Department of Psychology, University of South Carolina, Columbia, SC, USA.
Oregon Research Institute, Eugene, OR, USA.
J Child Psychol Psychiatry. 2022 Feb;63(2):199-209. doi: 10.1111/jcpp.13426. Epub 2021 Apr 8.
This study evaluated whether an evidence-based parenting intervention, when delivered online, could effectively address disruptive behavior problems in young children and yield outcomes comparable to in-person delivery of the same intervention.
Families (n = 334) of children (3-7 years; 63% White, 22% African American, 15% other races; 63% male) with disruptive behavior problems were randomized to online-delivered intervention (ODI) or staff-delivered intervention (SDI), resulting in baseline and demographic equivalence. Primary outcome measures for child disruptive behavior (independent observation, parent report) and secondary outcome measures of parenting and family impact were assessed at baseline, postintervention, and follow-up. Conducted using intent-to-treat (ITT) as well as per-protocol (PP) methods, noninferiority analyses, which drew on an HLM framework with repeat measures across three timepoints and on REML to provide unbiased estimates of model parameters, tested whether the outcome-difference CI did not exceed the a priori noninferiority margin.
For ITT and PP analyses, the ODI was found to be noninferior to the SDI on the primary outcome: independently observed child disruptive behavior and parent-reported child behavior problems. The pattern for secondary outcomes was more varied: (a) noninferiority for observed positive and aversive parenting; (b) noninferiority for observed quality of parent-child relationship at post but not follow-up assessment; (c) noninferiority for parent-reported inappropriate/inconsistent discipline for PP but not ITT analyses; and (d) noninferiority not confirmed for parenting daily hassles and adverse family quality of life, despite large effect sizes for the ODI (Cohen's d .75-1.07). Finally, ODI noninferiority was found for teacher-reported child disruptive behavior.
The tested online-delivered parenting intervention demonstrated clear noninferiority with the corresponding staff-delivered parenting intervention on the primary outcome, child disruptive behavior problems, and reflected substantial though nonuniform noninferiority and meaningful effect sizes for secondary outcomes related to parenting and family. Future research will guide optimization of online interventions.
本研究旨在评估基于循证的育儿干预措施在线实施时，是否能有效解决幼儿的行为问题，并取得与同一干预措施面授实施相当的效果。
334 个有行为问题的幼儿家庭（3-7 岁；63%为白人，22%为非裔美国人，15%为其他种族；63%为男性）的儿童被随机分配到在线干预组（ODI）或员工面授干预组（SDI），两组在基线和人口统计学方面具有可比性。使用独立观察、家长报告等方法评估儿童行为问题的主要结果，以及育儿和家庭影响的次要结果，在基线、干预后和随访时进行评估。采用意向治疗（ITT）和符合方案（PP）分析，非劣效性分析基于重复测量的 HLM 框架和 REML 提供模型参数的无偏估计，检验结果差异的置信区间（CI）是否超过事先设定的非劣效性边界。
对于 ITT 和 PP 分析，ODI 在主要结果上被发现与 SDI 非劣效，即独立观察到的儿童行为问题和家长报告的儿童行为问题。次要结果的模式更为多样化：（a）观察到的积极和消极育儿方式非劣效；（b）观察到的亲子关系质量在干预后而非随访评估时非劣效；（c）对于 PP 分析，家长报告的不适当/不一致的纪律处分非劣效，但对于 ITT 分析则不然；（d）尽管 ODI 的效应量较大（Cohen's d.75-1.07），但对于育儿日常琐事和不良家庭生活质量的非劣效性未得到确认。最后，ODI 在教师报告的儿童行为问题上被发现具有非劣效性。
经测试的在线育儿干预措施在主要结果、儿童行为问题方面表现出明显的非劣效性，并且在与育儿和家庭相关的次要结果方面反映出相当大但非均匀的非劣效性和有意义的效应量。未来的研究将指导在线干预措施的优化。
