Authors
Raffaella Dobrina, Chiara De Vita, Laura Brunelli, Giulia Galvani, Margherita Dal Cin, Manuela Giangreco, Milena Ciampechini, Silvana Schreiber, Giada Ferrari, Paola Di Rocco, Sara Zaccariotto, Maria Lucrezia Saija, Ilaria Del Giorno, Sara Zanchiello, Anja Starec, Andrea Cassone
Published in
JMIR mHealth and uHealth. Volume 14. Pages e93989. Sep 01, 2026. Epub Sep 01, 2026.
Abstract
Pediatric ear, nose, and throat (ENT) surgery is common, but generates perioperative anxiety for caregivers and distress in children. Limited time for perioperative education and reliance on unverified online information can reduce family preparedness and increase stress. Few studies have evaluated co-designed mobile health (mHealth) apps to support and engage families in the perioperative ENT journey.
This study aimed to compare caregiver anxiety between an mHealth app-supported care pathway and standard supportive and educational care alone in the perioperative ENT context. Secondary objectives explored between-group differences in caregiver anxiety at follow-up, family preparation, child distress, and social-impact indicators.
A 2-arm, parallel-group, open-label randomized controlled trial (RCT) enrolled caregivers of children undergoing ENT surgery (tonsillectomy, adenoidectomy, tympanostomy tube insertion). The intervention was an mHealth app co-designed through a user-centered participatory approach and developed following Schnall and colleagues' Information Systems Research Framework, with content based on caregivers' informational needs. RCT participants were recruited at the hospital during their presurgery visit, when a health care provider introduced the study and provided instructions on how to use the app. No additional human support was scheduled thereafter. A sample size of 180 participants (90 per group) was estimated to detect the expected between-group difference in caregiver anxiety. Participants were randomly assigned in a 1:1 ratio to app use or standard care alone. The primary outcome was the between-group difference in caregiver state anxiety (State-Trait Anxiety Inventory [STAI-Y]). Secondary outcomes included between-group differences in child distress (modified version of the Yale Preoperative Anxiety Scale [mYPAS]), child preparation for surgery, family preparation for hospital admission and surgery, and social impact indicators. Outcomes were assessed online through questionnaires, which included both self-reported measures and evaluations completed by a nurse on the day of surgery. App engagement metrics were also collected. Reporting followed the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines.
The study enrolled 227 caregivers, with 111 allocated to the control group (CG) and 116 to the experimental group (EG), achieving the target sample size. No statistically significant differences were observed between the groups for the primary or secondary outcomes (all P>.05). In the EG, 75% (n=87) of the participants accessed at least 1 item of in-app content. Higher baseline anxiety was linked to lower app use (ρ=-0.22, 95% CI -0.39 to -0.04; P=.02), while greater use was linked to lower child distress (ρ=-0.23, 95% CI -0.40 to -0.04; P=.02).
Although the hypotheses were not confirmed, these findings provide valuable insights for future perioperative mHealth research. The lack of effectiveness may reflect limited exposure to the intervention, outcome selection and timing, and contextual factors such as caregivers' independent information-seeking. These findings support a greater focus on implementation processes and on identifying the caregivers most likely to benefit from mHealth-supported education.
PMID:
42678982
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 3
- Comments 0