Brief parenting intervention (Triple P) for families of children with eczema: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy and costs of a brief, group-delivered parenting intervention for families of children with eczema. METHODS: A randomized controlled trial design was used. Families attending the Queensland Children's Hospital and from the community (n = 257) were assessed for eligibility (child 2-10 years, diagnosed with eczema, prescribed topical corticosteroids). Families who consented to participate (N = 59) were assessed at baseline for clinician-rated eczema severity, parent-reported eczema symptom severity, and electronically-monitored topical corticosteroid adherence (primary outcomes); and parenting behavior, parents' self-efficacy and task performance when managing eczema, eczema-related child behavior problems, and child and parent quality of life (secondary outcomes). Families were randomized (1:1, unblinded) to intervention (n = 31) or care-as-usual (n = 28). The intervention comprised two, 2-hr Healthy Living Triple P group sessions (face-to-face/online) and 28 intervention families attended one/both sessions. All families were offered standardized eczema education. Families were reassessed at 4-weeks post-intervention and 6-month follow-up, with clinician-raters blinded to condition. Costs of intervention delivery were estimated. RESULTS: Multilevel modeling across assessment timepoints showed significant intervention effects for ineffective parenting (d = .60), self-efficacy (d = .74), task performance (d = .81), and confidence with managing eczema-related child behavior (d = .63), but not disease/symptom severity, treatment adherence or quality of life. Mean cost per participating family with parenting behavior (clinically) improved was $159. CONCLUSIONS: Healthy Living Triple P is effective in reducing ineffective parenting practices and improving parents' self-efficacy and task performance when managing children's eczema and eczema-related behavior difficulties. There was no effect on disease/symptom severity, treatment adherence, or quality of life. CLINICAL TRIAL REGISTRATION: ACTRN12618001332213.

Patient Perception of Education, Care Coordination, and Psychological Distress After Developing Facial Paralysis: A Qualitative Study.

Importance: The management of vestibular schwannoma may include observation, microsurgical resection, or radiation of a tumor near the facial nerve. Injury to the facial nerve can result in facial paralysis with major functional, social, and psychological sequelae, and the experiences of patients after paralysis are not well studied. Objective: To (1) identify patient preparedness for developing facial paralysis and how well their care is coordinated following its development and (2) present in their own words outcomes of facial paralysis in terms of physical health, emotional health, self-perception, and social interactions. Design, Setting, and Participants: A qualitative observational study was performed using semistructured interviews at a tertiary care academic medical center. Semistructured interviews were conducted between January 1, 2018, and June 30, 2019, with adults aged 25 to 70 years who developed facial paralysis after treatment for vestibular schwannoma. Data were analyzed from July 2019 to June 2020. Main Outcomes and Measures: Perceptions of the educational and emotional experiences of individuals who developed complete facial paralysis after surgical treatment of vestibular schwannoma. Results: Overall, 12 participants were interviewed (median age, 54 years [range, 25-70 years]; 11 were female). Saturation was achieved after 12 interviews, indicating that no further information could be elicited from additional interviews. Four major themes were identified: (1) lack of sufficient patient education about the diagnosis of facial paralysis; (2) lack of appropriate care coordination related to facial paralysis; (3) changes in physical and emotional health following facial paralysis; and (4) changes in social interactions and external support following facial paralysis. Conclusions and Relevance: It is well-known that patients with facial paralysis have reduced quality of life, severe psychological and emotional sequelae. However, little is currently done to help prepare patients for this undesirable outcome. In this qualitative study of facial paralysis, patients express, in their own words, their feeling that the education and management of facial paralysis by their clinicians was inadequate. Before patients undergo surgery, and certainly after injury to the facial nerve, clinicians should consider the patient's goals, preferences, and values to ensure that a comprehensive educational program and psychosocial support system are implemented. Facial reanimation research has not adequately captured these key patient factors associated with the quality of communication.

Randomised controlled trial of the Healthy Living Triple P-Positive Parenting Program for families of children with type 1 diabetes.

This randomised controlled trial examined the efficacy of a brief, group-based parenting program in improving child and family outcomes for families of children with type 1 diabetes. Families (N = 50) of children (2-10 years) with type 1 diabetes were randomly allocated to intervention (n = 22) or care-as-usual (n = 28). Assessments (pre-intervention, post-intervention and 6-month follow-up) evaluated parent- and child-reported parenting behaviour, child behaviour/adjustment and child quality of life (primary outcomes); and metabolic control (routinely-collected blood glucose data), parents' self-efficacy with diabetes management, diabetes-specific child behaviour difficulties, family quality of life, parents' diabetes-related and general parenting stress and observed parent and child behaviour (secondary outcomes). Intent-to-treat analyses indicated greater rate of improvement over time for families allocated to intervention compared to care-as-usual for use of corporal punishment (primary caregivers only), and confidence with managing children's emotions/behaviours, parent-rated child quality of life and adjustment to the child's illness (secondary caregivers only). There were no other intervention effects. Although families found the intervention useful, low levels of psychosocial problems at baseline limited the scope for group-level improvement and there was limited evidence for intervention efficacy. Individually-tailored measures of goal-specific behaviour change may be considered in future research.

Age Effects of Frames of Reference in Self-reports of Health, Well-being, Fatigue and Pain.

RATIONALE: Self-reports of health and well-being are central for population monitoring, so it is paramount that they are measured accurately. The goal of this study was to examine the impact of age on the use of the comparison standards or frames of reference (FoRs) in self-reports of health, life-satisfaction, fatigue, and pain, and to determine if the age-health outcome associations were affected by age differences in FoRs. METHODS: Respondents (n = 2000) selected from the U.S. general population self-rated their life-satisfaction and health outcomes. Following this, they were asked to indicate if they used any comparisons (FoRs) when making their rating and the direction of these comparisons (upward, lateral or downward). Analyses examined (a) whether age groups differed in the type and direction of FoRs, and (b) whether age patterns in health, life-satisfaction, fatigue, and pain were altered when FoRs were statistically controlled. RESULTS: Compared to middle-aged and older people, younger respondents were more likely to compare themselves with other people when self-rating their health and life-satisfaction. They were also more likely to use a hypothetical situation when evaluating their pain and fatigue. Younger participants used lateral comparisons less often and downward comparisons more often than middle-aged and older participants. When these age differences in FoRs were statistically controlled, the observed age patterns in self-reported health outcomes were somewhat reduced. CONCLUSIONS: The results show that people of different ages use different FoRs when self-reporting their life-satisfaction and health outcomes.

Assessing Children's Eudaimonic Well-Being: The PROMIS Pediatric Meaning and Purpose Item Banks.

OBJECTIVE: To describe the development of the Patient-Reported Outcome Measurement Information System (PROMIS) Pediatric Meaning and Purpose item banks, child-report and parent-proxy editions. METHODS: Data were collected from two samples. The first comprised 1,895 children (8-17 years old) and 927 parents of children 5-17 years old recruited from an Internet panel, medical clinics, and schools. The second comprised a nationally representative sample of 990 children 8-17 years old and 1,292 parents of children 5-17 years old recruited from a different Internet panel. Item pool evaluation was done with Sample 1 and analyses were used to support decisions about item retention. The combined sample was used for item response theory (IRT) calibration of the item bank. Both samples were used in validation studies. RESULTS: Eleven items were deleted from the item pool because of poor psychometric performance. The final versions of the scales showed excellent reliability (>0.90). Short form scales (4 or 8 items) had a high degree of precision across over 4 SD units of the latent variable. The item bank positively correlated with extant measures of positive psychological functioning, and negatively correlated with measures of emotional distress, pessimism, and pain. Lower meaning and purpose scores were associated with adolescence and presence of a special healthcare need. CONCLUSION: The PROMIS Pediatric Meaning and Purpose item banks and their short forms are ready for use in clinical research and practice. They are measures of children's eudaimonic well-being and indicative of children's hopefulness, optimism, goal-directedness, and feelings that life is worth living.

The International Parenting Survey: Rationale, Development, and Potential Applications.

The quality of parent-child interactions and family relationships has a powerful influence on children's development and well-being. The International Parenting Survey (IPS) is a brief, web-based survey developed to provide a cross-national, community-level, population snapshot of the experiences of parents related to raising children. The IPS was developed as a planning tool to assist policy makers and community agencies plan, implement, and evaluate parenting programs and as a tracking tool to evaluate parenting support programs in different countries. We report the preliminary psychometric properties of the IPS on various domains of measurement in an international sample of over 9,000 parents. Moderate to high reliabilities were obtained for all domains of measurement. High internal consistency reliabilities (α = .88-.97) were obtained for the domains of children's behavior and emotional maladjustment, for parental self-efficacy, parental distress and parental beliefs. Moderate levels of reliabilities (α = .52-.83) were obtained for domains of parental consistency, coercive parenting, positive encouragements, and parent-child relationships. Overall, the measure appears to have satisfactory reliability justifying further psychometric validation studies in population level studies of parenting. Examples of uses of the IPS are described and directions for future research and policy explored.

Initial Validation of the Parent-Report Child Adjustment and Parent Efficacy Scale (CAPES) in a Chinese Cultural Context.

This study aimed to validate a parent-report measure of child adjustment and parenting efficacy (Child Adjustment and Parent Efficacy Scale [CAPES]) in a Chinese cultural context. Six hundred and fifty Chinese parents in China participated in the study and completed a set of questionnaires including the CAPES, the Strengths and Difficulties Questionnaire (SDQ), the Parenting Sense of Competence Scale (PSOC), and the Parenting and Family Adjustment Scales (PAFAS). The factorial, convergent, and concurrent validity as well as internal consistency were evaluated. The results provided support for a new 2-factor structure of child behavioral and emotional adjustment. The 1-factor structure of parenting efficacy was confirmed. The three constructs obtained satisfactory internal consistency. Moreover, the CAPES scores correlated significantly with the SDQ, PSOC, and PAFAS in the expected pattern, which indicated its excellent convergent and concurrent validity. Therefore, it is a promising measure, due to its brevity and comprehensiveness, with the first indications of satisfactory internal consistency and validity among Chinese parents. However, a revision of the instrument is needed to avoid the ordering effects of positive and negative items, and further hypothesis-driven research is also needed to validate the (revised) instrument in different Chinese samples.

DOES A PERINATAL PARENTING INTERVENTION WORK FOR FATHERS? A RANDOMIZED CONTROLLED TRIAL.

Fathers are increasingly expected to contribute to their parenting role at the transition to parenthood; however, many fathers experience mental health problems during this time. Parenting support for new fathers is limited, and research often only includes the mothers in intervention studies. Clear evidence for parenting programs for fathers has not yet been established. This study evaluated the effects of a parenting intervention (Baby Triple P) on fathers who were expecting their first baby. The design was a randomized controlled trial comparing Baby Triple P with care as usual over three time points (pregnancy, 10 weeks' postbirth, and 6 months' postbirth) for 112 fathers living in Brisbane, Australia. The primary outcomes included paternal psychological distress such as depression, anxiety, and stress and several secondary measures. No significant intervention effects for Baby Triple P were found at either post- or follow-up assessments. Fathers in both groups reported significant increases in their parenting confidence and self-efficacy. The results indicate no conclusive evidence for the effectiveness of Baby Triple P for new fathers. Future research using a sample with greater likelihood of experiencing problems at the transition to parenthood is needed as is offering more tailored need-based support to obtain substantial evidence for this preventative parenting program.

Preparing parents for parenthood: protocol for a randomized controlled trial of a preventative parenting intervention for expectant parents.

BACKGROUND: Becoming the parent of a new baby comes with a range of challenges including difficulties with emotional adjustment, couple relationship issues and difficulty managing common infant behaviors, such as crying and sleep problems. This time can be especially challenging for couples who experience a range of risk factors. Previous parenting interventions for parents of babies have shown mixed results. This protocol paper describes a randomized controlled trial of a group-based parenting intervention for high-risk parents expecting their first baby. METHODS/DESIGN: Participants will be randomized to either Group Baby Triple P or Care as Usual (CAU). Group Baby Triple P involves 4 × 2 h group sessions delivered during pregnancy and 4 individual telephone sessions of 30 min each in the early postnatal period. Outcomes will be assessed via parent self-report questionnaire, home observations and a baby diary 10 weeks and 6 months post-birth. Primary outcomes will be parental confidence and perceived competence. Secondary outcomes will include parental responsiveness and bonding with the baby, relationship happiness, life satisfaction, depression, anxiety and stress, and infant crying and sleep. Analyses will involve a series of rANOVA and rMANOVAs, t-tests and a multilevel modeling approach. DISCUSSION: A brief summary, strengths and potential implications are discussed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ANZCTR 12613000948796 . Registered 27 August, 2013.

Dietary patterns of Australian children at three and five years of age and their changes over time: A latent class and latent transition analysis.

Consuming a healthy diet characterised by a variety of nutritious foods is essential for promoting and maintaining health and wellbeing, yet the diets of Australian children continue to fall well short of national healthy eating recommendations. This research endeavours to identify patterns of dietary intake in Australian children at three and five years of age and investigate associations between early childhood dietary patterns and socio-economic and demographic indicators and Body Mass Index (BMI), as well as identify changes in children's dietary patterns over time. Cross-sectional dietary patterns were derived for 1565 and 631 children aged three and five years, respectively using Latent Class Analysis (LCA), with changes over time analysed with Latent Transition Analysis (LTA). Demographic variables of interest included child sex, parental age, family status, and use of childcare services and socio-economic variables included education, income and employment status. Three patterns of dietary intake were identified at three years (Highly Unhealthy, Healthier and Moderately Unhealthy) and two patterns at five years (Unhealthy and Healthier). Children with younger mothers, working mothers, fathers with a higher BMI and living in a two-carer household were more likely to have unhealthy eating patterns at three years, and children with working mothers and living in a two-carer household were more likely to have unhealthy patterns of dietary intake at five years. Approximately one eighth of the sample transitioned from the healthier to unhealthy pattern of dietary intake from three to five years. The quality of Australian children's diets appears to be declining through the early childhood years, continuing to highlight the importance of nutrition policies and interventions targeted towards the early years of life.

Working with parents to treat anxiety-disordered children: A proof of concept RCT evaluating Fear-less Triple P.

Little is known about the efficacy of parent-only interventions and the maintenance of gains over time with anxiety-disordered children and adolescents. The current study aimed to evaluate the efficacy of a 6-session parent-focused intervention (Fear-less Triple P) in reducing children's anxiety symptomatology. The parents of 61 anxiety-disordered children (7-14 years) were randomly assigned to either the 6-session parent-only group CBT intervention or a wait-list control (WL) group. Diagnostic and questionnaire measures were administered at post-treatment; as well as 3-, 6- and 12 months following the completion of treatment. Families in the WL group were re-assessed after 6 weeks (the duration of the active intervention) and were then offered the intervention. The parent-only intervention produced superior outcomes for children on diagnostic and questionnaire measures. The percentages of children free of any anxiety diagnosis following the intervention were 38.7% (post-treatment); 58.6% (3-mth); 69.2% (6-mth); and 84% (12-mth). At the post-treatment assessment point, 3.4% of children in the WL group were free of any anxiety diagnosis. Mother and child questionnaire measures demonstrated gains from pre to post-treatment that were maintained over time. This proof of concept study suggests that the brief, parent-only intervention evaluated is an efficacious treatment approach for child anxiety disorders. A parent-only, group CBT intervention such as the one described here offers a cost-effective, low intensity alternative to traditional child-focused interventions.

Sustained Implementation Support Scale: Validation of a Measure of Program Characteristics and Workplace Functioning for Sustained Program Implementation.

An evaluation measure of enablers and inhibitors to sustained evidence-based program (EBP) implementation may provide a useful tool to enhance organizations' capacity. This paper outlines preliminary validation of such a measure. An expert informant and consumer feedback approach was used to tailor constructs from two existing measures assessing key domains associated with sustained implementation. Validity and reliability were evaluated for an inventory composed of five subscales: Program benefits, Program burden, Workplace support, Workplace cohesion, and Leadership style. Exploratory and confirmatory factor analysis with a sample of 593 Triple P-Positive Parenting Program-practitioners led to a 28-item scale with good reliability and good convergent, discriminant, and predictive validity. Practitioners sustaining implementation at least 3 years post-training were more likely to have supervision/peer support, reported higher levels of program benefit, workplace support, and positive leadership style, and lower program burden compared to practitioners who were non-sustainers.

Using the Health Belief Model to Explain Mothers' and Fathers' Intention to Participate in Universal Parenting Programs.

Using the Health Belief Model (HBM) as a theoretical framework, we studied factors related to parental intention to participate in parenting programs and examined the moderating effects of parent gender on these factors. Participants were a community sample of 290 mothers and 290 fathers of 5- to 10-year-old children. Parents completed a set of questionnaires assessing child emotional and behavioral difficulties and the HBM constructs concerning perceived program benefits and barriers, perceived child problem susceptibility and severity, and perceived self-efficacy. The hypothesized model was evaluated using structural equation modeling. The results showed that, for both mothers and fathers, perceived program benefits were associated with higher intention to participate in parenting programs. In addition, higher intention to participate was associated with lower perceived barriers only in the sample of mothers and with higher perceived self-efficacy only in the sample of fathers. No significant relations were found between intention to participate and perceived child problem susceptibility and severity. Mediation analyses indicated that, for both mothers and fathers, child emotional and behavioral problems had an indirect effect on parents' intention to participate by increasing the level of perceived benefits of the program. As a whole, the proposed model explained about 45 % of the variance in parental intention to participate. The current study suggests that mothers and fathers may be motivated by different factors when making their decision to participate in a parenting program. This finding can inform future parent engagement strategies intended to increase both mothers' and fathers' participation rates in parenting programs.

Positive parenting for healthy living (Triple P) for parents of children with type 1 diabetes: protocol of a randomised controlled trial.

BACKGROUND: Type 1 diabetes is a serious, life-long condition which causes major health, social and economic burden for children, their families and the community. Diabetes management involves strict adherence to a complex regimen, and poor management and non-adherence are a persistent problem among children. Parent-child interactions and parenting have been identified as crucial points of intervention to support children's health and emotional well-being, yet few parenting interventions have been developed or evaluated for parents of young children. This paper describes a randomised controlled trial of a brief, group-based parenting intervention for parents of young children (2-10 years) with type 1 diabetes compared against care as usual (CAU). METHODS/DESIGN: Families will be randomised to either Positive Parenting for Healthy Living Triple P or CAU. Positive Parenting for Healthy Living Triple P involves 2 × 2 h group sessions. Outcomes will be assessed via parent and child questionnaire, home observations and blood glucose monitoring at baseline, 1-month and 6-months post-intervention. Primary outcomes will be parent- and child-reported parenting behaviour, parent-reported child behaviour and adjustment, and parent-reported child quality-of-life. Secondary outcomes will include parental self-efficacy with diabetes management, illness-specific and general parenting stress, parent-reported child illness behaviour, family quality-of-life, observed parenting and child behaviour, and child's illness control. DISCUSSION: The theoretical background, study hypotheses, methods and planned analyses are discussed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12613001281785 . Registered 20 November, 2013.

Measuring positive and negative aspects of youth behavior: Development and validation of the Adolescent Functioning Scale.

This paper outlines the development and validation of the Adolescent Functioning Scale (AFS) in an Australian sample of parents of young people aged 11-18 years (N = 278). The AFS, a parent self-report measure, was designed to assess problem behavior and positive development in adolescents. Principal components analysis produced a 33-item measure comprising four subscales: Positive Development, Oppositional Defiant Behavior, Antisocial Behavior and Emotional Difficulties. Convergent validity was established via correlations between the AFS and established measures of adolescent functioning and parenting, and discriminant validity was shown through no association between the AFS and a measure of technology use. Internal consistency for the subscales was high (H = .82-.92 for different age groups), as was test-retest reliability (r = .77-.86). The study indicated that the AFS is a potentially valuable tool for assessing levels of problem behaviors and positive development in adolescents.

Correlates of Prenatal Parenting Expectations in new Mothers: Is Better Self-Efficacy a Potential Target for Preventing Postnatal Adjustment Difficulties?

The extent to which a mother's prenatal expectations are realistic or unrealistic has been associated with postnatal adjustment in first-time mothers. This cross-sectional study investigated the associations with prenatal parenting expectations to determine what makes them more or less realistic. A mediational model was developed to explain the relationships between family and social support, maternal adjustment (i.e., depression, anxiety, worry, stress, and happiness), parenting self-efficacy, and prenatal expectations. We recruited 255 first-time expectant mothers living in Brisbane, Australia. Using structural equation modeling, we found that higher levels of social and family support were associated with lower levels of maternal maladjustment, which in turn was related to higher parental self-efficacy. Finally, self-efficacy was a significant positive predictor of prenatal parenting expectations, implying that the more confident mothers are, the more realistic are their parenting expectations during pregnancy. This was a fully mediated effect. Our findings are of particular relevance for the educational and counseling services offered to pregnant mothers. Specifically, they could assist health professionals in identifying mothers who may be prone to having unrealistic expectations and prepare them for the demands and challenges of having a new baby, which may prevent poor adjustment in the postnatal period.

Measuring parenting practices and family functioning with brief and simple instruments: validation of the Spanish version of the PAFAS.

A set of instruments with different response formats is usually used to assess parenting practices in clinical settings and in research studies. These complex protocols can be problematic for parents with low-literacy levels. The Parenting and Family Adjustment Scales (PAFAS) is a brief, easy to read instrument that has been developed to address these concerns. The English version of this instrument suggested that it has good internal consistency (range from .70 to .96), as well as satisfactory construct and predictive validity. The aim of the present study was to explore the validity and reliability of the Spanish version of the PAFAS. A sample of 174 Spanish-speaking parents (85% mothers; M = 37 years old; SD = 9.1) from Panama in Central America completed the instrument alongside the Parenting Scale and the Depression Anxiety Stress Scale (DASS-21). Psychometric evaluations revealed that the measure had satisfactory construct and concurrent validity as well as good internal consistency (values >.60 for all subscales) and test-retest reliability (ICC >.60 for all subscales). The PAFAS shows promise as a brief outcome measure to assess parenting practices and family functioning with Spanish-speaking parents. Potential uses of the measure and implications for further validation with diverse samples are discussed.

The Work-Family Conflict Scale (WAFCS): development and initial validation of a self-report measure of work-family conflict for use with parents.

This paper outlines the development and validation of the Work-Family Conflict Scale (WAFCS) designed to measure work-to-family conflict (WFC) and family-to-work conflict (FWC) for use with parents of young children. An expert informant and consumer feedback approach was utilised to develop and refine 20 items, which were subjected to a rigorous validation process using two separate samples of parents of 2-12 year old children (n = 305 and n = 264). As a result of statistical analyses several items were dropped resulting in a brief 10-item scale comprising two subscales assessing theoretically distinct but related constructs: FWC (five items) and WFC (five items). Analyses revealed both subscales have good internal consistency, construct validity as well as concurrent and predictive validity. The results indicate the WAFCS is a promising brief measure for the assessment of work-family conflict in parents. Benefits of the measure as well as potential uses are discussed.

Parenting and Family Adjustment Scales (PAFAS): validation of a brief parent-report measure for use in assessment of parenting skills and family relationships.

This study examined the psychometric characteristics of the Parent and Family Adjustment Scales (PAFAS). The PAFAS was designed as a brief outcome measure for assessing changes in parenting practices and parental adjustment in the evaluation of both public health and individual or group parenting interventions. The inventory consists of the Parenting scale measuring parenting practices and quality of parent-child relationship and of the Family Adjustment scale measuring parental emotional adjustment and partner and family support in parenting. Two studies were conducted to validate the inventory. A sample of 370 parents participated in Study 1 and a sample of 771 parents participated in Study 2. Children's ages ranged from 2 to 12 years old. In Study 1 confirmatory factor analysis supported an 18-item, four factor model of PAFAS Parenting, and a 12-item, three factor model of PAFAS Family Adjustment. Psychometric evaluation of the PAFAS revealed that the scales had good internal consistency, as well as satisfactory construct and predictive validity. In Study 2 confirmatory factor analysis supported stability of the factor structures of PAFAS Parenting and PAFAS Family Adjustment revealed in Study 1. Potential uses of the measure and implications for future validation studies are discussed.