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Nelson AK, Griest CJ, Munoz LM, Rumaldo N, Miller AC, Soplapuco GM, Lecca L, Shin SS, Acuña LR, Valdivia YV, Ramos AR, Ahumada DG, Ramos BRH, Mejia SA, Serrano EO, Castro WH, Oliva VE, Heyman AS, Hartwell LP, Blackwell RL, Diaz DF, Vibbert MM. Proof of concept of the Universal Baby video innovation for early child development in Lima, Peru. J Pediatr Psychol 2024:jsae035. [PMID: 38872286 DOI: 10.1093/jpepsy/jsae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Community-based video interventions offer an effective and potentially scalable early interaction coaching tool for caregivers living in low resource settings. We tested the Universal Baby (UB) video innovation; an early interaction coaching tool using video sourced and produced locally with early child development (ECD) expert supervision. METHODS This proof-of-concept study enrolled 40 caregivers of children ages 10-18 months assigned to intervention and control groups by health establishments in Carabayllo, Lima, Peru. Mother/child dyads received 12 weekly group health education sessions with social support. Of those, 16 caregivers also received 6 UB videos featuring brain science education and local clips of responsive, reciprocal interaction, also known as "serve and return" interaction. Survey data assessed feasibility and acceptability of the intervention. We assessed improved quality of mother/child interaction using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO). RESULTS We found the program feasible. We successfully trained the local team to produce UB videos using locally-sourced footage and delivered the videos as part of a community-based intervention. We also found it to be acceptable in that participants enthusiastically received the UB videos, reporting they enjoyed being videotaped, and learned how to recognize and appropriately respond to their child's nuanced sounds and gestures. The median change in total PICCOLO scores favored the intervention group compared to the control group. CONCLUSIONS UB offers great potential as a sustainable, potentially scalable, and culturally appropriate tool to promote equity for child development among young children living in low resource homes globally.
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Affiliation(s)
- Adrianne K Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Blavatnik Institute, Harvard Medical School, Boston, MA, United States
| | | | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | - Sarah A Mejia
- Wheelock College of Education and Human Development, Boston University, Boston, MA, United States
| | | | | | | | - Annie S Heyman
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Lauren P Hartwell
- Boston University School of Public Health, Boston, MA, United States
| | - Ronnie L Blackwell
- Wheelock College of Education and Human Development, Boston University, Boston, MA, United States
| | | | - Martha M Vibbert
- Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Lin-Lewry M, Thi Thuy Nguyen C, Hasanul Huda M, Tsai SY, Chipojola R, Kuo SY. Effects of digital parenting interventions on self-efficacy, social support, and depressive symptoms in the transition to parenthood: A systematic review and meta-analysis. Int J Med Inform 2024; 185:105405. [PMID: 38471407 DOI: 10.1016/j.ijmedinf.2024.105405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Parenting self-efficacy is essential for the transition to parenthood. As digital parenting educational interventions are rapidly being developed, their effects have not been examined by pooling available randomized controlled trials (RCTs). OBJECTIVES To comprehensively investigate the effects of digital educational interventions on parents' self-efficacy, social support, and depressive symptoms in the first year after childbirth and identify the significant associated factors. METHODS This study searched six electronic databases for relevant RCTs examining the efficacy of digital parenting interventions from inception to September 2022. The studied outcomes included changes in parent's self-efficacy, social support, and depressive symptoms observed after participating in a digital parenting program. The random-effects model was used to pool results. Subgroup and moderator analyses were performed. RESULTS In total, seven RCTs enrolling 1342 participants were included. The parents who received digital parenting interventions had higher parenting self-efficacy (standardized mean difference [SMD]: 1.06, 95 % confidence interval [CI]: 0.40-1.71, p =.002) and social support (SMD: 2.72, 95 % CI: 0.38-5.07, p =.02) and decreased depressive symptoms at 3 months postpartum (SMD: -0.39, 95 % CI: -0.73 to - 0.04, p =.03). Providing the interventions for ≥ 6 weeks (SMD: 1.62, 95 % CI: 1.18-2.06, p <.001), providing in-person orientation (SMD: 1.88, 95 % CI: 1.32-2.44, p <.001), including a guided curriculum (SMD: 2.00, 95 % CI: 1.78-2.22, p <.001), and conducting interventions in Organisation for Economic Co-operation and Development countries (SMD: 1.98, 95 % CI: 1.78-2.19, p <.001) were identified as significant moderators. CONCLUSIONS Digital parenting interventions significantly increase parenting self-efficacy and social support as well as alleviate depressive symptoms for parents during their first year after childbirth. Such interventions can be beneficial for parents who prefer online education. Future studies investigating the long-term effects of these interventions are warranted. REGISTRATION The protocol for this systematic review and meta-analysis is registered in PROSPERO (registration number: CRD42021243641).
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Affiliation(s)
- Marianne Lin-Lewry
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Cai Thi Thuy Nguyen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Viet Nam.
| | - Mega Hasanul Huda
- Faculty of Nursing, Universitas Indonesia, Depok, West Java 16424, Indonesia.
| | - Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Roselyn Chipojola
- Evidence Informed Decision-making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi.
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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3
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Ahun MN, Ali NB, Hentschel E, Jeong J, Franchett E, Yousafzai AK. A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development. Ann N Y Acad Sci 2024; 1533:99-144. [PMID: 38354095 DOI: 10.1111/nyas.15110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.
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Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nazia Binte Ali
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Franchett
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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4
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Aldridge G, Tomaselli A, Nowell C, Reupert A, Jorm A, Yap MBH. Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review. J Med Internet Res 2024; 26:e43994. [PMID: 38241066 PMCID: PMC10837762 DOI: 10.2196/43994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/28/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal. OBJECTIVE This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. METHODS Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. RESULTS We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. CONCLUSIONS This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. TRIAL REGISTRATION PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.
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Affiliation(s)
- Grace Aldridge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alessandra Tomaselli
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Clare Nowell
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Monash University, Clayton, Australia
| | - Anthony Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marie Bee Hui Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Mohammed K, Abubakari AR, Amoak D, Antabe R, Luginaah I. Geographic disparities in the time to under-five mortality in Ghana. PLoS One 2023; 18:e0291328. [PMID: 37699020 PMCID: PMC10497139 DOI: 10.1371/journal.pone.0291328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
Globally, there has been tremendous advancement in medicine and child healthcare with increased life expectancy. That notwithstanding, the risk of under-five mortality ─ children dying before their fifth birthday remains relatively high in countries in Sub-Saharan Africa such as Ghana. In Ghana, under-five mortality remains a major public health problem that requires significant policy interventions. Using data from the 2017 Maternal Health Survey (n = 4785), we examined the geographic disparities in the time to under-five mortality in Ghana. The Kaplan Meier estimator showed significant (Log-rank: p< 0.001) rural-urban differences in the time to under-five mortality in Ghana. A disaggregated cox proportional hazards analysis showed that despite wide consensus that children in urban areas have a high survival rate, children in urban areas in northern regions of Ghana, especially the Upper West (HR = 4.40, p < 0.05) and Upper East (HR = 5.37, p < 0.01) Regions were significantly at increased risk of dying before the age of five compared to children in urban areas in the Greater Accra Region. A rural-urban comparison showed that children born in rural areas in all the other regions of Ghana were at a higher risk of dying before the age of five when compared to their counterparts in the rural areas of Greater Accra Region. Other factors such as sex of child, mothers' age and use of the internet, number of household members, ethnicity and household wealth were significantly associated with the timing of under-five mortality in Ghana. Healthcare policies and programs such as immunizations and affordable child healthcare services should be prioritized especially in rural areas of regions with a high risk of child mortality. Also, there is a need to improve healthcare delivery in urban areas, particularly in northern Ghana, where deplorable healthcare service infrastructure and delivery coupled with high poverty rates put children at risk of dying before their fifth birthday.
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Affiliation(s)
- Kamaldeen Mohammed
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Abdul Razak Abubakari
- Department of Population and Reproductive Health, University for Development Studies, Tamale, Ghana
| | - Daniel Amoak
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario. Canada
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
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Komanchuk J, Letourneau N, Duffett-Leger L, Cameron JL. Recruitment and Retention Strategies for Parents Experiencing Vulnerability: Lessons from an Online Parenting Program. Can J Nurs Res 2023; 55:377-387. [PMID: 37186778 DOI: 10.1177/08445621231171971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Supportive parenting programs can promote parent-child interactions and children's development. However, families experiencing vulnerability (e.g., low socioeconomic status) report barriers (e.g., transportation, distrust of researchers) to research participation, and attrition rates of 40% and higher have been reported in parenting research. In response, we conducted a longitudinal evaluation of a digital parenting program in a major metropolitan centre in western Canada and retained 99% of our sample. AIM Review recruitment and retention strategies employed in the First Pathways study and evaluate associations between sociodemographic (e.g., income) and psychosocial (e.g., parental depression) factors with recruitment and retention strategies. METHODS AND FINDINGS In collaboration with community agencies, we commenced recruitment of 100 families experiencing vulnerability (e.g., low-income) in June 2021. We utilized strategies to engage staff (e.g., presentations, gift cards, updates) and employed snowball sampling. Families recruited through community agencies were significantly more likely to experience vulnerability (e.g., low income and education, high adverse experiences) compared to families in the snowball sample. We incorporated strategies to minimize participant burden (e.g., choice of online or in-person meetings), promoted rapport (e.g., holiday texts, nonjudgmental environment), incorporated trauma-informed practices (e.g., sensitive inquiry), and demonstrated appreciation for participants' contributions (i.e., honorarium). Family experiences of vulnerability (i.e., low income, depressive symptoms, adversity) were correlated with higher participant rescheduling. CONCLUSION Nurses need knowledge of strategies to promote equitable access to research for families experiencing vulnerability. Digital programs with protocols designed to establish rapport, include trauma-informed practices, and minimize participant burden will likely optimize participation and retention.
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Affiliation(s)
| | | | | | - Judy L Cameron
- Faculty of Psychiatry, University of Pittsburgh, Pittsburgh, USA
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7
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Baggett KM, Davis B, Olwit C, Feil EG. Pre-intervention child maltreatment risks, intervention engagement, and effects on child maltreatment risk within an RCT of MHealth and parenting intervention. Front Digit Health 2023; 5:1211651. [PMID: 37497187 PMCID: PMC10367099 DOI: 10.3389/fdgth.2023.1211651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Evidence-based mental health and parenting support services for mothers postpartum can reduce risk for child maltreatment. However, women suffering economic and cultural stressors disproportionately shoulder the burden of infant caregiving while experiencing profound barriers to accessing mental health and parenting services. This article reports on an MHealth and parenting intervention targeting maternal mood and positive parent practices within a randomized controlled trial, which provided a unique opportunity to view pre-intervention child maltreatment risk, its relationship to subsequent intervention engagement, and intervention engagement effects on pre-post child maltreatment risk reduction. Method Principal component factor analysis was conducted to identify a modifiable pre-intervention child maltreatment risk construct within a combined MHealth and parenting intervention sample of 184 primarily Black mothers and their infants. An independent t-test was conducted to compare pre-intervention child maltreatment risk levels between mothers who went on to complete at least two-thirds of the intervention and those who did not. A GLM repeated measures analysis of variance was conducted to determine effects of intervention engagement on child maltreatment risk reduction. Results Pre-intervention child maltreatment risk did not differentiate subsequent maternal intervention completion patterns. Mothers who completed two-thirds of the intervention, compared to those who did not, demonstrated significant reductions in pre-post child maltreatment risk. Discussion Findings underscore the potential of MHealth parenting interventions to reduce substantial child maltreatment risk through service delivery addressing a range of positive parenting and behavioral health needs postpartum, a particularly vulnerable developmental period for maternal depression and child maltreatment risk.
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Affiliation(s)
- Kathleen M. Baggett
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Betsy Davis
- Oregon Research Institute, Eugene, OR, United States
| | - Connie Olwit
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
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8
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Tiwari A, Recinos M, Garner J, Self-Brown S, Momin R, Durbha S, Emery V, O’Hara K, Perry E, Stewart R, Wekerle C. Use of technology in evidence-based programs for child maltreatment and its impact on parent and child outcomes. Front Digit Health 2023; 5:1224582. [PMID: 37483318 PMCID: PMC10357009 DOI: 10.3389/fdgth.2023.1224582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Technology has been used in evidence-based child maltreatment (CM) programs for over a decade. Although advancements have been made, the extent of the application of technology in these programs, and its influence on parental and child outcomes, remains unclear within the context of changes that emerged because of the COVID-19 pandemic. This scoping review provides a contextualized overview and summary of the use of technology in evidence-based parenting and child programs serving families impacted by child maltreatment and the effects of technology-enhanced programs on target outcomes. Materials and methods Using Arksey and O'Malley's methodological framework, we searched seven databases to identify peer-reviewed and grey literature published in English from 2000 to 2023 on evidence-based programs, according to the California Evidence-Based Clearinghouse (CEBC), that included technological supports for two populations: at-risk parents for child maltreatment prevention, and children and youth 0-18 years exposed to child maltreatment. All study designs were included. Results Eight evidence-based parenting programs and one evidence-based child trauma program were identified as using technology across a total of 25 peer-reviewed articles and 2 peer-reviewed abstracts meeting inclusion criteria (n = 19 on parent-level programs; n = 8 on child-level programs). Four studies were published in the context of COVID-19. Two main uses of technology emerged: (1) remote programmatic delivery (i.e., delivering all or part of the program virtually using technology) and (2) programmatic enhancement (i.e., augmenting program content with technology). Improvements across parenting and child mental health and behavioral outcomes were generally observed. Discussion Technology use in evidence-based child maltreatment programs is not new; however, the small sample since the start of the COVID-19 pandemic in this review that met inclusion criteria highlight the dearth of research published on the topic. Findings also suggest the need for the inclusion of implementation outcomes related to adoption and engagement, which could inform equitable dissemination and implementation of these programs. Additional considerations for research and practice are discussed.
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Affiliation(s)
- Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States
| | - Manderley Recinos
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Jamani Garner
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Shannon Self-Brown
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Rushan Momin
- Department of Psychiatry and Behavioral Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Sadhana Durbha
- Department of Psychiatry and Behavioral Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Vanessa Emery
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States
| | - Kathryn O’Hara
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Elizabeth Perry
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Regan Stewart
- Medical University of South Carolina, Charleston, SC, United States
| | - Christine Wekerle
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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Estrada KA, Govindaraj S, Abdi H, Moraglia LE, Wolff JJ, Meera SS, Dager SR, McKinstry RC, Styner MA, Zwaigenbaum L, Piven J, Swanson MR. Language exposure during infancy is negatively associated with white matter microstructure in the arcuate fasciculus. Dev Cogn Neurosci 2023; 61:101240. [PMID: 37060675 PMCID: PMC10130606 DOI: 10.1016/j.dcn.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023] Open
Abstract
Decades of research have established that the home language environment, especially quality of caregiver speech, supports language acquisition during infancy. However, the neural mechanisms behind this phenomenon remain under studied. In the current study, we examined associations between the home language environment and structural coherence of white matter tracts in 52 typically developing infants from English speaking homes in a western society. Infants participated in at least one MRI brain scan when they were 3, 6, 12, and/or 24 months old. Home language recordings were collected when infants were 9 and/or 15 months old. General linear regression models indicated that infants who heard the most adult words and participated in the most conversational turns at 9 months of age also had the lowest fractional anisotropy in the left posterior parieto-temporal arcuate fasciculus at 24 months. Similarly, infants who vocalized the most at 9 months also had the lowest fractional anisotropy in the same tract at 6 months of age. This is one of the first studies to report significant associations between caregiver speech collected in the home and white matter structural coherence in the infant brain. The results are in line with prior work showing that protracted white matter development during infancy confers a cognitive advantage.
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Affiliation(s)
- Katiana A Estrada
- Department of Psychological Sciences, Purdue University, West Lafayette, IN 47906, USA; Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Sharnya Govindaraj
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Hervé Abdi
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Luke E Moraglia
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Shoba Sreenath Meera
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Martin A Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton AB T6G 2R3, Canada
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Meghan R Swanson
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA.
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10
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Prime H, Andrews K, Markwell A, Gonzalez A, Janus M, Tricco AC, Bennett T, Atkinson L. Positive Parenting and Early Childhood Cognition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Child Fam Psychol Rev 2023; 26:362-400. [PMID: 36729307 PMCID: PMC10123053 DOI: 10.1007/s10567-022-00423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 02/03/2023]
Abstract
This review examines the effectiveness of positive parenting interventions aimed at improving sensitivity, responsiveness, and/or non-harsh discipline on children's early cognitive skills, in four meta-analyses addressing general mental abilities, language, executive functioning, and pre-academics. The objectives are to assess the magnitude of intervention effectiveness and identify moderators of effectiveness. We include randomized controlled trials of interventions targeting positive parenting to improve cognition in children < 6 years. Studies that include children with neurodevelopmental and/or hearing disorders were excluded. MEDLINE, PsycINFO, ERIC, and ProQuest Dissertations & Theses (October 2021) and citation chaining identified relevant records. Five reviewers completed screening/assessments, extraction, and risk of bias. Pooled analysis in Comprehensive Meta-Analysis (Version 3) used random effects modeling, with moderation via Q-statistics and meta-regression. Positive parenting interventions led to significant improvements in mental abilities (g = 0.46, N = 5746; k = 33) and language (g = 0.25, N = 6428; k = 30). Effect sizes were smaller and nonsignificant for executive functioning (g = 0.07, N = 3628; k = 14) and pre-academics (g = 0.16, N = 2365; k = 7). Robust moderators emerged for language and cognition. For cognition, studies with higher risk of bias scores yielded larger intervention effects. For language, studies with younger children had larger effect sizes. Studies mitigated selection and detection bias, though greater transparency of reporting is needed. Interventions that promote parental sensitivity, responsiveness, and non-harsh discipline improve early mental abilities and language. Studies examining executive functioning and pre-academics are needed to examine moderators of intervention effectiveness. Trial registration Systematic review PROSPERO registration. CRD42020222143.
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Affiliation(s)
- Heather Prime
- Department of Psychology, York University, Toronto, Canada. .,LaMarsh Centre for Child & Youth Research, York University, Toronto, Canada.
| | - Krysta Andrews
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Alexandra Markwell
- Department of Psychology, York University, Toronto, Canada.,LaMarsh Centre for Child & Youth Research, York University, Toronto, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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11
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Effect of parenting intervention through "Care for Child Development Guideline" on early child development and behaviors: a randomized controlled trial. BMC Pediatr 2022; 22:690. [PMID: 36461019 PMCID: PMC9716152 DOI: 10.1186/s12887-022-03752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Several studies showed that parenting intervention programs play a core component in early child development. Considering the limited healthcare resources in developing countries, group-session intervention based on care for child development (CCD) guideline might be cost-effective. METHODS This randomized controlled trial was conducted at an outpatient public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women aged 18-45 years in their third trimester and followed their children for 18 months. The intervention group underwent 5 educational group sessions, each lasting for almost 45 minutes. The main outcomes were the children's development and socio-emotional behavior problems based on Bayley Scales of Infant and Toddler Development-III (BSID-III) at 12 months and the Children Behavior Checklist (CBCL) at 18 months. RESULTS Overall, data of 181 children were included in the current study, including 80 in the intervention group and 101 controls. The adjusted median/mean differences between intervention and control groups using median/linear regression were not significant for all BSID-III domains except for median differences for cognitive score based on BSID-III (β (SE): - 4.98(2.31), p:0.032) and mean differences for anxiety/depression score based on CBCL (β (SE): - 2.54(1.27), p:0.046). CONCLUSION In this study, parenting interventions through CCD group sessions were significantly effective on just one subscale of children's socio-emotional behavior domains based on CBCL and one domain of children's development based on BSID-III. There might be a ceiling or floor effects for the BSID-III and CBCL assessment, respectively, leaving little room for improvement as almost all children have achieved their full developmental potential in our study. TRIAL REGISTRATION IRCT20190128042533N2, Date of registration: 16/01/2020, www.irct.ir.
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12
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Achouche V, Piollet M, Temame M, Cao XN, D’herbemont V, Moreau J, Wendland J. The impact of a mobile application on parental attitudes, their knowledge of child development, and sense of parenting self-competence: A pilot study. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2022. [DOI: 10.1016/j.amp.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Rachmawati PD, Kurnia ID, Asih MN, Kurniawati TW, Krisnana I, Arief YS, Mani S, Dewi YS, Arifin H. Determinants of under-five mortality in Indonesia: A nationwide study. J Pediatr Nurs 2022; 65:e43-e48. [PMID: 35216837 DOI: 10.1016/j.pedn.2022.02.005] [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: 07/23/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mortality rate for infants and children under five in Indonesia is an ongoing challenge for the government, with figures exceeding the targets set for the country by the Sustainable Development Goals (SDGs). OBJECTIVES This study aims to discover the factors causing under-five mortality in Indonesia. METHODS This study will employ a cross-sectional study design with data sourced from the 2017 Indonesian Demographic and Health Survey (IDHS) between July and September 2017. The sample included 10,014 women who had given birth in the five years prior to the survey. The data was analyzed using Binary logistic regression with a significance level of p < 0.05. RESULTS The significant factors relating to under-five mortality in Indonesia are: mother's age at birth (AOR = 2.04; 95% CI 95% = 1.11-3.77); birth weight (AOR = 7.60; 95% CI 95% = 5.17-11.19); the sex of the child (AOR = 1.80; 95% CI 95% = 1.28-2.52); frequency of using the internet (AOR = 1.13; 95% CI 95% = 0.02-0.95); residence (AOR = 0.64; 95% CI 95% = 0.33-0.94); and birth interval (AOR = 0.52; 95% CI 95% = 0.29-0.92). Birth weight is the more likely cause for under-five mortality in Indonesia. CONCLUSIONS This study revealed that the characteristics of mothers, children, the area of residence, and the behavior of the mother affect the under-five mortality. PRACTICE IMPLICATIONS Pediatric nurses can have a role to play in developing knowledge about health for both mothers and families. Additionally, accessible health education on issues from planning a pregnancy to childcare should be promoted in both rural and urban areas as well as a campaign on proper hygiene practices.
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Affiliation(s)
| | | | | | | | - Ilya Krisnana
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
| | | | - Smriti Mani
- Govt College of Nursing, Medical College and Hospital, Kolkata, India; OSD, Nursing Directorate, Govt of West Bengal, India.
| | | | - Hidayat Arifin
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia.
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14
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Solís-Cordero K, Duarte LS, Fujimori E. Effectiveness of Remotely Delivered Parenting Programs on Caregiver-child Interaction and Child Development: a Systematic Review. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:3026-3036. [PMID: 35615461 PMCID: PMC9123827 DOI: 10.1007/s10826-022-02328-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 06/01/2023]
Abstract
Remotely delivered parenting interventions are suitable to promote child well-being and development, in a context of social isolation, as our society faced due to COVID-19. The objective of this systematic review was to assess the effectiveness of remotely delivered parenting interventions for typically developing children on caregiver-child interaction and child development. We carried out a systematic search to find studies from the inception of the database to September 2021 on six electronic databases: MEDLINE, CINAHL, Embase, Scopus, Web of Science Core Collection and Regional Portal Information and Knowledge for Health (BVS), and gray literature. Eligible study designs were experimental and quasi-experimental studies. We included parenting interventions as long as they were remotely delivered and focused on typically developing children. Two outcomes were considered: caregiver-child interaction and child development. Three randomized controlled trials (RCT) and one quasi-experimental study met the inclusion criteria. Results from two RCT revealed positive, small-to-medium effects on child development. One study showed that the new intervention had a not inferior effect compared to the results achieved by the traditional support. Children who participated in the quasi-experimental study showed significant elevations in language ability. One study reported positive caregiver-child interaction results. There is insufficient evidence to draw definitive conclusions regarding the effectiveness of remotely delivered parenting interventions on child development due to the heterogeneity of participant profiles, mode of delivery, and assessment tools. The results suggest the need to develop future methodologically rigorous studies assessing the effectiveness of remotely delivered parenting interventions for typically developing children on caregiver-child interaction and child development.
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Affiliation(s)
| | - Luciane Simões Duarte
- Chronic Non-communicable Diseases Division, Disease Control Coordination, São Paulo State Health Department, São Paulo, Brazil
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15
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Donkin L, Merry S, Moor S, Mowat A, Hetrick S, Hopkins S, Seers K, Frampton C, D'Aeth L. Effectiveness of a digital parenting program to improve parental well-being after the Christchurch earthquakes: a cluster-randomized trial (Preprint). JMIR Form Res 2022; 7:e37839. [PMID: 37103986 PMCID: PMC10176136 DOI: 10.2196/37839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/13/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children's mental health. OBJECTIVE The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. METHODS A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. RESULTS A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. CONCLUSIONS Kākano is an app co-designed with parents to help manage their children's mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true.
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Affiliation(s)
- Liesje Donkin
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Auckland University of Technology, Auckland, New Zealand
| | - Sally Merry
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Stephanie Moor
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Sarah Hetrick
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- A Better Start: E Tipu e Rea National Science Challenge, Wellington, New Zealand
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sarah Hopkins
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Kara Seers
- The National Public Health Service (Te Mana Ora), Te Whatu Ora, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Lucy D'Aeth
- The National Public Health Service (Te Mana Ora), Te Whatu Ora, Christchurch, New Zealand
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16
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Linhares MBM, Altafim ERP, Gaspardo CM, de Oliveira RC. A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial. INTERVENCION PSICOSOCIAL 2022; 31:21-32. [PMID: 37362619 PMCID: PMC10268541 DOI: 10.5093/pi2021a9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/09/2021] [Indexed: 06/28/2023]
Abstract
The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.
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17
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Baggett KM, Davis B, Mosley EA, Miller K, Leve C, Feil EG. Depressed and Socioeconomically Disadvantaged Mothers' Progression Into a Randomized Controlled Mobile Mental Health and Parenting Intervention: A Descriptive Examination Prior to and During COVID-19. Front Psychol 2021; 12:719149. [PMID: 34456828 PMCID: PMC8397379 DOI: 10.3389/fpsyg.2021.719149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 12/13/2022] Open
Abstract
Infants of low-income and depressed mothers are at high risk for poor developmental outcomes. Early parenting mediates infant experiences from birth, and early intervention can support sensitive and responsive parent practices that optimize infant outcomes via promoting developmental competencies. However, low-income and depressed mothers experience substantial challenges to participating in early intervention. They also have extremely limited access to interventions targeting depression. Interventions targeting maternal depression and parent practices can improve maternal and infant outcomes. Mobile internet-based interventions overcome numerous barriers that low-resource mothers face in accessing home-based interventions. Pandemic-related stressors likely reduce family resources and exacerbate distress of already heavily-burdened mother-infant dyads. During crises such as the COVID-19 pandemic, evidence-based remote coaching interventions are paramount. This article reports on a mobile intervention for improving maternal mood and increasing parent practices that promote infant development. An ongoing randomized controlled trial study provided a unique opportunity to monitor progression from referral to intervention initiation between two groups of depressed mothers: those prior to the pandemic and during the pandemic. The study also examines mother and infant characteristics at baseline. The sample consisted primarily of Black mothers experiencing extreme poverty who self-referred to the study in a large southern city, which is one of the most income disparate in the United States. Prior to the pandemic, 97% of study participants successfully progressed from consent to intervention, as compared to significantly fewer–86%–during the pandemic. Mother-infant dyads during COVID-19, as compared to those prior to COVID-19, displayed similar pre-intervention demographic characteristics and intrapersonal characteristics.
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Affiliation(s)
- Kathleen M Baggett
- Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA, United States
| | - Betsy Davis
- Oregon Research Institute, Eugene, OR, United States
| | - Elizabeth A Mosley
- Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA, United States
| | - Katy Miller
- Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA, United States
| | - Craig Leve
- Oregon Research Institute, Eugene, OR, United States
| | - Edward G Feil
- Oregon Research Institute, Eugene, OR, United States
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18
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Baggett KM, Davis B, Sheeber L, Miller K, Leve C, Mosley EA, Landry SH, Feil EG. Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting. JMIR Res Protoc 2021; 10:e31072. [PMID: 34406122 PMCID: PMC8411326 DOI: 10.2196/31072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. OBJECTIVE The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. METHODS This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. RESULTS The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)-approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. CONCLUSIONS Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. TRIAL REGISTRATION ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31072.
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Affiliation(s)
| | - Betsy Davis
- Oregon Research Institute, Eugene, OR, United States
| | - Lisa Sheeber
- Oregon Research Institute, Eugene, OR, United States
| | - Katy Miller
- Georgia State University, Atlanta, GA, United States
| | - Craig Leve
- Oregon Research Institute, Eugene, OR, United States
| | | | - Susan H Landry
- University of Texas Health Sciences Center, Houston, TX, United States
| | - Edward G Feil
- Oregon Research Institute, Eugene, OR, United States
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Alvarenga P, Kuchirko Y, Cerezo MÁ, de Mendonça Filho EJ, Bakeman R, Tamis-LeMonda CS. An intervention focused on maternal sensitivity enhanced mothers' verbal responsiveness to infants. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2021. [DOI: 10.1016/j.appdev.2021.101313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Elmquist M, Finestack LH, Kriese A, Lease EM, McConnell SR. Parent education to improve early language development: A preliminary evaluation of LENA Start TM. JOURNAL OF CHILD LANGUAGE 2021; 48:670-698. [PMID: 32921333 DOI: 10.1017/s0305000920000458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Parents play an important role in creating home language environments that promote language development. A nonequivalent group design was used to evaluate the effectiveness of a community-based implementation of LENA Start™, a parent-training program aimed at increasing the quantity of adult words (AWC) and conversational turns (CT). Parent-child dyads participated in LENA Start™ (n = 39) or a generic parent education program (n = 17). Overall, attendance and engagement in the LENA StartTM program were high: 72% of participants met criteria to graduate from the program. Within-subject gains were positive for LENA Start™ families. Comparison families declined on these measures. However, both effects were non-significant. Between-group analyses revealed small to medium-sized effects favoring LENA Start™ and these were significant for child vocalizations (CV) and CT but not AWC. These results provide preliminary evidence that programs like LENA StartTM can be embedded in community-based settings to promote quality parent-child language interactions.
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Affiliation(s)
| | - Lizbeth H Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota, USA
| | - Amanda Kriese
- Department of Speech-Language-Hearing Sciences, University of Minnesota, USA
| | - Erin M Lease
- Department of Educational Psychology, University of Minnesota, USA
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21
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Jeong J, Franchett EE, Ramos de Oliveira CV, Rehmani K, Yousafzai AK. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Med 2021; 18:e1003602. [PMID: 33970913 PMCID: PMC8109838 DOI: 10.1371/journal.pmed.1003602] [Citation(s) in RCA: 207] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. METHODS AND FINDINGS We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. CONCLUSIONS Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily E. Franchett
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Clariana V. Ramos de Oliveira
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karima Rehmani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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22
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Baggett KM, Davis B, Sheeber LB, Ammerman RT, Mosley EA, Miller K, Feil EG. Minding the Gatekeepers: Referral and Recruitment of Postpartum Mothers with Depression into a Randomized Controlled Trial of a Mobile Internet Parenting Intervention to Improve Mood and Optimize Infant Social Communication Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8978. [PMID: 33276610 PMCID: PMC7730083 DOI: 10.3390/ijerph17238978] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/28/2020] [Indexed: 12/21/2022]
Abstract
Mothers in the United States (U.S.) who are of non-dominant culture and socioeconomically disadvantaged experience depression during postpartum at a rate 3 to 4 times higher than mothers in the general population, but these mothers are least likely to receive services for improving mood. Little research has focused on recruiting these mothers into clinical intervention trials. The purpose of this article is to report on a study that provided a unique context within which to view the differential success of three referral approaches (i.e., community agency staff referral, research staff referral, and maternal self-referral). It also enabled a preliminary examination of whether the different strategies yielded samples that differed with regard to risk factors for adverse maternal and child outcomes. The examination took place within a clinical trial of a mobile intervention for improving maternal mood and increasing parent practices that promote infant social communication development. The sample was recruited within the urban core of a large southern city in the U.S. and was comprised primarily of mothers of non-dominant culture, who were experiencing severe socioeconomic disadvantage. Results showed that mothers self-referred at more than 3.5 times the rate that they were referred by either community agency staff or research staff. Moreover, compared to women referred by research staff, women who self-referred and those who were referred by community gatekeepers were as likely to eventually consent to study participation and initiate the intervention. Results are discussed with regard to implications for optimizing referral into clinical intervention trials.
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Affiliation(s)
- Kathleen M. Baggett
- Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA 30303, USA; (E.A.M.); (K.M.)
| | - Betsy Davis
- Oregon Research Institute, Eugene, OR 97403, USA; (B.D.); (L.B.S.); (E.G.F.)
| | - Lisa B. Sheeber
- Oregon Research Institute, Eugene, OR 97403, USA; (B.D.); (L.B.S.); (E.G.F.)
| | - Robert T. Ammerman
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Elizabeth A. Mosley
- Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA 30303, USA; (E.A.M.); (K.M.)
| | - Katy Miller
- Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA 30303, USA; (E.A.M.); (K.M.)
| | - Edward G. Feil
- Oregon Research Institute, Eugene, OR 97403, USA; (B.D.); (L.B.S.); (E.G.F.)
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Baggett KM, Davis B, Landry SH, Feil EG, Whaley A, Schnitz A, Leve C. Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination. J Med Internet Res 2020; 22:e18519. [PMID: 32960178 PMCID: PMC7539159 DOI: 10.2196/18519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions.
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Affiliation(s)
- Kathleen M Baggett
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State Universtiy, Atlanta, GA, United States
| | - Betsy Davis
- Oregon Research Institute, Eugene, OR, United States
| | - Susan H Landry
- University of Texas Health Sciences Center- Houston, Houston, TX, United States
| | - Edward G Feil
- Oregon Research Institute, Eugene, OR, United States
| | - Anna Whaley
- University of Kansas, Kansas City, KS, United States
| | - Alana Schnitz
- Juniper Gardens Children's Project, University of Kansas, Kansas City, KS, United States
| | - Craig Leve
- Oregon Research Institute, Eugene, OR, United States
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24
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Mobile-based consortium of parenting resources for low-income and underserved mothers and caregivers: app development, testing and lessons learned. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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