n = 64) found it hard to understand, with the rest stating that it was neither hard nor easy. Ease of use of the kiosk (easy versus not hard, not easy or hard) was associated with Internet use (any versus rarely/never; prevalence ratio: 1.44; 95% confidence interval: 1.09–1.91) but not with above high school education versus less (prevalence ratio: 1.04; 95% confidence interval: 0.81–1.34). More than one half responded that at least some of the information they read was new for them (66%; n = 165) and helpful (66%; n = 168). More than one half (55%; n = 127) indicated that they planned to try what they had read in the kiosk. Almost one half indicated that they would speak with their physician about what they had read (49%; n = 113).
Users with at-risk children did not vary according to grade level (P = .72) or Internet use (P = .64), compared with other users. Previous users varied slightly, compared with first-time users. There was no difference in their grade level (P = .18) or Internet use (P = .71); however, they were more likely to view 2 modules at their return visit (prevalence ratio: 1.38; 95% confidence interval: 1.13–1.69).
Differences in use according to kiosk location also existed. The kiosk located at the public library had more previous users (35% of all sessions there) than did the kiosks at the other 2 locations (DMV office: 19%; McDonald's: 13%; P < .001). First-time users at the DMV office were more likely to explore 2 modules (P = .002). However, users at the 3 locations did not vary according to grade level or reported Internet use. In addition, the number of identified at-risk children for first-time users did not vary according to the kiosk location, nor did the selection of modules viewed.
|
DISCUSSION |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Touchscreen computer kiosks located in low-income, urban, community locations were used by users seeking information for children of all ages, on a variety of topics. Notably, users sought information for at-risk children, highlighting their need for information and the potential importance of community-based health kiosks. Overall, users represented a diverse group that included those with low educational levels and a lack of familiarity with the Internet. The majority of users reported a positive experience with their kiosk use, noting that the kiosk was easy to use and contained helpful information.
We placed the kiosks in varied, public, nonmedical locations. The amount of use in the 3 locations varied, with almost one half of the sessions being at the McDonald's location. To our knowledge, no one has evaluated the public use of a health kiosk placed in a fast food restaurant. Nicholas et al26 noted that a kiosk placed in a supermarket, compared with other medical or nonmedical locations, in the United Kingdom was highly used. The advantages of these locations include high visibility and potentially high volume of use.26 We also found that the number of modules explored varied according to location. First-time users at the DMV office were more likely to explore 2 modules. This might be attributable to wait times involved in using services at the DMV office. However, we did not find any difference in the type of user, although this might be attributable simply to the use of only 2 variables (educational level and frequency of Internet use) to characterize viewers. Another study of community-based health kiosks found that users in different locations differed with respect to other characteristics.26
It was notable in our findings that the majority of first-time users responded that they planned to try what they read and almost one half planned to speak with their physician about what they read. This highlights an important strength of community-based health kiosks, which is the ability to provide tailored information to users. Kiosks used in this study were user-driven; users could select the topics that interested them. In addition, information given to users in most modules was customized on the basis of the responses they provided on previous screens. A few studies examined the effect of providing tailored messages versus general health messages and found that customized messages were better accepted by readers and were more likely to have an impact on the readers' behavior.27–30 The ability for users to select what they read and the customization of some messages on our kiosks may account for our findings and deserve additional exploration.
An additional benefit of community-based child health kiosks is the ability to provide low-cost information to caretakers of at-risk children and adolescents in a manner that is convenient to the user. The majority of costs are start-up costs, including the costs for purchase of the equipment and development of the software. There was no training required for staff members at the community locations. Gould and Anderson31 performed an economic analysis comparing computer kiosks with group sessions with a trainer for nutritional education and found that computer kiosks could reach more individuals at lower costs.
The placement of these kiosks in the community allows users to use the kiosks at a place and time that may be more convenient for them than at a physician's office. Also, the kiosks provide an additional source of information for those most in need of information, that is, caretakers of at-risk children. More than one half of first-time users who completed risk assessments in the 9 modules with risk questions were identified as having at-risk children. In comparing our findings with national risk levels for some of the specific module findings, we found that users who chose to view each of these modules were more likely to have high-risk children. For example, a recent study found that 20% of parents of infants in Washington state put their child to sleep in a nonsupine position.32 Fifty-six percent of users who viewed the sudden infant death syndrome prevention module in this study reported that they put their child to sleep in a nonsupine position. A national study found that only 3% of households in the United States reported that they did not have a smoke detector.33 Thirty-six percent of kiosk users in our study who chose to view the house fire prevention module reported that they did not have a smoke detector in their home. Therefore, community-based health kiosks allow caretakers of those at most risk to view the information they need.
There are a few important limitations of this study that warrant mention. The most significant of these limitations is that we did not validate the information users entered into the computer kiosks. This does not affect our presentation of results related to use, but it may affect the validity of our results related to the risk behaviors of users' children and our exit survey. Users might have answered module questions inaccurately for their child simply because of curiosity regarding what information might be presented. In addition, some users might have marked responses incorrectly because of difficulty using the kiosk. Thirty percent of users found the kiosks difficult to use. Another limitation is that only 28% of participants entered data in our exit survey, with 11% answering all of the questions. This hampers our ability to generalize from those users to the larger group of users. Significant differences may exist between those who answered the exit questions and those who did not. In addition, our data do not show whether a child was playing with the kiosk or using it. Users were asked whether they were children or adults; however, children could have been playing with the kiosk and hitting it randomly. We think that this most likely would affect only the overall numbers of sessions we counted for adults. To prevent random hits to the screen affecting our remaining data, users needed to view 4 or 5 different pages and to make 6 to 9 screen touches sequentially to view the module topics page. Any user hitting the screen randomly would have a low likelihood of getting to the modules and answering intramodule questions or viewing the optional exit survey.
An additional limitation is that simply viewing a page or a module does not mean that the viewer is interested in the topic or even reads the information on the screen.17 Therefore, we do not report pages viewed or time spent viewing the pages. Because viewers had multiple options regarding which modules they viewed, we can assume some interest in most viewers for the modules they viewed. The fact that the majority of viewers viewed only 1 module is consistent with the results of another study.17 Whether this reflects interest or time constraints is not known.
Despite these limitations, our study shows that community-based, child health kiosks are used by diverse users seeking information for at-risk children. Additional study is needed in a number of areas. Enhancing the ease of use of the kiosk is important, because almost one third of users responded that the kiosk was difficult to use. This is much higher than findings from 2 other community-based kiosk studies, in which >90% of users found the kiosks easy/fairly easy to use.13,14 However, both of those studies collected the data on ease of use through in-person interviews, compared with use of the kiosk. Nevertheless, the reasons why one third of the user population had difficulty with the kiosk (ie, software design, unidentified technological problems, factors unique to the users at these locations, or some other reason) need to be explored before widespread distribution. It would also be important to know whether the users who reported that they intended to act on what they learned actually followed through with this. A recent study that was more home Internet based examined similar module content and parents' implementation of a health promotion change and found that viewing the content did lead to reported behavior change.19 More attention should be given to those in this study who did not report that they intended to act on this information; understanding why would be important. Similarly, it must be asked whether additional tailoring of the information in the kiosk would have stimulated more parents to report an intention to act. In general, more emphasis needs to be placed on improving child health through effective methods outside medical facilities. Community-based health kiosks with child health information have the potential to have an impact on health care and health outcomes for children.
|
ACKNOWLEDGMENTS |
|---|
This study was funded by a royalty research grant from the University of Washington (to Dr Christakis) and by a grant from the Agency for Healthcare Research and Quality (grant 1 R01 HS013302, to Dr Christakis). Support for this study for Dr Thompson was provided by the Robert Wood Johnson Foundation through the Robert Wood Johnson Clinical Scholars Program.
|
FOOTNOTES |
|---|
Accepted Nov 8, 2006.
Address correspondence to Darcy A. Thompson, MD, MPH, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University, 200 N Wolfe St, Room 2023, Baltimore, MD 21287. E-mail: dthomp46{at}jhmi.edu
The authors have indicated they have no financial relationships relevant to this article to disclose.
This work was presented in part at the annual meeting of the Pediatric Academic Societies; April 29–May 2, 2006; San Francisco, CA.
The opinions are those of the authors and not those of the Robert Wood Johnson Foundation.
|
REFERENCES |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
- LeBaron CW, Rodewald L, Humiston S. How much time is spent on well-child care and vaccinations?
Arch Pediatr Adolesc Med. 1999;153
:1154
–1159
[Abstract/Free Full Text] - Reisinger KS, Bires JA. Anticipatory guidance in pediatric practice.
Pediatrics. 1980;66
:889
–892
[Abstract/Free Full Text] - Schor EL. Rethinking well-child care.
Pediatrics. 2004;114
:210
–216
[Free Full Text] - Green M. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Arlington, VA: National Center for Education in Maternal and Child Health; 1994
- Schuster MA, Duan N, Regalado M, Klein DJ. Anticipatory guidance: what information do parents receive? What information do they want?
Arch Pediatr Adolesc Med. 2000;154
:1191
–1198
[Abstract/Free Full Text] - Lewis D. Computer-based approaches to patient education: a review of the literature.
J Am Med Inform Assoc. 1999;6
:272
–282
[Abstract/Free Full Text] - Wofford JL, Smith ED, Miller DP. The multimedia computer for office-based patient education: a systematic review. Patient Educ Couns. 2005;59 :148 –157[CrossRef][Web of Science][Medline]
- Goldschmidt L, Goodrich GL. Development and evaluation of a point-of-care interactive patient education kiosk. J Telemed Telecare. 2004;10(suppl 1) :30 –32
- Lewis D, Nath C. Feasibility of a kiosk-based patient education system in a busy outpatient clinic setting.
Diabetes Educ. 1997;23
:577
–581, 585–586
[Free Full Text] - Maio RF, Shope JT, Blow FC, et al. A randomized controlled trial of an emergency department-based interactive computer program to prevent alcohol misuse among injured adolescents. Ann Emerg Med. 2005;45 :420 –429[CrossRef][Web of Science][Medline]
- Sanghavi DM. Taking well-child care into the 21st century: a novel, effective method for improving parent knowledge using computerized tutorials.
Arch Pediatr Adolesc Med. 2005;159
:482
–485
[Abstract/Free Full Text] - McDonald EM, Solomon B, Shields W, et al. Evaluation of kiosk-based tailoring to promote household safety behaviors in an urban pediatric primary care practice. Patient Educ Couns. 2005;58 :168 –181[CrossRef][Web of Science][Medline]
- Radvan D, Wiggers J, Hazell T. Health C.H.I.P.s: opportunistic community use of computerized health information programs.
Health Educ Res. 2004;19
:581
–590
[Abstract/Free Full Text] - Peters J, Jackson M. Accessibility and use of touchscreens by black and ethnic minority groups in the Three Cities Project. Ethn Health. 2005;10 :199 –211[CrossRef][Web of Science][Medline]
- Connell CM, Shaw BA, Holmes SB, Hudson ML, Derry HA, Strecher VJ. The development of an Alzheimer's disease channel for the Michigan Interactive Health Kiosk Project. J Health Commun. 2003;8 :11 –22[Web of Science][Medline]
- Nicholas D, Huntington P, Williams P. Three years of digital consumer health information: a longitudinal study of the touch screen kiosk. Inf Process Manage. 2003;39 :479 –502[CrossRef]
- Nicholas D, Huntington P, Williams P. Establishing metrics for the evaluation of touch screen kiosk. J Inf Sci. 2001;27 :61 –71
- Nicholas D, Huntington P, Williams P. Delivering consumer health information digitally: a comparison between the web and touchscreen kiosk. J Med Syst. 2003;27 :13 –34[CrossRef][Web of Science][Medline]
- Christakis DA, Zimmerman FJ, Rivara FP, Ebel B. Improving pediatric prevention via the Internet: a randomized, controlled trial.
Pediatrics. 2006;118
:1157
–1166
[Abstract/Free Full Text] - Lozano P, Wright J, Brown J, et al. Randomized trial of tailored guideline-based electronic decision support: can computers help pediatricians prescribe controllers for persistent asthma? Presented at: annual meeting of the Pediatric Academic Societies; May 14–17, 2005; Washington, DC
- The United States Preventive Services Task Force Guide to Clinical Preventive Services. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996
- National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: Department of Health and Human Services, National Institutes of Health; 1997. Publication No. 97-405
- Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a referred population.
J Pediatr Psychol.2003;28
:559
–567
[Abstract/Free Full Text] - Glascoe FP. Parents' Evaluations of Developmental Status: A Method for Detecting and Addressing Developmental and Behavioral Problems in Children. Nashville, TN: Ellsworth & Vandermeer Press; 1997
- Zou G. A modified Poisson regression approach to prospective studies with binary data.
Am J Epidemiol. 2004;159
:702
–706
[Abstract/Free Full Text] - Nicholas D, Huntington P, Williams P. The impact of location on the use of information systems: case study: health information kiosks. J Doc. 2002;58 :284 –301[CrossRef][Web of Science]
- Bull FC, Kreuter MW, Scharff DP. Effects of tailored, personalized and general health messages on physical activity. Patient Educ Couns. 1999;36 :181 –192[CrossRef][Web of Science][Medline]
- Brug J, Campbell M, van Assema P. The application and impact of computer-generated personalized nutrition education: a review of the literature. Patient Educ Couns. 1999;36 :145 –156[CrossRef][Web of Science][Medline]
- Oenema A, Brug J, Lechner L. Web-based tailored nutrition education: results of a randomized controlled trial.
Health Educ Res. 2001;16
:647
–660
[Abstract/Free Full Text] - Strecher VJ. Computer-tailored smoking cessation materials: a review and discussion. Patient Educ Couns. 1999;36 :107 –117[CrossRef][Web of Science][Medline]
- Gould SM, Anderson J. Economic analysis of bilingual interactive multimedia nutrition education. J Nutr Educ Behav. 2002;34 :273 –278[CrossRef][Web of Science][Medline]
- Suellentrop K, Morrow B, Williams L, D'Angelo D. Monitoring progress toward achieving Maternal and Infant Healthy People 2010 objectives: 19 states: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2003. MMWR Surveill Summ. 2006;55(9) :1 –11
- Runyan CW, Johnson RM, Yang J, et al. Risk and protective factors for fires, burns, and carbon monoxide poisoning in US households. Am J Prev Med. 2005;28 :102 –108[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Self-Brown and D. J. Whitaker Parent-Focused Child Maltreatment Prevention: Improving Assessment, Intervention, and Dissemination With Technology Child Maltreat, November 1, 2008; 13(4): 400 - 416. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Stevens, K. J. Kelleher, W. Gardner, D. Chisolm, J. McGeehan, K. Pajer, and L. Buchanan Trial of Computerized Screening for Adolescent Behavioral Concerns Pediatrics, June 1, 2008; 121(6): 1099 - 1105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Palermo Editorial: Section on Innovations in Technology in Measurement, Assessment, and Intervention J. Pediatr. Psychol., January 1, 2008; 33(1): 35 - 38. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
