A Digital Health Solution for Improving Parent Adherence and Sustainability of ADHD Treatment Outcomes

用于提高家长依从性和多动症治疗结果可持续性的数字健康解决方案

基本信息

批准号：
10056759
负责人：
Linda Pfiffner
金额：
$ 72.68万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10056759
关键词：
Address Adherence Affect Aftercare Attention deficit hyperactivity disorder Attitude Behavior Therapy Behavioral Child Child Behavior Child Rearing Clinical Competence Data Development Enhancement Technology Family Focus Groups Goals Health Health Personnel Impairment Income Internet Interview Knowledge Libraries Life Link Maintenance Measures Mediating Mental Health Methods Motivation Notification Outcome Parents Persons Pilot Projects Population Process Psychological reinforcement Rewards Role School-Age Population Schools Social support Symptoms Testing Training Training Programs Treatment outcome Youth base design digital evidence base executive function functional disability handheld mobile device health application improved in vivo innovation novel parental monitoring skills social sustained attention tool treatment strategy uptake usability

项目摘要

ABSTRACT Behavioral parent training (BPT) is well-established for treating Attention Deficit Hyperactivity Disorder and associated impairments, but short-term treatment gains for children typically lack generalizability and sustainability. Lack of parental adherence contributes to these limited effects, since BPT relies on parents using treatment-recommended parenting skills with children in daily life contexts. A number of barriers can impede parent adherence including skill competence, executive functioning (EF) processes, and motivation/ attitudes, as well as maintenance-specific barriers after in-person treatment ends (e.g. competence adapting skills to new challenges; EF/motivational barriers from lack of ongoing social support). Such barriers may be directly addressable through innovative dHealth tools. The objective of this study is to develop and test a novel and scalable digital health solution designed to address barriers and improve parent skill utilization in daily life contexts, the hypothesized mechanism of action for BPT, with the goal of improving sustainability of treatment outcomes for youth with ADHD. A dHealth tool will be fully developed to augment group-based BPT in school settings, maximizing accessibility of the treatment. Aim 1 is to develop a technology-enhanced version of behavioral parent training for improving parent adherence and collect preliminary data on usability, feasibility and acceptability. Qualitative and quantitative input from key stakeholders (parents, children and clinicians) through focus groups, qualitative interviews and extended formative usage testing will be obtained. The tool addresses barriers to skill utilization with specific features: 1) skill competence: skills library/videos, knowledge questions, tailored content, and interactive troubleshooting wizard, 2) EF processes: in vivo notifications for skill use/coaching, linked parent/child views of interactive/personalized plans integrated in daily routines with child involvement, streamlined content, 3) motivation/attitudes: motivational/ ”change talk” messaging, goal- setting, automated monitoring of parent/child progress, gamification, and digital rewards, 4) maintenance- specific barriers: individualized troubleshooting to assist with new problems and social features to support parents after in-person treatment ends. Aim 2 is to implement a pilot RCT of the technology-enhanced version of BPT (N=30) compared to BPT only (N=30) to gather preliminary efficacy data on immediate and sustained (up to 12 months after treatment) parent skill utilization (primary target), and parenting barriers (intermediate targets) to inform a larger scale trial. Aim 3 is to examine whether parent skill utilization (target mechanism) is engaged by the app and whether this engagement is associated with improved child outcomes. We will explore the association between: (a) app use and skill utilization; (b) skill utilization and child outcomes, and c) app use with reduced parent barriers for predicting skill utilization and child outcomes. Exploratory analyses examine the potential mediating mechanism of skill utilization (immediate and sustained) for optimizing the association between the dHealth tool and improved child and parenting outcomes.

抽象的行为父母培训（BPT）是为治疗出勤赤字多动障碍和相关障碍，但儿童的短期治疗收益通常缺乏普遍性和可持续性。缺乏父母的依从性会导致这些有限的影响，因为BPT依赖于父母在日常生活中，使用儿童的治疗育儿技能。许多障碍可以阻碍父母的依从性，包括技能能力，执行功能（EF）流程和动力/ 面对面治疗结束后的态度以及特定于维护的障碍（例如能力适应应对新挑战的技能； EF/激励障碍由于缺乏持续的社会支持）。这样的障碍可能是直接通过创新的DHealth工具寻址。这项研究的目的是开发和测试新颖以及可扩展的数字健康解决方案，旨在解决障碍和改善日常生活中的父母技能利用背景是BPT的假设行动机制，目的是提高治疗的可持续性 ADHD青年的成果。 DHealth工具将完全开发以增强学校的基于小组的BPT 设置，最大化治疗的可及性。目标1是开发技术增强版本的行为父母培训，以提高父母的依从性并收集有关可用性，可行性的初步数据和可接受性。主要利益相关者（父母，孩子和临床医生）的定性和定量投入通过焦点小组，将获得定性访谈和扩展格式使用测试。该工具通过特定功能解决技能利用的障碍：1）技能能力：技能库/视频，知识问题，量身定制的内容和交互式故障排除向导，2）EF流程：体内通知技能使用/教练，链接的互动/个性化计划的父母/子女观点与日常计划集成在一起儿童参与，精简内容，3）动机/态度：激励/“改变谈话”消息传递，目标 - 设置，对父母/子女进度，游戏化和数字奖励的自动监控，4）维护 - 特定障碍：个性化故障排除以协助解决新问题和社交功能以支持亲自治疗后的父母结束了。 AIM 2是实施技术增强版本的试点RCT BPT（n = 30）与仅BPT（n = 30）相比，以收集有关即时和持续的初步效率数据（治疗后长达12个月）父母技能利用（主要目标）和育儿障碍（中级）目标），以告知大规模试验。 AIM 3是检查父级技能利用（目标机制）是否为该应用程序参与其中以及这种参与是否与改善的儿童结局有关。我们将探索：（a）应用程序使用和技能利用之间的关联；（b）技能利用和儿童成果，c）应用使用通过降低父母障碍，以预测技能利用和儿童结果。探索性分析检查技能利用的潜在中介机制（立即和持续）以优化关联在DHealth工具和改善的儿童和育儿成果之间。