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Deng Y, Zhang Z, Gui Y, Li W, Rong T, Jiang Y, Zhu Q, Zhao J, Zhang Y, Wang G, Jiang F. Sleep Disturbances and Emotional and Behavioral Difficulties Among Preschool-Aged Children. JAMA Netw Open 2023; 6:e2347623. [PMID: 38095895 PMCID: PMC10722331 DOI: 10.1001/jamanetworkopen.2023.47623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
Importance Sleep disturbances and mental health problems are highly comorbid and bidirectionally correlated across childhood. The association between the natural history of sleep disturbances and the transition of mental health problems has not been quantified. Objective To examine the association between the natural history of sleep disturbances and resolved and incident emotional and behavioral difficulties (EBDs). Design, Setting, and Participants This cohort study used data from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P), a prospective and population-based longitudinal cohort study of children enrolled in preschools in Shanghai, China, from November 10 to 24, 2016. A total of 20 324 children aged 3 to 4 years were recruited from the junior class of 191 kindergartens, of whom 17 233 (84.8%) participated in the 2-year follow-up. A multilevel regression model was used to evaluate the association between the development of sleep disturbances and the occurrence of resolved and incident EBDs. The data analysis spanned from August 4, 2021, to October 31, 2023. Exposures Sleep disturbances were assessed using the Children's Sleep Habit Questionnaire; EBDs were assessed using the Strengths and Difficulties Questionnaire. Main Outcomes and Measures Occurrence of incident and resolved EBDs at the 2-year follow-up. Results The cohort included 17 182 participants, with a mean (SD) age of 3.73 (0.29) years at enrollment; 52.0% were boys. The prevalence of EBDs at school entry and graduation years was 27.8% and 18.7%, respectively, while the prevalence of sleep disturbances was 41.3% and 31.5%, respectively. Among those with EBDs at the entry year, 35.0% maintained stability in the graduation year, while sleep disturbances were stable in 50.0% of those with sleep disturbances. After controlling for confounding factors, the odds ratio (OR) for resolved EBDs was lower in the incident sleep disturbance (ISD) group (OR, 0.50 [95% CI, 0.41-0.62]; P < .001) and stable sleep disturbance (SSD) group (OR, 0.47 [95% CI, 0.40-0.56]; P < .001) compared with the group with no sleep disturbances. The ORs for incident EBDs among the ISD group (OR, 2.58 [95% CI, 2.22-3.01]; P < .001) and SSD group (OR, 2.29, [95% CI, 1.98-2.64]; P < .001) were higher than among the group with no sleep disturbances. Conclusions and Relevance In this prospective cohort study, the natural history of sleep disturbances among preschool-aged children was associated with both resolved and incident EBDs. Routine screening and precise intervention for sleep disturbances may benefit the psychosocial well-being of this population.
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Affiliation(s)
- Yujiao Deng
- Department of Neurology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zichen Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ministry of Education–Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiding Gui
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ministry of Education–Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Li
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tingyu Rong
- Department of Child and Adolescent Healthcare, Children’s Hospital of Soochow University, Suzhou, China
| | - Yanrui Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ministry of Education–Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Zhu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ministry of Education–Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Zhao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Child Health Advocacy Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ministry of Education–Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ministry of Education–Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
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Tauscher JS, DePue MK, Swank J, Salloum RG. Determinants of preference for telehealth versus in-person treatment for substance use disorders: A discrete choice experiment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208938. [PMID: 36880898 DOI: 10.1016/j.josat.2022.208938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity. METHODS Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making. RESULTS Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use. CONCLUSIONS Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.
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Affiliation(s)
- Justin S Tauscher
- BRiTE Center, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - M Kristina DePue
- Department of Human Development, Family Science, and Counseling, University of Nevada- Reno, Reno, NV, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - Jacqueline Swank
- School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA; Department of Educational, School, and counseling Psychology, College of Education & Human Development, University of Missouri, Columbia, MO, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
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Peyton D, Wadley G, Hackworth N, Grobler A, Hiscock H. A co-designed website (FindWays) to improve mental health literacy of parents of children with mental health problems: Protocol for a pilot randomised controlled trial. PLoS One 2023; 18:e0273755. [PMID: 36943835 PMCID: PMC10030009 DOI: 10.1371/journal.pone.0273755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Mental health problems, such as behavioural and emotional problems, are prevalent in children. These problems can have long lasting, detrimental effects on the child, their parents and society. Most children with a mental health problem do not receive professional help. Those that do get help can face long wait times. While waiting, parents want to learn how they can help their child. To address this need, we co-designed a new website to help parents find ways of helping their child's mental health problem while waiting to get specialist help. OBJECTIVES To assess the acceptability and feasibility of a new co-designed website, FindWays, through a pilot randomised controlled trial. The protocol is registered with ISRCTN (ISRCTN64605513). METHODS This study will recruit up to 60 parents of children aged two-twelve years old referred to a paediatrician for behavioural and/or emotional problems. Participants will be randomly allocated by computer generated number sequence to either the intervention or control group. Intervention group participants will receive access to the FindWays website to help them manage their child's mental health problem while they wait to see the paediatrician. Acceptability and feasibility will be assessed over the 4-month intervention through mixed methods including: recruitment, adherence, retention, net promoter score (quantitative measures) and semi-structured interviews to gain an in-depth understanding of parents' experience and potential adverse effects (qualitative measure). Secondary outcomes measured by parent survey at 4-months post randomisation include child mental health, parent mental health, impact of the child's mental health problem on their functioning and family, and health service use and associated costs. RESULTS Recruitment commenced June 2022 with publication expected in October 2023. CONCLUSION This study will provide novel data on the acceptability and feasibility of a new website co-designed with parents to help them find ways of managing their child's behaviour and emotions.
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Affiliation(s)
- Daniel Peyton
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Greg Wadley
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Naomi Hackworth
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Parenting Research Centre, East Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Australia
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Australia
| | - Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Gustafsson BM, Sund-Levander M. Parents’ experiences of investigations and interventions by Child Healthcare, Child and Adolescent Psychiatry and Child and Youth Habilitation. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2143360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- B M Gustafsson
- Department of Psychiatry and Rehabilitation, Psychiatric Clinic, Högland Hospital, Eksjö, Region Jönköping County, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - M Sund-Levander
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Broomfield G, Brown SD, Yap MB. Socioeconomic factors and parents' preferences for internet- and mobile-based parenting interventions to prevent youth mental health problems: A discrete choice experiment. Internet Interv 2022; 28:100522. [PMID: 35309756 PMCID: PMC8924632 DOI: 10.1016/j.invent.2022.100522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/12/2022] [Accepted: 03/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The positive impact of parenting programs for youth mental health is undermined by difficulties engaging parents. Low engagement disproportionately impacts parents of lower-socioeconomic positions (SEPs). Internet- and mobile-based interventions hold potential for overcoming barriers to enrolment, but additional research is needed to understand how programs can appropriately meet the needs of parents across SEPs. Consumer preference methods such as discrete choice experiments may be valuable in this endeavour. METHOD A discrete choice experiment was used to determine the relative influence of modifiable program features on parents' intent to enrol. 329 Australian parents of children aged 0-18 repeatedly selected their preferred program from randomized sets of hypothetical programs in an online survey. Each hypothetical program was unique, varying across four program features: module duration, program platform, user control, and program cost. Cumulative link models were used to predict choices, with education, household income, and community advantage used as indicators of SEP. RESULTS Overall, parents preferred cheaper programs and briefer modules. Parents' preferences differed based on their socioeconomic challenges. Lower-income parents preferred briefer modules, cheaper programs and application-based programs compared to higher-income parents. Parents with less education preferred briefer modules and a predefined module order. Parents living in areas of less advantage preferred website-based programs, user choice of module order, and more expensive programs. CONCLUSIONS This study offers program developers evidence-based strategies for tailoring internet- and mobile-based parenting interventions to increase lower-SEP parent enrolment. Findings also highlight the importance of considering parents' socioeconomic challenges to ensure programs do not perpetuate existing mental health inequalities, as "one-size-fits-all" approaches are likely insufficient for reaching lower-SEP parents.
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Affiliation(s)
- Grace Broomfield
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Scott D. Brown
- School of Psychological Sciences, The University of Newcastle, Callaghan, Australia
| | - Marie B.H. Yap
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia,Corresponding author at: Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, Melbourne 3800, Australia.
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Peyton D, Goods M, Hiscock H. The Effect of Digital Health Interventions on Parents' Mental Health Literacy and Help Seeking for Their Child's Mental Health Problem: Systematic Review. J Med Internet Res 2022; 24:e28771. [PMID: 35142623 PMCID: PMC8874802 DOI: 10.2196/28771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/20/2021] [Accepted: 12/10/2021] [Indexed: 01/17/2023] Open
Abstract
Background Many children with mental health problems do not receive professional help. Despite the frequent use of digital health interventions (DHIs) such as websites or web-based service navigation platforms, their effects on parents’ mental health literacy, help seeking, or uptake of professional services are unclear. Objective This study aims to provide a systematic review and narrative synthesis to describe whether DHIs improve the aforementioned parental outcomes. Methods Databases, including CINAHL, Embase, MEDLINE OVID, PsycINFO, and PubMed (2000-2020), were accessed. Studies were included if they evaluated quantitative changes in mental health literacy, help seeking, or the uptake of services by parents of children with mental health problems. Theoretical frameworks, sample sizes, participant demographics, recruitment, interventions, DHI use, results, and health economic measures were used for data extraction. Results Of the 11,379 search results, 5 (0.04%) studies met the inclusion criteria. One randomized controlled trial found the reduced uptake of services after using a DHI coupled with a telephone coach for a child’s behavioral problem. Of 3 studies, 2 (66.7%) found statistically significant improvement in mental health literacy for attention-deficit/hyperactivity disorder but had no control group. One study found nonsignificant improvement in mental health literacy and help-seeking attitudes toward anxiety and depression compared with those in active controls. All studies were rated as having a high or serious risk of bias. Search results were affected because of a single reviewer screening articles, overall low-quality studies, and a lack of consistent nomenclature. Conclusions There is no high-quality evidence that DHIs can improve parents’ mental health literacy, help seeking, or uptake of services. More research is needed to evaluate DHIs by using rigorous study designs and consistent measures. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020130074; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020130074
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Affiliation(s)
- Daniel Peyton
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Australia
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Jones R, Hiscock H, Wurzel D, Kao KT, Freeman JL, Ride J. Mental healthcare for children with chronic conditions: a qualitative study. Arch Dis Child 2022; 107:134-140. [PMID: 35058237 DOI: 10.1136/archdischild-2021-321795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore parent perspectives on accessing mental healthcare for children with a chronic physical health condition. DESIGN Qualitative research using semistructured interviews and Framework Analysis. Rankings were used to select attributes for a Discrete Choice Experiment (DCE). SETTING Four specialty outpatient clinics (diabetes, epilepsy, bronchiectasis unrelated to cystic fibrosis and epidermolysis bullosa) at an Australian tertiary paediatric hospital. PARTICIPANTS Eighteen parents of children with a chronical physical health condition. RESULTS Most parents identified the child's general practitioner and/or hospital team as an initial pathway to seek help if they were worried about their child's mental health. Parents see mental healthcare as part of care for the whole child and want the outpatient clinics to proactively discuss child and family mental health, as well as refer to appropriate services as needed. The hospital being a familiar, child-friendly environment was identified as a key reason the hospital might be a desired place to access mental healthcare, as previous research has found. Six attributes of mental health services were identified as important and will be included in an upcoming DCE: travel time, cost, wait time, available hours, knowledge of physical health condition, and recommendation. CONCLUSIONS This study highlights the opportunity presented in specialist outpatient clinics to address the often unmet mental healthcare needs of children with chronic physical health conditions. Parents identified practical ways for outpatient clinics to better facilitate access to mental healthcare. These will be further explored through a quantitative study of parent preferences.
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Affiliation(s)
- Renee Jones
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Danielle Wurzel
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Health, Allergy and Lung Health Unit, The University of Melbourne School of Population and Global Health, Parkville, Victoria, Australia
| | - Kung-Ting Kao
- Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Diabetes Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jeremy L Freeman
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurosciences Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jemimah Ride
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Economics Unit, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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Wymbs F, Doctoroff GL, Chacko A, Sternheim G. Preferences for Parenting Programs in Head Start: Using Conjoint Analysis to Understand Engagement in Parenting Health Promotion Programs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:866-879. [PMID: 34453658 DOI: 10.1007/s11121-021-01288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
The impact of evidence-based parenting health promotion programs is threatened by limited enrollment and attendance. We used a discrete choice experiment (DCE) to examine how Early Head Start and Head Start parents prioritized key attributes of parenting programs when considering potential participation. Utility values and importance scores indicate that parents placed the highest priority on a program that optimized child academic outcomes, and after that, on a program that offered incentives and logistical supports, and maximized potential effects on friendship skills, behavioral skills, and the parent-child relationship. Next, we used simulations or forecasting tools to estimate parents' preferences for types of programs. Sixty-five percent of parents preferred Outcome-focused Programs that fostered parents' understanding and practice of skills, whereas 23% prioritized Enhanced Support Programs offering logistic support, such as incentives, followed by child outcomes. The remaining 12% of parents preferred Format-focused Programs that targeted positive outcomes via one 30-min meeting. Parents preferring Outcome-focused Programs reported higher child prosocial behaviors compared to parents preferring Enhanced Support and Format-focused Programs. Parents preferring Outcome-focused Programs were more likely to be those of 3- and 4-year-old children than of 2-year-olds. Findings challenge the one-size-fits-all approach to offering parenting programs and suggest ways to enhance accessibility and program reach.
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Affiliation(s)
- Frances Wymbs
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
| | - Greta L Doctoroff
- Department of Psychology, Ferkauf Graduate School, Yeshiva University, New York, NY, USA
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Gillian Sternheim
- Department of Psychology, Ferkauf Graduate School, Yeshiva University, New York, NY, USA
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Larsen A, Tele A, Kumar M. Mental health service preferences of patients and providers: a scoping review of conjoint analysis and discrete choice experiments from global public health literature over the last 20 years (1999-2019). BMC Health Serv Res 2021; 21:589. [PMID: 34144685 PMCID: PMC8214295 DOI: 10.1186/s12913-021-06499-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients' needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers. METHODS We performed a scoping review from the past 20 years (2009-2019) to identify and describe applications of conjoint analysis and discrete choice experiments. We searched the following electronic databases: Pubmed, CINAHL, PsychInfo, Embase, Cochrane, and Web of Science to identify stakehold,er preferences for mental health services using Mesh terms. Studies were categorized according to pertaining to patients, providers and parents or caregivers. RESULTS Among the 30 studies we reviewed, most were published after 2010 (24/30, 80%), the majority were conducted in the United States (11/30, 37%) or Canada (10/30, 33%), and all were conducted in high-income settings. Studies more frequently elicited preferences from patients or potential patients (21/30, 70%) as opposed to providers. About half of the studies used CA while the others utilized DCEs. Nearly half of the studies sought preferences for mental health services in general (14/30, 47%) while a quarter specifically evaluated preferences for unipolar depression services (8/30, 27%). Most of the studies sought stakeholder preferences for attributes of mental health care and treatment services (17/30, 57%). CONCLUSIONS Overall, preference elicitation approaches have been increasingly applied to mental health services globally in the past 20 years. To date, these methods have been exclusively applied to populations within the field of mental health in high-income countries. Prioritizing patients' needs and preferences is a vital component of patient-centered care - one of the six domains of health care quality. Identifying patient preferences for mental health services may improve quality of care and, ultimately, increase acceptability and uptake of services among patients. Rigorous preference-elicitation approaches should be considered, especially in settings where mental health resources are scarce, to illuminate resource allocation toward preferred service characteristics especially within low-income settings.
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Affiliation(s)
- Anna Larsen
- Department of Global Health, University of Washington, Seattle, WA 98195 USA
| | | | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, (47074), Nairobi, 00100 Kenya
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Developing a Messaging Graphic for Storage Times of Refrigerated Ready to Eat (RTE) Foods for a Consumer Food Safety Health Campaign. Eur J Investig Health Psychol Educ 2020; 10:859-875. [PMID: 34542516 PMCID: PMC8314301 DOI: 10.3390/ejihpe10030062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
This study developed and evaluated risk communication messages for ready to eat (RTE) foods targeted towards consumer storage practices in a food safety health campaign. Concepts were determined from a fractional factorial design of five categories of attributes potentially present in health promotion: title, message, graphic, slogan, and icon. Consumers viewed a subset of concepts and scored how useful the concept was in remembering to throw away RTE foods that were stored too long. Regression analysis determined which combinations of message attributes were most likely to result in using the information to throw out foods, which could help prevent foodborne illness. Findings showed that for this type of information, a graphic is a critical element for the printed schematic. The slogan (i.e., a short statement similar to a jingle or tag-line in a commercial) may be important to consumers, but the icon was not important.
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Using Conjoint Analysis to Predict Teachers’ Preferences for Intervention Intensity. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Modeling Treatment-Related Decision-Making Using Applied Behavioral Economics: Caregiver Perspectives in Temporally-Extended Behavioral Treatments. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:607-618. [PMID: 31982979 DOI: 10.1007/s10802-020-00619-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Evidence-based behavioral therapies for children with disruptive and challenging behavior rarely yield immediate improvements in behavior. For caregivers participating in behavioral therapies, the benefits from these efforts are seldom visible until after substantial time commitments. Delays associated with relief from challenging behavior (i.e., improved behavior) can influence how caregivers decide to respond to instances of problem behavior, and in turn, their continued commitment (i.e., integrity, adherence) to treatments that require long-term implementation to produce improvements in child behavior. This study applied delay discounting methods to evaluate how delays affected caregiver preferences related to options for managing their child's behavior. Specifically, methods were designed to evaluate the degree to which caregiver preferences for a more efficacious, recommended approach was affected by delays (i.e., numbers of weeks in treatment). That is, methods evaluated at which point caregivers opted to disregard the optimal, delayed strategy and instead elected to pursue suboptimal, immediate strategies. Results indicated that caregivers regularly discounted the value of the more efficacious treatment, electing to pursue suboptimal approaches when delays associated with the optimal approach grew larger. Caregivers demonstrated similar patterns of suboptimal choice across both clinical (i.e., intervention) and non-clinical (i.e., monetary) types of decisions. These findings are consistent with research that has highlighted temporal preferences as an individual factor that may be relevant to caregiver adherence to long-term evidence-based treatments and encourage the incorporation of behavioral economic methods to better understand caregiver decision-making.
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McGrady ME, Pai ALH, Prosser LA. Using discrete choice experiments to develop and deliver patient-centered psychological interventions: a systematic review. Health Psychol Rev 2020; 15:314-332. [PMID: 31937184 DOI: 10.1080/17437199.2020.1715813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Developing and/or tailoring psychological interventions to align with patient preferences is a critical component of patient-centered care and has the potential to improve patient engagement and treatment outcomes. Discrete choice experiments (DCEs) are a quantitative method of assessing patient preferences that offer numerous strengths (i.e., ability to account for trade-offs), but are not routinely incorporated into health psychology coursework, likely leaving many unaware of the potential benefits of this methodology. To highlight the potential applications of DCEs within health psychology, this systematic review synthesises previous efforts to utilise DCEs to inform the design of patient-centered psychological care, defined as interventions targeting psychological (e.g., depression, anxiety) or behavioural health (e.g., pain management, adherence) concerns. Literature searches were conducted in March 2017 and November 2019 for articles reporting on DCEs using the terms 'discrete choice', 'conjoint', or 'stated preference'. Thirty-nine articles met all inclusion criteria and used DCEs to understand patient preferences regarding psychosocial clinical services (n = 12), lifestyle behaviour change interventions (n = 11), HIV prevention and/or intervention services (n = 10), disease self-management programmes (n = 4), or other interventions (n = 2). Clinical implications as well as limitations and directions for future research are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center, Cancer and Blood Diseases Institute; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center, Cancer and Blood Diseases Institute; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lisa A Prosser
- Department of Pediatrics, Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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Melathopolous K, Cawthorpe D. Impact of Central Intake Development and System Change on Per Capita Child and Adolescent Mental Health Discharges from 2002 to 2017: Implications for Optimizing System Design by Shaping Demand. Perm J 2019; 23:18.215. [PMID: 31702981 DOI: 10.7812/tpp/18.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION After several Canadian public hospital systems merged, a centralized intake system and associated regional access and intake system were developed and implemented for child and adolescent mental health services in 2002. OBJECTIVES To describe the catchment area's per capita service rates (overall and annual discharges) and changes in staff time per unit of intake activity, client wait times, and length of stay. METHODS Patient data (2002-2017) and census data permitted calculation of annual and overall per capita mental health service episodes of care on the basis of discharge rates. Population-based discharge rates, wait times, length of stay, and staff workload were described, referring service investment and system changes. RESULTS From 117,500 referrals (64% admitted and discharged; 53% female) to all regional services, 16,750 unique males and 17,140 unique females were admitted and discharged between April 1, 2002, and March 31, 2017. Per capita annual discharge rates increased over baseline 1.8-fold for both sexes, and investments increased 2.8-fold. Wait times and length of stay decreased in the 90th percentile over time for both scheduled (ambulatory) and urgent/emergent service levels. Staff workload increased. CONCLUSION Per capita system capacity increased but did not change in linear relation to investment, even though wait times and length of stay decreased. Steps focusing on future optimization of system capacity are discussed using a novel concept termed shaping demand, which refers to strategies for orienting/educating families after referral and before admission. Two new education programs focus on community-based primary care physicians and school-based services.
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Affiliation(s)
- Karen Melathopolous
- Child and Adolescent Mental Health Program, Alberta Health Services, Calgary, Canada
| | - David Cawthorpe
- Research and Evaluation, Psychiatry and Community Health Services, University of Calgary, Alberta, Canada
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Oliver D, Deal K, Howard M, Qian H, Agarwal G, Guenter D. Patient trade-offs between continuity and access in primary care interprofessional teaching clinics in Canada: a cross-sectional survey using discrete choice experiment. BMJ Open 2019; 9:e023578. [PMID: 30904840 PMCID: PMC6475162 DOI: 10.1136/bmjopen-2018-023578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Timely access to care and continuity with a specific provider are important determinants of patient satisfaction when booking appointments in primary care settings. Advanced access booking systems restrict the majority of providers' appointment spots for same-day appointments and keep the number of prebooked appointments to a minimum. In the teaching clinic environment, continuity with the same provider can be a challenge. This study examines trade-offs that patients may consider during appointment bookings for six different clinical scenarios across a number of key access and continuity attributes using a discrete choice experiment (DCE) method. DESIGN Cross-sectional survey. SETTING Two urban family medicine teaching clinics in Canada. PARTICIPANTS Convenience sample of 430 patients of family medicine clinics aged 18 and older. INTERVENTION Discrete choice conjoint experiment survey. PRIMARY OUTCOME MEASURES Patient preferences on six attributes: appointment booking method, appointment wait time, time spent in the waiting room, appointment time convenience, familiarity with healthcare provider and position of healthcare provider. Data were analysed by hierarchical Bayes analysis to determine estimates of part-worth utilities for each respondent. RESULTS Patients rated appointment wait time as the most highly valued attribute, followed by position of provider, then familiarity with the provider. Patients showed a significant preference (p<0.02) for their own physician for booking of routine annual check-ups and other logical preferences across attributes overall and by clinical scenario. CONCLUSIONS Patients preferred timely access to their primary care team over other attributes in the majority of health state scenarios tested, especially urgent issues, however they were willing to wait for a check-up. These results support the notion that advanced access booking systems which leave the majority of appointment spots for same day access and still leave a few for continuity (check-up) bookings, align well with trends in patient preferences.
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Affiliation(s)
- Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ken Deal
- Michael G. DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Helen Qian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Gewirtz AH, Lee SS, August GJ, He Y. Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:78-88. [PMID: 29352401 PMCID: PMC6054560 DOI: 10.1007/s11121-018-0865-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.
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Affiliation(s)
- Abigail H Gewirtz
- Department of Family Social Science & Institute of Child Development, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA.
| | - Susanne S Lee
- Department of Psychiatry, University of Minnesota, 2312 S 6th St. Minneapolis, St. Paul, MN, 55454, USA
| | - Gerald J August
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA
| | - Yaliu He
- The Family Institute, Northwestern University, 618 Library Place, Evanston, IL, 60201, USA
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Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Hinkka-Yli-Salomäki S, Kurki M, Lingley-Pottie P. Two-Year Follow-Up of Internet and Telephone Assisted Parent Training for Disruptive Behavior at Age 4. J Am Acad Child Adolesc Psychiatry 2018; 57:658-668.e1. [PMID: 30196869 DOI: 10.1016/j.jaac.2018.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether an internet-based and telephone-assisted parent training intervention, which used whole population screening and which comprehensively targeted symptomatic 4-year-old children, was effective 24 months after the start of treatment. No long-term follow-up studies using a randomized controlled trial (RCT) existed on this subject. METHOD Of the 4,656 children 4 years old who were screened in Southwest Finland, 730 met the criteria for high-level disruptive behavioral problems, and 464 parents agreed to be randomized to the 11-week Strongest Families Smart Website (SFSW) intervention (n = 232) or an educational control (EC) (n = 232). After 24 months, 163 SFSW parents (70%) and 165 EC parents (71%) were still participating. RESULTS When we compared the results at baseline and 24 months, the primary outcome of the Child Behavior Checklist (CBCL) externalizing score showed significantly higher improvements in the SFSW group (effect size 0.22; p < 0.001). This group also showed greater improvements in the secondary outcomes: the CBCL total and internalizing scales, 5 of the 7 CBCL symptom domains, 3 of the 5 DSM subscores, and self-reported parenting skills. Fewer SFSW children (17.5%) than EC children (28.0%) had been referred to child mental health services between baseline and 24 months (odds ratio = 1.8; 95% confidence interval = 1.1-3.1). CONCLUSION The SFSW internet-based and telephone-assisted parental training program was effective 24 months after initiation, underlining the value of identifying children at risk in the community early and providing evidence-based parent training for a large number of families. CLINICAL TRIAL REGISTRATION INFORMATION STRONGEST FAMILIES FINLAND CANADA: Family-based Prevention and Treatment Program of Early Childhood Disruptive Behavior (Fin-Can). http://www.clinicaltrials.gov; NCT01750996.
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Affiliation(s)
- Andre Sourander
- University of Turku, Finland; Turku University Hospital, Finland.
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada
| | - Terja Ristkari
- University of Turku, Finland; Turku University Hospital, Finland
| | - Charles Cunningham
- DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada; QEII Health Sciences Centre, Halifax, Nova Scotia
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Engaging patients and caregivers in prioritizing symptoms impacting quality of life for Duchenne and Becker muscular dystrophy. Qual Life Res 2018; 27:2261-2273. [PMID: 29804169 DOI: 10.1007/s11136-018-1891-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 09/29/2022]
Abstract
PURPOSE Patient preference information (PPI) have an increasing role in regulatory decision-making, especially in benefit-risk assessment. PPI can also facilitate prioritization of symptoms to treat and inform meaningful selection of clinical trial endpoints. We engaged patients and caregivers to prioritize symptoms of Duchenne and Becker muscular dystrophy (DBMD) and explored preference heterogeneity. METHODS Best-worst scaling (object case) was used to assess priorities across 11 symptoms of DBMD that impact quality of life and for which there is unmet need. Respondents selected the most and least important symptoms to treat among a subset of five. Relative importance scores were estimated for each symptom, and preference heterogeneity was identified using mixed logit and latent class analysis. RESULTS Respondents included patients (n = 59) and caregivers (n = 96) affected by DBMD. Results indicated that respondents prioritized "weaker heart pumping" [score = 5.13; 95% CI (4.67, 5.59)] and pulmonary symptoms: "lung infections" [3.15; (2.80, 3.50)] and "weaker ability to cough" [2.65; (2.33, 2.97)] as the most important symptoms to treat and "poor attention span" as the least important symptom to treat [- 5.23; (- 5.93, - 4.54)]. Statistically significant preference heterogeneity existed (p value < 0.001). At least two classes existed with different priorities. Priorities of the majority latent class (80%) reflected the aggregate results, whereas the minority latent class (20%) did not distinguish among pulmonary and other symptoms. CONCLUSIONS Estimates of the relative importance for symptoms of Duchenne muscular dystrophy indicated that symptoms with direct links to morbidity and mortality were prioritized above other non-skeletal muscle symptoms. Findings suggested the existence of preference heterogeneity for symptoms, which may be related to symptom experience.
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Gross D, Belcher HME, Budhathoki C, Ofonedu ME, Uveges MK. Does Parent Training Format Affect Treatment Engagement? A Randomized Study of Families at Social Risk? JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:1579-1593. [PMID: 29713137 PMCID: PMC5918300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined whether parent engagement in parent training (PT) differed based on PT format (parent group-based with video versus mastery-based individual coaching with child) in an economically disadvantaged sample of families seeking behavioral treatment for their preschool children in an urban mental health clinic. Parents (N=159; 76.1% mothers, 69.8% African American, 73% low-income) were randomized to one of two interventions, Chicago Parent Program (parent group + video; CPP) or Parent Child Interaction Therapy (individualized mastery-based coaching; PCIT). Parent engagement indicators compared were PT attendance and completion rates, participation quality, and parent satisfaction. Risk factors predictive of PT attrition (parent depression, psychosocial adversity, child behavior problem severity, length of wait time to start PT) were also compared to determine whether they were more likely to affect engagement in one PT format versus the other. No significant differences were found in PT attendance or completion rates by format. Clinicians rated parents' engagement higher in PCIT than in CPP while satisfaction with PT was rated higher by parents in CPP compared to PCIT. Never attending PT was associated with more psychosocial adversity and externalizing behavior problems for CPP and with higher baseline depression for PCIT. Parents with more psychosocial adversities and higher baseline depression were less likely to complete PCIT. None of the risk factors differentiated CPP completers from non-completers. Delay to treatment start was longer for PCIT than CPP. Strengths and limitations of each PT format are discussed as they relate to the needs and realities of families living in urban poverty.
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Affiliation(s)
- Deborah Gross
- School of Nursing, Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, 410-614-5311
| | - Harolyn M E Belcher
- Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute, 716 Broadway, Baltimore, MD 21205, 443-923-5933
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, 410-614-5320
| | - Mirian E Ofonedu
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, 1750 E. Fairmont Avenue, 443-923-9200
| | - Melissa K Uveges
- School of Nursing, Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, 410-614-5311
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Caserta A, Fabiano GA, Hulme K, Pyle K, Isaacs L, Jerome S. A Waitlist-Controlled Trial of Behavioral Parent Training for Fathers of Preschool Children. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23794925.2018.1446768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Abigail Caserta
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Gregory A. Fabiano
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Karen Hulme
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Kellina Pyle
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Lesthia Isaacs
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Stephanie Jerome
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, New York, USA
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21
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Parents' Preferences for School- and Community-Based Services for Children at Risk for ADHD. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9258-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zhou M, Thayer WM, Bridges JFP. Using Latent Class Analysis to Model Preference Heterogeneity in Health: A Systematic Review. PHARMACOECONOMICS 2018; 36:175-187. [PMID: 28975582 DOI: 10.1007/s40273-017-0575-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Latent class analysis (LCA) has been increasingly used to explore preference heterogeneity, but the literature has not been systematically explored and hence best practices are not understood. OBJECTIVE We sought to document all applications of LCA in the stated-preference literature in health and to inform future studies by identifying current norms in published applications. METHODS We conducted a systematic review of the MEDLINE, EMBASE, EconLit, Web of Science, and PsycINFO databases. We included stated-preference studies that used LCA to explore preference heterogeneity in healthcare or public health. Two co-authors independently evaluated titles, abstracts, and full-text articles. Abstracted key outcomes included segmentation methods, preference elicitation methods, number of attributes and levels, sample size, model selection criteria, number of classes reported, and hypotheses tests. Study data quality and validity were assessed with the Purpose, Respondents, Explanation, Findings, and Significance (PREFS) quality checklist. RESULTS We identified 2560 titles, 99 of which met the inclusion criteria for the review. Two-thirds of the studies focused on the preferences of patients and the general population. In total, 80% of the studies used discrete choice experiments. Studies used between three and 20 attributes, most commonly four to six. Sample size in LCAs ranged from 47 to 2068, with one-third between 100 and 300. Over 90% of the studies used latent class logit models for segmentation. Bayesian information criterion (BIC), Akaike information criterion (AIC), and log-likelihood (LL) were commonly used for model selection, and class size and interpretability were also considered in some studies. About 80% of studies reported two to three classes. The number of classes reported was not correlated with any study characteristics or study population characteristics (p > 0.05). Only 30% of the studies reported using statistical tests to detect significant variations in preferences between classes. Less than half of the studies reported that individual characteristics were included in the segmentation models, and 30% reported that post-estimation analyses were conducted to examine class characteristics. While a higher percentage of studies discussed clinical implications of the segmentation results, an increasing number of studies proposed policy recommendations based on segmentation results since 2010. CONCLUSIONS LCA is increasingly used to study preference heterogeneity in health and support decision-making. However, there is little consensus on best practices as its application in health is relatively new. With an increasing demand to study preference heterogeneity, guidance is needed to improve the quality of applications of segmentation methods in health to support policy development and clinical practice.
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Affiliation(s)
- Mo Zhou
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 690, Baltimore, MD, 21205, USA.
| | - Winter Maxwell Thayer
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 690, Baltimore, MD, 21205, USA
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 690, Baltimore, MD, 21205, USA
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Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system. Med J Aust 2017; 207:S27-S37. [DOI: 10.5694/mja17.00972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
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Cunningham CE, Zipursky RB, Christensen BK, Bieling PJ, Madsen V, Rimas H, Mielko S, Wilson F, Furimsky I, Jeffs L, Munn C. Modeling the mental health service utilization decisions of university undergraduates: A discrete choice conjoint experiment. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:389-399. [PMID: 28511031 DOI: 10.1080/07448481.2017.1322090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 10/24/2016] [Accepted: 01/20/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVE We modeled design factors influencing the intent to use a university mental health service. PARTICIPANTS Between November 2012 and October 2014, 909 undergraduates participated. METHOD Using a discrete choice experiment, participants chose between hypothetical campus mental health services. RESULTS Latent class analysis identified three segments. A Psychological/Psychiatric Service segment (45.5%) was most likely to contact campus health services delivered by psychologists or psychiatrists. An Alternative Service segment (39.3%) preferred to talk to peer-counselors who had experienced mental health problems. A Hesitant segment (15.2%) reported greater distress but seemed less intent on seeking help. They preferred services delivered by psychologists or psychiatrists. Simulations predicted that, rather than waiting for standard counseling, the Alternative Service segment would prefer immediate access to E-Mental health. The Usual Care and Hesitant segments would wait 6 months for standard counseling. CONCLUSIONS E-Mental Health options could engage students who may not wait for standard services.
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Affiliation(s)
- Charles E Cunningham
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
- b Hamilton Health Sciences Corporation , Hamilton , Ontario , Canada
| | - Robert B Zipursky
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
- c Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton , Hamilton , Ontario , Canada
| | - Bruce K Christensen
- d Research School of Psychology , The Australian National University , Canberra , Australia
| | - Peter J Bieling
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
- c Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton , Hamilton , Ontario , Canada
| | | | - Heather Rimas
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Stephanie Mielko
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Fiona Wilson
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
- c Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton , Hamilton , Ontario , Canada
| | - Ivana Furimsky
- c Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton , Hamilton , Ontario , Canada
| | - Lisa Jeffs
- f Youth Wellness Centre, St. Joseph's Healthcare Hamilton , Hamilton , Ontario , Canada
| | - Catharine Munn
- a Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
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Fraenkel L, Lim J, Garcia-Tsao G, Reyna V, Monto A, Bridges JFP. Variation in Treatment Priorities for Chronic Hepatitis C: A Latent Class Analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:241-9. [PMID: 26518200 DOI: 10.1007/s40271-015-0147-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data describing patients' priorities, or main concerns, are essential to inform important decisions in healthcare, including treatment planning, diagnostic testing, and the development of programs to improve access and delivery of care. To date, the majority of studies performed does not account for variability in patients' priorities, and as a consequence may not effectively inform end users. The objective of this study was to examine the value of segmentation analysis as a method to illustrate variability in priorities for treatment of chronic hepatitis C (HCV). METHODS We elicited patients' main concerns when considering antiviral therapy for HCV using a Best-Worst Scaling experiment (Case 1) with ten objects. Latent class analysis was used to estimate part-worth utilities and the probability that each respondent belongs to each segment. RESULTS In the aggregate, subjects (N = 162) had three main concerns: (1) not being cured; (2) experiencing a lot of side effects; and (3) developing viral resistance to therapy. Segmentation into two groups demonstrated that both groups prioritized the likelihood of cure and coping with side effects, but that only one group (n = 78) was concerned about developing viral resistance to therapy, while subjects in the second group (n = 84) prioritized being able to keep up with their responsibilities. Further segmentation revealed distinct clusters of patients with unique priorities. CONCLUSIONS Patients' priorities vary significantly. Preference studies should consider including methods to determine whether distinct clusters of priorities and/or concerns exist in order to accurately inform end users' decision making.
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Affiliation(s)
- Liana Fraenkel
- VA Connecticut Health Care System, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, PO Box 208031, New Haven, CT, USA.
| | - Joseph Lim
- VA Connecticut Health Care System, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, PO Box 208031, New Haven, CT, USA
| | - Guadalupe Garcia-Tsao
- VA Connecticut Health Care System, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, PO Box 208031, New Haven, CT, USA
| | - Valerie Reyna
- Department of Human Development and Psychology, Cornell University, Ithaca, NY, USA
| | - Alexander Monto
- Section of Digestive Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - John F P Bridges
- Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cunningham CE, Niccols A, Rimas H, Robicheau R, Anderson C, DeVries B. Using a Discrete Choice Conjoint Experiment to Engage Stakeholders in the Design of an Outpatient Children’s Health Center. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 10:12-27. [DOI: 10.1177/1937586716686350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: To engage users in the design of a regional child and youth health center. Background: The perspective of users should be an integral component of a patient-centered, evidence-based approach to the design of health facilities. Methods: We conducted a discrete choice conjoint experiment (DCE), a method from marketing research and health economics, as a component of a strategy to engage users in the preconstruction planning process. A sample of 467 participants (290 staff and 177 clients or community stakeholders) completed the DCE. Results: Latent class analysis identified three segments with different design preferences. A group we termed an enhanced design (57%) segment preferred a fully featured facility with personal contacts at the start of visits (in-person check-in, personal waiting room notification, volunteer-assisted wayfinding, and visible security), a family resource center with a health librarian, and an outdoor playground equipped with covered heated pathways. The self-guided design segment (11%), in contrast, preferred a design allowing a more independent use of the facility (e.g., self-check-in at computer kiosks, color-coded wayfinding, and a self-guided family resource center). Designs affording privacy and personal contact with staff were important to the private design segment (32%). The theme and decor of the building was less important than interactive features and personal contacts. Conclusion: A DCE allowed us to engage users in the planning process by estimating the value of individual design elements, identifying segments with differing views, informing decisions regarding design trade-offs, and simulating user response to design options.
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Affiliation(s)
- Charles E. Cunningham
- Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alison Niccols
- Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Heather Rimas
- Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Randi Robicheau
- Child and Youth Developmental and Rehabilitation Health, Ron Joyce Children’s Health Centre, Hamilton, Ontario, Canada
| | - Colleen Anderson
- Child and Youth Developmental and Rehabilitation Health, Ron Joyce Children’s Health Centre, Hamilton, Ontario, Canada
| | - Bart DeVries
- Hamilton Health Sciences, Hamilton, Ontario, Canada
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Schatz NK, Fabiano GA, Cunningham CE, dosReis S, Waschbusch DA, Jerome S, Lupas K, Morris KL. Systematic Review of Patients' and Parents' Preferences for ADHD Treatment Options and Processes of Care. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:483-97. [PMID: 25644223 DOI: 10.1007/s40271-015-0112-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient preferences are an important topic of study with respect to attention-deficit hyperactivity disorder (ADHD) interventions, as there are multiple treatment choices available, multiple developmental levels to consider, and multiple potential individuals involved in treatment (children, parents, and adults with ADHD). Stated preference methods such as discrete choice experiment (DCE), best-worst scaling (BWS), and other utility value methods such as standard gamble interview (SGI) and time trade-off (TTO) are becoming more common in research addressing preferences for ADHD treatments. A synthesis of this research may facilitate improved patient-centered and family-centered treatment for ADHD. OBJECTIVE The purpose of this review was to synthesize reports across existing DCE, BWS, TTO, and SGI studies to assess which aspects of ADHD treatment are most studied as well as most preferred and influential in treatment decisions. DATA SOURCES MEDLINE, PsycINFO. STUDY SELECTION A total of 41 studies referring to preferences for ADHD treatment were identified through the initial search and contact with researchers. Of these, 13 reported ADHD treatment preference data from a study using DCE, BWS, or SGI methods. No TTO studies were identified that met inclusion criteria. RESULTS Methods and designs varied considerably across studies. Relatively few studies focused on preferences among children, adolescents, and adults compared with those that focused on the preferences of parents of children with ADHD. The majority of studies focused primarily on medication treatments, with many fewer focused on psychosocial treatments. Some studies indicated that parents of children with ADHD prefer to avoid stimulant medications in favor of behavioral or psychosocial interventions. Others report that parents see medication as a preferred treatment. Treatment outcome is a particularly salient attribute for treatment decisions for many informants. CONCLUSIONS Potential outcomes of various treatments play a proximal role in patients' and families' decisions for ADHD treatment. Because the majority of studies focus on medication treatments for children with ADHD, more research is necessary to understand preferences related to behavioral and other psychosocial treatments both as stand-alone interventions and used in combination with medication. Additional research is also needed to assess the treatment preferences of adults with ADHD. In general, DCE, BWS, and SGI methods allow measurement of patient preferences in a manner that approximates the uncertainty and trade-offs inherent in real-world treatment decision making and provides valuable information to inform patient-centered and family-centered treatment.
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Affiliation(s)
- Nicole K Schatz
- Department of Counseling, School and Educational Psychology, University at Buffalo, State University of New York at Buffalo, 3rd Floor, Diefendorf Hall, 3435 Main Street, Buffalo, NY, 14214, USA.
| | - Gregory A Fabiano
- Department of Counseling, School and Educational Psychology, University at Buffalo, State University of New York at Buffalo, 3rd Floor, Diefendorf Hall, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Charles E Cunningham
- Jack Laidlaw Chair in Patient-Centered Health Care, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Susan dosReis
- Pharmaceutical Health Services Research Department, University of Maryland, Baltimore, MD, USA
| | - Daniel A Waschbusch
- Penn State Hershey Medical Group Psychiatry, Penn State Hershey, Hershey, PA, USA
| | - Stephanie Jerome
- Department of Counseling, School and Educational Psychology, University at Buffalo, State University of New York at Buffalo, 3rd Floor, Diefendorf Hall, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Kellina Lupas
- Department of Counseling, School and Educational Psychology, University at Buffalo, State University of New York at Buffalo, 3rd Floor, Diefendorf Hall, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Karen L Morris
- Department of Counseling, School and Educational Psychology, University at Buffalo, State University of New York at Buffalo, 3rd Floor, Diefendorf Hall, 3435 Main Street, Buffalo, NY, 14214, USA
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Van Eck K, Warren P, Flory K. A Variable-Centered and Person-Centered Evaluation of Emotion Regulation and Distress Tolerance: Links to Emotional and Behavioral Concerns. J Youth Adolesc 2016; 46:136-150. [DOI: 10.1007/s10964-016-0542-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
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Doty JL, Rudi JH, Pinna KLM, Hanson SK, Gewirtz AH. If You Build It, Will They Come? Patterns of Internet-Based and Face-To-Face Participation in a Parenting Program for Military Families. J Med Internet Res 2016; 18:e169. [PMID: 27334833 PMCID: PMC4935796 DOI: 10.2196/jmir.4445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/29/2015] [Accepted: 04/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some evidence suggests parents are drawn to media-based interventions over face-to-face interventions, but little is known about the factors associated with parents' use of Internet-based or Internet-enhanced programs, especially among military families. Research is needed to understand characteristics of parents who may be most likely to use online components or attend face-to-face meetings in order to ensure maximum engagement. OBJECTIVE In this study, we examined characteristics that predict various patterns of Internet use and face-to-face attendance in a parenting program designed for military families. METHODS An ecological framework guided analysis of differences in patterns of Internet-based use and face-to-face attendance by parents' demographic characteristics (gender, education, employment, and child age), incentives offered, and number of months the parent was deployed. We reported differences in the total number of online components completed over the 14 modules, total number of face-to-face sessions attended, and the use of different types of online components accessed (videos, downloadable handouts, mindfulness exercises, knowledge checks, and downloadable summaries). Then, we computed multinomial logistic regression accounting for nestedness (parents within families) to examine associations between demographic, programmatic, and military-related characteristics and patterns of engagement (use of online components and attendance at face-to-face sessions). RESULTS Just over half (52.2%, 193/370) of the participants used the online components at least once, and the majority of participants (73.2%, 271/370) attended at least 1 face-to-face session. An examination of different patterns of participation revealed that compared with those who participated primarily in face-to-face sessions, parents who participated online but had little face-to-face participation were more likely to have received incentives than those who did not (95% CI 1.9-129.7). Among participants who had been deployed, those who had earned a 4-year degree (95% CI 1.0-2.2) and those who had been offered incentives to participate online (95% CI 2.1-58.6) were more likely to be highly engaged in online components and attend face-to-face compared with those who attended primarily face-to-face. However, those with a high number of months of deployment (95% CI 0.6-1.0) were less likely to be in the pattern of highly engaged in online components and face-to-face attendance. Compared with those who participated primarily face-to-face, deployed mothers were about 4 times more likely to engage in moderate online use with face-to-face attendance than deployed fathers (95% CI 1.21-11.83) and participate primarily online (95% CI 0.77-25.20). CONCLUSIONS Results imply that parents may be drawn to different delivery options of a parenting program (online components vs face-to-face sessions) depending on their education level, incentives to engage in online components, and their military-related experience. Results suggest potential directions for tailoring Internet-based interventions.
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Affiliation(s)
- Jennifer L Doty
- University of Minnesota, Division of General Pediatrics & Adolescent Health, Department of Pediatrics, Minneapolis, MN, United States
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Schraeder KE, Reid GJ. Why wait? The effect of wait-times on subsequent help-seeking among families looking for children's mental health services. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:553-65. [PMID: 25178864 DOI: 10.1007/s10802-014-9928-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Placement on a wait-list may increase families' help-seeking efforts, leading them to contact more than one children's mental health (MH) agency/professional. Two issues were examined in the current study: 1) Does time on a wait-list for families impact the time to contact a new agency for children's MH services? 2) What are the effects of predisposing (e.g., child age), need (e.g., child psychopathology), and enabling/system-level factors (e.g., parent treatment history) on the length of time parents wait before they contact a new agency for help with their child's MH problems? A total of 273 families seeking help for their child (64% boys, M = 10.7 years old, SD = 3.3) were asked about their contact with MH agencies/professionals during the previous year. Survival analyses, modeling time from initial wait-list placement to when a new agency was contacted, were conducted separately for families who did (n = 114), and those who did not (n = 159), receive help prior to contacting a new agency. Almost half of wait-listed families contacted a new agency by the end of the study period. Longer wait-time was associated with a greater likelihood of seeking help at a second agency with 25% of families contacting a new agency within the first month of being wait-listed. Parents with previous treatment experience and families living in areas with more agencies contacted a new agency sooner. Subsequent help-seeking behaviour suggests parents' intolerance for lengthy treatment delays may result in disorganized pathways to care. These findings suggest a highly fragmented service delivery system.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 363 Windermere Rd, Room 326E, Westminister Hall, N6A 3K7, London, ON, Canada,
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Parental Preferences for Early Intervention Programming Examined Using Best–Worst Scaling Methodology. CHILD & YOUTH CARE FORUM 2016. [DOI: 10.1007/s10566-016-9348-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cunningham CE, Hutchings T, Henderson J, Rimas H, Chen Y. Modeling the hospital safety partnership preferences of patients and their families: a discrete choice conjoint experiment. Patient Prefer Adherence 2016; 10:1359-72. [PMID: 27555752 PMCID: PMC4968982 DOI: 10.2147/ppa.s105605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients and their families play an important role in efforts to improve health service safety. OBJECTIVE The objective of this study is to understand the safety partnership preferences of patients and their families. METHOD We used a discrete choice conjoint experiment to model the safety partnership preferences of 1,084 patients or those such as parents acting on their behalf. Participants made choices between hypothetical safety partnerships composed by experimentally varying 15 four-level partnership design attributes. RESULTS Participants preferred an approach to safety based on partnerships between patients and staff rather than a model delegating responsibility for safety to hospital staff. They valued the opportunity to participate in point of service safety partnerships, such as identity and medication double checks, that might afford an immediate risk reduction. Latent class analysis yielded two segments. Actively engaged participants (73.3%) comprised outpatients with higher education, who anticipated more benefits to safety partnerships, were more confident in their ability to contribute, and were more intent on participating. They were more likely to prefer a personal engagement strategy, valued scientific evidence, preferred a more active approach to safety education, and advocated disclosure of errors. The passively engaged segment (26.7%) anticipated fewer benefits, were less confident in their ability to contribute, and were less intent on participating. They were more likely to prefer an engagement strategy based on signage. They preferred that staff explain why they thought patients should help make care safer and decide whether errors were disclosed. Inpatients, those with immigrant backgrounds, and those with less education were more likely to be in this segment. CONCLUSION Health services need to communicate information regarding risks, ask about partnership preferences, create opportunities respecting individual differences, and ensure a positive response when patients raise safety concerns.
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Affiliation(s)
- Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Michael G DeGroote School of Medicine, McMaster University
- Correspondence: Charles E Cunningham, Ron Joyce Children’s Health Centre, Child and Youth Mental Health Program, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada, Tel +1 905 521 2100 ext 77307, Fax +1 905 577 8453, Email
| | - Tracy Hutchings
- Department of Quality and Performance, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jennifer Henderson
- Department of Quality and Performance, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Heather Rimas
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Michael G DeGroote School of Medicine, McMaster University
| | - Yvonne Chen
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Michael G DeGroote School of Medicine, McMaster University
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Bailey K, Cunningham C, Pemberton J, Rimas H, Morrison KM. Understanding Academic Clinicians' Decision Making for the Treatment of Childhood Obesity. Child Obes 2015; 11:696-706. [PMID: 26580274 DOI: 10.1089/chi.2015.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although most clinicians agree that obesity is a major problem, treatment rates remain low. We conducted this discrete choice experiment (DCE) to understand academic clinicians' decisions in treating childhood obesity. METHODS A total of 198 academic pediatric surgeons, pediatricians, family physicians, and allied health professionals were recruited from 15 teaching hospitals across Canada to participate in this DCE. Participants completed 15 tasks choosing between three obesity treatment scenarios to identify the scenario in which they would most likely treat pediatric obesity. RESULTS Latent class analysis revealed two classes with early intervention and late intervention preferences. Participants in the early intervention group (30%) were sensitive to variations in patient and family support. They would likely intervene if patients were obese, with normal lipid levels, were prediabetic, had high blood pressure, and when obesity was lifestyle associated. Late intervention clinicians (70%) were more likely to intervene if patients were morbidly obese, had abnormal lipid levels, required insulin for diabetes, had very high blood pressure, or when obesity impacted the patient's mental health. Simulations predicted that increasing colleague support for intervention, providing expert consultation, and mobilizing multidisciplinary support would increase the likelihood of treating pediatric obesity earlier from 16.1% to 81.5%. CONCLUSIONS This DCE was implemented to understand the factors clinicians use in making decisions. Most academic clinicians choose to intervene late in the clinical course when more-severe obesity-related morbidities are present. Increased support from colleagues, expert consultation, and multidisciplinary support are likely to lead to earlier treatment of obesity among academic clinicians caring for children.
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Affiliation(s)
- Karen Bailey
- 1 Division of Pediatric Surgery, Department of Surgery, McMaster Children's Hospital , Hamilton, Ontario, Canada .,2 McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Charles Cunningham
- 3 Department of Psychiatry & Behavioral Neurosciences, McMaster University , Hamilton, Ontario, Canada
| | - Julia Pemberton
- 2 McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Heather Rimas
- 3 Department of Psychiatry & Behavioral Neurosciences, McMaster University , Hamilton, Ontario, Canada
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Erdem S, Campbell D, Hole AR. Accounting for Attribute-Level Non-Attendance in a Health Choice Experiment: Does it Matter? HEALTH ECONOMICS 2015; 24:773-89. [PMID: 24798402 DOI: 10.1002/hec.3059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 02/05/2014] [Accepted: 04/01/2014] [Indexed: 05/15/2023]
Abstract
An extensive literature has established that it is common for respondents to ignore attributes of the alternatives within choice experiments. In most of the studies on attribute non-attendance, it is assumed that respondents consciously (or unconsciously) ignore one or more attributes of the alternatives, regardless of their levels. In this paper, we present a new line of enquiry and approach for modelling non-attendance in the context of investigating preferences for health service innovations. This approach recognises that non-attendance may not just be associated with attributes but may also apply to the attribute's levels. Our results show that respondents process each level of an attribute differently: while attending to the attribute, they ignore a subset of the attribute's levels. In such cases, the usual approach of assuming that respondents either attend to the attribute or not, irrespective of its levels, is erroneous and could lead to misguided policy recommendations. Our results indicate that allowing for attribute-level non-attendance leads to substantial improvements in the model fit and has an impact on estimated marginal willingness to pay and choice predictions.
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Affiliation(s)
- Seda Erdem
- Economics Division, Stirling Management School, University of Stirling, Stirling, UK
| | - Danny Campbell
- Economics Division, Stirling Management School, University of Stirling, Stirling, UK
| | - Arne Risa Hole
- Department of Economics, University of Sheffield, Sheffield, UK
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Wymbs FA, Cunningham CE, Chen Y, Rimas HM, Deal K, Waschbusch DA, Pelham WE. Examining Parents' Preferences for Group and Individual Parent Training for Children with ADHD Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:614-631. [PMID: 25700219 DOI: 10.1080/15374416.2015.1004678] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Parent training (PT) programs have been found to reduce some behavioral impairment associated with children's attention deficit hyperactivity disorder (ADHD) as well as improve parenting competence, but poor uptake and participation by parents are formidable barriers that affect service effectiveness. We used a discrete-choice experiment (DCE) to examine how parent preferences for treatment format (i.e., group vs. individual) might influence their participation in PT. Participants were 445 parents seeking mental health services for children with elevated symptoms of ADHD in Ontario, Canada. Parents completed a DCE composed of 30 choice tasks used to gauge PT format preference. Results showed that 58.7% of parents preferred individual PT; these parents were most interested in interventions that would make them feel more informed about their child's problems and in understanding-as opposed to solving-their child's problems. A minority of parents (19.4%) preferred group PT; these parents were most interested in active, skill-building services that would help them solve their child's problems. About one fifth of parents (21.9%) preferred the Minimal Information alternative (i.e., receiving neither individual or group PT); these parents reported the highest levels of depression and the most severe mental health problems in their child. Results highlight the importance of considering parent preferences for format and suggest that alternative formats to standard PT should be considered for multiply stressed families.
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Affiliation(s)
| | | | - Yvonne Chen
- b Department of Psychiatry and Behavioural Neurosciences , McMaster University
| | - Heather M Rimas
- b Department of Psychiatry and Behavioural Neurosciences , McMaster University
| | - Ken Deal
- c Department of International Marketing and Health Services Management , McMaster University
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Cunningham CE, Rimas H, Chen Y, Deal K, McGrath P, Lingley-Pottie P, Reid GJ, Lipman E, Corkum P. Modeling Parenting Programs as an Interim Service for Families Waiting for Children's Mental Health Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:616-29. [PMID: 24702236 DOI: 10.1080/15374416.2014.888666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using a discrete choice conjoint experiment, we explored the design of parenting programs as an interim strategy for families waiting for children's mental health treatment. Latent class analysis yielded 4 segments with different design preferences. Simulations predicted the Fast-Paced Personal Contact segment, 22.1% of the sample, would prefer weekly therapist-led parenting groups. The Moderate-Paced Personal Contact segment (24.7%) preferred twice-monthly therapist-led parenting groups with twice-monthly lessons. The Moderate-Paced E-Contact segment (36.3%), preferred weekly to twice-monthly contacts, e-mail networking, and a program combining therapist-led sessions with the support of a computerized telephone e-coach. The Slow-Paced E-Contact segment (16.9%) preferred an approach combining monthly therapist-led sessions, e-coaching, and e-mail networking with other parents. Simulations predicted 45.3% of parents would utilize an option combining 5 therapist coaching calls with 5 e-coaching calls, a model that could reduce costs and extend the availability of interim services. Although 41.0% preferred weekly pacing, 58% were predicted to choose an interim parenting service conducted at a twice-monthly to monthly pace. The results of this study suggest that developing interim services reflecting parental preferences requires a choice of formats that includes parenting groups, telephone-coached distance programs, and e-coaching options conducted at a flexible pace.
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Cunningham CE, Barwick M, Short K, Chen Y, Rimas H, Ratcliffe J, Mielko S. Modeling the Mental Health Practice Change Preferences of Educators: A Discrete-Choice Conjoint Experiment. SCHOOL MENTAL HEALTH 2013; 6:1-14. [PMID: 24563679 PMCID: PMC3924025 DOI: 10.1007/s12310-013-9110-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Schools are sometimes slow to adopt evidence-based strategies for improving the mental health outcomes of students. This study used a discrete-choice conjoint experiment to model factors influencing the decision of educators to adopt strategies for improving children’s mental health outcomes. A sample of 1,010 educators made choices between hypothetical mental health practice change strategies composed by systematically varying the four levels of 16 practice change attributes. Latent class analysis yielded two segments with different practice change preferences. Both segments preferred small-group workshops, conducted by engaging experts, teaching skills applicable to all students. Participants expressed little interest in Internet options. The support of colleagues, administrators, and unions exerted a strong influence on the practice change choices of both segments. The Change Ready segment, 77.1 % of the sample, was more intent on adopting new strategies to improve the mental health of students. They preferred that schools, rather than the provincial ministry of education, make practice change decisions, coaching was provided to all participants, and participants received post-training follow-up sessions. The Demand Sensitive segment (22.9 %) was less intent on practice change. They preferred that individual teachers make practice change decisions, recommended discretionary coaching, and chose no post-training follow-up support. This study emphasizes the complex social, organizational, and policy context within which educators make practice change decisions. Efforts to disseminate strategies to improve the mental health outcomes of students need to be informed by the preferences of segments of educators who are sensitive to different dimensions of the practice change process. In the absence of a broad consensus of educators, administrators, and unions, potentially successful practice changes are unlikely to be adopted.
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Affiliation(s)
- Charles E Cunningham
- Hamilton Health Sciences, McMaster Children's Hospital, McMaster University, Hamilton, ON L9C 7N4 Canada ; Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, The Jack Laidlaw Chair in Patient-Centred Health Care, McMaster University, Hamilton, ON Canada
| | - Melanie Barwick
- Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Kathy Short
- Hamilton-Wentworth District School Board, Hamilton, ON Canada
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McGrath PJ, Sourander A, Lingley-Pottie P, Ristkari T, Cunningham C, Huttunen J, Filbert K, Aromaa M, Corkum P, Hinkka-Yli-Salomäki S, Kinnunen M, Lampi K, Penttinen A, Sinokki A, Unruh A, Vuorio J, Watters C. Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 2013; 13:985. [PMID: 24139323 PMCID: PMC4015286 DOI: 10.1186/1471-2458-13-985] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION ClinicalTrials.gov # NCT01750996.
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Affiliation(s)
- Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
- Center for Child and Adolescent Mental Health, North Norway (RBUP), University of Tromsø, 9037, Breivika, Norway
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
- Strongest Families Institute, 7105 Chebucto Road, Suite 355, Halifax, Nova Scotia B3L 4W8, Canada
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Science, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katharine Filbert
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Itäinen Pitkäkatu 30, 20700, Turku, Finland
- Department of Public Health, University on Turku, FI-20014, Turun Yliopisto, Finland
| | - Penny Corkum
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katja Lampi
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anne Penttinen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anita Unruh
- Dalhousie University, Faculty of Health Professions, Burbidge Building, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jenni Vuorio
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Carolyn Watters
- Dalhousie University, Faculty of Computer Science, 6050 University Avenue, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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