dHealth Solution for Improving Parent Adherence to Behavioral Treatment for ADHD
Study Details
Study Description
Brief Summary
This study aims to develop, refine and preliminarily test a novel and scalable digital health solution designed to address parent adherence barriers in daily life contexts and increase parent's sustained use of evidence-based parenting strategies.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The study includes the following 3 phases:
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Discovery phase: During the Discovery phase, we will conduct 1-hour focus groups at school sites with parents (N=8) and school mental health providers (N=4), who are considered major stakeholders and potential users of the dHealth tool. The purpose of these groups is to obtain feedback and guidance on features and procedures in order to maximize the usability and feasibility of the dHealth tool. This design includes participants who have completed a parenting skills treatment (CLS) and thus would be better informed to comment on needs for the augmented treatment. Stakeholders will be queried about their preferences regarding the application layout, tools, content, and features (e.g., reminders, badges). Recorded focus group sessions will be transcribed and coded for themes related to usability and feasibility.
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Design and Build phases: Feedback from the discovery phase will be incorporated into the design and build phases, during which time prototypes will be put through proof of concept testing with parents and school clinicians who had participated in the discovery phase. Qualitative data will be collected at 2 time points during the design and build phases. Quantitative data will be gathered using the System Usability Scale (SUS) for each component prototype (e.g., description of skill, video examples, interactive activities). A fully functioning application will be completed at the end of the build phase and ready for the test phase.
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Test Phase: The test phase is a 2-month pilot open trial of the dHealth tool with parents. We will provide the dHealth tool to parents who participated in the prior phases (N=5) as well as a new sample of parents (N=12) who will test the tool with their children in conjunction with the parent's participation in BPT at their school (to test tool utility during the course of treatment). Parents will be advised to use the tool daily to record parenting strategy use and to access information/training as needed. Qualitative semi-structured interviews during and after the trial will assess reactions to the platform (usability, feasibility, acceptability) to inform refinements and identify barriers and facilitators relating to use. Primary outcomes focus on usage metrics with the tool (e.g., frequency of use, module and activity completion, time, repeat activity), reported daily parenting skills use on the tool, and measures of feasibility and acceptability. Application usage analytics will be collected by the mobile application, providing objective descriptives including how often and for how long individuals access the application and each component, as well as how users navigate through the application. This data will be analyzed for patterns associated with tool satisfaction ratings, feasibility, and acceptability ratings and reported skill utilization. Secondary outcomes of parent knowledge, motivation and confidence in using EBT skills; parenting practices, ADHD symptoms and functional outcomes will be assessed before and after tool usage.
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Randomized Controlled Trial (RCT) Phase: The RCT phase is a 20-month pilot randomized controlled trial of the refined dHealth tool with parents. We will randomly assign groups to receive either the parenting skills training plus the tool (N=5 groups, 30 parents) or parenting skills training without the tool (N=5 groups, 30 parents). Exploratory analyses will examine the potential mediating mechanism of skill utilization (immediate and sustained) for optimizing the association between the dHealth intervention and improved child and parenting outcomes and the potential moderating effect of parent ADHD/EF functioning and internalizing mental health dimensions.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: CaregiverAssist Parents and School Mental Health Providers (SMHPs) will participate in focus groups and discussions to facilitate the build, design, and use of a digital Health (dHealth) tool to improve parent adherence sustained use of evidence-based parenting strategies. Parents will participate in a 2-month trial during which time they will use the dHealth tool in daily life contexts. |
Device: CaregiverAssist
CaregiverAssist is a proposed dHealth tool to promote parent adherence and sustained strategy use of evidence-based parenting strategies.
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Outcome Measures
Primary Outcome Measures
- System Usability Scale [Change from baseline on technology usability at 6 months]
10-item sale for assessing technology product usability
- Feasibility Rating Scale [Change from baseline on technology use at 6 months]
1-5 Likert scale rating of amount of time and level of effort needed to use the tool regularly
- Parent Acceptability and Satisfaction Questionnaire [Change from baseline on technology use at 6 months]
1-5 Likert scale rating level of engagement, usefulness, and acceptability
- Parent adherence/implementation [Change from baseline on application use at 2 months]
5-point Likert scale rating daily use of skills and behavior plans (tracked on application)
Secondary Outcome Measures
- Parent Confidence and Motivation to Use Evidence Based Parenting Skills [Change from baseline on confidence and motivation at 2 months]
5-point Likert scale of parent rated confidence and motivation
- Parent Knowledge of Evidence Based Parenting Skills [Change from baseline on knowledge of EBT at 2 months]
Assessed via content question, vignettes, and behavior plans to rate parent knowledge of EBT skills
- Alabama Parenting Questionnaire [Change from baseline on parenting skills at 2 months]
Assessment of parenting skills
- Parenting Stress Index [Change from baseline on parent stress at 2 months]
Assessment of parent stress
- Barkley Deficit in Executive Functions Scale [Change from baseline on parent executive functioning at 2 months]
We will use the Barkley Deficits in Executive Functioning Scale for Adults (BDEFS; Barkley, 2011) which is an empirically based tool for evaluating dimensions of adult executive functioning in daily life. We will use the Overall Executive Functioning Total Score which is a sum of all 89 items (each rated on a likert scale from 1 "never or rarely" to 4 "very often" such that higher scores represent greater degrees of executive functioning impairments) and possible values on the Total Score range from 89 to 356.
- Child and Adolescent Symptom Inventory (CASI-V) [Change from baseline on ADHD and oppositional behaviors at 2 months]
Assessment of ADHD and oppositional behaviors
- Strengths and Difficulties Questionnaire [Change from baseline on child impairments at 2 months]
Assessment of child impairments
Eligibility Criteria
Criteria
Inclusion Criteria:
•Participation in ongoing CLS-R open trials (total of 8 parents and 4 school mental health providers) who met eligibility criteria for their children:
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Child aged 7-11 (grades 2-5)
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Identification by school mental health professionals as experiencing challenges with inattention and/or hyperactivity/impulsivity
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Attending a participating SFUSD elementary school full time in a mainstream classroom
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Living with a caretaker who is available to participate in treatment
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Absence of significant visual/hearing impairment, severe language delay, psychosis, pervasive developmental disorder, or global intellectual impairment per school records
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Significant ADHD symptoms as evidenced by having (i) six or more symptoms of inattention and/or hyperactivity/impulsivity rated as occurring "often" or "very often" by parents or teachers, with each informant endorsing at least two symptoms on the Child and Adolescent Symptom Inventory; (ii) at least one area of functioning rated as -≥ 3 on the Impairment Rating Scale by both parent and teacher
Exclusion Criteria:
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Parents and SMHPs who are not participating in ongoing CLS-R trials (Phase 1 only)
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Parents who are not participants in ongoing CLS-R/CLS trial and who do not complete CLS-R/CLS by March 2020 (Phase 1 and Phase 2)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | HALP Clinic, Children's Center at Langley Porter, UCSF | San Francisco | California | United States | 94143 |
Sponsors and Collaborators
- University of California, San Francisco
Investigators
- Principal Investigator: Linda Pfiffner, PhD, University of California, San Francisco
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 19-28558