Hall Daniel L, Fell Lucy, Perez Giselle K, Markwart Michaela, Cammarata Craig, Si Yan, Cantillon Audrey, Park Elyse R, Kuhlthau Karen
Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Brain Behav Immun Integr. 2024 Jan;5. doi: 10.1016/j.bbii.2024.100052. Epub 2024 Feb 12.
Fathers of children and youth with special healthcare needs (FCYSHCN) are an overlooked population at risk for chronic stress. Mind-body practices offer a patient-centered approach to foster coping and resiliency, yet low engagement from fathers in existing programs suggests adaptation is needed. This multiphase study examines the feasibility of a synchronous, virtual mind-body intervention adapted for FCYSHCN.
31 FCYSHCN were recruited online via community partners and recruitment portals in an academic medical center in Boston, MA. Phase 1 consisted of individual interviews (N = 17) to determine fathers' stressors, coping strategies, program needs, and suggested adaptations to the intervention protocol. The Phase 2 single arm pilot feasibility trial (N = 14) consisted of eight weekly 60-minute group sessions delivered virtually. Primary feasibility metrics were attendance (benchmark: mean=6 sessions) and electronic survey completion at baseline and post-intervention. Acceptability was assessed using post-session ratings of program satisfaction (4-point Likert scale; scores ≥3 coded as helpful) and helpfulness (e.g., group structure). Exploratory outcomes included validated measures of stress coping, resiliency, parental stress, depression, anxiety, which were analyzed using paired-samples t-tests (alpha=.05) to generate effect sizes (η2).
In Phase 1, FCYSHCN discussed primary stressors (e.g., perceived inadequacy as a father) and multifaceted impacts of these stressors on physical, cognitive, emotional, and social wellbeing. Fathers also described coping strategies deemed helpful (e.g., humor) and unhelpful (e.g., "shutting down" from others). Qualitative findings informed intervention modifications. In Phase 2, most FCYSHCN (79%) attended ≥ 6 intervention sessions (mean=7). Follow-up survey completion was high (86%). Session satisfaction was high, with 7/8 sessions rated as helpful by most fathers. Program components deemed most helpful were the group structure, virtual delivery, exposure to a variety of relaxation and meditation skills, and the length of sessions. Although we were not powered to observe pre-post change, stress coping improved (p = .02, η2 = 0.42) and confidence increased in applying relaxation (p = .04, η2 = 0.34) and assertiveness techniques (p = .05, η2 = 0.31).
The first mind-body resiliency program for FCYSHCN is feasible and acceptable. Further testing is warranted in randomized trials with diverse samples of fathers, an appropriate comparison arm, and longitudinal assessments of psychosocial and biobehavioral outcomes.
患有特殊医疗需求的儿童和青少年的父亲（FCYSHCN）是一个被忽视的、面临慢性压力风险的群体。身心实践提供了一种以患者为中心的方法来促进应对能力和恢复力，然而现有项目中父亲的参与度较低，这表明需要进行调整。这项多阶段研究考察了一种为FCYSHCN量身定制的同步虚拟身心干预措施的可行性。
通过社区合作伙伴和马萨诸塞州波士顿一家学术医疗中心的招募门户网站在线招募了31名FCYSHCN。第一阶段包括个体访谈（N = 17），以确定父亲们的压力源、应对策略、项目需求以及对干预方案的建议调整。第二阶段的单臂试点可行性试验（N = 14）包括八次每周一次、每次60分钟的虚拟小组会议。主要可行性指标是出勤率（基准：平均=6次会议）以及基线和干预后电子调查问卷的完成情况。使用会议后对项目满意度的评分（4点李克特量表；得分≥3被编码为有帮助）和有用性（例如，小组结构）来评估可接受性。探索性结果包括压力应对、恢复力、父母压力、抑郁、焦虑的有效测量指标，使用配对样本t检验（α = 0.05）进行分析以生成效应量（η2）。
在第一阶段，FCYSHCN讨论了主要压力源（例如，作为父亲的自我认知不足）以及这些压力源对身体、认知、情感和社会幸福感的多方面影响。父亲们还描述了被认为有帮助的应对策略（例如，幽默）和无帮助的应对策略（例如，与他人“隔绝起来”）。定性研究结果为干预措施的修改提供了依据。在第二阶段，大多数FCYSHCN（79%）参加了≥6次干预会议（平均=7次）。随访调查问卷的完成率很高（86%）。会议满意度很高，大多数父亲将8次会议中的7次评为有帮助。被认为最有帮助的项目组成部分是小组结构、虚拟授课方式、接触各种放松和冥想技巧以及会议时长。尽管我们没有足够的能力观察干预前后的变化，但压力应对能力有所提高（p = 0.02，η2 = 0.42），应用放松技巧（p = 0.04，η2 = 0.34）和 assertiveness 技巧（p = 0.05，η2 = 0.31）的信心有所增强。
首个针对FCYSHCN的身心恢复力项目是可行且可接受的。有必要在随机试验中对不同样本的父亲进行进一步测试，设置合适的对照组，并对心理社会和生物行为结果进行纵向评估。
