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Table 2 Characteristics of included studies

From: A systematic review of the use and effectiveness of social media in child health

Author, Year (Country) Study design, target population, and quality assessment Objectives (Length of intervention) Social media intervention Comparator Primary outcome measure (Tool)
Acute      
Braner, 2004 (USA) [11] Cross-sectional. To describe an experience with a Web-based communications program for the patients, families, and referring physicians of patients admitted to the PICU. (Access to website during PICU stay) Social networking site in which PICU nurses and family posted notes and messages, respectively. (n = 78) NA Satisfaction (survey).
PICU patients, their families, and referring physicians.
NA
Lim Fat, 2011 (Canada) [12] Content analysis. To assess YouTube videos on infantile spasms for quality and efficacy as an educational tool for parents and medical staff. (NA) YouTube (n = 54 videos) NA Technical quality (Medical Video Rating System, designed by authors).
Parents of infants experiencing infantile spasms.
NA
Chronic      
Cancer      
Ewing, 2009 (USA) [13] Mixed methods. To develop a Web-based resource for families of children newly diagnosed with cancer. (Access to website for 6 months) Discussion forum as part of a multimedia website including information on coping strategies, ask-an-expert and FAQ sections, and additional resources. (n = 21 families) NA Website usage (usage statistics, Website Evaluation Instrument).
Families with a child (8–17 years) diagnosed with cancer in the past 6 weeks.
NA
Nicholas, 2012 (Canada) [14] Mixed methods. To evaluate the effectiveness of the online peer support network. (Access to forum for 3 months) Discussion forum monitored by social worker. (n = 19) NA Paternal coping, social support and meaning of illness (Coping Health Inventory for Parents, Multi-Dimensional Support Scale, Meaning of Illness Questionnaire).
Fathers of children (4–17 years) with brain tumors.
NA
Juvenile Idiopathic Arthritis     
Stinson, 2010 (Canada) [15] Content analysis. To explore the usability of a self-management program for youth with JIA and their parents to refine the health portal prototype. (NR) Discussion forum as part of 12 modules containing content, graphics, video clips, interactive components, and animations. (n = 19) NA Ease of use (qualitative usability testing approach with semi-structured interviews and observation by a trained observer).
Adolescents (mean 15.7 ± 1.5 years) with JIA.
NA
Renal Disease      
Bers, 2001 (USA) [16] Ethnography. To determine if Zora is safe and satisfying for children with end-stage renal disease on hemodialysis. (NR) Zora, a virtual world in which avatars can build a virtual city, chat with each other in real-time or through message boards, create virtual places and characters and write interactive stories. (n = 12) NA Satisfaction (survey and interview).
Children (7–21 years) receiving dialysis for end-stage renal disease.
NA
Transplant      
Bers, 2009 (USA) [17] Content analysis. To facilitate peer network-building amongst same-age pediatric post-transplant patients. (8 months) Zora, a virtual world in which avatars can build a virtual city, chat with each other in real-time or through message boards, create virtual places and characters and write interactive stories. (n = 22) NA Description of pilot study (home visits, interviews, notes from parents and medical staff, and analysis of the participant chat log).
Post-transplant children (11–15 years).
NA
Type 1 Diabetes      
Merkel, 2012 (USA) [18] Before-after. To determine parents’ self-reported self-efficacy scores related to diabetes care management pre- and post-implementation of a Web-based social support platform. (6 weeks) Discussion threads with area/national community resources and links, and diabetes camp information. (n = 14) NA Parental self-efficacy (Self-Efficacy for Diabetes Scale-Parent Modified; Diabetes Empowerment Scale-Short Form-Parent Modified).
Parents of a child diagnosed with type 1 diabetes.
7/13 points (BAQA)
Moderate quality
Nordfeldt, 2010 (Sweden) [19] Content analysis. Explore patients' and parents' attitudes toward a local Web 2.0 portal tailored to young patients with type 1 diabetes and their parents. (Accessed between 2006–2008) Portal containing blogs, discussion forums and specific diabetes-related information. (n = 24) NA Attitudes toward the functionality of the web portal (interviews).
Parents and pediatric patients (11–18 years) treated by diabetes teams, and their practitioners.
NA
Whittemore, 2010 (USA) [20] RCT To develop an Internet coping skills training program. (4–5 weeks) Discussion forum moderated by a health professional, along with information sessions presented through graphic novel models, and profile creation. (n = 6) Four weekly sessions on glucose control, nutrition, exercise and sick days, and new technology. (n = 6) HbA1C (blood test,%).
Adolescents (13–16 years) with type 1 diabetes.
Unclear RoB
Moderate quality
Other      
Baum, 2004 (USA) [21] Cross-sectional. To determine how primary caregivers of a child with special health care needs rate and describe their reasons for participating in an Internet parent support group in terms of problem-focused and emotion-focused coping. (NR) Discussion forum for a peer support group. (n = 114) NA How problem-focused and emotion-focused coping are associated with reasons for participating in Internet parent support groups (survey).
Parents of children (mean: males 6.5 years, females 8.7 years) with special health care needs.
NA
Nicholas, 2007 (Canada) [22] Ethnography. To examine perceptions and experiences of children who use an online pediatric support network. (NR) Discussion forum as part of an interactive network with other features including information, entertaining activities, chat rooms and videoconferencing. (n = 21) NA Perceived outcomes following hospitalized children’s participation in a pediatric online support network (“long interview”, based on semi-structured approach).
Hospitalized children and adolescents (4–17 years), their parents/caregivers, and healthcare professionals.
NA
Health Promotion      
Healthy Diet & Exercise
Cordeira, 2012 (USA) [23] Before-after. To determine if the Young Leaders for
Healthy Change Fall 2011 program had a significant effect on
nutrition and physical activity behaviors; and known determinants of behavior, including: knowledge, beliefs, attitudes (self-efficacy
and social support) in the domains of nutrition, physical activity, and advocacy. (12 weeks)
Facebook page plus 12 online education-based lessons, 2 online training programs, 12 peer/family weekly challenges, and a community service project. (n = 238) NA Participation in 60 minutes of physical activity every 5–7 days of the week (2008 Physical Activity Guidelines for Americans survey).
High school students in grades 9–12.
4/13 points (BAQA)
Weak quality
DeBar, 2009 (USA) [24] RCT. To test the efficacy of a health plan-based lifestyle intervention to increase bone mineral density in adolescent girls. Youth Talk discussion board, online scrapbook page, psycho-educational information, diet and exercise goal and achievement records, “I Need” and “Ask a Health Question” forums, all available through a web-based study site; group and individual meetings; attendance at a retreat; and coaching telephone calls. (n = 113) Social activities with discussions focused on general health issues rather than bone health specifically; no personalized feedback about behavioral goal attainment. (n = 115) Bone mineral density (Dual Energy X-ray Absorptiometry).
Girls aged 14–16 years with a body mass index below the national average.
High RoB
Weak quality
Lao, 2011 (USA) [25] RCT. To evaluate the impact and feasibility of the Individual Nutrition Health Plans, a nutrition and exercise pilot curriculum focused on improving beverage choice, physical activity, fruit and vegetable consumption, and fast food consumption behaviors. (8 weeks) Individual Nutritional Health Plan administered through text, Facebook, and Twitter. (n = 106) Wait list control. (n = 86) Frequency of sweetened beverage consumption (survey).
Hispanics or low-income high school students aged 14–17 years receiving health plans.
High RoB
Weak quality
Rydell, 2005 (USA) [26] RCT. To promote bone mass gains among girls through increased intake of calcium-rich foods and weight-bearing physical activity. (2 years) Discussion forum, girl scout troop meetings, home activities and summer camp. (n = 194) Regular girl scout troop meetings. (NR) Change in bone mineral content (Dual Energy X-ray Absorptiometry).
Preadolescent girls aged 10–12 years.
High RoB
Weak quality
Savige, 2005 (Australia) [27] Cross-sectional. To examine how one model of e-learning can be used to support the food and nutrition education of future learners. (NR) Discussion forum along with information about food and nutrition, quizzes, story writing, interactive food activities, positive role model profiles, and games with food and nutrition themes. (n = 1349) NA Self-reported intake of food and drink (online survey including a 24-hour recall checklist).
Primary school students in grade 4 and associated composite grades.
NA
Sexual Health      
Cox, 2009 (USA) [28] RCT. To describe the development of a Web-based program to help mothers talk to their children about sex (CASE), and to pilot test the feasibility and efficacy of CASE. Free access to monitored discussion board postings and discussion, professional advice, and e-mail. (n = 20) Same information as the mothers in the intervention group, in notebook form. (n = 20) Self-efficacy (Self-Efficacy of Parents to Discuss Sexual Health Issues with their Adolescents Scale).
Rural, low-income mothers of children in grades 5–10.
High RoB
Weak quality
Jones, 2012 (USA) [29] Cross-sectional. To evaluate an evidence-based social-networking intervention aimed at reducing the incidence of chlamydia among youth. (NR) Facebook page including educational information, and links to videos and resources. (n = 70) NA Intention to engage in risky sexual behavior (survey).
Youth aged 15–24 years.
NA
Lou, 2006 (China) [30] NRCT. To evaluate the effectiveness of the website in increasing adolescents' and young people's knowledge and in changing their attitudes and behaviors regarding sex. (10 months) Website including a discussion forum, information, videos and expert mailbox. (n = 624) No sex education. (n = 713) Knowledge score (survey).
Adolescents and unmarried youth in China.
High RoB
Weak quality
Yager, 2012 (USA) [31] Cross-sectional. To develop and evaluate a Facebook site, Teen Sexual Health Information; and to empower sexually active adolescents who viewed the site with confidential information to help them remain sexually healthy. (NR) Facebook page with videos, photographs, fact sheets about sexually transmitted infections, free and reduced-cost clinic locations for testing and treatment, and links to other online resources. (n = 39) NA Website evaluation (survey).
Adolescents aged 13–20 years.
NA
Smoking Cessation      
Chen, 2006 (Taiwan) [32, 33] NRCT. To develop an Internet-assisted smoking cessation program accompanied with auricular acupressure, and compare the quit rate and self-efficacy of youth smokers receiving auricular acupressure with and without the Internet-assisted smoking cessation program. (4 weeks) Website with eight components: impact of smoking, auricular acupuncture for smoking cessation, critical issues in smoking cessation, online questionnaire, professional counseling, discussion forum, hot topics, and hyperlinked websites. (n = 38) Auricular acupressure only. (n = 39) Mean serum cotinine levels (cotinine direct ELISA kit and reader).
High school seniors who smoke.
High RoB
Weak quality
Patten, 2006 (USA) [34] RCT. To evaluate a novel treatment delivery method for smoking cessation. (24 weeks) Discussion forum along with a gallery to post artwork, information services, videos of personal stories, private journaling, quizzes, quit plan and quit notes. (n = 70) Four brief sessions with research counselors and homework assignments. (n = 69) Point-prevalence smoking abstinence (Cigarette Timeline Followback interview, verified by expired breath carbon monoxide levels ≤8 parts per million).
Adolescent smokers aged 11–18 years
High RoB
Weak quality
Other      
Baggett, 2010 (USA) [35] RCT. To determine if parents would engage in an Internet-delivered intervention to support their infant’s social-emotional development. (NR) Information sharing via a discussion board, with multimedia presentation of concepts, behaviours, and skills; check-in questions; summary of key concepts; daily homework; video of mother-infant interactions for review by coach and parent; and a weekly telephone call from a coach to review content and provide personalized support. (n = 20) Provision of computer and Internet connection, with links to infant development and parenting resources on the Internet. (n = 20) Mother-infant interaction (Landry Parent–child Interaction Scales, free-play observation).
Mothers of infants (3–8 months) at risk for poor social-emotional outcomes.
Unclear RoB
Moderate quality
Hudson, 2012 (USA) [36] RCT. To test the effects of the New Mothers Network on single, low-income, adolescent, African American mothers’ psychological, parenting, and health care utilization outcomes. (6 months) Discussion forum involving research nurse and peers, along with online educational information and e-mail access. (n = 21) Usual care. (n = 21) Depressive symptoms (20-item Center for Epidemiologic Studies Depression Scale).
Single, low-income, adolescent (16–22 years), African American new mothers.
High RoB
  Weak quality     
  1. BAQA: Before-After Quality Assessment Tool; ELISA: enzyme-linked immunosorbent assay; FAQ: frequently asked questions; HbA1C: hemoglobin A1C; JIA: juvenile idiopathic arthritis; NA: not applicable; NR: not reported; NRCT: non-randomized controlled trial; PICU: pediatric intensive care unit; RCT: randomized controlled trial; RoB: Risk of Bias.