Abstract
BACKGROUND: Injury is a leading cause of child morbidity and mortality worldwide. Delivering injury prevention programs via mobile platforms, such as applications (apps), may reduce risky behaviors. iBsafe is an "interactive Bike and Bite safety" mobile game app founded in behavioral theory and designed to educate kindergarten-aged children about bicycle and dog-related safety. This study assessed the relationship of iBsafe game play and child safety knowledge and skills; hypothesizing that iBsafe increases safety knowledge with translation to practice. METHODS: This single-blinded, randomized, controlled field trial included sixty 5-6-year-old children. Parent-child dyads were randomly assigned to receive a weeklong field trial of iBsafe or control. Pre- and post-intervention safety knowledge tests were completed; post-intervention safety skills assessments occurred in a simulated safety lab using real props (i.e., safety street, bicycles, and live dogs). The primary outcome was child bicycle and dog-related safety knowledge and skills performance. Performance was assessed by blinded reviewers. Secondary outcomes included frequency of safety discussion in groups and iBsafe acceptability. RESULTS: Thirty children were randomized to each group; there were no substantial demographic differences between groups. Compared to controls, post-intervention iBsafe children had higher bicycle and dog-related safety knowledge scores (9.2±0.9 vs. 8.7±1.0, P=0.029 and 8.2±2.1 vs. 6.7±1.8, P=0.003, respectively); and they exhibited more safety skills (median number bicycle skills 5 vs. 4, P=0.007; median number dog-related skills 5 vs. 3, P<0.001, respectively). Frequency of safety conversations increased among intervention families during the trial, and iBsafe acceptability was near universal. CONCLUSIONS: iBsafe was effective at increasing child safety knowledge and improving safety skills. Child injury prevention programs that embrace interactive mobile platforms may expand reach and possibly decrease injury outcomes.