The Feasibility and Acceptability of Using a Digital Conversational Agent (Chatbot) for Delivering Parenting Interventions: Systematic Review

BACKGROUND

Parenting interventions are crucial for promoting family well-being, reducing violence against children, and improving child development outcomes; however, scaling these programs remains a challenge. Prior reviews have characterized the feasibility, acceptability, and effectiveness of other more robust forms of digital parenting interventions (eg, via the web, mobile apps, and videoconferencing). Recently, chatbot technology has emerged as a possible mode for adapting and delivering parenting programs to larger populations (eg, Parenting for Lifelong Health, Incredible Years, and Triple P Parenting).

OBJECTIVE

This study aims to review the evidence of using chatbots to deliver parenting interventions and assess the feasibility of implementation, acceptability of these interventions, and preliminary outcomes.

METHODS

This review conducted a comprehensive search of databases, including Web of Science, MEDLINE, Scopus, ProQuest, and Cochrane Central Register of Controlled Trials. Cochrane Handbook for Systematic Review of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to conduct the search. Eligible studies targeted parents of children aged 0 to 18 years; used chatbots via digital platforms, such as the internet, mobile apps, or SMS text messaging; and targeted improving family well-being through parenting. Implementation measures, acceptability, and any reported preliminary measures of effectiveness were included.

RESULTS

Of the 1766 initial results, 10 studies met the inclusion criteria. The included studies, primarily conducted in high-income countries (8/10, 80%), demonstrated a high mean retention rate (72.8%) and reported high acceptability (10/10, 100%). However, significant heterogeneity in interventions, measurement methods, and study quality necessitate cautious interpretation. Reporting bias, lack of clarity in the operationalization of engagement measures, and platform limitations were identified as limiting factors in interpreting findings.

CONCLUSIONS

This is the first study to review the implementation feasibility and acceptability of chatbots for delivering parenting programs. While preliminary evidence suggests that chatbots can be used to deliver parenting programs, further research, standardization of reporting, and scaling up of effectiveness testing are critical to harness the full benefits of chatbots for promoting family well-being.

Digital resilience in Chinese adolescents: a portrayal of the current condition, influencing factors, and improvement strategies

Inroduction

Digital resilience is an important skill for adolescents in the digital age, but there is a lack of valid and reliable assessment methods. This study aimed to develop and validate a digital resilience questionnaire for Chinese adolescents based on the Digital Resilience Framework proposed by the UK Children's Internet Safety Council.

Methods

This study employed a mixed research design, combining quantitative and qualitative data collected and analyzed. Over a six-month period (January to June 2023), a questionnaire was distributed to 12,208 adolescents from 10 high schools and 16 middle schools, with in-depth interviews performed with 10 of the participants.

Results

The study revealed that Chinese adolescents digital resilience levels are slightly higher than average (M = 3.5038 > 3.5), but there is still potential for development, particularly in active learning. Additionally, a variety of characteristics influencing adolescents digital resilience were discovered, including gender, family residency, whether they are only children, grade level, the number of digital devices used per week, and the length of hours spent online daily.

Discussion

This study developed and verified a digital resilience questionnaire for Chinese adolescents, which may be used to assess and improve their digital skills and well-being in the digital age. The study also identified various variables and themes that influence digital resilience, which can be used to navigate educational initiatives and policy. However, this study's shortcomings included a cross-sectional design, self-reported data, and cultural distinctiveness. Future research could address these limitations by undertaking a longitudinal study, utilizing numerous data sources, and contrasting different cultural contexts.

Prevalence of hikikomori and associations with suicidal ideation, suicide stigma, and help-seeking among 2,022 young adults in Hong Kong

BACKGROUND

Young adults are at elevated risks of hikikomori (severe social withdrawal) under the COVID-19 pandemic, which could lead to psychological distress and suicidal ideation.

AIMS

The present study aimed to examine the associations among hikikomori, suicide stigma, suicidal ideation, and help-seeking behaviors among young adults in Hong Kong.

METHOD

This study recruited a large sample of 2,022 young adults in Hong Kong via an online survey at the end of 2021. The participants completed the Hikikomori Questionnaire and validated measures on psychological distress, suicide stigma, and suicidal ideation severity and report their help-seeking behaviors. Multivariate analysis of variance was conducted to compare the profiles of the hikikomori groups. Path analysis evaluated the effects of hikikomori and suicide stigma on occurrence and severity of suicidal ideation and their associations with help-seeking behaviors.

RESULTS

Hikikomori showed significant and positive indirect effects on prevalence and severity of suicidal ideation via psychological distress. Glorification positively predicted hikikomori and suicidal ideation severity among suicidal persons. Hikikomori was associated with reduced help-seeking. Isolation and suicidal ideation were associated with greater barriers to seek help among the non-help-seekers. Perceived helpfulness of sought help was negatively associated with hikikomori and suicidal ideation among the help-seekers.

CONCLUSIONS

The present findings demonstrated greater prevalence and severity of suicidal ideation and less help-seeking in young adults with hikikomori. Suicide stigma showed differential associations with hikikomori, suicidal ideation, and help-seeking behaviors.

Digital competence and psychological wellbeing in a social housing community: a repeated survey study

BACKGROUND

Little is known about whether digital competence is related to psychological wellbeing, with most previous research focusing on students and elderly people. There is also limited evidence on seasonal changes in psychological wellbeing, particularly in specific groups. Social housing residents are an underserved and under-researched population. The objectives of this study were to explore associations between digital competence (assessed by general technology self-efficacy) and psychological wellbeing (assessed by mental wellbeing and life satisfaction), and to explore seasonal effects, in social housing residents.

METHODS

A repeated survey design was used. The Happiness Pulse questionnaire with a bespoke digital module was sent via post or e-mail at four timepoints between July 2021 and July 2022 to 167 social housing residents in West Cornwall, England. There were 110 respondents in total; thirty completed all four questionnaires and 59 completed an autumn/winter and summer questionnaire. Data were analysed using descriptive and inferential methods including regression, repeated measures analysis of variance and panel analysis.

RESULTS

Significant positive associations were found between digital self-efficacy and mental wellbeing, and between digital self-efficacy and life satisfaction. However, there were no significant seasonal changes in psychological wellbeing.

CONCLUSIONS

The findings extend the existing literature beyond student and elderly populations and suggest that improving digital competence is a potential pathway to improving psychological wellbeing. Surveys with larger samples and qualitative studies are needed to elucidate the mechanisms involved.

A Scoping Review of Digital Well-Being in Early Childhood: Definitions, Measurements, Contributors, and Interventions

Digital well-being concerns the balanced and healthy use of digital technology, and the existing studies in this area have focused on adolescents and adults. However, young children are more vulnerable to digital overuse and addiction than adults; thus, their digital well-being deserves empirical exploration. In this scoping review, we synthesized and evaluated 35 collected studies on young children's digital use and their associated well-being that were published up to October of 2022 to understand the related definitions, measurements, contributors, and interventions. The synthesis of the evidence revealed that (1) there was no consensus about the definition of the concept of digital well-being; (2) there were no effective ways of measuring young children's digital well-being; (3) both child factors (the duration and place of digital use, as well as the child's demographic characteristics) and parent factors (digital use, parental perception, and mediation) contribute to young children's well-being; and (4) there were some effective applications and digital interventions reported in the reviewed studies. This review contributes to the development of this concept by mapping the existing research on young children's digital well-being, as well as proposing a model and identifying the research gaps for future studies.

Review: Digital experiences and their impact on the lives of adolescents with pre-existing anxiety, depression, eating and nonsuicidal self-injury conditions - a systematic review

BACKGROUND

Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre-existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self-injury to identify common and condition-specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.

METHODS

A systematic literature search using a combination of mental health, digital experience (including social media use), and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.

RESULTS

Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self-injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self-regulation during engagement with digital media.

CONCLUSIONS

Digital practices of adolescents with pre-existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder-specific practices, with too few direct or indirect comparisons between conditions.

Using a socio-ecological framework to understand how 8-12-year-olds build and show digital resilience: A multi-perspective and multimethod qualitative study

Educationalists', researchers', and policy makers' work on children's digital resilience has marginalised the role of the broader context within which digital resilience is constituted, experienced and derived. We aimed to address this lacuna by exploring how pre-teen's digital resilience operates as a dynamic socio-ecological process. Addressing this aim, we employed participatory methods and thematically analysed eight focus groups with children aged 8-12 years (n = 59) and 20 telephone interviews with parents/carers and teachers of 8-12-year-olds and internet safety experts to examine this issue. We used purposive sampling and collected data over three months (January-March 2020). Our analysis constructed a matrix of main themes, constituent, and cross-cutting sub-themes. By placing this within a socio-ecological framework, we illustrate how pre-teens' digital resilience operates within and across differing four levels (individual, home, community and societal) and four domains (learning, recognising, managing, and recovery). The paper advances the literature by illustrating how children can be supported to build and show digital resilience within and across different levels and domains. It is argued that digital resilience should be re-conceptualised as a collective endeavour involving children at an individual level, parents/carers within home environments, youth workers, civil society, teachers, and schools at a community level, along with governments, policymakers, and the education system and internet corporations at a societal level. We conclude by providing practice and research recommendations guiding those supporting children to facilitate opportunities to thrive online.