Translating the Knowledge Gap Between Researchers and Communication Designers for Improved mHealth Research

Our industry insight focuses on the challenges for health researchers collaborating with communication designers during the development of an App for improving maternal mental health and parenting stress. We discuss the challenges around explicating and communicating tacit and domain knowledge across disciplinary boundaries. We believe this report can widen communication design’s traditional focus on users in mHealth research to consider partnerships with academic researchers. The lessons learned from our experience developing a mHealth program can be used to reduce challenges in future mHealth research, especially for collaborations between health researchers and communications designers. Considering the growth of interest in mHealth, this is extremely relevant for future team satisfaction, the optimal use of research funds and industry time, and faster development of effective mHealth tools.This is the accepted manuscript version of the following publication: Rioux, C., Weedon, S., MacKinnon, A. L., Watts, D., Salisbury, M. R., Penner-Goeke, L., Simpson, K. M., Harrington, J., Tomfohr-Madsen, L. M. & Roos, L. E. (2022). Translating the Knowledge Gap Between Researchers and Communication Designers for Improved mHealth Research. SIGDOC '22: The 40th ACM International Conference on Design of Communication, USA, 157–160. doi: 10.1145/3513130.3558997BEAM was funded by a Research Manitoba COVID-19 Rapid Response Operating Grant. CR was supported by a Postdoctoral fellowship from Research Manitoba and the Children’s Hospital Foundation of Manitoba. ALM was supported by a Social Sciences & Humanities Research Council (SSHRC) Banting Postdoctoral Fellowship (#01353-000).Ye

Feasibility of an Online Acute Stressor in Preschool Children of Mothers with Depression

Maternal depression is a risk factor for future mental health problems in offspring, with stress-system function as a candidate vulnerability factor. Here we present initial validation of an online matching-task paradigm in young children exposed to maternal depression (N=40), a first in stressor-paradigm research for this age group. Investigations of stress-system reactivity that can be conducted online are an innovative assessment approach, accelerated by the COVID-19 pandemic. Results indicate high feasibility, with ~80% success across measures, similar-to or better-than in-person success rates in young children. Overall, the online matching task elicited significant HR but not cortisol reactivity. Individual differences in child mental health symptoms were a moderator of reactivity to the stressor such that children with lower, but not higher, behavioural problems exhibited the expected pattern of cortisol reactivity to the online matching task. Results are aligned with allostatic load models, which suggest down-regulation of stress-system reactivity as a result of experiencing adversity and mental health vulnerability. Consistent with in-person research, this suggests an early phenotype for the emergence of behaviour problems may be linked to altered stress-system reactivity. Results hold potential clinical implications for intervention development and the future of online stress-system research

Digital Parent Training RCT Meta-Analysis and Systematic Review

Background. Disruptive behavior disorders have increased during the pandemic and are associated with family conflict and child risk of child maltreatment. While parent training interventions are a best-practice intervention to treat a range of disruptive behavior disorders and family dysfunction concerns, there are limited and mixed findings on the efficacy of telehealth or digital parent training interventions. As the field of digital therapeutics continues to expand, it is imperative we seek to understand the program and client factors linked to differential efficacy. Objective. Our objective was to compare digital therapies to their “best-practice” in-person counterparts (i.e. non-inferiority trials), as well as comparing the relative benefits of a given program to waitlists, other ehealth programs, or treatment as usual. Furthermore, we aimed to interrogate which types and components of digital therapeutics are most efficacious and for whom. Methods. We conducted a systematic review and meta-analysis (k = 24, total number of intervention participants = 1654 and control participants = 1001) of the impact of digital parent training interventions on parent skill, parent mental health, and child externalizing outcomes from 2000 to 2021, among children 2-12 years old, across four databases. Exclusionary criteria include programs targeted for parents of children with intellectual disabilities, autism, brain injury, nutrition/health/dental needs or primary medical diagnosis. Results. Across outcomes, digital parent training interventions had a modest effect size (g = .27 to .33), compared to controls. The effects of digital parent training on parent skills and child outcomes were stronger if the intervention was evidence-based, combined interactive platforms with a therapist and was compared to an inactive control. Conclusions. Together, these findings suggest digital parent training interventions are an effective approach linked to modest improvements in reducing child disruptive behavioral symptoms and improving parenting skills. Such scalable and accessible approaches hold high potential to reduce burdens of child and adolescent mental illness, particularly when applied in a stepped care model. We call on future studies to provide standardized sociodemographic reporting to aide in future knowledge synthesis work that can inform tailored interventions to different populations and provide templates for shared measurement. Preregistration and open data files: https://osf.io/e35bt/

Supporting Families to Protect Child Health: Parenting Quality and Household Needs During the COVID-19 Pandemic

Background: Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs. Methods: Mixed methods were applied to data collected between April 14th - 28th, 2020 from the “Parenting During the Pandemic” survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5-8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic-linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions. Findings: Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time. Interpretations: Lower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent-child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response

Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic.

BackgroundSupportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs.MethodsMixed methods were applied to data collected between April 14th - 28th, 2020 from the "Parenting During the Pandemic" survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5-8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions.FindingsCaregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time.InterpretationsLower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent- child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response

Building Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants

Abstract Background Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care. Methods To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6–17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys. Results The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen’s d = .93). Discussion This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants. Trial registration NCT04772677 . Registered on February 26 2021

Building Emotional Awareness and Mental Health (BEAM): A pilot randomized controlled trial of an App-based program for mothers of toddlers

Families have faced unprecedented challenges during the COVID-19 pandemic, leading to increased maternal mental health problems and barriers to accessing care. Innovative programs are needed to support both maternal mental health and parenting, and to buffer the long-term impacts of stress on young children. Using a patient-oriented approach, our research team co-developed and pilot tested an App-based psychoeducation and social-connection platform: Building Emotional Awareness and Mental Health (BEAM). The co-development process involved a parent advisory board from conceptualization and design, through to direct participation in the program delivery. The BEAM program includes weekly videos and activities based on Unified Protocol therapy modules and emotion-focused parenting strategies, a weekly telehealth group review session, and access to a private online forum for support from other mothers and clinical coaches. A pilot randomized control trial was conducted across two provinces in Canada. 65 mothers of preschool children (aged 18-36 months old), with moderate-to-severe depression (Patient Health Questionaire-9≥10), were allocated to either the 10-week BEAM intervention (n=33) or treatment as usual control (n=32) groups. Participants completed questions about feasibility and acceptability of the program and pre/post self-report measures of mental health, parenting, positive coping and child behavior outcomes. Engagement was relatively high at the beginning of the program, with 78.8% starting the BEAM App and 70.6% attending ≥1 telehealth session. Most respondents felt socially supported, satisfied with the App, and found it easy to use. Data were analysed using mixed models and an intention-to-treat approach. Pre-post results indicated interaction effects with greater reductions in overall mental health problems and specific anxiety and sleep symptoms among BEAM versus control participants, as well as time effects with reductions in depression symptoms across both groups. No significant treatment effects emerged for the other mental health symptoms, parenting problems, positive coping, or child behaviour outcomes. Descriptive data are included to highlight possible areas of promise for future large efficacy trials. Technological difficulties and other challenges that may have led to attrition and impacted outcomes are discussed. The BEAM program has promise as a novel, feasible and acceptable intervention for improving mental health among mothers of young children

Protocol for a randomized control trial of the Building Regulation in Dual Generations Program (BRIDGE): preventing the intergenerational transmission of mental illness in at-risk preschool children

Abstract Background Since the onset of the COVID-19 pandemic, the worldwide prevalence of maternal depression has risen sharply; it is now estimated that one quarter of mothers experience clinically significant depression symptoms. Exposure to maternal depression during early childhood increases the risk for the development of childhood mental illness (MI) in offspring, with altered parenting practices mediating the association between maternal depression and child outcomes. Dual-generation interventions, which aim to simultaneously treat parent and child mental health, show promise for improving outcomes for mothers with depression and their young children. The Building Regulation in Dual Generations (BRIDGE) program combines Dialectical Behavior Therapy (DBT) and parenting skills training to concurrently treat maternal depression and improve parenting practices. In pilot within-group studies, BRIDGE has led to large reductions in maternal depression and child MI symptoms. The aim of the current study is to evaluate the efficacy of BRIDGE in reducing maternal depression and child MI symptoms (primary outcomes) as well as parenting stress and harsh parenting (secondary outcomes). Methods A three-armed randomized control trial with equal group sizes will be conducted to compare the efficacy of (1) BRIDGE (DBT + parenting skills), (2) DBT skills training, and (3) services-as-usual. Participants (n = 180) will be mothers of 3- to 5-year-old children who report elevated depression symptoms. Those randomized to BRIDGE or DBT skills training will complete a 16-week group therapy intervention. Assessments will be administered at pre-intervention(T1) post-intervention (T2), and 6-month follow-up (T3). Discussion Dual-generation programs offer an innovative approach to prevent the intergenerational transmission of mental illness. The current study will add to the evidence base for BRIDGE by comparing it to a stand-alone mental health intervention and a services-as-usual group. These comparisons will provide valuable information on the relative efficacy of including parenting support in a mental health intervention for parents. The results will contribute to our understanding of how maternal depression affects children’s development and how intervening at both a mental health and parenting level may affect child and family outcomes. Trial registration Name of registry: Clinical Trials Protocol Registration and Results System; trial registration number: NCT05959538; date of registry: July 24, 2023; available: https://classic.clinicaltrials.gov/ct2/show/NCT0595953