The development and feasibility of gamified digital intervention aiming to promote physical activity in early childhood

This study aimed to develop a gamified digital intervention aiming to promote physical activity in early childhood. A further aim was to evaluate the feasibility of the intervention among the target group in child health clinics. The study consists of two phases. The development phase – a cross-sectional correlational study explored developmental factors associated with active play behaviour of 2.5-year-old toddlers (n = 717). Data were collected in child health clinics and consisted of the assessment of child’s neurological development and preference to participate in active play. Data were analyzed statistically. The results showed that delayed gross motor skills, self-help skills and auditory perception were negatively associated with a child’s preference to participate in physically active play. A quantitative systematic review explored previous gamified digital interventions that enhanced the physical activity self-efficacy of children. Data were collected from five electronic databases and analyzed narratively and statistically. The results showed that the gamified digital interventions are effective in enhancing the physical activity self-efficacy of children. The results from a correlational study and systematic review, together with National Physical Activity Recommendations, contributed to the development of the intervention. The feasibility and piloting phase – a mixed-method post-test feasibility study – evaluated the usability and acceptability of the intervention from the perspective of public health nurses (n = 5) and families with a child either 1.5 or 4 years old (n = 15). Data were collected using questionnaires and interviews, and analyzed statistically and with deductive qualitative content analyses. The results showed that the intervention was usable and acceptable. Suggestions for further development of the intervention consisted of simplifying the intervention, adding more gamified elements to be more attractive to children and adding more precise feedback for the parents. Based on these results, the intervention was modified and a cluster-randomized controlled study was planned to evaluate the effectiveness of the intervention.Varhaislapsuuden fyysistä aktiivisuutta edistävän pelillisen digitaalisen intervention kehittäminen ja soveltuvuus Tämän tutkimuksen tarkoituksena oli kehittää pelillisyyttä hyödyntävä digitaalinen interventio lasten fyysisen aktiivisuuden edistämiseen lastenneuvoloissa, sekä arvioida intervention soveltuvuutta lasten, perheiden ja terveydenhoitajien näkökulmasta. Tutkimus koostuu kahdesta vaiheesta. Kehittämisen vaiheessa, korrelatiivinen poikkileikkaustutkimus tutki 2,5-vuotiaiden lasten (n=717) kehityksen ja liikunnallisen leikin välisiä yhteyksiä. Aineisto kerättiin lastenneuvoloissa ja se koostui lasten neurologisen kehityksen arvioinneista ja liikunnalliseen leikkiin osallistumisen arvioinneista. Aineisto analysoitiin tilastollisin menetelmin. Tulosten mukaan motorinen kehitys, omatoimisuus ja kuullun ymmärtäminen olivat yhteydessä lapsen liikunnalliseen leikkiin osallistumiseen. Kvantitatiivisen systemaattisen katsauksen tarkoituksena oli tarkastella aiempia pelillisiä interventioita lasten fyysisen aktiivisuuden minäpystyvyyden edistämisen näkökulmasta. Aineisto kerätiin viidestä sähköisestä tietokannasta ja analysoitiin narratiivisesti ja tilastollisin menetelmin. Tulosten mukaan peli-interventiot ovat tehokkaita lasten fyysisen aktiivisuuden minäpystyvyyden edistämisessä. Korrelatiivisen tutkimuksen ja katsauksen tulokset sekä kansalliset lasten liikunnan suositukset toimivat intervention kehittämisen pohjana.  Soveltuvuuden ja pilotoinnin vaiheessa, monimenetelmäinen soveltuvuustutkimus arvioi intervention käytettävyyttä ja hyväksyttävyyttä terveydenhoitajien (n=5) sekä 1,5- ja 4-vuotiaiden lasten ja heidän perheidensä (n=15) näkökulmasta. Aineisto kerättiin kyselyin ja haastatteluin sekä analysoitiin tilastollisin menetelmin ja laadullisella deduktiivisella sisällön analyysilla. Tulosten mukaan interventio oli käytettävä ja hyväksyttävä. Tutkittavat toivat esiin intervention parantamisehdotuksia, jotka liittyivät intervention sujuvuuden ja pelillisten elementtien lisäämiseen sekä vanhemmille osoitetun yksityiskohtaisemman palautesysteemin luomiseen. Soveltuvuustutkimuksen tulosten perusteella interventiota muokattiin ja intervention vaikuttavuuden tutkimus suunniteltiin satunnaistettuna kontrolloituna tutkimuksena

Instruments assessing nurse educator's competence : A scoping review

AimThe aim of this review was to synthesize the instruments that assess nurse educators' competence. DesignA scoping review was conducted with the five-stage process informed by Arksey and O'Malley. Review MethodsThe predetermined search strategy was used including an additional hand search. The studies were selected according to inclusion and exclusion criteria to answer the research questions followed: (1) "What instruments are used to assess nurse educators' competence?", (2) "How are the psychometric properties of nurse educators' competence instruments reported in the literature?". The thematic synthesis was used. Data SourcesThe literature search was conducted in January 2021 using the CINAHL, MEDLINE and ERIC databases from January 2000 to December 2020. ResultsOf the 1,567 articles searched through, 25 met the inclusion criteria. A total of 19 instruments with 10 areas of competence were identified. Typical competence areas were pedagogical and nursing competence. In addition, leadership in managerial competence was included in several instruments. However, the theoretical backgrounds of the instruments varied and the psychometric properties were reported in varied ways in reviewed studies. Implications for the ProfessionThis study provides evidence about the valid and comprehensive assessment of nurse educators' competence, as competent nurse educators promote excellence in nursing education. To assess a nurse educators' competence comprehensively, a variety of theoretical backgrounds of this competence and more than one instrument for the measurement need to be considered. The selection of the instruments to assess nurse educators' competence should be based on the selected theoretical background and use of valid measurements. Reporting MethodThis study was reported by following the reporting recommendations of the PRISMA extension for Scoping Reviews (PRISMA-ScR). Patient or Public ContributionNo Patient or Public Contribution was applied, since research design was a scoping review.Peer reviewe

Encountering sexual and gender minority youth in healthcare : an integrative review

Aim: To describe the encounters with sexual and gender minority (SGM) youth in healthcare based on the existing research. Background: The development of sexual orientation and gender identity can create challenges in an SGM youth's life, and they may need support from health professionals. Heteronormativity has been recognised as a barrier to the identification of diversity in sexuality and gender, and no previous literature review has studied heteronormativity thoroughly. Methods: An integrative review following Whittemore and Knafl was conducted. A literature search was systematically undertaken in six databases (PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO, Eric, and Academic Search Premier). Finally, 18 research articles were included. Data were analysed deductively with the theoretical framework from Stevi Jackson's (2006) article to understand the role of heteronormativity in the healthcare of SGM youth. Findings: The encounters with SGM youth consisted of two simultaneous themes. Heteronormative care included three elements: (1) the effect of heteronormativity on health professionals' competence to work with SGM youth, (2) false assumptions about SGM youth, and (3) the influence of heteronormativity on encounters with SGM youth. Diversity-affirming care included two elements: (4) the considerateness of health professionals towards SGM youth and (5) inclusive care of SGM youth. Conclusion: This review summarised how SGM youth were encountered in healthcare and how heteronormativity was affecting their healthcare. Furthermore, this review identified elements that supported diversity-affirming care. With diversity-affirming care, SGM youth may access the information and support they need from healthcare. Further research is needed about how diversity-affirming care can be applied to the healthcare of SGM youth and how elements of heteronormative care are occurring globally in the healthcare of SGM youth. The perceptions of transgender and other gender minority youth were under-represented in the studies and research needs to focus more on how they are encountered in healthcare.Peer reviewe

Mobiiliavusteinen ja ammatillisesti ohjattu uusperheinterventio - Intervention soveltuvuus uusperheiden ja sote-ammattilaisten näkökulmasta

Tutkimuksen tarkoituksena oli kuvata uusperheiden hyvinvoinnin edistämiseen kehitetyn mobiiliavusteisen, ammatillisesti ohjatun intervention soveltuvuutta uusperheiden ja ammattilaisten näkökulmasta. Soveltuvuuden arviointi kohdistui intervention hyväksyttävyyteen, hyödyllisyyteen ja jatkokehittämistarpeisiin sekä mobiilisovelluksen käytettävyyteen ja jatkokehittämistarpeisiin. Interventio sisältää viisi sote-ammattilaisten ohjaamaa ryhmätapaamista uusperheiden aikuisille sekä StepApp-mobiilisovelluksen uusperheille. Tutkittavat rekrytoitiin tarkoituksenmukaisella otannalla ja aineisto kerättiin sähköisellä tai paperisella kyselylomakkeella intervention jälkeen. Intervention soveltuvuutta arvioitiin puolistrukturoiduilla kyselyillä ja mobiilisovelluksen käytettävyyttä arvioitiin SUS(System Usability Scale) -kyselyllä. Aineisto analysoitiin temaattisella analyysilla ja kvantifioimalla. Uusperheiden aikuisten (n=35) ja ammattilaisten (n=9) näkemysten mukaan interventio näyttäisi soveltuvan hyvin sote-alan perhepalveluihin. Suurin osa uusperheiden aikuisista ja kaikki sote-ammattilaiset kokivat intervention hyödyllisenä. Uusperheiden aikuisten kuvaamat hyödyt liittyivät interventiosta saatuun vertaistukeen, tietoon, ymmärrykseen sekä käytännön vinkkeihin, ideoihin ja työkaluihin. Lapset ja nuoret (n=5) pitivät osasta sovelluksen pelillisistä ominaisuuksista, mutta esittivät sovellukseen myös kehittämiskohteita. Perheet ja ammattilaiset arvioivat mobiilisovelluksen käytettävyyden hyväksi (SUS-arvo=75). Tutkimuksen tuottamaa tietoa voidaan hyödyntää sote-alalla uusien digitaalisten menetelmien kehittämissä ja käyttöönoton tukena.&nbsp

LGBTQ plus Students' Experiences of Junior High School Nursing in Finland : A Qualitative Study

Previous research shows that lesbian, gay, bisexual, transgender, queer/questioning, and other (LGBTQ+) students can experience substantial emotional- and health-related issues at school, but research into LGBTQ+ students' experiences of school nursing is limited. This qualitative study describes the experiences of Finnish LGBTQ+ students engaging with junior high school nurses. Data were collected from 35 LGBTQ+ students using an online survey tool comprising of a set of open-ended questions. Two interconnecting themes were identified following thematic analysis: (1) junior high school nurse engagement: a mixed or unsatisfactory experience and (2) LGBTQ+ students' needs for diversity-affirming junior high school nursing. Findings show that LGBQT+ students felt junior high school nurse engagement was often unsupportive with issues around their sexuality and gender identity. LGBTQ+ students expressed the need for diversity-affirming information and support in school settings. Further research from school nurses' perspective is needed to increase understanding of this topic.Peer reviewe

3D technologies to support teaching and learning in health care education – scoping review

This scoping review aimed to describe the use of three-dimensional (3D) technology to support teaching and learning in health care education and the outcomes related to 3D technology from the perspective of teaching and learning. The study identified 31 articles that met the inclusion criteria. The results are presented in four categories: 3D environment, 3D image, 3D holograms and 3D print. There were multiple pedagogical contexts, including the teaching of anatomy. All categories were connected to positive learning outcomes and outcomes that supported learning, e.g. satisfaction. Positive learning outcomes were related to skills, knowledge, students’ perceptions and emotions. These findings describe multiple uses of 3D technology, which can have a positive effect on student learning in health care education.</p

No Longer Without a Reward: Do Digital Rewards Crowd Out Intrinsic Motivation of Young Children?

In the learning journey of young children, rewards are ubiquitous. Yet, psychologists and behavioral economists question the success of rewards and even claim that they displace intrinsic motivation, a phenomenon referred to as motivation crowding out. While information systems can help children learn everyday tasks, it is unclear if and when digital rewards produce motivation crowding out. Theoretically sound, empirical field studies on this topic are lacking and existing information system research on motivation crowding is limited to specific domains, not covering children’s behavior. Therefore, we aim to elicit how digital rewards influence an everyday health behavior that children learn in kindergarten – handwashing – and the underlying intrinsic motivation. We conduct a randomized controlled trial that is conceptualized in this paper. Our results will extend motivation crowding theory in the context of young children and inform the design of digital behavior change interventions

Encountering sexual and gender minority youth in healthcare: an integrative review

AimTo describe the encounters with sexual and gender minority (SGM) youth in healthcare based on the existing research.BackgroundThe development of sexual orientation and gender identity can create challenges in an SGM youth’s life, and they may need support from health professionals. Heteronormativity has been recognised as a barrier to the identification of diversity in sexuality and gender, and no previous literature review has studied heteronormativity thoroughly.MethodsAn integrative review following Whittemore and Knafl was conducted. A literature search was systematically undertaken in six databases (PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO, Eric, and Academic Search Premier). Finally, 18 research articles were included. Data were analysed deductively with the theoretical framework from Stevi Jackson’s (2006) article to understand the role of heteronormativity in the healthcare of SGM youth.FindingsThe encounters with SGM youth consisted of two simultaneous themes. Heteronormative care included three elements: (1) the effect of heteronormativity on health professionals’ competence to work with SGM youth, (2) false assumptions about SGM youth, and (3) the influence of heteronormativity on encounters with SGM youth. Diversity-affirming care included two elements: (4) the considerateness of health professionals towards SGM youth and (5) inclusive care of SGM youth.ConclusionThis review summarised how SGM youth were encountered in healthcare and how heteronormativity was affecting their healthcare. Furthermore, this review identified elements that supported diversity-affirming care. With diversity-affirming care, SGM youth may access the information and support they need from healthcare. Further research is needed about how diversity-affirming care can be applied to the healthcare of SGM youth and how elements of heteronormative care are occurring globally in the healthcare of SGM youth. The perceptions of transgender and other gender minority youth were under-represented in the studies and research needs to focus more on how they are encountered in healthcare.</div

Feasibility of mobile health game “Fume” in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

Objective: New interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10–13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website.Methods: In total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n=61), a group with access to the website (n=47), and a group with no intervention (n=43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests.Results: Statistically significant favorable changes during the study period were found for positive (P=0.002)and negative (P=0.02) smoking outcome expectations and attitudes towards cigarette smoking (P=0.01) within the group using Fume. No statistically significant changes were detected within the website or controlgroups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P Conclusions: The intervention with embedded game elements, the health game Fume, was found to be morefeasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking selfefficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.</p

Supporting LGBTQ+ Students: A Focus Group Study with Junior High School Nurses

LBGTQ+ students often miss the support and information they need in the school nursing, but little is known about junior high school (JHS) nurses’ work with LGBTQ+ students. 15 JHS nurses were interviewed in focus groups about their perceptions of supporting LGBTQ+ students. Four interconnected themes were identified with inductive thematic analysis: (1) JHS nurses’ professional identity and practice; (2) Recognition of sexual and gender diversity in school; (3) Family acceptance process; and (4) LGBTQ+ students as school nursing clients. JHS nurses self-identified as accepting professionals, but having limited skills, knowledge, and education needed in supporting LGBTQ+ students. Supporting LGBTQ+ students is a complex phenomenon, and to enhance JHS nurses’ competence in providing care for these students, sexual and gender diversity needs to be included in evidence-based nursing information sources, covered in nursing education, and the school needs to be secured as LGBTQ+ safe place.</p