Juan Luque Solano

Background: Parenting programs are the recommended treatment for common mental health problems of childhood such as conduct disorder. In the United Kingdom, local authorities have responsibility for providing or commissioning these programs through face-to-face and video call weekly groups and e-learning style asynchronous offerings. However, there has been a shortage of research into the potential of digital resources to augment and enhance parenting groups. Objective: This pilot study aimed to explore whether providing digital microinterventions in a mobile app (Pause) to augment parenting programs is a feasible strategy. Pause fits into parenting programs and prompts and supports parents to use each week’s new parenting skill at home. Specifically, we want to understand (1) whether parents use Pause, (2) what type of features or tools in Pause are most frequently used for support, and (3) what are the perceived strengths and weaknesses of Pause. Methods: Pause was provided to parents attending 3 of the most common parenting programs delivered across 3 local authorities in the United Kingdom. During weekly sessions, parents were supported to add “tools” in the app, which mapped onto the training in their session, for example, distracting their child, setting age-appropriate consequences, and using praise. Preprogram surveys were obtained at the first session. After programs were completed, postprogram surveys were administered to measure app use, gather which tools parents used, and explore the strengths and weaknesses of the app. Participants and practitioners were invited for interviews, where the strengths and weaknesses of augmenting parenting programs with Pause were discussed in more detail. Results: In total, 53 parents were recruited from groups. A total of 25 of 53 (47%) parents completed postsurveys distributed at their final parenting group session, in keeping with typical rates of attrition in parenting programs. In addition, 7 parents and 3 practitioners agreed to interviews after the program. Most of the parents (23/25, 92%) had used Pause. Other than the journal, used by 17 parents, the most popular tools were the relax tool and praise tool, each used by 10 parents. Survey data revealed specific strengths and weaknesses of the tools in Pause, particularly highlighting that parents wanted Pause to provide more ideas for distraction or relaxation activities. Interviews revealed the challenges parents attending programs face, the range of family members using Pause, and the diverse settings where it was used. Interviews also revealed specific opportunities for improving the user interface and for addressing challenges in the journaling function. Conclusions: This pilot study found good acceptability and engagement with Pause. Interviews revealed promising evidence, suggesting that Pause may improve family life and aid child behavior change. Future research should evaluate whether adding Pause to parenting programs increases their positive effects on children’s behavior and mental health.

BACKGROUND Parenting programs are the recommended treatment for common mental health problems of childhood such as conduct disorder. In the United Kingdom, local authorities have responsibility for providing or commissioning these programs through face-to-face and video call weekly groups and e-learning style asynchronous offerings. However, there has been a shortage of research into the potential of digital resources to augment and enhance parenting groups. OBJECTIVE This pilot study aimed to explore whether providing digital microinterventions in a mobile app (Pause) to augment parenting programs is a feasible strategy. Pause fits into parenting programs and prompts and supports parents to use each week’s new parenting skill at home. Specifically, we want to understand (1) whether parents use Pause, (2) what type of features or tools in Pause are most frequently used for support, and (3) what are the perceived strengths and weaknesses of Pause. METHODS Pause was provided to parents attending 3 of the most common parenting programs delivered across 3 local authorities in the United Kingdom. During weekly sessions, parents were supported to add “tools” in the app, which mapped onto the training in their session, for example, distracting their child, setting age-appropriate consequences, and using praise. Preprogram surveys were obtained at the first session. After programs were completed, postprogram surveys were administered to measure app use, gather which tools parents used, and explore the strengths and weaknesses of the app. Participants and practitioners were invited for interviews, where the strengths and weaknesses of augmenting parenting programs with Pause were discussed in more detail. RESULTS In total, 53 parents were recruited from groups. A total of 25 of 53 (47%) parents completed postsurveys distributed at their final parenting group session, in keeping with typical rates of attrition in parenting programs. In addition, 7 parents and 3 practitioners agreed to interviews after the program. Most of the parents (23/25, 92%) had used Pause. Other than the journal, used by 17 parents, the most popular tools were the relax tool and praise tool, each used by 10 parents. Survey data revealed specific strengths and weaknesses of the tools in Pause, particularly highlighting that parents wanted Pause to provide more ideas for distraction or relaxation activities. Interviews revealed the challenges parents attending programs face, the range of family members using Pause, and the diverse settings where it was used. Interviews also revealed specific opportunities for improving the user interface and for addressing challenges in the journaling function. CONCLUSIONS This pilot study found good acceptability and engagement with Pause. Interviews revealed promising evidence, suggesting that Pause may improve family life and aid child behavior change. Future research should evaluate whether adding Pause to parenting programs increases their positive effects on children’s behavior and mental health.

Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents’ values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family’s experience. Conclusions: Parents’ use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app.

BACKGROUND Disruptive behaviour disorders are among the most common disorders of childhood and evidence-based parenting programs are the first line treatment. Digital micro interventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behaviour. Until now, no digital micro intervention supporting evidence-based parenting skills programs has been evaluated. OBJECTIVE To evaluate the subjective experience of parents using a digital micro intervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents’ values. METHODS We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including three digital micro interventions. Parents were recruited via local authorities in the Midlands region of the UK. Previous participation in a parenting program was an inclusion criteria. Interviews explored family composition, child behaviour problems, and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centred design perspective and illustrative case vignettes produced. RESULTS Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behaviour. Parents and children responded in a variety of ways to the use of the phone, many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family’s experience. CONCLUSIONS Parents’ use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app.