Brief parenting intervention (Triple P) for families of children with eczema: a randomized controlled trial

OBJECTIVE

To evaluate the efficacy and costs of a brief, group-delivered parenting intervention for families of children with eczema.

METHODS

A randomized controlled trial design was used. Families attending the Queensland Children's Hospital and from the community (n = 257) were assessed for eligibility (child 2-10 years, diagnosed with eczema, prescribed topical corticosteroids). Families who consented to participate (N = 59) were assessed at baseline for clinician-rated eczema severity, parent-reported eczema symptom severity, and electronically-monitored topical corticosteroid adherence (primary outcomes); and parenting behavior, parents' self-efficacy and task performance when managing eczema, eczema-related child behavior problems, and child and parent quality of life (secondary outcomes). Families were randomized (1:1, unblinded) to intervention (n = 31) or care-as-usual (n = 28). The intervention comprised two, 2-hr Healthy Living Triple P group sessions (face-to-face/online) and 28 intervention families attended one/both sessions. All families were offered standardized eczema education. Families were reassessed at 4-weeks post-intervention and 6-month follow-up, with clinician-raters blinded to condition. Costs of intervention delivery were estimated.

RESULTS

Multilevel modeling across assessment timepoints showed significant intervention effects for ineffective parenting (d = .60), self-efficacy (d = .74), task performance (d = .81), and confidence with managing eczema-related child behavior (d = .63), but not disease/symptom severity, treatment adherence or quality of life. Mean cost per participating family with parenting behavior (clinically) improved was $159.

CONCLUSIONS

Healthy Living Triple P is effective in reducing ineffective parenting practices and improving parents' self-efficacy and task performance when managing children's eczema and eczema-related behavior difficulties. There was no effect on disease/symptom severity, treatment adherence, or quality of life.

CLINICAL TRIAL REGISTRATION

ACTRN12618001332213.

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries

INTRODUCTION

Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence.

METHODS

We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates.

RESULTS

Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings.

CONCLUSIONS

Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

Effects of comorbid asthma and eczema on child and family quality of life

Paediatric chronic health conditions are associated with poorer psychological wellbeing and quality of life for children and families. This study investigated differences in child and parent/family quality of life between families of children with asthma only, eczema only, or both asthma and eczema, and tested predictors of child and parent/family quality of life. A convenience sample of 106 families completed parent-report measures of child and parent/family quality of life, child emotional and behavioural difficulties, parent adjustment and parenting practices. Between-groups ANOVAs indicated no differences for child quality of life, whereas parent/family quality of life was worse for those with eczema only compared to asthma only. Multiple linear regression revealed that child emotional difficulties predicted worse child quality of life, whereas worse parent adjustment, child emotional difficulties and eczema only (compared to both asthma and eczema) predicted worse parent quality of life. Results suggest that families of children with eczema may be at particular risk for impaired parent/family quality of life. Interventions that take a family-centred approach to improving child and parent adjustment should be investigated as an adjunct to medical treatment to reduce the impact of chronic health conditions on quality of life for children and families.

Psychometric properties of the parenting belief scale in a multi-country sample of parents from high-income countries

BACKGROUND

Parents' beliefs about how private/public their parenting role is and their acceptability of the use of corporal punishment as a disciplinary measure have been associated with how parents raise their children and their willingness to seek support. However, there are no reliable and valid instruments measuring these beliefs.

OBJECTIVE

This study evaluated the psychometric properties of the Parenting Belief Scale, a self-reported brief measure targeting parents' perception of parenting as a private concern and their attitudes towards the use of corporal punishment.

PARTICIPANTS AND SETTING

Participants were 6949 parents from several high-income countries (i.e., Australia, Belgium, Canada, Germany, Hong Kong, Australia, and the UK) who completed the International Parenting Survey, an online cross-sectional survey focused on parents' self-report of their parenting, children, and family.

METHODS

This study evaluated the internal consistency, factor structure (i.e., exploratory and confirmatory factor analyses), and convergent and discriminant validity of the Parenting Belief Scale.

RESULTS

Findings indicated that this scale was a relatively reliable measure to evaluate parents' perceived privacy in their role and acceptability of corporal punishment. A two-factor structure was confirmed by both exploratory and confirmatory factor analyses. Correlations with scales of parenting practices supported the convergent and discriminant validity of the Parenting Belief Scale.

CONCLUSIONS

This study supported the use of the Parenting Belief Scale across high-income countries to evaluate parenting beliefs in influencing parenting practices and parents' help-seeking behaviours.

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families

Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

The role of health behavior theories in parents' initial engagement with parenting interventions

OBJECTIVE

To examine the relationship between health belief model (HBM; i.e., perceived threat, benefits, costs, and self-efficacy) and theory of planned behavior (TPB; i.e., attitudes, social norms, and perceived behavioral control) constructs and parents' intention to participate and initial engagement (i.e., recruitment, enrollment, and first attendance) with a parenting intervention.

METHOD

Participants were parents (n = 699, mean age = 38.29 years, 90.4% mothers) of 2-12-year-old children. The study conducted secondary analysis of cross-sectional data collected for an experimental study of engagement strategies. Participants provided self-report data on HBM constructs, TPB constructs, and intention to participate. Measures of initial parent engagement were also collected (i.e., recruitment, enrollment, and first attendance). Logistic regressions evaluated the impact of HBM and TPB constructs, and their combination, on intention to participate and initial parent engagement.

RESULTS

Analyses indicated that all HBM constructs increased the odds of parents' intention to participate and enrollment. In terms of TPB, parents' attitudes and subjective norms, but not perceived behavioral control, were significant predictors of intention to participate and enrollment. When combined in one model, parents' perceived costs, self-efficacy, attitudes, and subjective norms predicted intention to participate, whereas perceived threat, costs, attitudes, and subjective norms increased odds of enrolling in the intervention. Regression models for first attendance were not significant and those for recruitment could not be conducted due to lack of variance.

CONCLUSIONS

The findings demonstrate the relevance of using both HBM and TPB constructs when enhancing parent intention to participate and enrollment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Corporal punishment of children in Australia: The evidence-based case for legislative reform

OBJECTIVE

Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform.

METHODS

We review the laws that allow corporal punishment, the international agreements on children's rights, the evidence on the effects of corporal punishment, and outcomes of legislative reform in countries that have changed their laws to prohibit corporal punishment.

RESULTS

Legislative reform typically precedes attitude changes and reductions in the use of corporal punishment. Countries with the most ideal outcomes have instigated public health campaigns educating the population about law reform while also providing access to alternative non-violent discipline strategies.

CONCLUSIONS

Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public about these effects, and provide alternative strategies for parents, rates of corporal punishment decrease.

IMPLICATIONS FOR PUBLIC HEALTH

We recommend law reform in Australia to prohibit corporal punishment, a public health campaign to increase awareness of corporal punishment and its effects, provision of access for parents to alternative evidence-based strategies to assist in parenting, and a national parenting survey to monitor outcomes.

Relationships between parenting and illness factors and child behaviour difficulties in children with asthma and/or eczema

Chronic health conditions such as asthma and eczema are common and are associated with significant psychosocial sequelae for children and their families. A number of parenting variables have been implicated in child health outcomes; however, there are gaps in understanding of the relationships between parenting and child adjustment in the context of chronic illness. This study examined the role that modifiable parenting factors including parenting style, self-efficacy, and adjustment play in explaining general and illness-related child behaviour and emotional problems. Parents (N = 107) of children diagnosed with asthma only (n = 22), eczema only (n = 59), or both conditions (n = 26) completed a range of parenting and child adjustment measures. The majority of the modifiable parenting factors (parents' self-efficacy with managing their child's internalising, asthma-related, and eczema-related behaviours; parent adjustment; and use of ineffective parenting strategies) made significant contributions to explaining variance child behaviour. Parenting variables consistently explained greater proportions of variance in general and illness-related child behaviour difficulties compared to demographic and illness factors and represent important intervention targets.

Pakistani orphanage caregivers' perspectives regarding their caregiving abilities, personal and orphan children's psychological wellbeing

BACKGROUND

Pakistan is home to 4.6 million children who have been orphaned. Limited data on caregiving in orphanages suggests that caregivers do not have specialized training and experience heavy workloads and high-stress levels. Supporting these caregivers to provide responsive and consistent caregiving can improve their well-being along with the psychological and physical development of children who have been orphaned. This research explored the main caregiving-related challenges faced by caregivers in orphanage settings, their professional and personal needs and perceived emotional and behavioural problems manifesting in children under their care.

METHOD

This research adopted a qualitative research design with a thematic analysis approach. Semi-structured interviews were conducted with 14 caregivers who were currently caring for four to 12-year-old children in Pakistani orphanages.

RESULTS

Five main themes: (1) religiosity, (2) economic relief, (3) caregivers' needs and well-being, (4) caring for children who have been orphaned and (5) need for context specific training, emerged from the data, which included several subthemes. Findings revealed the presence of positive religious views regarding the upbringing and care of children who have been orphaned. Work-provided accommodation was an important economic relief. Caregivers' psychological, physiological and personal lives were affected by job-related stress and demands. Many helpful and unhelpful parenting practices were documented, and challenges such as children's verbal and physical aggression, stealing, non-cooperation and poor social skills were reported. The main professional issues included low salary, high numbers of children in care and lack of context specific professional caregiving training provided.

CONCLUSION

This study established the need for a tailored programme that suits the context specific caregiving needs in Pakistani orphanages to support the training and professional growth of caregivers and promote their wellbeing along with positive developmental outcomes in the children under their care.

Predicting Chinese father involvement: Parental role beliefs, fathering self-efficacy and maternal gatekeeping

Introduction

Despite the well-established importance of positive father involvement for child adjustment, father involvement tends to be much lower compared to mother involvement. Furthermore, there are few empirical studies on Chinese fathers and their involvement in parenting. Given the importance of father involvement, it is necessary to examine the factors that may facilitate or hinder Chinese father involvement in parenting.

Methods

This study used survey methodology to examine the predictors of Chinese father involvement with their preschoolers. The sample consisted of 609 Chinese parent dyads in Mainland China.

Results

Fathering self-efficacy and their beliefs about parental roles directly predicted father involvement in parenting. Maternal gate-opening had both direct and indirect associations with father involvement via fathers' beliefs and fathering self-efficacy. Maternal gate-closing was not associated with father involvement.

Discussion

The findings suggest that fathers' beliefs about parental roles, fathering self-efficacy, and maternal gate-opening are likely to play an important role in facilitating father involvement with their children. Family interventions and programs could target these modifiable factors to facilitate father involvement in Mainland China.

Parent-reported barriers to establishing a healthy diet with young children in Australia

BACKGROUND

Parents' beliefs and behaviours affect children's nutrition, eating behaviours, and health outcomes; however, little is known about parents' experiences and perspectives on establishing a healthy diet with young children.

METHODS

A community-recruited sample of 391 parents of young children (under age 5) completed an anonymous cross-sectional online survey assessing the degree to which their children met recommendations outlined in Australian nutrition guidelines, perceived barriers to establishing a healthy diet with their child, and interest in receiving tips/information about establishing healthy eating habits with their children. Descriptive statistics illustrated proportions of children adhering to recommendations. Thematic analysis was used to analyse qualitative data.

RESULTS

Adherence to recommended nutrition guidelines varied across age groups. Most children across all age groups had water as their main drink, routinely consumed a variety of fruit, and consumed sweet drinks or fast foods only rarely. In contrast, less than half of 2- and 3-year-olds regularly consumed a variety of vegetables. The proportion of children consuming discretionary "treat" foods increased sharply over the first 2 years of life, and two thirds of 2-, 3-, and 4-year-olds consumed treat foods a few days per week or more. Parent-reported barriers to establishing a healthy diet with young children included child behavioural factors (e.g., dislike of vegetables), parental influences (e.g., lack of time), family dynamics (e.g., influence of extended family) and external influences (e.g., external environment). Parents were most often interested in ways to modify child behaviour and information about child nutrition.

CONCLUSIONS

Parents cite child behavioural issues as a major barrier to establishing a healthy diet with young children. Behavioural interventions that provide parents with information and support on how to establish a healthy diet with young children, as opposed to educational interventions focusing mainly on what children should be eating, may better meet families' needs.

Protocol of a cluster randomised controlled trial evaluating the effectiveness of an online parenting intervention for promoting oral health of 2-6 years old Australian children

INTRODUCTION

Dental decay is a major problem among Australian children. It can be prevented through good self-care and limiting sugar intake, but many parents/caregivers lack the skills and confidence to help their children adopt these practices. This trial will evaluate the efficacy of Healthy Habits Triple P - Oral health, a web-based online programme, in improving children's oral health-related behaviours (toothbrushing, snacking practices and dental visits) and related parenting practices, thereby preventing dental caries.

METHODS AND ANALYSIS

This is a cluster, parallel-group, single-blinded, randomised controlled trial of an online intervention for parents/caregivers of children aged 2-6 years. From the City of Gold Coast (Australia), 18 childcare centres will be randomly selected, with equal numbers randomised into intervention and control arms. Intervention arm parents/caregivers will receive access to a web-based parenting intervention while those in the control arm will be directed to oral health-related information published by Australian oral health agencies. After the completion of the study, the Healthy Habits Triple P - Oral health intervention will be offered to parents/caregivers in the control arm. The primary outcome of this trial is toothbrushing frequency, which will be assessed via Bluetooth supported smart toothbrushes and parent/caregiver report. Data on other outcomes: parenting practices and child behaviour during toothbrushing, consumption of sugar rich foods and parents' confidence in dealing with children's demands for sugar rich food, and dental visiting practices, will be collected through a self-administered questionnaire at baseline (before randomisation), and 6 weeks (primary endpoint), 6 months and 12 months after randomisation. Data on dental caries will be collected at baseline, 12 and 18 months post-randomisation.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from Human Research Ethics Committees of Griffith University (2020/700) and the University of Queensland (2020002839). Findings will be submitted for publication in leading international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12621000566831.

Child- and family-level factors associated with toothbrushing frequency in a sample of Australian children

BACKGROUND

Identifying the factors that are conducive to good toothbrushing practices is fundamental for planning oral health promotion interventions.

AIM

This study evaluated the relationships between child and family socio-demographic characteristics; children's behaviour during toothbrushing; family support for toothbrushing; parents' practices, attitudes and knowledge related to toothbrushing; general parenting practices; and children's behavioural problems, and children's toothbrushing frequency.

DESIGN

A cross-sectional survey was conducted between February and May 2020 with parents of children aged 2-8 years, recruited through childcare centres throughout Australia. Parents completed self-administered surveys on child and family characteristics.

RESULTS

A total of 606 parents completed the survey. Only half (52.5%) of the children of surveyed parents brushed their teeth twice or more/day. Children of university-educated parents [odds ratio (OR): 6.48; 95% confidence intervals (CIs): 1.21-34.71] and those concerned about their child's toothbrushing (OR: 1.44; 95% CI: 1.21-1.72) were more likely to brush twice or more/day. Where children were non-compliant during toothbrushing or parents reported using ineffective parenting strategies during toothbrushing, children were less likely to brush their teeth twice or more/day. Lack of concern of parent about toothbrushing was associated with brushing less than twice/day in children CONCLUSIONS: Measures of parenting and child behaviour that were specific to the toothbrushing context were associated with twice daily brushing while general measures of parenting and child behaviour were not correlated with twice daily brushing.

Randomised controlled trial of the Healthy Living Triple P-Positive Parenting Program for families of children with type 1 diabetes

This randomised controlled trial examined the efficacy of a brief, group-based parenting program in improving child and family outcomes for families of children with type 1 diabetes. Families (N = 50) of children (2-10 years) with type 1 diabetes were randomly allocated to intervention (n = 22) or care-as-usual (n = 28). Assessments (pre-intervention, post-intervention and 6-month follow-up) evaluated parent- and child-reported parenting behaviour, child behaviour/adjustment and child quality of life (primary outcomes); and metabolic control (routinely-collected blood glucose data), parents' self-efficacy with diabetes management, diabetes-specific child behaviour difficulties, family quality of life, parents' diabetes-related and general parenting stress and observed parent and child behaviour (secondary outcomes). Intent-to-treat analyses indicated greater rate of improvement over time for families allocated to intervention compared to care-as-usual for use of corporal punishment (primary caregivers only), and confidence with managing children's emotions/behaviours, parent-rated child quality of life and adjustment to the child's illness (secondary caregivers only). There were no other intervention effects. Although families found the intervention useful, low levels of psychosocial problems at baseline limited the scope for group-level improvement and there was limited evidence for intervention efficacy. Individually-tailored measures of goal-specific behaviour change may be considered in future research.

The Impact of Message Content and Format on Initial Parental Engagement in a Parenting Intervention: An Experimental Study

Background

Engagement strategies are commonly used to enhance parents’ involvement in parenting interventions. However, few strategies have been evaluated to determine their effectiveness at increasing initial engagement. This study tested the effectiveness of message content (benefits vs. costs) and format (video vs. written) of engagement strategies on the initial engagement (i.e., recruitment, enrolment, and first attendance) of parents to parenting interventions.

Methods

Participants were 692 parents of children aged 2 to 12 years old. Parents were randomly allocated to one of four experimental conditions, which tested the combination of message (benefits vs. costs) and format (video vs. written). Recruitment, enrolment, and first attendance were measured as part of parent’s initial engagement to a self-directed parenting intervention.

Results

Neither message content nor format had an effect on recruitment, enrolment, or first attendance. However, parents who saw the costs content were significantly more likely to review the intervention workbook compared to parents who saw the message about the benefits of the intervention.

Conclusions

Brief testimonials have the potential to early engage parents when the message is positive, independently of its format. Future research should further explore the effects of different messages as well as other engagement strategies used to engage parents.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618001282279, prospectively registered 30/07/2018.

A review of Australian Government funding of parenting intervention research

OBJECTIVES

Parenting is central to children's optimal development and accounts for a substantial proportion of the variance in child outcomes, including up to 40% of child mental health. Parenting is also one of the most modifiable, proximal, and direct factors for preventing and treating a range of children's problems and enhancing wellbeing. To determine the effectiveness of new approaches to parenting intervention, and to evaluate how to optimise reach and uptake, sufficient funding must be allocated for high quality research.

METHOD

We reviewed funding awarded by the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) for parenting intervention research during 2011-2020.

RESULTS

Parenting intervention research received 0.25% of the NHMRC and ARC research budgets.

CONCLUSIONS

There is a substantial mismatch between the funding of parenting intervention research and the impact of improved parenting on short- and long-term child outcomes. To rectify this, it is critical that Australian Government funding schemes include parenting interventions as priority areas for funding.

IMPLICATIONS FOR PUBLIC HEALTH

Changes in allocation of funding to parenting research will support the establishment of evidence for the effective development, implementation and dissemination of parenting interventions to maximise health outcomes for children and their families.

Profiles of Parents' Preferences for Delivery Formats and Program Features of Parenting Interventions

Parents are the targeted consumers of parenting interventions but a small body of research has examined parental preferences for program characteristics to incorporate them in the adaptation and implementation of such programs. Furthermore, the relationship between parents' preferences for program characteristics and their cognitions and behaviours has not yet been explored. This study aimed to identify profiles of parental preferences for delivery formats and program features of parenting interventions. Data from 6949 participants from the International Parenting Survey was analysed. Two-step cluster analyses were conducted to determine clusters of delivery formats and program features of parenting interventions. Preferences for delivery formats showed two clusters, a face-to-face cluster and a media-based cluster. In terms of program features, two clusters were also obtained, a personalised cluster and logistic cluster. While these clusters differed in some demographics, parents' report of child emotional and behavioural problems and parent factors were the key differentiating variables.

A Systematic Review of Parenting Interventions to Support Siblings of Children with a Chronic Health Condition

This systematic review summarises the parenting intervention literature for parents of children who have a sibling with a chronic health condition, and evaluates intervention efficacy for improving parent (parenting skills, parenting efficacy) and child (emotional and behavioural adjustment, condition knowledge, quality of life) outcomes. Electronic databases were searched to identify relevant papers published in English from inception until May 2020. Reference lists of eligible papers were further searched for relevant articles. Six papers (two controlled trials, four uncontrolled trials) evaluating four separate intervention programs met inclusion criteria. All included parent- and child-focused intervention components. Results showed an overall trend for pre- to post-intervention improvement in children's behavioural and emotional adjustment and health condition knowledge. Few studies examined effects on parent outcomes, and there was no evidence of change on these measures. Overall, results suggest that parenting interventions may help to improve siblings' emotional and behavioural adjustment and condition knowledge; however, all of the interventions combined parent- and child-directed intervention components, making it difficult to determine which intervention elements drive change. Further research is needed to test mechanisms by which parenting interventions may improve outcomes for siblings of children with chronic health conditions, and to establish the efficacy of this approach.

A Model of Intention to Participate in Parenting Interventions: The Role of Parent Cognitions and Behaviors

A wide range of factors, from perceived child behavior problems to sociocultural factors, have been identified as impacting the engagement of parents in parenting interventions. However, parents' cognitions and behaviors have not been evaluated sufficiently to understand their role in initial parental engagement. The current study aimed to examine why some parents are more likely to want to participate in parenting programs and how their cognitions and behaviors are related to their intention to participate in future parenting interventions. We tested the hypothesised model of parental factors on intention to participate using structural equation modelling (SEM) in AMOS. This study (N = 6,733) analyzed existing data from the International Parenting Survey (IPS), a web-based tool developed to collect information about parents' views on family and parenting at a population level in several countries. Results showed that parents' coercive parenting, parental consistency, positive encouragement, relationship with their child, parental self-efficacy, psychological distress, and help-seeking behaviors were significantly related to their intention to participate in future parenting interventions. The structural model of parents' cognitions and behaviors explained 16% of the variance in intention to participate. Although the current model explained a small but significant percentage of the variance, it expands existing understanding regarding parental cognitions and behaviors and their relationship to intention. Implications for further research and engagement practice are discussed.

Development and validation of the parenting and child tooth brushing assessment questionnaire

OBJECTIVE

We report the development and validation of a comprehensive Parenting and Child Tooth brushing Assessment (PACTA) questionnaire.

METHODS

This cross-sectional study was conducted with community-recruited Australian parents (N = 450) of children aged 2-8 years. Parents completed an online survey including the newly developed PACTA (comprising four scales assessing children's tooth brushing behaviours, parenting strategies, attitudes and knowledge) and established scales assessing parenting behaviours, attitudes and self-efficacy.

RESULTS

Exploratory factor analyses revealed two-factor structures for scales assessing child behaviour ('noncompliance' and 'avoidance behaviour'), parenting strategies ('effective strategies' and 'ineffective strategies') and attitudes ('emotional reactions' and 'lack of concern'), whereas the knowledge scale was unidimensional. Internal consistencies were satisfactory (>0.7) for all except the knowledge scale. There was good evidence of convergent and predictive validity. All subscales predicted children's parent-reported tooth brushing frequency; children were more likely to brush at least twice per day when parents reported fewer tooth brushing behavioural problems, using effective parenting strategies, and having better attitudes and knowledge. Poorer scores on the 'lack of concern' subscale of the attitudes scale were the strongest unique predictor of twice-daily brushing (OR, 95% CI: 1.51, 1.36-1.67).

CONCLUSIONS

PACTA demonstrates satisfactory validity and reliability. Further research assessing sensitivity to change following intervention is warranted.

Triple P for Parents of Children with Phenylketonuria: A Nonrandomized Trial

OBJECTIVE

Families of children with phenylketonuria (PKU) report child emotional and behavioral problems, parenting stress, and parenting difficulties, which are associated with worse health-related quality of life. This study aimed to examine acceptability and feasibility of a brief, group-based parenting program (Healthy Living Triple P) for families of children with PKU.

METHODS

An uncontrolled nonrandomized trial design was used. Families of children aged 2-12 years (N = 17) completed questionnaire measures assessing child behavior and impact of PKU on quality of life (primary outcomes), and parenting behavior, self-efficacy and stress, and children's behavioral and emotional adjustment (secondary outcomes). Routinely collected blood phenylalanine (Phe) levels were obtained from the treating team. Parents selected two child behaviors as targets for change. The intervention comprised two, 2-hr group sessions delivered face-to-face or online. Assessment was repeated at 4-week postintervention (T2) and 4-month follow-up (T3).

RESULTS

Attrition was low and parent satisfaction with the intervention (face-to-face and online) was high. All families achieved success with one or both child behavior goals, and 75% of families achieved 100% success with both behavior goals by T3; however, there was no change in health-related quality of life. There were moderate improvements in parent-reported ineffective parenting (total score, d = 0.87, 95% CI -1.01 to 2.75) and laxness (d = 0.59, 95% CI -1.27 to 2.46), but no effects on parenting stress or children's adjustment. Phe levels improved by 6month post-intervention for children with elevated preintervention levels.

CONCLUSIONS

Results support intervention acceptability and feasibility. A randomized controlled trial is warranted to establish intervention efficacy.

A systematic review of parenting interventions for child chronic health conditions

This systematic review summarizes the parenting intervention literature for parents of children with chronic health conditions and evaluates intervention effects on parenting (parenting skills and parenting efficacy) and child (behaviour, illness severity/control and quality of life) outcomes. Systematic searches using seven electronic databases (including CINHAL, MEDLINE and PsycINFO) were used to identify relevant papers published in English between 1997 and 2017, and reference lists were searched for additional relevant articles. Ten papers reporting on eight separate studies met inclusion criteria: three studies evaluated stand-alone parenting interventions, while the remaining five studies included parenting components in broader interventions that also targeted medically oriented aspects of illness management. Results suggest that parenting interventions may lead to improved parent self-efficacy, parenting behaviour, illness severity/control, child quality of life and child behaviour; however, intervention effects were mixed and confined to parent-report outcome measures. A paucity of studies using rigorous randomized controlled trial study designs limits the conclusions that can be drawn regarding intervention efficacy. Achieving adequate enrolment and retention of families in parenting intervention trials appears to be problematic within these clinical groups. Larger samples and more diverse clinical populations will support the reliability of future evaluations of parenting interventions in this context and improve generalizability of results.

Development and initial validation of the parent-report Academic Behavior Scale in a Chinese context

This study aimed to develop and evaluate a new parent-report measure to assess primary schoolchildren’s academic behaviors in the home context. We developed the Academic Behavior Scale (ABS) and administered it to Chinese parents of primary schoolers along with other measures. Six hundred and forty-five parents and 170 primary schoolchildren in Grades 4–6 were recruited from a public primary school and completed a set of questionnaires. After that, the psychometric properties of the ABS including factorial validity, convergent and concurrent validity, as well as internal consistency were evaluated using confirmatory factor analysis and correlation analysis in Mplus v.8.3. The results confirmed a two-factor structure for the scale, with satisfactory convergent and concurrent validity and internal consistency. This study provides preliminary evidence for the satisfactory psychometric properties of the ABS among Chinese parents.

Do Australian children carry out recommended preventive child health behaviours? Insights from an online parent survey

AIM

To investigate (i) the proportion of Australian children who do not adhere to preventive child health behaviours, (ii) clustering of child health behaviours, (iii) the proportion of parents who are concerned about not meeting recommendations and (iv) parents' access to and interest in information on ways to establish healthy habits in their child.

METHODS

A cross-sectional online survey of 477 Australian parents of 0-4-year-old children assessed the degree to which children meet key child health recommendations (diet, physical activity, oral health, sleep, pedestrian/vehicle safety, screen use, sun safety, personal hygiene, medical care), examined clustering of health behaviours and identified parents' greatest concerns.

RESULTS

A significant proportion of children do not meet recommendations for many preventive child health behaviours. More than half of the parents report infrequent toothbrushing and dentist check-ups, less than the recommended vegetable consumption, excessive consumption of treats, not wearing safety equipment, excessive screen time and screen time during meals, child inactivity, insufficient sleep, not covering coughs and sneezes, insufficient hand and nail hygiene and inadequate sun protection. No clustering of life-style risk behaviours was found. Areas of greatest concern to parents are vegetable consumption, toothbrushing, covering coughs and sneezes, screen time and wearing sunglasses.

CONCLUSIONS

While the majority of Australian parents have accessed child health recommendations, relatively few consistently implement health-protective practices with their children. Parents are concerned about this and interested in receiving information. Future research should investigate barriers to following guidelines and how parents can best be supported in establishing healthy habits.

Parenting and child behaviour as predictors of toothbrushing difficulties in young children

BACKGROUND

Oral disease is one of the most prevalent chronic health conditions affecting children. Twice-daily toothbrushing is recommended to promote good oral health; however, a large proportion of Australian families are not meeting this recommendation.

AIM

This study aimed to identify important barriers to regular toothbrushing for young children.

DESIGN

In this study, 239 parents of 0- to 4-year-old children completed an online survey that investigated child, family, and parent factors associated with child toothbrushing. Hierarchical linear regression was used to identify predictors of toothbrushing frequency in children and perceived difficulty of the task by parents.

RESULTS

We found that parent factors, specifically oral health knowledge, were the most significant predictors of toothbrushing frequency. Conversely, parent factors did not contribute significantly to the prediction of perceived difficulty of toothbrushing once family and child factors were taken into account. Oral health knowledge and use of routines were identified as the most important predictors of toothbrushing frequency, whereas resistant child behaviour and household organisation were found to be the most important predictors of perceived difficulty of regular toothbrushing.

CONCLUSIONS

The findings of the study have implications for behavioural interventions to support parents, as well as directions for future research.

Psychosocial functioning in children with phenylketonuria: Relationships between quality of life and parenting indicators

OBJECTIVE

This study aimed to assess the impact of phenylketonuria (PKU) and its treatment on parent and child health-related quality of life (HRQoL) and to identify the parenting-related correlates of parent and child HRQoL, as well as metabolic control.

METHODS

Eighteen mothers of 2- to 12-year-old children with PKU participated and completed a series of self-report questionnaires including the PKU Impact and Treatment Quality of Life Questionnaire (PKU-QOL).

RESULTS

Mothers reported that the most significant impact of PKU on HRQoL was in relation to the impact of their child's anxiety during blood tests on their own HRQoL and guilt related to poor adherence to dietary restrictions and supplementation regimens. Higher reported intensity of child emotional and behavioural difficulties and parenting stress were associated with higher scores for PKU symptoms on the PKU-QOL, higher scores for emotional, social, and overall impact of PKU, and higher scores for the impact of dietary restriction. Where mothers reported greater use of overreactivity as a parenting strategy, children tended to have better lifetime phenylalanine levels; however, the overall impact of PKU and the impact of supplement administration on mothers' HRQoL were worse for these families.

CONCLUSIONS

These findings have implications for a holistic family-centred approach to the care of children with PKU and their families.

Comparing apples and pears: misleading conclusions about the population mental health impact of a parenting programme, a commentary on Marryat, Thompson and Wilson (2017)

Background

The article by Marryat, Thompson and Wilson (2017) in BMC Pediatrics presents an evaluation of the implementation of the Triple P system as a public health intervention conducted by the Glasgow City Council and NHS Greater Glasgow and Clyde.

Discussion

Unfortunately, the conclusions drawn are questionable for multiple reasons. The lack of a controlled design precludes defensible conclusions about intervention effects free from routine threats to internal validity. There was a substantial mismatch between the intervention sample and the population sample assessed. The article’s title and abstract leave readers with the mistaken impression that the children assessed for outcome were suitably representative of intervention families, when in fact many of the children in the intervention families were missing from the teacher-report outcome assessment (a single questionnaire), and many or most of the children in the teacher-report outcome assessment belonged to families who had never received the intervention. Although Triple P targets parent-child relations and child behavioural and emotional problems at home, Marryat et al. narrowly defined mental health impact as child difficulties in nursery or preschool, while not reporting data from practitioners and parents in the same evaluation that did not support the authors’ conclusion. The paper was further diminished by a number of misleading statements and factual errors related for example to other research on Triple P.

Summary

Studying the extent to which child mental health functioning at home can generalise to school settings is an important topic of inquiry in relation to parenting support interventions, but unfortunately the Marryat et al. article did not move this area forward.

Promoting Self-Regulation in Young Children: The Role of Parenting Interventions

Self-regulation is a foundational skill in childhood and underpins various positive and negative outcomes throughout childhood, adolescence and into adulthood. Parents and the way they parent their children play a key role in the development of young children's self-regulatory capacity. However, there is limited evidence for the effectiveness of parenting interventions on child self-regulatory outcomes. This paper provides an overview of the role of parenting in the development of child self-regulation and a summary of the evidence base for parenting interventions to promote self-regulation in children under age eight, focusing on infancy, the toddler/preschooler period, and early school-age. We conclude by examining the gaps in this field of research and providing directions for future research.

Enhancing Initial Parental Engagement in Interventions for Parents of Young Children: A Systematic Review of Experimental Studies

Low rates of participation in parenting interventions may undermine their effectiveness. Although a wide range of strategies to engage parents in interventions are described in the literature, little is known about which engagement strategies are most effective in enhancing parental engagement. This systematic review explores effective engagement strategies to encourage initial parental engagement (recruitment, enrolment, and first attendance) in parenting interventions for parents of children aged 2-8 years old. This review was conducted based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green 2011) and the Preferred Reporting Items for Systematic Review and Meta-Analysis (Moher et al. 2009). Electronic systematic searches from January 1996 to August 2017 were conducted in PsycINFO, Scopus, ProQuest Social Sciences Journals, CINAHL, and PubMed databases. Eight studies met the inclusion criteria representing 1952 parents from four different countries. Of the engagement strategies tested in included studies (monetary incentive, setting, testimonial, advertisement, and engagement package), three strategies (advertisement, incentive, and engagement package) showed a significant effect on a stage of engagement, but none across stages. The low methodological quality of the selected studies limits their generalisability and thus provides limited evidence regarding effective engagement strategies to increase recruitment, enrolment, and first attendance rates in parenting interventions. There is a need for further, more methodologically rigorous, research evidence regarding how to engage parents more effectively in the early stages of parenting interventions.

DOES A PERINATAL PARENTING INTERVENTION WORK FOR FATHERS? A RANDOMIZED CONTROLLED TRIAL

Fathers are increasingly expected to contribute to their parenting role at the transition to parenthood; however, many fathers experience mental health problems during this time. Parenting support for new fathers is limited, and research often only includes the mothers in intervention studies. Clear evidence for parenting programs for fathers has not yet been established. This study evaluated the effects of a parenting intervention (Baby Triple P) on fathers who were expecting their first baby. The design was a randomized controlled trial comparing Baby Triple P with care as usual over three time points (pregnancy, 10 weeks' postbirth, and 6 months' postbirth) for 112 fathers living in Brisbane, Australia. The primary outcomes included paternal psychological distress such as depression, anxiety, and stress and several secondary measures. No significant intervention effects for Baby Triple P were found at either post- or follow-up assessments. Fathers in both groups reported significant increases in their parenting confidence and self-efficacy. The results indicate no conclusive evidence for the effectiveness of Baby Triple P for new fathers. Future research using a sample with greater likelihood of experiencing problems at the transition to parenthood is needed as is offering more tailored need-based support to obtain substantial evidence for this preventative parenting program.

Preparing parents for parenthood: protocol for a randomized controlled trial of a preventative parenting intervention for expectant parents

Background

Becoming the parent of a new baby comes with a range of challenges including difficulties with emotional adjustment, couple relationship issues and difficulty managing common infant behaviors, such as crying and sleep problems. This time can be especially challenging for couples who experience a range of risk factors. Previous parenting interventions for parents of babies have shown mixed results. This protocol paper describes a randomized controlled trial of a group-based parenting intervention for high-risk parents expecting their first baby.

Methods/design

Participants will be randomized to either Group Baby Triple P or Care as Usual (CAU). Group Baby Triple P involves 4 × 2 h group sessions delivered during pregnancy and 4 individual telephone sessions of 30 min each in the early postnatal period. Outcomes will be assessed via parent self-report questionnaire, home observations and a baby diary 10 weeks and 6 months post-birth. Primary outcomes will be parental confidence and perceived competence. Secondary outcomes will include parental responsiveness and bonding with the baby, relationship happiness, life satisfaction, depression, anxiety and stress, and infant crying and sleep. Analyses will involve a series of rANOVA and rMANOVAs, t-tests and a multilevel modeling approach.

Discussion

A brief summary, strengths and potential implications are discussed.

Trial registration

Australian New Zealand Clinical Trials Registry: ANZCTR 12613000948796. Registered 27 August, 2013.

Fathers' Perceptions of Change Following Parenting Intervention: Randomized Controlled Trial of Triple P for Parents of Children With Asthma or Eczema

Objective

To test whether families' participation in an evidence-based parenting program can improve health-related outcomes reported by fathers of 2- to 10-year-old children with asthma and/or eczema.

Methods

A 2 (Triple P-Positive Parenting Program vs. care as usual) by 3 (baseline, postintervention, 6-month follow-up) design was used, with random group assignment. Of 107 families, 51.4% (N = 55) had a father participate alongside the child's mother, who was the primary intervention target. Fathers completed questionnaires assessing illness-related child behavior problems; self-efficacy with illness management and illness-related child behavior problems; and health-related quality of life.

Results

Secondary intent-to-treat analyses indicated improved child behavior and self-efficacy for managing eczema, but not asthma. Health-related quality of life improved for children, but not parents/families. There were no other significant intervention effects.

Conclusions

Intervention outcomes were positive for eczema but not asthma, and did not depend on the extent of father participation in the intervention.

EARLY PARENTING SUPPORT AND INFORMATION: A CONSUMER PERSPECTIVE

The transition to parenthood is a period of both joy and challenge for most parents. There is a recognized need to support parents during this period, yet existing interventions have shown limited evidence of efficacy. This study takes a consumer-focused approach to examine the needs and preferences of parents both prenatally (n = 77) and postnatally (n = 123) for parenting support. The study used a cross-sectional design with a purpose-built online survey. Parents were recruited via online forums, Facebook and parenting blogs, childcare centers, and playgroups. In general, all parents were satisfied with their current levels of both formal and informal support, and about one fourth of parents had accessed a parenting intervention. Parents expressed a moderate level of interest in additional parenting information, and parents expecting their first baby indicated preferences for information about basic baby care needs whereas postnatally, parents expressed more interest in topics around self-care and behavior management. The implications for developing interventions and engaging families are discussed.

The International Parenting Survey: Rationale, Development, and Potential Applications

The quality of parent-child interactions and family relationships has a powerful influence on children's development and well-being. The International Parenting Survey (IPS) is a brief, web-based survey developed to provide a cross-national, community-level, population snapshot of the experiences of parents related to raising children. The IPS was developed as a planning tool to assist policy makers and community agencies plan, implement, and evaluate parenting programs and as a tracking tool to evaluate parenting support programs in different countries. We report the preliminary psychometric properties of the IPS on various domains of measurement in an international sample of over 9,000 parents. Moderate to high reliabilities were obtained for all domains of measurement. High internal consistency reliabilities (α = .88-.97) were obtained for the domains of children's behavior and emotional maladjustment, for parental self-efficacy, parental distress and parental beliefs. Moderate levels of reliabilities (α = .52-.83) were obtained for domains of parental consistency, coercive parenting, positive encouragements, and parent-child relationships. Overall, the measure appears to have satisfactory reliability justifying further psychometric validation studies in population level studies of parenting. Examples of uses of the IPS are described and directions for future research and policy explored.

Randomized controlled trial of Triple P for parents of children with asthma or eczema: Effects on parenting and child behavior

OBJECTIVE

Parents play an important role in children's illness management, in promoting child adjustment and reducing behavior problems. Little research has focused on the evaluation of parenting interventions in the context of childhood chronic illness. The aim of this study was to test the efficacy of a brief, group parenting intervention (Healthy Living Triple P) in improving parenting skills and parent adjustment, and reducing child behavioral and emotional difficulties in the context of childhood asthma and eczema.

METHOD

One hundred seven parents of children with a diagnosis of asthma and/or eczema were randomly assigned to intervention (n = 52) or care as usual (CAU; n = 55). Parents completed self-report measures of their child's behavioral and emotional adjustment, their own parenting, and their own level of adjustment at pre- and postintervention and at 6-month follow-up. Parent-child interactions were observed and coded at each time point. The intervention consisted of 2 group sessions of 2 hr each delivered by trained, accredited practitioners.

RESULTS

Attrition was low, with T2 and T3 assessment completed by 84.6% and 80.8% of intervention families and 92.7% and 81.8% of CAU families, respectively. Intention-to-treat analyses indicated that overall parent-reported ineffective parenting as well as parental overreactivity reduced as a result of intervention. Parent report of child behavior problems also decreased, but there were no changes in children's emotional adjustment. No changes in observed parent or child behavior were found. Stress reduced for parents in the intervention group compared to the CAU group, but there were no changes in parental anxiety or depression. Effects showed evidence of reliable and clinical change and were maintained at 6-month follow-up.

CONCLUSIONS

The intervention shows promise as an addition to clinical services for children with asthma and eczema and may have broader application to other chronic health conditions. (PsycINFO Database Record

Development and Validation of a Measure Assessing Child Diabetes Behavior: The Diabetes Behavior Checklist

Previous research in pediatric diabetes management has focused on general child behavior, which is linked with treatment adherence and health outcomes in children with type 1 diabetes. Little is known about child diabetes behavior problems specifically. The current study aimed to develop and validate a measure of diabetes-specific child behavior problems, and parents' confidence in managing these behaviors. Participants were a community sample of 186 parents of children aged 2-10 years with type 1 diabetes, recruited via online parenting forums and advertisements placed in school and childcare newsletters throughout Australia. The measure demonstrated excellent internal consistency and evidence of construct validity, and factor analyses revealed a 3-factor and a 1-factor structure for the Extent and Confidence scales, respectively. This study provides preliminary evidence of validity of the Diabetes Behavior Checklist. The implications of these findings for intervention development are discussed.

"I just feel like I am broken. I am the worst pregnant woman ever": A qualitative exploration of the "at odds" experience of women's antenatal distress

Advances in perinatal mental health research have provided valuable insights around risk factors for the overall development of maternal distress. However, there is still a limited understanding of the experience of women struggling emotionally during pregnancy. We explored how women view, experience, and interpret psychological distress antenatally. Eighteen Australian women participated in in-depth interviews that were analyzed thematically within a critical realist theoretical framework. We present and situate the current findings within the dominant discourse of the good mother, which arguably promotes guilt and stigma and results in women self-labeling as bad mothers.

A randomized controlled trial evaluating a low-intensity interactive online parenting intervention, Triple P Online Brief, with parents of children with early onset conduct problems

OBJECTIVE

This randomized controlled trial examined the efficacy of Triple P Online Brief, a low-intensity online positive parenting program for parents of children with early onset disruptive behavior problems.

METHOD

Two hundred parents with 2-9-year-old children displaying early onset disruptive behavior difficulties were randomly assigned to either the intervention condition (n = 100) or a Waitlist Control group (n = 100).

RESULTS

At 8-week post-assessment, parents in the intervention group displayed significantly less use of ineffective parenting strategies and significantly more confidence in dealing with a range of behavior concerns. These effects were maintained at 9-month follow-up assessment. A delayed effect was found for child behavior problems, with parents in the intervention group reporting significantly fewer and less frequent child behavior problems at follow-up, but not at post-assessment. All effect sizes were in the small to medium range. There were no significant improvements in observed negative parent and child behavior. No change was seen for parents' adjustment, anger, or conflict over parenting. Consumer satisfaction ratings for the program were high.

CONCLUSIONS

A brief, low-intensity parenting program delivered via the Internet can bring about significant improvements in parenting and child behavior.

Child behaviour problems and childhood illness: development of the Eczema Behaviour Checklist

BACKGROUND/OBJECTIVES

Children with atopic dermatitis are at increased risk of both general behaviour problems, and those specific to the condition and its treatment. This can hamper the ability of parents to carry out treatment and manage the condition effectively. To date, there is no published instrument available to assess child behaviour difficulties in the context of atopic dermatitis management. Our aim was to develop a reliable and valid instrument to assess atopic dermatitis-specific child behaviour problems, and parents' self-efficacy (confidence) for managing these behaviours.

METHODS

The Eczema Behaviour Checklist (EBC) was developed as a 25-item questionnaire to measure (i) extent of behaviour problems (EBC Extent scale), and (ii) parents' self-efficacy for managing behaviour problems (EBC Confidence scale), in the context of child atopic dermatitis management. A community-based sample of 292 parents completed the EBC, measures of general behaviour difficulties, self-efficacy with atopic dermatitis management and use of dysfunctional parenting strategies.

RESULTS

There was satisfactory internal consistency and construct validity for EBC Extent and Confidence scales. There was a negative correlation between atopic dermatitis-specific behaviour problems and parents' self-efficacy for dealing with behaviours (r = -.53, p < .001). Factor analyses revealed a three-factor structure for both scales: (i) treatment-related behaviours; (ii) symptom-related behaviours; and (iii) behaviours related to impact of the illness. Variation in parents' self-efficacy for managing their child's atopic dermatitis was explained by intensity of illness-specific child behaviour problems and parents' self-efficacy for dealing with the behaviours.

CONCLUSIONS

The new measure of atopic dermatitis-specific child behaviour problems was a stronger predictor of parents' self-efficacy for managing their child's condition than was the measure of general child behaviour difficulties. Results provide preliminary evidence of reliability and validity of the EBC, which has potential for use in clinical and research settings, and warrant further psychometric evaluation.

Initial Validation of the Parent-Report Child Adjustment and Parent Efficacy Scale (CAPES) in a Chinese Cultural Context

This study aimed to validate a parent-report measure of child adjustment and parenting efficacy (Child Adjustment and Parent Efficacy Scale [CAPES]) in a Chinese cultural context. Six hundred and fifty Chinese parents in China participated in the study and completed a set of questionnaires including the CAPES, the Strengths and Difficulties Questionnaire (SDQ), the Parenting Sense of Competence Scale (PSOC), and the Parenting and Family Adjustment Scales (PAFAS). The factorial, convergent, and concurrent validity as well as internal consistency were evaluated. The results provided support for a new 2-factor structure of child behavioral and emotional adjustment. The 1-factor structure of parenting efficacy was confirmed. The three constructs obtained satisfactory internal consistency. Moreover, the CAPES scores correlated significantly with the SDQ, PSOC, and PAFAS in the expected pattern, which indicated its excellent convergent and concurrent validity. Therefore, it is a promising measure, due to its brevity and comprehensiveness, with the first indications of satisfactory internal consistency and validity among Chinese parents. However, a revision of the instrument is needed to avoid the ordering effects of positive and negative items, and further hypothesis-driven research is also needed to validate the (revised) instrument in different Chinese samples.

Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour, skin care management, and disease severity in young children

BACKGROUND

The development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group.

OBJECTIVES

To examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents' self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity.

DESIGN

Cross-sectional study design.

PARTICIPANTS

Parent-child dyads (N=64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3months and no other chronic health conditions except asthma, allergic rhinitis, or allergy.

METHODS

Parents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour.

RESULTS

Pearson's and Spearman's correlations identified relationships (p<0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho=0.48, p<0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r=0.35, p=0.005) and less authoritarian (r=0.41, p=0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems.

CONCLUSION

This study revealed relationships between parents' self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.