School of Occupational Therapy, Faculty of Medicine of the Hebrew University, Mt. Scopus, P.O.B: 24026, Jerusalem, Israel.
BMC Public Health. 2024 Feb 29;24(1):645. doi: 10.1186/s12889-024-18126-4.
Attention Deficit Hyperactivity Disorder (ADHD) is a common neuro-developmental health condition in children and adolescents, in which its associated behavior manifestations are known to negatively affect members of the family unit, especially mothers. Ultra-orthodox Jewish (UOJ) community is growing globally and mothers of children with ADHD in this community are potentially at risk for negative health outcomes. As the UOJ community is culturally conservative, maintaining a distinct separation from outside influences, they often avoid utilizing public mental health services due to stigma and a lack of culturally sensitive treatments. Thus, this study aimed to develop a theory-driven and culturally appropriate psychological health promotion intervention for these mothers using the Intervention Mapping protocol.
A mixed-method design was used. Qualitative content analysis was performed on four focus groups (n=25). Additionally, descriptive statistics including the content validity index was used to measure feedback regarding the developed intervention protocol's relevance, effectiveness, and appropriateness Theoretical models for behavior change, including the Behavior Change Wheel's COM-B system and the Theoretical Domains Framework, and literature on ADHD in the general population and the ultra-orthodox community were integrated in the process. Intervention components were systematically derived from findings.
Key determinants of health behavior change were identified, resulting in formulating intervention objectives addressing stigma reduction surrounding ADHD, increasing knowledge about the ADHD condition and treatment, awareness of the school systems' capabilities in meeting the ADHD child's needs, enhancing mothers' advocacy skills, and maternal self-care. Intervention? strategies included a group setting, providing information on health consequences, social support, re-attribution, active learning, goal setting, and promoting an identity associated with the desired behavior change. Mothers' quantitative feedback confirmed the overall relevance, effectiveness, and appropriateness of the interventions' content (CVI= .86, .85, .87).
Intervention Mapping facilitated the development of a culturally sensitive psychological health promotion intervention for ultra-orthodox Jewish mothers of children with ADHD. Further research is warranted to assess intervention feasibility and effectiveness.
注意力缺陷多动障碍（ADHD）是儿童和青少年常见的神经发育健康状况，其相关行为表现已知会对家庭单位的成员产生负面影响，尤其是母亲。极端正统犹太教（UOJ）社区在全球范围内不断壮大，而该社区中患有 ADHD 的儿童的母亲可能面临负面健康后果的风险。由于 UOJ 社区在文化上较为保守，与外界影响保持明显的分离，他们常常由于污名化和缺乏文化敏感的治疗而避免使用公共心理健康服务。因此，本研究旨在使用干预映射协议为这些母亲制定一个基于理论且文化适宜的心理健康促进干预措施。
采用混合方法设计。对四个焦点小组（n=25）进行了定性内容分析。此外，还使用描述性统计包括内容效度指数来衡量对开发的干预方案的相关性、有效性和适宜性的反馈，包括行为改变的理论模型，如行为改变车轮的 COM-B 系统和理论领域框架，以及一般人群和极端正统社区中 ADHD 的文献。干预组件是从研究结果中系统推导出来的。
确定了健康行为改变的关键决定因素，从而制定了干预目标，旨在减少 ADHD 相关的污名化，增加对 ADHD 状况和治疗的了解，提高对学校系统满足 ADHD 儿童需求能力的认识，增强母亲的倡导技能和自我护理能力。干预策略包括小组设置、提供有关健康后果、社会支持、归因再分配、主动学习、目标设定和促进与所需行为改变相关的身份认同的信息。母亲的定量反馈证实了干预内容的整体相关性、有效性和适宜性（CVI=.86、.85、.87）。
干预映射促进了针对患有 ADHD 的犹太教极端正统母亲的文化敏感心理健康促进干预措施的制定。需要进一步研究来评估干预的可行性和有效性。
