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In recent years, real-world studies (RWS) are gaining increasing interests, because they can generate more realistic and generalizable results than randomized controlled clinical trials (RCT). In 2017, we published a RCT in 741 early childhood care and education providers (CCPs). It is the Phase I of our  iLookOut for Child Abuse  project ( iLookOut ), an online, interactive learning module about reporting suspected child maltreatment. That study demonstrated that in a RCT setting, the  iLookOut  is efficient at improving CCPs’ knowledge of and attitudes towards child maltreatment reporting. However, the generalizability of that RCT’s results in a RWS setting remains unknown. To address this question, we design and conduct this large RWS in 11,065 CCPs, which is the Phase II of the  iLookOut . We hypothesize replication of the earlier RCT findings, i.e., the  iLookOut  can improve CCPs’ knowledge of and attitudes toward child maltreatment reporting in a real world setting. In addition, this RWS also explores whether demographic factors affect CCPs’ performance. Results of this RWS confirmed the generalizability of the previous RCT’s results in a real world setting. It yielded similar effect sizes for knowledge and attitudes as were found in the earlier RCT. Cohen’s d for knowledge improvement was 0.95 in that RCT, 0.96 in this RWS; Cohen’s d for attitude improvement was 0.98 in that RCT, 0.80 in this RWS. Also, we found several significant differences in knowledge and attitude improvement with regard to age, race, education, and employment status. In conclusion,  iLookOut  improves knowledge and attitudes of CCPs about child maltreatment prevention and reporting in a real-world setting. The generalizability of the initial RCT findings to this RWS provides strong evidence that the  iLookout  will be effective in other real world settings. It can be a useful model for other interventions aimed at preventing child maltreatment.  Clinical trial registration for the original RCT:  NCT02225301  (ClinicalTrials.gov Identifier)

plos one

Generalizing findings from a randomized controlled trial to a real-world study of the iLookOut, an online education program to improve early childhood care and education providers’ knowledge and attitudes about reporting child maltreatment