Perceptions, Use, and Impact of Digital Technologies for Strengthening Parenting

Background: Social, emotional, and behavioral problems are among the top public health issues affecting approximately 10% of children in the United States. There is evidence demonstrating parent training as cost-effective method promoting positive parent-child relationships. ezParent, a tablet-based delivery adaptation of the group-based Chicago Parent Program (CPP), answers that call. This study (1) classifies levels of engagement by identifying individual usage of ezParent based on observed user activity (i.e. “metadata”). The following usage metrics were analyzed: number of modules completed, number of skills a parent saved in the program, and total time spent in the program; (2) to explore parents’ perceptions of the benefits and barriers associated with their use of the ezParent program; and (2) the ways in which the ezParent components and perceived usability varied by program use; and (3) using Maximum Likelihood Estimation (MLE), examine whether parents’ levels of engagement are associated with improvements in four parent-child outcomes previously shown to be sensitive to parent training interventions: parenting self-efficacy, parenting discipline strategies, parenting stress, and child behavior problems. Methods: Using an explanatory mixed-methods single group pre-test post-test design, data were collected from 92 parents recruited from two pediatric primary care clinics in two urban cities: Chicago, Illinois (Cohort 1) and Baltimore, Maryland (Cohort 2). Parents participated in interviews and completed surveys to assess changes in parenting and child outcomes: Parenting Stress Index Short Form (PSI-SF), Toddler Care Questionnaire (TCQ), Parenting Questionnaire (PQ), and the Eyberg Child Behavior Inventory – Intensity and Problem Scale (ECBI). Results: Seventy-eight (84.7) parents engaged in the program, 26 (28.3%) completed the entire program (6 modules), and 32 parents did not complete Module 1 (34.7%). Although similar barriers were described by both Cohorts, Cohort 2 reported more barriers than Cohort 1 (p=0.000). Although the data showed reductions in parenting stress (p=0.00), increased confidence (p=0.012), warmth (p=0.00), follow through (p=0.007), from baseline to T3, it was not dependent on level of engagement. Conclusion: mHealth interventions are not “one-size-fits-all”. Additional considerations regarding situational factors experienced by low-income minority parents need to be addressed to encourage greater success of these interventions