A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial

Yingfeng Zheng, Wei Wang, Yuxin Zhong, Fengchun Wu, Zhuoting Zhu, Yih-Chung Tham, Ecosse Lamoureux, Liang Xiao, Erta Zhu, Haoning Liu, Ling Jin, Linyi Liang, Lixia Luo, Mingguang He, Ian Morgan, Nathan Congdon, Yizhi Liu, Yingfeng Zheng, Wei Wang, Yuxin Zhong, Fengchun Wu, Zhuoting Zhu, Yih-Chung Tham, Ecosse Lamoureux, Liang Xiao, Erta Zhu, Haoning Liu, Ling Jin, Linyi Liang, Lixia Luo, Mingguang He, Ian Morgan, Nathan Congdon, Yizhi Liu

Abstract

Background: The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions.

Objective: The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children's anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic.

Methods: In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality.

Results: On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root-transformed self-reported anxiety scores was greater in the intervention (-0.23, 95% CI -0.27 to -0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference -0.36, 95% CI -0.63 to -0.08; P=.02). There was a significant reduction in square-root-transformed eye strain in the intervention group (-0.08, 95% CI -0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference -0.15, 95% CI -0.26 to -0.03; P=.02). Change in sleep quality was similar between the two groups.

Conclusions: This digital behavior change intervention reduced children's anxiety and eye strain during COVID-19-associated online schooling.

Trial registration: ClinicalTrials.gov NCT04309097; https://ichgcp.net/clinical-trials-registry/NCT04309097.

Keywords: COVID-19; anxiety, digital eye strain; app; behavior; children; digital health; health information; homeschooling; intervention; live streaming; mobile phone; online learning; peer to peer; physical activity.

Conflict of interest statement

Conflicts of Interest: YL reports receiving grants from the National Natural Science Foundation of China. Y Zheng has served on the digital advisory board for Novartis and is the owner of the REAP app. NC is the director of research for Orbis International, a nongovernmental organization that carries out children’s eye health work in China. The remaining authors have no disclosures to report.

©Yingfeng Zheng, Wei Wang, Yuxin Zhong, Fengchun Wu, Zhuoting Zhu, Yih-Chung Tham, Ecosse Lamoureux, Liang Xiao, Erta Zhu, Haoning Liu, Ling Jin, Linyi Liang, Lixia Luo, Mingguang He, Ian Morgan, Nathan Congdon, Yizhi Liu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.04.2021.

Figures

Figure 1
Figure 1
Flow diagram for the trial.
Figure 2
Figure 2
The proportion of participants sharing photos or video content related to home workouts in the intervention group.

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