@Article{info:doi/10.2196/53864,
author="Pokorna, Nikola
and Palmer, Melanie
and Pearson, Oliver
and Beckley-Hoelscher, Nicholas
and Shearer, James
and Kostyrka-Allchorne, Katarzyna
and Robertson, Olly
and Koch, Marta
and Slovak, Petr
and Day, Crispin
and Byford, Sarah
and Waite, Polly
and Creswell, Cathy
and Sonuga-Barke, Edmund J S
and Goldsmith, Kimberley",
title="Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="8",
volume="7",
pages="e53864",
keywords="parenting; intervention; smartphone app; randomized controlled trial; COVID-19 pandemic; moderators; conduct problems; emotional problems",
abstract="Background: A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95{\%} CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=--0.41, 95{\%} CI --0.82 to 0.0004; P=.05) or significant (T3: B=--0.76, 95{\%} CI --1.22 to --0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 ",
issn="2561-6722",
doi="10.2196/53864",
url="https://pediatrics.jmir.org/2024/1/e53864",
url="https://doi.org/10.2196/53864",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378100"
}