The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort

Melanie Palmer; Nick Beckley-Hoelscher; James Shearer; Kasia Kostyrka-Allchorne; Olly Robertson; Marta Koch; Oliver Pearson; Petr Slovak; Crispin Day; Sarah Byford; Kimberley Goldsmith; Polly Waite; Cathy Creswell; Edmund Sonuga-Barke

doi:10.2196/44079

The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort

Melanie Palmer, Nick Beckley-Hoelscher, James Shearer, Kasia Kostyrka-Allchorne, Olly Robertson, Marta Koch, Oliver Pearson, Petr Slovak, Crispin Day, Sarah Byford, Kimberley Goldsmith, Polly Waite, Cathy Creswell, Edmund Sonuga-Barke^*

^*Corresponding author for this work

University of Oxford

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.

Original language	English
Article number	e44079
Journal	Journal of Medical Internet Research
Volume	25
DOIs	https://doi.org/10.2196/44079
Publication status	Published - 27 Jul 2023

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Palmer, M., Beckley-Hoelscher, N., Shearer, J., Kostyrka-Allchorne, K., Robertson, O., Koch, M., Pearson, O., Slovak, P., Day, C., Byford, S., Goldsmith, K., Waite, P., Creswell, C., & Sonuga-Barke, E. (2023). The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort. Journal of Medical Internet Research, 25, [e44079]. https://doi.org/10.2196/44079

@article{9db7f4546da34ae5a4872ffac8b369df,

title = "The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort",

abstract = "Background: Children{\textquoteright}s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families{\textquoteright} mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.",

author = "Melanie Palmer and Nick Beckley-Hoelscher and James Shearer and Kasia Kostyrka-Allchorne and Olly Robertson and Marta Koch and Oliver Pearson and Petr Slovak and Crispin Day and Sarah Byford and Kimberley Goldsmith and Polly Waite and Cathy Creswell and Edmund Sonuga-Barke",

note = "Funding Information: The SPARKLE trial was funded by the Economic and Social Research Council: Grant ES/V016393/1 from the, UK. Co-SPACE was funded by grants from UKRI (2004CQ002/BS3) and the Westminster Foundation. The animations used in the Parenting Boosters were produced through funding by The Maudsley Charity and the South London and Maudsley NHS Foundation Trust. KG and ESBs contributions represent, respectively, independent research part funded by the National Institute for Health and Care Research (NIHR) Applied Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King{\textquoteright}s College Hospital NHS Foundation Trust. CC receives funding from the NIHR Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust. PW receives funding through a NIHR Development and Skills Enhancement award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright}Melanie Palmer, Nicholas Beckley-Hoelscher, James Shearer, Katarzyna Kostyrka-Allchorne, Olly Robertson, Marta Koch, Oliver Pearson, Petr Slovak, Crispin Day, Sarah Byford, Kimberley Goldsmith, Polly Waite, Cathy Creswell, Edmund J S Sonuga-Barke.",

year = "2023",

month = jul,

day = "27",

doi = "10.2196/44079",

language = "English",

volume = "25",

journal = "Journal of Medical Internet Research",

issn = "1438-8871",

publisher = "Journal of medical Internet Research",

}

Palmer, M , Beckley-Hoelscher, N , Shearer, J , Kostyrka-Allchorne, K, Robertson, O, Koch, M, Pearson, O , Slovak, P , Day, C , Byford, S , Goldsmith, K, Waite, P, Creswell, C & Sonuga-Barke, E 2023, 'The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort', Journal of Medical Internet Research, vol. 25, e44079. https://doi.org/10.2196/44079

The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort. / Palmer, Melanie ; Beckley-Hoelscher, Nick ; Shearer, James et al.
In: Journal of Medical Internet Research, Vol. 25, e44079, 27.07.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic

T2 - Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort

AU - Palmer, Melanie

AU - Beckley-Hoelscher, Nick

AU - Shearer, James

AU - Kostyrka-Allchorne, Kasia

AU - Robertson, Olly

AU - Koch, Marta

AU - Pearson, Oliver

AU - Slovak, Petr

AU - Day, Crispin

AU - Byford, Sarah

AU - Goldsmith, Kimberley

AU - Waite, Polly

AU - Creswell, Cathy

AU - Sonuga-Barke, Edmund

N1 - Funding Information: The SPARKLE trial was funded by the Economic and Social Research Council: Grant ES/V016393/1 from the, UK. Co-SPACE was funded by grants from UKRI (2004CQ002/BS3) and the Westminster Foundation. The animations used in the Parenting Boosters were produced through funding by The Maudsley Charity and the South London and Maudsley NHS Foundation Trust. KG and ESBs contributions represent, respectively, independent research part funded by the National Institute for Health and Care Research (NIHR) Applied Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. CC receives funding from the NIHR Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust. PW receives funding through a NIHR Development and Skills Enhancement award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: ©Melanie Palmer, Nicholas Beckley-Hoelscher, James Shearer, Katarzyna Kostyrka-Allchorne, Olly Robertson, Marta Koch, Oliver Pearson, Petr Slovak, Crispin Day, Sarah Byford, Kimberley Goldsmith, Polly Waite, Cathy Creswell, Edmund J S Sonuga-Barke.

PY - 2023/7/27

Y1 - 2023/7/27

N2 - Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.

AB - Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.

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U2 - 10.2196/44079

DO - 10.2196/44079

M3 - Article

SN - 1438-8871

VL - 25

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

M1 - e44079

ER -

Palmer M , Beckley-Hoelscher N , Shearer J , Kostyrka-Allchorne K, Robertson O, Koch M et al. The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort. Journal of Medical Internet Research. 2023 Jul 27;25:e44079. doi: 10.2196/44079

The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort

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