Parent Use and Efficacy of a Self-Administered, Tablet-Based Parent Training Intervention: A Randomized Controlled Trial

Abstract

BackgroundParent training programs are traditionally delivered in face-to-face formats and require trained facilitators and weekly parent attendance. Implementing face-to-face sessions is challenging in busy primary care settings and many barriers exist for parents to attend these sessions. Tablet-based delivery of parent training offers an alternative to face-to-face delivery to make parent training programs easier to deliver in primary care settings and more convenient and accessible to parents. We adapted the group-based Chicago Parent Program (CPP) to be delivered as a self-administered, tablet-based program called the ez Parentprogram.ObjectiveThe purpose of this study was to (1) assess the feasibility of the ez Parentprogram by examining parent satisfaction with the program and the percent of modules completed, (2) test the efficacy of the ez Parentprogram by examining the effects compared with a control condition for improving parenting and child behavior in a sample of low-income ethnic minority parents of young children recruited from a primary care setting, and (3) compare program completion and efficacy with prior studies of the group-based CPP.MethodsThe study used a two-group randomized controlled trial (RCT) design with repeated measures follow up. Subjects (n=79) were randomly assigned to an intervention or attention control condition. Data collection was at baseline and 12 and 24 weeks post baseline. Parents were recruited from a large, urban, primary care pediatric clinic. ez Parentmodule completion was calculated as the percentage of the six modules completed by the intervention group parents. Attendance in the group-based CPP was calculated as the percentage of attendance at sessions 1 through 10. Satisfaction data were summarized using item frequencies. Parent and child data were analyzed using a repeated measures analysis of variance (RM-ANOVA) with simple contrasts to determine if there were significant intervention effects on the outcome measures. Effect sizes for between group comparisons were calculated for all outcome variables and compared with CPP group based archival data.Results ez Parentmodule completion rate was 85.4% (34.2/40; 95% confidence interval [CI] = 78.4%-93.7%) and was significantly greater ( P<.05) than face-to-face CPP group attendance (135.2/267, 50.6%) attendance of sessions; 95% CI = 46.8%-55.6%). ez Parentparticipants reported the program as very helpful (35/40, 88.0%) and they would highly recommend the program (33/40, 82.1%) to another parent. ez Parentparticipants showed greater improvements in parenting warmth (F1,77 = 4.82, P<.05) from time 1 to 3. No other significant differences were found. Cohen’s d effect sizes for intervention group improvements in parenting warmth, use of corporal punishment, follow through, parenting stress, and intensity of child behavior problems were comparable or greater than those of the group-based CPP.ConclusionsData from this study indicate the feasibility and acceptability of the ez Parentprogram in a low-income, ethnic minority...

A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care

“…Under these assumptions, a sample size of 68 parents (34 interventions; 34 controls) in each of four sites for a total sample size of 272 will provide power of 0.80 to detect differences in the analysis of intervention effects on parent and child outcomes. A previous study of the group-based Chicago Parent Program had a reported attrition rate of 13% over 12 months [7] and our pilot study had an attrition rate of 4% over 6 months [17]. Although attrition in the pilot study was quite low, we conservatively estimated attrition to be 13% over 12 months; therefore, we will recruit a total sample size of 312 at baseline.…”

“…Our power calculation is based on an effect size of d = 0.31, α 2-tailed =0.05, an intracluster correlation (ICC) of 0.50 across repeated assessments. The effect size was established from analysis of parent outcomes from our pilot study of the ezParent program [17]. Using data from the pilot study, ICCs for outcome variables ranged from 0.65-0.78 over three assessments.…”

“…In preliminary testing with a sample of primarily low income African American and Hispanic mothers of children age 2 to 5 years old (n = 40) recruited from a pediatric primary care clinic, we found that the average ezParent module completion was 85.4%, indicating that parents completed approximately five of the six modules. Further, 65% of parents completed all six modules, the full curriculum [17].…”

Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination

“…These interventions reduce reliance on harsh discipline, and reduce child behavior problems before they become chronic and entrenched (National Academies, 2016). In fact, many of these evidence-based parenting programs have been developed and implemented by nurses, including the Chicago Parent Program (Breitenstein et al, 2012; Gross et al, 2009); ezParent Program (Breitenstein, Fogg, Ocampo,Acosta, & Gross, 2016); the Incredible Years Program (Webster-Stratton et al, 1997); and Insights (McClowry,Snow, Tamis-LeMonda, & Rodriguez, 2010). All of these programs provide parents with skills to strengthen the quality of the parent-child relationship and reduce problematic behaviors without reliance on harsh discipline.…”

Protocol for digital intervention for effective health promotion of small children—A cluster randomized trial

“…A recent randomized control trial (RCT) of a mobile health intervention (ezPARENT) aimed at promoting parenting competence and preventing child behaviour problems among children aged 2–5 showed that the intervention was engaging (Breitenstein, Brager, Ocampo, & Fogg, ), acceptable and feasible (Breitenstein, Fogg, Ocampo, Acosta, & Gross, ). Another recent pilot study of mobile health intervention (Children Eating Well‐CHEW) aimed at reinforcing nutrition education and help prevent childhood obesity among children aged 2–4 showed moderate to high usability and feasibility of the intervention (Hull et al., ).…”