Effectiveness of a technology-assisted, family volunteers delivered, brief, multicomponent parents’ skills training intervention for children with developmental disorders in rural Pakistan: a cluster randomized controlled trial

International Journal of Mental Health Systems

Chiara Servili¹  Laura Pacione²  Erica Salomone³  Huma Nazir⁴  Nadia Suleman⁴  Mahjabeen Tariq⁴  Ahmareen Koukab⁴  Aqsa Masood⁴  Parveen Akhtar⁴  Fareed Aslam Minhas⁵  Syed Usman Hamdani⁶  Duolao Wang⁷  Felicity Brown⁸  Stephanie Shire⁹  Siham Sikander^1,10  Atif Rahman^1,10  Zill-e- Huma^1,11 

[1] Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland;Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland;Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, ON, Canada;Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland;Department of Psychology, University of Milan-Bicocca, Milan, Italy;Human Development Research Foundation, Islamabad, Pakistan;Institute of Psychiatry, Rawalpindi Medical University (RMU) and Benazir Bhutto Hospital, Rawalpindi, Pakistan;Institute of Psychiatry, Rawalpindi Medical University (RMU) and Benazir Bhutto Hospital, Rawalpindi, Pakistan;University of Liverpool, Liverpool, UK;Human Development Research Foundation, Islamabad, Pakistan;Liverpool School of Tropical Medicine, Liverpool, UK;Research and Development Department, War Child Holland, Amsterdam, The Netherlands;Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands;Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, USA;University of Liverpool, Liverpool, UK;University of Liverpool, Liverpool, UK;Human Development Research Foundation, Islamabad, Pakistan;

关键词: Developmental disorders;    WHO mhGAP-IG;    Family Volunteers;    Technology assisted task-shifting;    Low income settings;    Caregivers’ skills training;    Low resource settings;   

DOI  :  10.1186/s13033-021-00476-w

来源: Springer

【 摘 要 】

BackgroundGlobally, there is a large documented gap between needs of families and children with developmental disorders and available services. We adapted the World Health Organization’s mental health Gap-Intervention Guidelines (mhGAP-IG) developmental disorders module into a tablet-based android application to train caregivers of children with developmental disorders. We aimed to evaluate the effectiveness of this technology-assisted, family volunteers delivered, parents’ skills training intervention to improve functioning in children with developmental disorders in a rural community of Rawalpindi, Pakistan.MethodsIn a single-blinded, cluster randomized controlled trial, 30 clusters were randomised (1:1 ratio) to intervention (n = 15) or enhanced treatment as usual (ETAU) arm (n = 15). After screening, 540 children (18 participants per cluster) aged 2–12 years, with developmental disorders and their primary caregivers were recruited into the trial. Primary outcome was child’s functioning, measured by Childhood Disability Assessment Schedule for Developmental Disorders (DD-CDAS) at 6-months post-intervention. Secondary outcomes were parents’ health related quality of life, caregiver-child joint engagement, socio-emotional well-being of children, family empowerment and stigmatizing experiences. Intention-to-treat analyses were done using mixed-models adjusted for covariates and clusters.ResultsAt 6-months post-intervention, no statistically significant mean difference was observed on DD-CDAS between intervention and ETAU (mean [SD], 47.65 [26.94] vs. 48.72 [28.37], Adjusted Mean Difference (AMD), − 2.63; 95% CI − 6.50 to 1.24). However, parents in the intervention arm, compared to ETAU reported improved health related quality of life (mean [SD] 65.56 [23.25] vs. 62.17 [22.63], AMD 5.28; 95% CI 0.44 to 10.11). The results were non-significant for other secondary outcomes.ConclusionsIn the relatively short intervention period of 6 months, no improvement in child functioning was observed; but, there were significant improvements in caregivers’ health related quality of life. Further trials with a longer follow-up are recommended to evaluate the impact of intervention.Trial registration Clinicaltrials.gov, NCT02792894. Registered April 4, 2016, https://clinicaltrials.gov/ct2/show/NCT02792894

【 授权许可】

CC BY