The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort.
The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort.
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DOI：
10.2196/44079
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发表时间：
2023-07-27
影响因子：
7.4
通讯作者：
Sonuga-Barke, Edmund J. S.
中科院分区：
文献类型：
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作者：
Palmer, Melanie;Beckley-Hoelscher, Nicholas;Shearer, James;Kostyrka-Allchorne, Katarzyna;Robertson, Olly;Koch, Marta;Pearson, Oliver;Slovak, Petr;Day, Crispin;Byford, Sarah;Goldsmith, Kimberley;Waite, Polly;Creswell, Cathy;Sonuga-Barke, Edmund J. S.
关键词：
在COVID-19大流行期间，儿童的行为和情绪问题有所增加。我们测试了专门为此目的开发的智能手机育儿支持应用程序Parent Positive是否以具有成本效益的方式逆转了这些影响。母阳性包括3个区域。育儿助推器（第1区）提供的内容改编自标准的面对面父母培训计划，以应对父母和育儿专家确定的在大流行期间与父母特别相关的8个具体挑战。家长交流（第二区）是一个家长与家长和家长与专家的交流论坛。育儿资源（第3区）提供了对父母有价值的一系列其他主题（例如，神经发育问题，饮食和睡眠）的现有高质量网络资源。通过封锁经验支持父母和孩子（SPARKLE）是一项随机对照试验，被纳入英国范围内的COVID-19：在流行期间支持父母，青少年和儿童（Co-SPACE）关于大流行期间家庭心理健康的纵向研究。在2021年5月19日至2021年7月26日期间，4至10岁儿童的父母以1：1的比例随机分配至父母阳性或照常随访（FAU）。Parent Positive提供关于常见育儿挑战的建议和基于证据的网络资源，并促进父母对父母和专家对父母的支持。在随机化前（T1）和随机化后1个月（T2）和2个月（T3）测量儿童行为和情绪问题以及家庭幸福感。服务使用，成本和不良事件进行了测量，沿着应用程序的使用和满意度。主要结局是T2父母报告的儿童行为问题，使用线性混合回归模型进行分析。共有320名参与者被随机分配到父母阳性组，326名参与者被随机分配到FAU组。主要结局分析包括79.3%（512/646）的参与者（脱落：84/320，26%为父母阳性，50/326，15%为FAU）。在T2（标准化效应=-0.01）或T3（次要结局;标准化效应=-0.09）时，对行为问题没有统计学显著的干预效果，基线行为问题也没有调节作用。在T2和T3观察到与干预相关的情绪问题显著减少（次要结局;两种情况下的标准化效应=-0.13）。父母积极，相对于FAU，与更多的父母担心在T3（标准化效应=0.14）。很少报告可归因于干预的不良事件。一旦排除了4个具有极高医疗保健费用的离群值，则父母阳性具有成本效益。父母积极减少儿童的情绪问题，并具有成本效益的FAU相比，一旦离群值被删除。尽管与有针对性的治疗干预措施相比，这些影响的大小与非针对性的普遍心理健康干预措施的试验一致。这突出表明，如果在社区一级实施，父母阳性的公共卫生潜力。然而，在作出这种解释之前需要谨慎，研究结果需要在大规模的全社区研究中重复。ClinicalTrials.gov NCT 04786080; https://clinicaltrials.gov/ct2/show/NCT04786080
Children’s conduct and emotional problems increased during the COVID-19 pandemic. We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080
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影响因子：
1.7
作者：
Kostyrka-Allchorne K;Ballard C;Byford S;Cortese S;Daley D;Downs J;French B;Glazebrook C;Goldsmith K;Groom MJ;Hall CL;Hedstrom E;Ibrahim Z;Jarvis C;Kovshoff H;Kreppner J;Lean N;Morris A;Gutierrez WM;Sayal K;Shearer J;Simonoff E;Thompson M;Zalewski L;Sonuga-Barke EJS
通讯作者：
Sonuga-Barke EJS
影响因子：
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通讯作者：
--
影响因子：
2.5
作者：
Grant S;Mayo-Wilson E;Montgomery P;Macdonald G;Michie S;Hopewell S;Moher D;, on behalf of the CONSORT-SPI Group
通讯作者：
, on behalf of the CONSORT-SPI Group
影响因子：
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作者：
Christie, Hope;Hiscox, Lucy V;Halligan, Sarah L;Creswell, Cathy
通讯作者：
Creswell, Cathy
影响因子：
3.7
作者：
Angrist, JD;Imbens, GW;Rubin, DB
通讯作者：
Rubin, DB