JMIR PEDIATRICS AND PARENTING Lam et al

Original Paper

Parents’ and Students’ Perceptions of Telepractice Services for

Speech-Language Therapy During the COVID-19 Pandemic:
Survey Study

Joseph Hin Yan Lam, BSc; Stephen Man Kit Lee, BSc; Xiuli Tong, PhD
Human Communication, Development, and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong

Corresponding Author:
Xiuli Tong, PhD
Human Communication, Development, and Information Sciences
Faculty of Education
The University of Hong Kong
Room 804C, Meng Wah Complex
Pokfulam
Hong Kong
Phone: 852 22415982
Email: [email protected]

Abstract
Background: The ongoing COVID-19 pandemic has resulted in the suspension of face-to-face classes and a considerable
increase in the use of telepractice services in speech-language pathology. However, little is known about parents’ and students’
satisfaction with telepractice services and their preferences for different service delivery modes. These factors may affect therapy
effectiveness and the future adoption of telepractice.
Objective: We evaluated students’ and parents’ perceptions of telepractice efficacy and their preferences for different service
delivery modes (ie, on-site practice vs telepractice). We also identified factors that affect parents’ and students’ preferences for
different service delivery modes during the COVID-19 pandemic.
Methods: A 19-question survey on telepractice satisfaction and preferences was administered to 41 Hong Kong Chinese students
and 85 parents who received telepractice services from school-based speech-language pathologists during the COVID-19 class
suspension period. In addition to providing demographic information and data on the implementation of telepractice services, all
participants were asked to rate their perceptions of the efficacy of telepractice services and compare on-site practices to telepractice
on a 5-point Likert scale (ie, 1=strongly disagree/prefer the use of on-site speech-language therapy services and 5=strongly
agree/prefer the use of telepractice services).
Results: Despite the fact that telepractice efficacy was highly rated by parents (95% CI 3.30-3.66) and students (95% CI
3.21-3.76), both groups believed that telepractice was less effective than on-site practices (parents: 95% CI 2.14-2.52; students:
95% CI 2.08-2.65). Moreover, parents preferred on-site practices over telepractice (95% CI 2.04-2.43), whereas students did not
prefer one mode of practice over the other (95% CI 2.74-3.41). A significant association between telepractice efficacy and a
preference for telepractice services was found only among the students (τ=.43, P<.001), not the parents (τ=.07; P=.44).
Conclusions: Although telepractice is an acceptable alternative service delivery option for providing speech and language
therapy services to school-aged individuals, speech-language therapists and parents must play a more proactive role in telepractice
services to facilitate effective communication between clinicians and parents.

(JMIR Pediatr Parent 2021;4(1):e25675) doi: 10.2196/25675

KEYWORDS
eHealth; telepractice; speech and language pathology; user satisfaction; COVID-19; school-based service

distancing and school closures worldwide. As a result, telehealth

Introduction (ie, the use of audio or videoconferencing technology to provide
As of January 2021, over 90 million people have been infected health care services) has received increasing attention.
with the SARS-CoV-2 virus. This has necessitated social Telehealth care has been regarded as an alternative to

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face-to-face care in many countries [1,2]. Furthermore, services. Thus, in this study, we examined how clients’ therapy
speech-language pathologists have engaged in telepractice over characteristics, including age, comorbidity, and parent support,
the past 2 decades in various countries [3-6]. The efficacy of influence their preferences for different modes of service. This
telepractice has been supported by scientific research on speech, information may inform speech-language pathologists about
language, voice, and fluency disorders across different age selecting appropriate students for telepractice services [10].
groups [7-9]. Additionally, telepractice has been deemed valid
In summary, the following 3 research questions were addressed
and effective by different professional organizations [10,11].
in this satisfaction survey study: (1) what are parents’ and
With the COVID-19 pandemic seriously disrupting the provision
students’ perceptions of telepractice efficacy; (2) do parents
of speech and language therapy services, telepractice services
and students prefer on-site practices or telepractice; and (3)
have been increasingly adopted and regarded as the best option
what are the critical factors that affect parents’ and students’
for delivering speech and language therapy during the pandemic
preferences for different service delivery modes?
[12,13].
Despite the increasing adoption of telepractice in schools, Methods
various stakeholders have held different beliefs about
telepractice. Although several surveys have shown that Survey Design and Development
school-based speech-language pathologists doubt the efficacy
Survey Summary
of telepractice, others have revealed a positive attitude after
using telepractice services [12,14,15]. However, parents’ and We developed a web-based survey for both parents and students
children’s perceptions of telepractice are not well understood. to evaluate school-based speech and language therapy practices
A few studies have examined parents’ and students’ satisfaction in Hong Kong (see Multimedia Appendix 1). To meet internal
with telepractice programs, but the findings have been mixed. clarity, construct, and content validity criteria, all survey
In a pilot survey, 13 teachers and 8 parents from a remote school questions were independently reviewed by 3 school-based
were highly satisfied with the progress brought about by speech-language pathologists. This review ensured that the
telepractice [8]. Positive findings were also noted in parents’ survey’s wording, content, and question order were clear and
and students’ responses to a survey on web-based speech and appropriate. The survey questions were revised and finalized
language interventions that were conducted by university clinics in accordance with the speech-language pathologists’
[8,16]. In contrast, an interview study of 5 parents raised suggestions. All respondents completed the survey in about 10
concerns about poor telepractice engagement by students and minutes. Ethics approval was granted by the Human Research
ineffective communication between parents and clinicians in Ethics Committee of University of Hong Kong, and participants
telepractice services [17]. These factors may lower people’s signed consent forms before completing the survey.
acceptance of school-based telepractice services [17]. Given The survey for parents and students consisted of 4 sections,
the high rate of telepractice adoption in school settings during including (1) the implementation of telepractice, which consisted
the pandemic [12,13], a survey study on parents’ and students’ of 2 items; (2) telepractice efficacy, which consisted of 7 items
satisfaction with telepractice could reveal the perceived efficacy for parents and 4 items for students; (3) the comparison between
of these services. telepractice and on-site practice, which consisted of 6 items for
Perceived efficacy is an important measure in speech and parents and 5 items for students; and (4) demographics, which
language therapy for both on-site practices and telepractice, consisted of 5 items. All responses for sections 2 and 3 were
because it reflects the effectiveness of the therapy and students’ based on Likert-type scale scores, which ranged from 1 (ie,
and parents’ motivations for undergoing the therapy [18,19]. strongly disagree) to 5 (ie, strongly agree).
The Davis’ Technology Acceptance Model also argues that Section 1: Implementation of Telepractice
perceived efficacy, which is based on perceived usefulness and
convenience, influences the future adoption of technology [20]. The 2 items in this section assessed the amount of therapy
Perceived efficacy can be reflected by people’s engagement students received and how frequently students used telepractice
with therapy sessions, which correlates with children’s treatment services during the COVID-19 class suspension period.
outcomes [21]. Moreover, the amount of therapeutic skills that Section 2: Telepractice Efficacy
families practice during their daily routine and the collaboration
The 7-item survey for parents included questions about whether
between clinicians and parents affect the generalization of
telepractice was effective in enhancing their child’s language
treatment [22]. Therefore, investigating parents’ and students’
skills, meeting their child’s needs, engaging with their child,
perceptions of telepractice efficacy and their involvement with
and providing satisfaction with the amount of therapy their child
telepractice and daily therapeutic practices are critical for
received (Cronbach α=.94). The 4-item survey for students
evaluating treatment fidelity.
included questions about whether telepractice services met their
Previous studies have largely focused on students’ and parents’ needs and whether they enjoyed telepractice services (Cronbach
satisfaction with research-oriented telepractice, but none have α=.84).
investigated clients’ and parents’ preferences for different modes
Section 3: Comparison Between Telepractice and On-site
of practice. Since service delivery modes have expanded during
the pandemic, students’ and parents’ preferences for different Practice
delivery models are critical for designing a future service The 6-item parent survey included questions about whether
delivery model for school-based speech and language therapy telepractice services for speech therapy provided better
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communication than on-site speech and language therapy. There week (parents’ survey: 21/85, 24%; students’ survey: 12/41,
were also questions regarding the implementation of home 29%).
therapy practices (Cronbach α=.89). The 5-item student survey
included questions about whether students learned better
Telepractice Efficacy
language skills and exhibited better engagement with on-site Parents and students had positive views of the efficacy of
practices than with telepractice (Cronbach α=.88). telepractice with respect to their understanding of the treatment
goals (parents: mean 3.48, SD 0.84; 95% CI 3.30-3.66; students:
Section 4: Demographics mean 3.49, SD 0.87; 95% CI 3.21-3.76) and the ability of
The 4 items in this section were used to collect information on telepractice services to meet the needs of students (parents:
each student’s grade, gender, special education needs status, mean 3.24, SD 1.03; 95% CI 3.01-3.46; students: mean 3.49,
and family income. SD 0.84, 95% CI 3.22-3.75). Based on the parents’ responses,
parents had positive views of students’ enjoyment of telepractice
Participants services (mean 3.29, SD 1.14; 95% CI 3.05-3.54) and the ability
From July to August 2020, 85 parents (ie, 75 mothers and 10 of telepractice services to enhance students’ language abilities
fathers) and 41 students (ie, 7 girls and 34 boys) participated in (mean 3.33, SD 1.01; 95% CI 3.11-3.55). Based on the students’
our web-based survey. Based on the last 4 digits of participants’ responses, students had a neutral view of telepractice efficacy
telephone numbers, 27 families participated in both the parent with regard to (1) enjoyment (mean 3.32, SD 1.08; 95% CI
and student surveys. These 27 families accounted for the 31% 2.98-3.66) and (2) language ability enhancement (mean 3.29,
(27/85) of parents and 65% (27/41) of students who participated. SD 0.96; 95% CI 2.99-3.59). Independent 2-tailed sample t tests
The families who responded to both the parent and student revealed that there were no significant differences in the above
questionnaires represented students from Grades 1-7 (parents’ views between parents and students (enjoyment: P=.92;
questionnaire: median=Grade 3; students’ questionnaire: understanding of treatment goals: P=.97; meeting students’
median=Grade 4). In terms of students’ comorbidities in the needs: P=.18; language ability enhancement: P=.85). In addition,
parent survey, the most prevalent special educational needs parents held a positive view of the progress that students made
subtype was autism spectrum disorder (53/85, 62%), followed during telepractice services (mean 3.35, SD 0.96; 95% CI
by attention deficit/hyperactivity disorder (33/85, 38%), specific 3.15-3.56) and a neutral view of the amount of therapy that
learning difficulties (20/85, 23%), intellectual disabilities (3/85, students received (frequency: mean 2.99, SD 1.04; 95% CI
3%), hearing impairment (2/85, 2%), visual impairment (1/85, 2.76-3.21; amount of therapy: mean 3.21, SD 1.03; 95% CI
1%), and physical disabilities (1/85, 1%). Additionally, 12% 2.99-3.43).
(11/85) of students had no comorbidities except for speech and
language disorders. In terms of students’ comorbidities in the Factors That Affected Telepractice Efficacy
student survey, the most prevalent special educational needs Our Spearman rank-order correlation analysis showed that there
subtype was autism spectrum disorder (24/85, 58%), followed were no significant correlations between student grade and
by attention deficit/hyperactivity disorder (15/41, 36%), specific perceived telepractice efficacy (parents: ρ=0.03; P=.76;
learning disorders (6/41, 14%), intellectual disabilities (1/41, students: ρ=0.07; P=.65). The Bayes factor (BF) was computed
2%), and visual impairment (1/41, 2%). Additionally, 21% to evaluate whether the evidence supported the null hypothesis
(9/41) of students had no comorbidities except for speech and over the alternative hypothesis. BF01 values of >3 and >10
language disorders. Around half of the participants (parents’ indicated moderate and strong support, respectively, for the null
survey: 42/85, 49%; students’ survey: 22/41, 53%) had an hypothesis [25]. Strong evidence that supported the null
average monthly family income that fell below the median for hypothesis (ie, no correlation between grade and telepractice
average household income (ie, around US $3290). efficacy) was found in the parent group (BF01=11.34), whereas
To achieve a Cronbach α value of .05 and a moderate effect moderate evidence that supported the null hypothesis was found
size (ie, Cohen d=0.5), a statistical power of .99 and .86 was in the student group (BF01=7.84).
needed for 85 parents and 41 students, respectively. This was
Comparison Between Telepractice and On-site Practice
determined by using G*Power 3 software (G*Power Team)
[23]. In addition, good quality results can be obtained by Students’ enjoyment of telepractice services and on-site services
performing a factor analysis on samples with at least 50 people was comparable, based on the students’ responses (mean 2.93,
or samples with a factor loading value of >.60 [24]. SD 1.06; 95% CI 2.59-3.26). However, students’ enjoyment of
telepractice services was lower in the parents’ responses (mean
Results 2.76, SD 1.02; 95% CI 2.54-2.98). Furthermore, telepractice
was rated lower than on-site practice in terms of treatment
Implementation of Telepractice effectiveness. The aspects of treatment effectiveness included
the acquisition of speech and language skills (parents: mean
Most students reported that they had fewer than 5 telepractice
2.47, SD 0.92; 95% CI 2.27-2.67; students: mean 2.46, SD 0.93;
sessions during the pandemic (parents’ survey: 73/85, 85%;
95% CI 2.17-2.76), communication with speech-language
students’ survey: 31/41, 75%). In terms of session frequency,
pathologists (parents: mean 2.52, SD 0.88; 95% CI 2.33-2.71;
the most common amount of therapy was 1 session per month
students: mean 2.32, SD 0.82; 95% CI 2.06-2.58), and treatment
(parents’ survey: 35/85, 41%; 36%; students’ survey: 15/41,
efficacy (parents: mean 2.33, SD 1.89; 95% CI 2.14-2.52;
36%), followed by 1 session per 2 weeks (parents’ survey:
students: mean 2.37, SD 0.92; 95% CI 2.08-2.65). An
25/85, 29%; students’ survey: 15/41, 37%), and 1 session per
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independent 2-tailed sample t test revealed no significant preferences for the 2 service delivery modes (parents: ρ=0.07;
differences in these aspects between parents and students P=.52; students: ρ=0.03; P=.85). The BF analysis showed
(enjoyment: P=.41; acquisition of speech and language skills: strong evidence that supported the null hypothesis (ie, no
P=.97; communication with speech-language pathologists: correlation between grade and preferences for the mode of
P=.22; treatment efficacy: P=.83). In addition, parents rated practice) in the parent group (BF01=10.89), whereas moderate
telepractice lower than on-site practice, in terms of the evidence that supported the null hypothesis was found in the
implementation of therapy practices at home via telepractice student group (BF01=8.17).
services or on-site services (mean 2.46; 95% CI 2.27-2.65).
Treatment Efficacy
Parents had a significant negative view of telepractice, with
regard to whether they preferred telepractice over on-site To examine the relationship between treatment efficacy and
practice (mean 2.24; 95% CI 2.04-2.43), whereas students had preferences for the 2 service delivery modes, we created a
a neutral view (mean 3.07; 95% CI 2.74-3.41). An independent composite score based on the factor scores that were obtained
2-tailed sample t test revealed a significant difference in from our exploratory factor analysis, by performing principal
preferences for telepractice and on-site practice between parents axis factoring extraction. As shown in Table 1, we obtained a
and students (t124=4.59; P<.001; d=0.87; 95% CI 0.48-1.26). factor score that accounted for 73% and 69% of the variance in
the parent and student groups, respectively. All factor loadings
Factors That Affected Preferences for Telepractice were greater than .55.
and On-site Practice
Grade
Our Spearman rank-order correlation analysis showed no
significant correlations between student grade and participants’

Table 1. Principal axis factoring analysis of questions on telepractice efficacy. The pattern matrix for parents and students is shown.
Item Parentsa, factor loading value Studentsb, factor loading value
Student enjoyment .857 .552
Understanding of treatment goals .798 .941
Meeting the needs of students .926 .776
Enhancing speech and language abilities .903 .819
Understanding treatment progress .914 N/Ac
Appropriate session frequency .726 N/A
Appropriate session duration .670 N/A

a
The factor score for the parent group accounted for 73% of the variance in the items. Each item had an eigenvalue of 5.13.
b
The factor score for the student group accounted for 69% of the variance in the items. Each item had an eigenvalue of 2.79.
c
N/A: not applicable. These items only appeared in the parent questionnaire.

The Kendall rank correlation coefficient, τ, was computed based Although students and parents had similar preferences for
on the factor scores for telepractice efficacy and preferences telepractice and on-site practice, parents preferred on-site
for the mode of practice. No significant correlation was found practices. These findings are discussed in terms of telepractice
in the parent group (τ=.07; P=.44); the BF for this correlation efficacy and factors that affect engagement with telepractice
(BF01=8.53) moderately supported the null hypothesis (ie, there services.
is no correlation between telepractice efficacy and preferences
Perceived Efficacy of Telepractice
for the mode of practice). A significant correlation between
telepractice efficacy and preferences for the mode of practice One important finding of this study was that students and parents
was found in the student group (τ=.43; P<.001). who engaged in telepractice services expressed satisfaction with
these services, as evidenced by their ratings for telepractice
Discussion services in school settings. These ratings show that telepractice
services not only improved students’ speech and language
Principal Findings abilities, but also increased students’ engagement with
speech-language therapy and their motivations for learning.
Unlike previous telepractice studies, which have largely focused
These results extend the findings of client satisfaction studies
on clinicians’ attitudes, our study examined parents’ and
that focused on the evaluation of telepractice treatment programs
students’ perceptions of telepractice efficacy and their attitudes
[16,26,27]. These results also suggest that telepractice services
toward telepractice during the COVID-19 pandemic. We found
help with retaining user satisfaction in real-life school service
that students and parents were satisfied with the efficacy of
settings. Users’ satisfaction with telepractice is supported by
treatments that were provided through telepractice services.

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compelling evidence concerning telepractice services for school-aged population during the COVID-19 pandemic.
school-aged students with various disorders [7,28,29]. This Evaluating parents’ and students’ perceptions of the efficacy of
evidence suggests that students with special education needs telepractice is critical. This information not only helps
can benefit from treatments that are provided through speech-language therapists understand clients’ perceptions of
telepractice services. telepractice, but also informs educational policy makers about
the implementation and adoption of telepractice services beyond
Preference for Telepractice and On-site Practice the pandemic period. Our study clearly demonstrates that users’
Despite students’ and parents’ satisfaction with telepractice satisfaction with telepractice helps to promote evidence-based
efficacy, students did not prefer one mode of practice over the telepractice. Based on our analysis of both parents’ and students’
other, whereas parents preferred on-site practice over attitudes toward telepractice, we believe that both stakeholders
telepractice. However, there was no significant correlation acknowledged the efficacy of telepractice. This is a positive
between telepractice efficacy and parents’ preference for on-site indicator for the future adoption of telepractice as another
practice (P=.44). This indicates that other concerns may have possible service delivery method, which is needed due to the
influenced parents’ preferences. Interestingly, compared to potential psychosocial challenges of the COVID-19 pandemic.
parents’ views of on-site practice, parents expressed a negative Such challenges include disrupted clinical routes, school
view of telepractice in terms of treatment effectiveness, the closures, and reduced educational and medical support [35].
implementation of therapy practices at home, and
communication with speech-language pathologists. This Limitations and Future Research
negative opinion can be explained by the lack of effective This study focused on a limited sample size with a restricted
communication in telehealth. Due to the lack of personal age range (ie, Grades 1-7), even though school-based speech
interaction that occurs in telehealth services, extra therapy services cover students in Grades 1-12. In addition, the
communication and visual features for communication are small sample size restricted our investigation of the effect of
needed to build a rapport between clinicians and parents [29]. comorbidity on telepractice efficacy, as communication and
For example, when discussing sensitive topics (eg, diagnosis, literacy characteristics can potentially affect telepractice
comorbidity, and prognosis) on web-based platforms, parents efficacy.
may feel a sense of depersonalization [29,30]. In addition,
Future research should consider investigating the effect of
face-to-face communication has been indicated as a preferred
comorbidity on telepractice efficacy and satisfaction, by testing
mode of communication in various studies, as face-to-face
a larger sample that includes students of different ages and
communication allows for the better observation of visual cues,
children with different types of special educational needs. For
such as facial expressions and body language [31-33]. Another
example, parental involvement is lower in the adolescent
explanation for parents preferring on-site practices over
population than in the younger student population. Furthermore,
telepractice is that parents need to provide extra effort and input
in the adolescent population, treatment is focused on academic
in telepractice services. In telepractice sessions, parents need
success. It is important to see whether the acceptance of
to solve technological problems and control students’ behaviors
telepractice services among adolescents differs from the
throughout the session. Therefore, parents must allocate more
acceptance among young, school-aged children. It should also
time and energy in telepractice sessions than they do in on-site
be noted that our study focused on parents’ and students’
sessions [33,34].
satisfaction with telepractice after a relatively short-term
In this study, the students did not prefer one mode of practice telepractice session. Future research should extend this study
over the other. This could be explained by their satisfaction by investigating parents’ and students’ perceptions of
with telepractice and the significant correlation between their telepractice efficacy and their attitudes toward telepractice after
perceptions of telepractice efficacy and their preferences for a long-term telepractice session. Our suggestions for future
modes of practice (P<.001). Given that the students had fewer research may elucidate the long-term benefits and sustainability
practical concerns than parents, and the fact that students of telepractice, and provide guidance for telepractice strategy
acknowledged the effectiveness of both on-site practice and development. This information is needed to enhance the quality
telepractice, they did not have a preference for the 2 service of digital medical approaches and psychological benefits for
delivery modes. children and their families [36].
Our findings also show that student grade was not significantly Implications
associated with telepractice efficacy (parents: P=.76; students: The results of this study indicate that telepractice efficacy was
P=.65) or preferences for telepractice and on-site practice well acknowledged by parents and students, and that students
(parents: P=.52; students: P=.85). These results reflect the in Grades 1-7 had similar preferences for telepractice and on-site
efficacy of telepractice and show that preferences did not differ practice. The use of telepractice is supported not only by
considerably across different ages. This is consistent with other scientific evidence, but also by students’ and parents’
scientific studies, which have suggested that telepractice is satisfaction. These results suggest that telepractice is a possible
suitable for school-aged students [7-9]. service delivery option for school-aged students.
Study Strengths The findings of our study are in line with those of existing
To our knowledge, this study is the first to investigate parents’ literature, which suggests that telepractice is a suitable service
and students’ satisfaction with telepractice services for a delivery method [7-9]. Our study provided supporting evidence

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for schools and speech-language pathologists to adopt Clinicians can pay attention to potential technical problems and
telepractice in real-life situations. In addition, our results suggest provide relevant support to parents. If clinicians participate in
that speech-language pathologists and parents should be more and engage with telepractice services more often, it is expected
proactive in telepractice services. Given that the parents had a that parents will have a better rapport with clinicians, which
negative view of treatment effectiveness and communication will facilitate the promotion and acceptance of telepractice [37].
with speech-language pathologists during telepractice sessions,
clinicians should consider engaging more effectively with both
Conclusions
students and their parents. Speech-language pathologists can This study showed that both Hong Kong Chinese parents and
regularly update and inform parents and students about treatment students believed that telepractice was satisfactory and effective.
effectiveness to increase their confidence during the transition Although students did not prefer one speech therapy delivery
to telepractice. In addition, clinicians should directly address mode over the other, parents preferred on-site speech and
parents’ concerns to build a therapeutic relationship [17]. The language therapy. The perceived efficacy of telepractice was
engagement and participation of parents is highly important in associated with students’ preferences for service delivery modes,
telepractice services. The importance of parent involvement is but it was not associated with parents’ preferences. This could
well noted in the literature [37,38], and the behavioral be explained by inadequate communication between clinicians
management of students during telepractice sessions relies on and parents. Our findings suggest that it is necessary for
parents. Moreover, the role of the parent in telepractice services speech-language pathologists to play a more proactive role by
extends to providing technical support and troubleshooting [10]. integrating telepractice into service delivery and explaining the
efficacy of telepractice to parents and students.

Acknowledgments
This research was supported, in part, by General Research Fund (17609518), and RGC Research Fellow Scheme (RFS2021-7H05)
from Hong Kong Research Grant Council to Xiuli Tong.

Conflicts of Interest
None declared.

Multimedia Appendix 1
Study questionnaire.
[DOCX File , 16 KB-Multimedia Appendix 1]

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Abbreviations
BF: Bayes factor

Edited by S Badawy; submitted 11.11.20; peer-reviewed by E Toki, S Pillon; comments to author 07.01.21; revised version received
13.01.21; accepted 13.01.21; published 28.01.21
Please cite as:
Lam JHY, Lee SMK, Tong X
Parents’ and Students’ Perceptions of Telepractice Services for Speech-Language Therapy During the COVID-19 Pandemic: Survey
Study
JMIR Pediatr Parent 2021;4(1):e25675
URL: http://pediatrics.jmir.org/2021/1/e25675/
doi: 10.2196/25675
PMID:

©Joseph Hin Yan Lam, Stephen Man Kit Lee, Xiuli Tong. Originally published in JMIR Pediatrics and Parenting
(http://pediatrics.jmir.org), 28.01.2021. This is an open-access article distributed under the terms of the Creative Commons
Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work, first published in JMIR Pediatrics and Parenting, is properly cited. The complete
bibliographic information, a link to the original publication on http://pediatrics.jmir.org, as well as this copyright and license
information must be included.

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