Parental Confidence Research Articles

Effectiveness of behavioral parent training in the outpatient setting for preschoolers at risk for ADHD

Abstract In 2019, the American Pediatric Association released updated guidelines regarding assessing and treating attention-deficit/hyperactivity disorder (ADHD). These guidelines prescribe behavioral parent training (BPT) as the first line of treatment for preschool-aged children with ADHD symptomatology. However, there are few studies documenting the effectiveness of BPT administered in real-word settings, outside the context of controlled research trials. Further, many available BPT programs are lengthy and costly. Here we investigate the effectiveness of an 8-session group-based BPT, previously shown effective in school-aged children with ADHD, in an outpatient clinic. Ratings of parental confidence, child impairment, number and severity of non-compliance in multiple situations, and ADHD and oppositional symptoms, were collected from 132 parents of preschoolers at risk for ADHD before and after the BPT groups. Improvements with a large effect size were observed for overall severity of impairment and parental confidence ratings. Improvements with a moderate effect size were observed for academic progress, severity of non-compliance, and ADHD symptom ratings. Small effect sizes were observed for reduced impairment in family functioning, peer and parental relationships, and self-esteem, frequency of non-compliance, and oppositional defiant symptom ratings. Together these findings support the effectiveness of a BPT program to treat preschool ADHD and ADHD-like behaviors that is accessible to families and clinicians.

The FeverApp registry \u2013 ecological momentary assessment (EMA) of fever management in families regarding conformity to up-to-date recommendations

BackgroundFever is one of the most common symptoms of pediatric consultations and its mismanagement is a health care burden. Guidelines on fever management are incoherent and data on fever management are still missing. This study protocol describes an app-based registry to evaluate the fever management of parents.ObjectiveThe primary objectives are to assess guideline adherence (primary outcome) and parental confidence in managing fever, and thus to reduce overuse of antipyretics, antibiotics and healthcare providers.Secondary objectives include creating a “FeverApp” that will enable parents to handle fever safely and to use the FeverApp registry as symptom and fever management diary. Further objectives include developing and testing a symptom-led registry model by app-based acquisition of parental entries of febrile illness cycle data and developing and testing models of how an interactive app-based registry can enable nationwide EMA information to inform science, guideline and policy makers, and the public.MethodsA FeverApp, guiding parents and carers in handling and documenting fever, will be developed with family pediatricians according to current guidelines and recommended for all parents in Germany. A registry will anonymously document features, management and outcomes of febrile episodes: basic sociodemographic and medical information, initial symptoms, course of fever, pharmacological and non-pharmacological interventions, consultations with doctors, outcomes, fever-associated fears, and app satisfaction.ResultsThis app may improve communication quality and health, e.g. asthma and antimicrobial resistance. Results will be published via website www.feverapp.de.Trial registrationThis app-based registry protocol is registered in the German Clinical Trials Register (DRKS) with registration number: DRKS00016591.

Seizures following vaccination in children: Risks, outcomes and management of subsequent revaccination

Seizures and status epilepticus can occur within 14 days following administration of inactivated and live-attenuated vaccines. These vaccine-proximate seizures can undermine parental confidence in vaccine safety and affect further vaccination decisions. Vaccine-proximate status epilepticus (VP-SE) is uncommon but may be the first manifestation of genetic developmental epileptic encephalopathies, including Dravet syndrome. The aim of this article is to review current literature on the risks and outcomes of vaccine-proximate seizures and, using two clinical scenarios, outline management of subsequent revaccination. Vaccine-proximate seizures require careful evaluation of the vaccine(s) involved, seizure type and duration to determine asafe course for revaccination. Vaccine-proximate febrile seizures (VP-FSs) have similar outcomes to other febrile seizures and are not associated with increased developmental or behavioural concerns. Vaccination for children with VP-FSs can occur safely in the community. However, VP-SE cases warrant prompt specialist review, consideration of genetic epilepsy testing and referral to a specialist immunisation clinic for subsequent vaccination under medical supervision.

Addressing the needs of parents with advanced cancer: Attitudes, practice behaviors, and training experiences of oncology social workers

Advanced cancer patients who are parents of minor children experience heightened psychosocial distress. Oncology social workers (OSWs) are essential providers of psychosocial support to parents with advanced cancer. Yet, little is known about the experiences and approaches of OSWs in addressing these patients' unique needs. The purpose of this study was to characterize the attitudes, practice behaviors, and training experiences of OSWs who provide psychosocial care for advanced cancer patients with minor children. Forty-one OSWs participated in a cross-sectional survey addressing multiple facets of their psychosocial care for parents with advanced cancer. The five assessed domains of psychosocial support were communication support, emotional support, household support, illness and treatment decision-making support, and end-of-life planning. Participants reported greatest confidence in counseling patients on communication with children about illness and providing support to co-parents about parenting concerns. OSWs reported less confidence in counseling parents on end-of-life issues and assisting families with non-traditional household structures. The majority of participants reported needing more time in their clinical practice to sufficiently address parents' psychosocial needs. Nearly 90% of participants were interested in receiving further training on the care of parents with advanced cancer. To improve the care of parents with advanced cancer, it is critical to understand how the psychosocial oncology workforce perceives its clinical practice needs. Study findings suggest an opportunity for enhanced training, particularly with respect to end-of-life needs and in response to the changing household structure of American families.

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania, Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family‐inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family‐inclusive approach. Future research could focus on attaining a more in‐depth understanding of individual family member experiences with a view to improving SST delivery.

Systematic review and meta-analysis of determinants associated with HPV vaccination uptake in Europe

Abstract Background Human papillomavirus (HPV) vaccines are the most important strategy to prevent HPV-related cancers and benign lesions. However, low immunization levels observed in several countries requires a deeper analysis of determinants associated with HPV vaccination uptake. Aim of the research is to identify the main determinants associated with HPV vaccination uptake among European adolescents, through a systematic literature review and meta-analysis. Methods The research was conducted on electronic databases including PubMed/MEDLINE and SCOPUS, identifying 1147 studies. Original articles published between 2000 and 2018 were retrieved, with restriction criteria applied to the European region and to the English language. Qualitative and quantitative studies describing the positive and negative determinants underlying vaccination uptake were analyzed. Adjusted and Crude Odds Ratios and their Confidence Intervals were extracted and included in the meta-analysis. Results After screening and eligibility processes, 28 articles were included in the meta-analysis. HPV vaccination uptake is significantly associated with correct information given by health-care workers, educational interventions organized at school about HPV and a gynecologist visits. Receiving information from parents and/or friends and a lack of information about HPV are significantly associated with lower vaccination adherence. Moreover, low socio-economic status and religious conviction represent additional barriers to HPV vaccination adherence. Conclusions One of the main future challenge for public health authorities will be the increase of HPV vaccination coverage rates. To reach this objective should be necessary to provide an unambiguous communication to general population and to promote educational interventions in the school setting. by all HCWs that play a key role in HPV vaccination recommendation (public health physicians, gynecologists, general practitioners, pediatricians). Key messages Health-care professionals play a key role in HPV vaccine recommendation, contributing to vaccination acceptance. Tailored and standardized educational intervention in school settings could improve knowledge and beliefs on HPV vaccines, improving adolescents and parents confidence towards vaccination.

17. ENHANCING INFLUENZA VACCINE KNOWLEDGE AND CONFIDENCE AMONG RESIDENTS

Background The 2017-18 influenza season was severe. Many children who died were unvaccinated. Yet a third of parents interviewed before the 2018-2019 influenza season reported their children would not receive influenza vaccines. Pediatric residents may not be comfortable counseling vaccine hesitant families. Through a fellow-led QI project, we aimed to provide educational interventions to increase pediatric residents’ knowledge and confidence counseling influenza vaccine hesitant families. Aim Statement To increase both pediatric residents’ perceived knowledge of resources and their confidence in addressing influenza vaccine hesitant parent concerns by 85% in 7 months. Interventions We obtained baseline data via anonymous online surveys to measure pediatric residents’ confidence and perceived knowledge of resources. Residents participated in fellow-led educational sessions that discussed vaccine manufacturing, adverse effects and common myths. We introduced the CASE method, a resource to improve counseling skills toward vaccine hesitant families. Resources were distributed with facts debunking common myths and an outline of the CASE method. Residents participated in a role play activity to practice counseling. In a second educational session for PDSA cycle 2, we modified the role play activity to facilitate more interaction and provide feedback on counseling techniques. Measures Outcome measures were resident perceived knowledge of resources and resident confidence. Results At baseline, 58% of pediatric residents reported being knowledgeable about resources for influenza vaccine hesitant families; 46% of residents reported being confident addressing parents’ influenza vaccine related concerns. After the first intervention, residents’ knowledge increased to 100% and confidence to 56%. After the second intervention, residents’ knowledge was 93% and confidence was 79%. Conclusions and Next Steps Providing education to pediatric residents on the influenza vaccine and guided counseling can increase residents’ knowledge and confidence in counseling parents who are influenza vaccine hesitant. Future studies will explore using this same technique to improve resident confidence in counseling other difficult situations.

‘Understanding your baby’: A course for parents and carers

‘Understanding your baby’ is a four-week psychoeducational group for parents/carers of 0-6-month-old infants, designed to increase parental knowledge and confidence. This paper outlines the development, implementation and evaluation of the course.

Support to responsive parenting through communication tools

Abstract Issue Counselling unit for positive parenting “Halobeba” has been established at Institute of Public Health of Belgrade with support of UNICEF in order to enable continuum of mother and child health care. Availability of information on child care and development was noticed as significant factor for parental confidence and practice. Description of the problem Trained nurses provide responses to parental questions through 24/7 phone and e mail communication to assist in problem solving and offer emotional support. Nurses are skilled in active listening, proper questioning, counselling and effective encouragement. Free mob app on breastfeeding was developed as knowledge base for parents. New interactive mob app was recently launched as parenting tool for child health and development monitoring. Results Since 2002, more than 1,700,000 responses were provided through phone communication and over 20,000 via email and number of beneficiaries has increased over the years. Most common topics were about breastfeeding, introducing solid food, treatment of fever and respiratory infections, gastrointestinal problems, injuries, immunization, and developmental milestones. Less than 15% of cases were referred to pediatric clinic. Level of parental overall satisfaction was very high and availability and effectiveness of service were especially valued as well as nurses communication skills. Lessons Family centered service that corresponds to caregivers needs is effective approach to support nurturing care for young children. Personalized M-health tools make child care more accessible and build capacities of caregivers. Key messages Sending consistent and trusted messages through different communication channels contribute to enhancing users' knowledge and skills. Knowledgeable and responsive caregivers properly interpret child’s needs, respond appropriately, facilitate the child’s social and emotional development, and provide proper care.

One-year sustained impact of supervised epinephrine autoinjector administration during food challenge on parent confidence

One-year sustained impact of supervised epinephrine autoinjector administration during food challenge on parent confidence

Examining the Effectiveness of WhatsApp-Based Spiritual Posts on Mitigating Stress and Building Resilience, Maternal Confidence and Self-efficacy Among Mothers of Children with ASD.

Spiritual posts delivered via WhatsApp were found effective for mothers of children with ASD in mitigating parenting stress and building parental self-efficacy, confidence and resilience as compared to a control group. Intervention compliance was a prerequisite, and, middle-class mothers, highly qualified, salaried/self-employed, who perceived full support from their spouses/families and who also participated in other support groups or skill development programs benefitted most. Latent class analyses revealed six subgroups of participants likely to gain most from the intervention: middle class mothers, highly qualified, salaried/self-employed, who participated in other skill development programs, above threshold posts readers and homework doers. Spirituality built mothers' psychological resources, but dyadic interventions may be needed for dealing with challenges and uncertainties of autistic child's emotional/behavioral characteristics.

A Quasi-Experimental Study of the Respectful Approach on Early Parenting Competence and Stress

Early parenthood can be stressful. Many parenting interventions emphasize skills training, as opposed to improving the parent-child relationship. We investigated whether the Respectful Approach intervention, based on building the parent-child relationship through observation and respect, improves stress and confidence in parents of infants and toddlers. Using a quasi-experimental design, we compared changes in self-reported levels of stress and parenting competence between 15 parents who attended the Respectful Approach parent-child classes (once a week for six weeks), to a control group of 23 parents utilizing the ‘Parenting Sense of Competence Scale’, ‘Parental Stress Scale’ and ‘Depression Anxiety Stress Scales’. A focus group was held at the conclusion of the intervention to provide feedback about the classes. A significant Time × Group interaction was observed for both parent competence (p = 0.004) and parent stress (p = 0.010). Parents in the intervention group demonstrated a significant increase in parent competence (p = 0.001) with no significant change observed in the control group (p = 0.787). Parent stress significantly increased in the control group (p = 0.017) and marginally decreased in the intervention group (p = 0.134). Qualitative analysis revealed that the intervention parents felt they were calmer and better understood their children. These findings suggest that the Respectful Approach intervention may improve parental stress and parenting competence. Our results justify development of a randomized controlled trial to further quantify the effect of this approach.

Change in foster parent knowledge, skills and confidence associated with support from a peer “trauma coach”

Background: Foster parents are in an ideal position to build resilience and manage trauma symptoms in the children they care for. Learning about trauma and using effective parenting strategies can mitigate the devastating impact of trauma on the youth. Peer support incorporating psychoeducation and skill building for the caregiver has been demonstrated to promote more accurate interpretation of children’s behavior in some settings. Objective: To identify changes in knowledge, skills and efficacy of foster caregivers who received trauma coach services. Design/Methods: The study was conducted …

Change in foster parent knowledge, skills and confidence associated with support from a peer “trauma coach”

Change in foster parent knowledge, skills and confidence associated with support from a peer “trauma coach”

A Brief Introduction to Parental Involvement in Early Childhood Education in Turkish and Finnish Contexts

Research conducted in recent decades has shown the importance of parental involvement in pupils’ well-being, learning, and future academic success as well as their cognitive, social, and emotional development. In addition to these benefits, parental involvement practices improve parental confidence and satisfaction as well as enriching educational programmes, enhancing the climate of educational institutions, and easing teachers’ work burden through responsibility-sharing and increased information flow. Although the significant role of parental involvement is well-supported by various studies, some research reveals that a gap continues to exist between the recommendations of related research and what is practised in educational institutions in reality. This gap explains in part the persistence of insufficient parental involvement practices. This paper, which is based on my public lektio aims to gain a better understanding of early childhood educators’ self-reported reasons for insufficient practices as well as identifying their parental involvement practices and their views in Finnish and Turkish contexts. The study is reported in four original articles, using the quantitative and qualitative data gathered from a representative sample of 287 early childhood educators from Helsinki and 225 early childhood educators from Ankara. Analysis of the results drew attention to the gap between theory and practice as well as the reasons behind this gap from the educators’ point of view. All the data material were discussed for each context, thus allowing for the highlighting of practical implications, which contributed not only to the research on parental involvement practices in different countries but also to the research on identifying factors affecting sufficient parental involvement. In addition to country-centred interpretations, the comparative aspect of this study contributes to existing research into world culture vs. local culture discussions.

Two media-reported vaccine events in China from 2013 to 2016: Impact on confidence and vaccine utilization

BackgroundChina media reported infant deaths following hepatitis B vaccination in late 2013, leading to temporary suspension of hepatitis B vaccine (HepB Event) until the deaths were shown to be coincidental and the vaccine was of standard, good quality. In 2016, a criminal ring in Shandong province that had been purchasing, improperly storing, and reselling Category 2 vaccines (private-sector) to 60 (of 200,000) clinics for 5 years, was exposed, publicized, and prosecuted, and the potential health and epidemiological impacts were investigated to determine whether revaccination was necessary (Shandong Vaccine Event). MethodsWe assessed parental confidence in vaccines through 9 telephone surveys in 6 and 11 provinces before, during, and after the two events. Provider confidence was assessed through in-person interviews following each event. Vaccine utilization was assessed using Immunization Information Management System data from township clinics. ResultsIn the early stages of each event, approximately 30% of parents indicated vaccine hesitancy and 18% said they would refuse routine immunization. Five and nine months after each event, hesitancy and refusal decreased, but not to pre-event levels. During the Shandong Vaccine Event, 49·1% of parents indicated refusal to use Category 2 vaccines; six months later, the rate was 32·8%. Use of HepB decreased by 21% during the first 2 weeks of the HepB Event and by 12·6% during the first 4 weeks of Shandong Vaccine Event, but returned to baseline in less than 3 months. Use of Category 2 vaccine decreased by 49·5% in the first 3 weeks of the Shandong Vaccine Event and by 28·7% 6 months later. After the Shandong Vaccine Event, 64% of clinicians held high confidence in routine immunization, lower than at baseline. ConclusionsThe two events caused mistrust, loss of confidence, and decreases in use of vaccines by parents and providers. In addition to ensuring immunization program integrity, effective communications and ongoing monitoring of vaccine use and confidence should be included to restore confidence and trust in vaccines.

Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

BackgroundKangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs).MethodsA cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC.ResultsOne hundred thirty-five preterm infants received KMC, 21.2% of all preterm infants discharged. 65.2% of those who received KMC were below 32 weeks GA, 60.7% had a birth weight below 1500 g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA < 28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants.ConclusionsAfter advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.

The effect of supportive program on maternal self-confidence in caring of infants with gastrointestinal anomalies: A randomized clinical trial

PurposeThis study aimed to determine the effect of supportive program on maternal self-confidence in caring of infants with gastrointestinal anomalies. MethodsIn this randomized clinical trial, 50 mothers of infants with gastrointestinal anomalies randomly allocated into control and intervention groups. The mothers of intervention group, in addition to the routine care, received supportive program. Maternal self-confidence was measured before and after the intervention, using Karitane Parenting Confidence Scale. ResultsThere was a significant difference in the pre-test and post-test scores of the intervention group (P < 0.001). Also, post-test scores of self-confidence was significant in both intervention and control groups after adjusting pre-test score (P < 0.001). ConclusionThe present study confirms the impact of a supportive program on increasing mothers' confidence. According to this, the four-dimensional support program can be offered as a systematic program in the neonatal units for mothers of infants with gastrointestinal anomalies.

Assessing the effectiveness of a pediatrician-led newborn parenting class on maternal newborn-care knowledge, confidence and anxiety: A quasi-randomized controlled trial

BackgroundThe postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well-positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians. AimsTo assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety. MethodsWe conducted a quasi-randomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls. Outcome measuresMaternal self-perceived parental confidence and anxiety were measured using standardized scales [Karitane Parenting Confidence Scale (KPCS) and State-Trait Anxiety Inventory for Adults (STAI-AD)]. Knowledge on newborn care was assessed using a novel scale. ResultsA total of 84 participants (intervention n = 36, control n = 48) were included in the study. Mothers who attended the class showed significantly higher levels of knowledge compared to the control group (Knowledge test, Two-tailed t-test, mean [SD], 8.08 [1.06] vs 6.78 [1.25]; P<0.001) as well as significantly higher parenting confidence levels (KPCS, Two-tailed t-test, mean [SD], 39.31 [3.88] vs 35.20 [3.99]; P<0.001). No change was observed in the overall level of anxiety (STAI-AD, Two-tailed t-test, mean [SD], 35.50 [8.73] vs 38.5 [9.53]; P=0.164). ConclusionsA short pediatrician-led parenting intervention may be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, there is a crucial need for cost- and time-effective intervention that can be widely implemented to promote parental knowledge and confidence with the ultimate goal of fostering healthy development in children.

Patterns of Parenting Confidence Among Infants With Medical Complexity: A Mixed-Methods Analysis.

Parenting confidence is an important factor in fostering optimal health and development of infants with medical complexity. However, our understanding of how parents of medically complex infants describe development of confidence is limited. The purpose of this mixed-methods study was to describe the nature and development of parenting confidence. A mixed-method design was used to examine how parents described their level of confidence. Ten parents of infants with medical complexity. Quantitative measures provided patterns of confidence and qualitative data focused on parent descriptions of confidence. Parents completed online surveys at 3 time points: (1) study enrollment, (2) infant discharge from hospital, and (3) 3 months after discharge. Parents were purposively sampled, using their confidence patterns, for qualitative phone interviews. Our analysis of quantitative findings revealed 3 confidence patterns: (1) increasing, (2) stable, and (3) varying. Parents described their confidence as either (1) a state of being confident or (2) how they behaved in the parenting role. Parents felt both certain and uncertain in their level of confidence and described confidence as being situationally dependent. Parenting confidence needs to be cultivated through encouragement and repeated exposure to parenting behaviors. Nurses are well-suited to help identify parents with low confidence to support parents so that they can develop confidence. Because there is variability in parent confidence during this critical early period of life, future research should consider a larger cohort of parents that compares confidence in diverse parent groups (ie, married vs living together couples, same-sex couples, and single parents). Research should also examine effective strategies to promote confidence and associated long-term health and developmental outcomes.