This cluster randomized trial is conducted in Beijing primary schools to evaluate the efficacy of a WeChat mini-program-based high-temperature early warning intervention on the physical and cognitive health of school-age children. Six participating schools are randomly assigned to two parallel groups. The intervention group receives tiered heat alerts and guided self-health monitoring via the mini-program. The control group follows standard daily school and family routines, with no dedicated digital high-temperature early-warning intervention. The primary outcome is children's executive function after a 2.5-month follow-up. A range of secondary indicators related to physical status, mental health and health behaviors are assessed concurrently to quantify the intervention's benefits in mitigating adverse health outcomes caused by high temperatures.
This pilot study is conducted in Beijing, with 6 primary schools selected as research sites. A stratified cluster randomized controlled design is adopted, with schools as the unit of randomization. Eligible primary schools are randomly assigned to the intervention group and the control group, with 3 schools in each group. A total of 5 Wisconsin Card Sorting Tests (WCST), 2 health examinations, 2 children's high-temperature protection themed drawing activities, and 5 mini-program questionnaire surveys will be conducted in this study. The intervention group receives a digital intervention of high-temperature health risk early warning. The research team uses a WeChat mini-program to release corresponding high-temperature health risk level information, health tips, protection science popularization information and other early warning content when the high-temperature health risk level reaches yellow, orange or red, and simultaneously pushes them to head teachers and parents. The monitoring and survey schedule for the intervention group during the study period is as follows: at baseline and endpoint, unified offline WCST and health examinations will be conducted for children once each, accompanied by one online mini-program questionnaire survey each time. One children's high-temperature protection themed drawing activity will be organized at baseline and at the end of the 3rd month after the intervention, and the works will be uploaded to the mini-program for check-in. At the end of the 1st, 2nd and 3rd months after the intervention, one online follow-up questionnaire and WCST will be completed each month, together with check-in. Meanwhile, blood pressure will be monitored once a week, and daily blood pressure monitoring and check-in will be carried out after each high-temperature health risk early warning release. In addition, after the release of high-temperature health risk early warnings, the intervention group is required to complete check-in for reading and transmitting early warning information, health tips and protection science popularization content, as well as online mini-program surveys on children's awareness of high-temperature health risk early warning information and short-term behavioral patterns. The above WCST and questionnaire surveys will be completed by children with parental assistance; blood pressure monitoring and check-in are the responsibility of head teachers during non-summer vacations and parents during summer vacations. The control group does not receive the high-temperature health risk early warning intervention and will only complete the corresponding WCST, health examinations, questionnaire surveys and blood pressure monitoring.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
200
This study implements a digital early warning intervention targeting children's high-temperature health risks. During the intervention period, when the high-temperature health risk level reaches yellow, orange or red, relevant risk information, health tips and heat protection education materials are released to parents and head teachers via the WeChat mini-program. Parents or teachers pass on the warning information to participating children. During non-summer periods, Beijing's high-temperature early warning information is pushed to head teachers and parents via the WeChat mini-program; during summer vacation, location-specific early warning information is sent to parents. All recipients are required to pass on the information to children promptly upon receipt.
The primary outcome is the comprehensive total score of children's executive function constructed based on the Wisconsin Card Sorting Test (WCST)
The only primary outcome of this study is the composite score of cognitive executive function derived from the Wisconsin Card Sorting Test (WCST) via the TOPSIS method. All WCST absolute indicators and sub-dimensions are sub-indicators instead of independent outcomes. The WCST indicators are grouped into three sub-dimensions: conceptual thinking (Total Correct, Total Errors, Nonperseverative Errors, Conceptual Level Responses, Categories Completed), perseveration (Perseverative Responses, Perseverative Errors), and set maintenance (Failure to Maintain Set). Negative indicators are converted using the formula (x' = Max(x) - x). After Z-score normalization, the decision matrix is established, positive and negative ideal solutions are identified, and Euclidean distances and relative closeness are computed. The resulting relative closeness value is taken as the final composite score of cognitive executive function, the single primary outcome of this study.
Time frame: at 2.5 months of intervention.
Systolic Blood Pressure
Systolic Blood Pressure measured in mmHg
Time frame: at 2.5 months of intervention
Diastolic Blood Pressure
Diastolic blood pressure measured in mmHg
Time frame: at 2.5 months of intervention
Heart Rate
Resting heart rate measured in beats per minute (bpm)
Time frame: at 2.5 months of intervention
Forced Expiratory Volume in 1 second (FEV1)
Pulmonary function indicator measured in liters (L)
Time frame: at 2.5 months of intervention
Forced Vital Capacity (FVC)
Pulmonary function indicator measured in liters (L)
Time frame: at 2.5 months of intervention
Peak Expiratory Flow (PEF)
Pulmonary function indicator measured in liters per second (L/s)
Time frame: at 2.5 months of intervention
Forced Expiratory Flow 25-75% (FEF25-75%)
Mid-expiratory flow measured in liters per second (L/s)
Time frame: at 2.5 months of intervention
Fractional Exhaled Nitric Oxide (FeNO50)
Exhaled nitric oxide level at 50 mL/s flow rate, measured in parts per billion (ppb)
Time frame: at 2.5 months of intervention
Fractional Exhaled Nitric Oxide (FeNO200)
Exhaled nitric oxide level at 200 mL/s flow rate, measured in parts per billion (ppb)
Time frame: at 2.5 months of intervention
Calcium Nitric Oxide (CaNO)
Airway nitric oxide parameter measured in ppb
Time frame: at 2.5 months of intervention
Fractional Expiratory Carbon Monoxide (FeCO)
Exhaled carbon monoxide level measured in parts per million (ppm)
Time frame: at 2.5 months of intervention
Body Fat Percentage
Body fat percentage measured by bioelectrical impedance analysis
Time frame: at 2.5 months of intervention
Total Body Water
Total body water measured in liters (L)
Time frame: at 2.5 months of intervention
Inorganic Salts
Inorganic salt content measured in kilograms (kg)
Time frame: at 2.5 months of intervention
Basal Metabolic Rate (BMR)
Basal metabolic rate measured in kilocalories per day (kcal/day)
Time frame: at 2.5 months of intervention
Body Weight
Body weight measured in kilograms (kg)
Time frame: at 2.5 months of intervention
High-Temperature Health KAP Score
Knowledge, Attitude, and Practice (KAP) score on high-temperature health
Time frame: at 2.5 months of intervention
High-Temperature Health Cognition and Protection Behavior Drawing Score
Drawing-based score of children's cognition and protective behaviors for high-temperature health
Time frame: at 2.5 months of intervention
Short-Term Behavioral Pattern Score
Score of children's short-term behavioral patterns related to heat health
Time frame: at 2.5 months of intervention
SAS Anxiety Scale Score
Self-rating Anxiety Scale (SAS) score for children's anxiety symptoms
Time frame: at 2.5 months of intervention
CDI Children's Depression Scale Score
Children's Depression Inventory (CDI) score for depressive symptoms
Time frame: at 2.5 months of intervention
SGRQ Respiratory Symptom Scale Score
St. George's Respiratory Questionnaire (SGRQ) score for respiratory symptoms
Time frame: at 2.5 months of intervention
School Absenteeism Days
Number of school absenteeism days during the study period
Time frame: at 2.5 months of intervention
Academic Performance
Scores of children's academic examinations
Time frame: at 2.5 months of intervention
Heat-Related Illness Incidence
Occurrence frequency of heat-related illnesses in children
Time frame: at 2.5 months of intervention
Gastrointestinal Diseases Incidence
Occurrence frequency of gastrointestinal diseases in children
Time frame: at 2.5 months of intervention
Respiratory Diseases Incidence
Occurrence frequency of respiratory diseases in children
Time frame: at 2.5 months of intervention
Allergies Incidence
Occurrence frequency of allergies in children
Time frame: at 2.5 months of intervention
Accidental Injuries Incidence
Occurrence frequency of accidental injuries in children
Time frame: at 2.5 months of intervention
Early Warning Information Check-in Rate
Check-in rate of early warning information received by the intervention group
Time frame: at 2.5 months of intervention
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