Burgess, Jacqueline, Watt, Kerrianne, Kimble, Roy, and Cameron, Cate (2018) Combining technology and research to prevent scald injuries: results from Cool Runnings randomised controlled trial. Journal of Medical Internet Research, 20 (10). e10361.

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Abstract

Background: New technologies, widespread availability of the internet, the rise of social media and increased ownership of smartphones provide new opportunities for health researchers to communicate and engage with target audiences. This new technology was used to recruit mothers of young children to a smartphone application (app) to increase their knowledge about childhood burns (specifically hot beverage scalds) and correct burn first-aid. This six-month intervention deployed on the Cool Runnings app, used gamification techniques to reinforce intervention messages and engage participants.

Method: A two-group, parallel, single blinded, randomized controlled trial (RCT) to evaluate the efficacy of a smartphone app-based burn prevention intervention. Participants were women aged 18+, living in Queensland, Australia, with at least one child aged 5-12 months at the time of enrolment. The primary outcome measures was were change in knowledge around burn risk and correct burn first-aid assessed via two methods: overall score; and categorised as adequate (score =4) vs inadequate (score less than 4). Efficacy of gamification techniques was also assessed (measured by: app opens, photo uploads, pop quiz completions and content views).

Results: In total, 498 participants were recruited via social media and enrolled. At 6-month follow-up, 244 participants completed the post-test questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those who were lost to follow up on any characteristics except for education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge post-test than control group participants on both primary outcome measures (overall knowledge intervention: (Mean±SD of overall knowledge ) Mean=2.68±SD1.00 for intervention vs 2.13±SD1.03 for control, and mean:2.13±SD1.03; intervention: 20.7% adequate in intervention vs 7.3% in control: 7.3%). Consequently, the NNT was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage had 7.3 times higher odds of improved overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between each of the four gamification techniques and knowledge change (p<0.001). In addition, odds of knowledge improvement between baseline and 6-month follow-up was higher in participants with low/moderate 'app activity' compared with no app activity (OR=8.59;95%CI=2.9-25.02); and much higher in participants with high app activity (OR= 18.26; 95%CI=7.1-46.8).

Conclusions: Despite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about hot beverage scald risks and burn first-aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to, and engage with targeted populations, results from this RCT provides important information on how smartphone applications can be used for widespread injury prevention campaigns, and public health campaigns generally.

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