Huang Keng-Yen, Nakigudde Janet, Christine Tusiime, Cheng Sabrina, Muyomba Dickson, Mugisa Eddie Tinka, Kisakye Elizabeth Nsamba, Sentongo Hafsa, Schoenthaler Antoinette, El-Shahawy Omar, Mann Devin
Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016, USA.
College of Health Science, Makerere University, P.O. Box 7072, Kampala, Uganda.
Med Res Arch. 2024 Oct;12(10). doi: 10.18103/mra.v12i10.5926. Epub 2024 Oct 30.
The burden of pediatric mental disorders in low-and middle-income countries (LMICs) is tremendous, but solutions for addressing the burden remain limited. Although digital solutions have potential to improve prevention services, such solutions have not been systematically tested in these countries.
This study explores the use of a digital parenting intervention tool designed for pediatric behavioral health, known as the Pediatric-Behavioral Health Digital Tool, in a preventive service model for low resource communities. We study the feasibility of implementing this new digital health service model and preliminary estimate the potential impacts on parenting and child social emotional outcomes when the program is implemented in faith-based organizations in Uganda. The Pediatric-Behavioral Health Digital Tool is a preventive intervention designed to be implemented by trained community-health-workers to facilitate caregivers' access to the preventive mental health service in community for their young children. The tool is based on the screening, brief intervention, and referral to treatment prevention service model for promoting pediatric behavioral and mental health.
The evaluation study was designed using a pre-post assessment design. The content in Pediatric-Behavioral Health Digital Tool was co-designed with local expert and iteratively adapted based on parents and caregivers as well as community-health-workers and experts who were invited to provide their feedback and suggestions for improvements in content, functions, and delivery model through a series of focus groups and workshops. This pilot evaluation focuses on the pre-post changes of the intervention families (91 families) and 10 community-health-workers.
We found high acceptability, appropriateness, and usefulness of the program based on the intervention families' community-health-workers' report. Intervention parents felt safe in using the digital toolkit. Parents felt comfortable for the CHWs asked them personal questions. In estimating the impacts, we found some expected findings on parenting and child social emotional health. Specifically, we found intervention parents become more mindful in their parenting (d=1.61, p=.049), and felt more effective in discipline their child's misbehavior (d=1.29, p=.003) after they receive the intervention. For children, we found improvement on children's social emotional outcomes, measured by decreased parent-child conflict (d=-1.08, p=.002) and increased child emotional regulation skills (d=1.0, p=.049) after their parents receive the intervention.
Our Pediatric-Behavioral Health Digital Tool has potential to provide a cost-effective service solution to provide preventive mental health care in communities to promote child social-emotional and mental wellbeing in low-resource settings.
低收入和中等收入国家（LMICs）中儿童精神障碍的负担极为沉重，但应对这一负担的解决方案仍然有限。尽管数字解决方案有潜力改善预防服务，但此类解决方案尚未在这些国家得到系统测试。
本研究探索在资源匮乏社区的预防服务模式中使用一种专为儿童行为健康设计的数字育儿干预工具，即儿童行为健康数字工具。我们研究实施这种新数字健康服务模式的可行性，并初步估计该项目在乌干达基于信仰的组织中实施时对育儿和儿童社会情感结果的潜在影响。儿童行为健康数字工具是一种预防性干预措施，旨在由经过培训的社区卫生工作者实施，以帮助照顾者为其幼儿获得社区预防心理健康服务。该工具基于促进儿童行为和心理健康的筛查、简短干预及转介治疗预防服务模式。
评估研究采用前后评估设计。儿童行为健康数字工具的内容与当地专家共同设计，并根据父母和照顾者以及社区卫生工作者和专家的反馈进行迭代调整，这些人员通过一系列焦点小组和研讨会被邀请就内容、功能和交付模式的改进提供反馈和建议。本次试点评估聚焦于干预家庭（91个家庭）和10名社区卫生工作者的前后变化。
根据干预家庭和社区卫生工作者的报告，我们发现该项目具有较高的可接受性、适宜性和有用性。参与干预的父母在使用数字工具包时感到安全。父母对社区卫生工作者询问他们的个人问题感到自在。在评估影响时，我们在育儿和儿童社会情感健康方面发现了一些预期结果。具体而言，我们发现参与干预的父母在接受干预后在育儿方面更加专注（d = 1.61，p = 0.049），并且在管教孩子的不当行为时感觉更有效（d = 1.29，p = 0.003）。对于儿童，我们发现父母接受干预后，以亲子冲突减少（d = -1.08，p = 0.
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