Mobilizing Community Networks to Optimize Child Well-being
Condition: Social Isolation
Study type: Interventional

Summary: 
      Caregiver social isolation adversely impacts child health and developmental outcomes; it also
      contributes to suboptimal engagement in health care services and enrichment resources, which
      also elevate risk for poor outcomes in childhood. The proposed pilot intervention aims to
      reduce social isolation and promote engagement in health promoting enrichment and activities,
      by embedding a community health worker assisted forum in a community-driven mobile
      communications (using a platform supported by the company txtwire).

      The investigators propose a two-arm, pilot study enrolling 100 parents of children age 0-5
      years old who reside in the Roxbury, Dorchester, and Mattapan neighborhoods of Boston.
      Participants will be recruited from Boston Medical Center and community sites in Roxbury,
      Dorchester, and Mattapan. The investigators will use quality improvement methods to improve
      the utilization of the mobile communications shared through txtwire to build collective
      efficacy for children and social support and engagement that will optimize family resiliency
      and thereby promote child well-being, as well as, assess the acceptability of the
      intervention, and logistics of the field implementation to ultimately inform an appropriately
      powered RCT. Participants will receive compensation for participation at baseline and
      follow-up interviews.

      The intent of this study is to support developement of mobile social communications to reduce
      social isolation.
    

Detailed description: 
      The investigators propose a two-arm, pilot study enrolling 100 parents of children age 0-5
      years old who reside in the Dudley Square neighborhood of Boston. Participants will be
      recruited from Boston Medical Center and community sites in Dudley Square. After completing
      the baseline survey, 50% of participants will be randomized to receive access to a free
      mobile communications and a web-based informational platform supported by txtwire. A simple
      randomization technique will be used.

      The investigators will engage a group of community residents (who are not study participants)
      in the process of designing the social network content for the txtwire site and features.

      The investigators will use quality improvement methods to improve the utilization of the
      txtwire mobile communications to improve social support and engagement that will optimize
      family resiliency and thereby promote child well-being, as well as, assess the acceptability
      of the intervention, and logistics of the field implementation to ultimately inform an
      appropriately powered RCT.

      Recruitment will take place at Boston Medical Center in the outpatient pediatric primary care
      clinic and at public, community sites in Dorchester, Roxbury and Mattapan. The investigators
      will have a trained research assistant approach and recruit parents who are presenting for
      well-child care visits. The locations will be selected to maximize convenience for the
      families. A trained research assistant, following this standard procedure will screen parents
      presenting with a child between the ages of 0 and 5 years old for a routine health care
      maintenance visit from the clinical waiting areas at BMC and from public community sites.

      Participants will be approached by a trained research assistant who will share a 1-page flyer
      about the study (see attached) and ask if they would like to proceed with the eligibility
      screening. For patients who meet inclusion/exclusion criteria, formal consent and contact
      information will be obtained. In order to proceed with the interview parents must agree to a
      follow-up interview in 6-months via phone or in-person.

      Participants will be approached in the clinic waiting area at Boston Medical Center and in
      open community sites in the Dorchester, Roxbury, and Mattapan neighborhoods.

        1. First, the investigators will conduct a preliminary eligibility screen to determine
           participant eligibility using the criteria described below.

        2. Next, each participant will complete a contact information form that includes name, cell
           phone number, home address, and email address.

        3. Next, Each participant will complete a baseline survey.

      After completing the baseline survey, the investigators will randomize 50% of participants to
      the intervention arm: the free txtwire social mobile communications. The investigators will
      randomize 100 caregivers with a child between the ages of 0-5 years old and have a primary
      residence in the Dorchester, Roxbury, or Mattapan neighborhoods of Boston. 50% of
      participants will be randomized to the free txtwire mobile communications. With the exception
      of cellphone number there will be no identifying data recorded by txtwire.

      Subjects will be randomly allocated to study arms to eliminate unmeasured confounding. For
      those who consent, the investigators will randomize 1:1, according to a pre-made, concealed
      schedule. Subjects will be randomized to txtwire mobile communications or no intervention.
      Fifty caregivers in the intervention arm will receive a brief, in-person, training on how to
      use the txtwire mobile communications and assistance with setting it up on their mobile
      devices. Fifty caregivers will be randomized to the control arm. Members of the control arm
      will not receive any additional training or app. For both arms, the investigators will track
      engagement with community resources and services for child health and enrichment, social
      support and networks, and child and family well-being over a 6 month period using brief
      monthly electronic surveys completed on the mobile phone. These surveys will be administered
      using Mobile Commons. At the end of the 6 month period all subjects will complete a follow-up
      survey. They will receive compensation for completion. If an in-person interview is not
      possible, the investigators will conduct a phone interview.

      The investigators will meet with community members who are not study participants to receive
      feedback on the content, layout, txtwire platform.

      The investigators will meet biweekly as a team with the Community Health Worker, Research
      Assistant, Dr. Boynton-Jarrett and data manager. Using the Institute for Healthcare
      Improvement's Model for Improvement Plan-Do-Study-Act (PDSA) methodology, the investigators
      will review the use of the txtwire mobile communications and attempt to improve functioning
      of the community health worker mediated forum in an iterative fashion. Intervention study
      participants will be able to provide feedback on the utility of information provided through
      the txtwire mobile communications using the online platform. The investigators will plan for
      a change in one facet of the intervention, implement that change (do), study whether the
      desired effect was achieved, and act to determine if further optimization is needed. The
      investigators hope to engage in two or three PDSA cycles during the intervention period.

      The investigators will conduct a semi-structured qualitative interviews with our intervention
      subjects to better understand engagement with the txtwire mobile communications at the time
      of the follow-up survey. The investigators intend to use the qualitative interview techniques
      to understand attitudes, behaviors, and motivations for interacting with the system.
    

Intervention name(s): Project NOW
Intervention type(s): Behavioral
Intervention description(s): This intervention aims to reduce social isolation and promote engagement in health promoting enrichment and activities, by embedding a community health worker-assisted forum in a community-driven mobile communications through a private, secure, and confidential platform supported by txtwire. The principal innovation is harnessing both the behavioral change utility of a mobile health application and the social support potential of an online social network the investigators can deliver more timely and dynamic reinforcement to caregivers and social support more in rhythm with the pace of community events and stressors.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other