Improving Psychological Wellbeing by Stress Reduction Among Parents Having Children With Neurodevelopmental Disorders

Mental Health Issue Clinical Trial

Official title:

Improving Psychological Wellbeing Through Stress Reduction Among Parents Having Children With Neurodevelopmental Disorders: A Multi-pronged Intervention in Bangladesh

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06166550
• Other study ID #: BSMMU/2022/10733
• Status: Not yet recruiting
• Phase: N/A
• Start date: April 30, 2024
• Est. completion date: December 31, 2024

Study information

• Verified date: March 2024
• Source: Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
• Contact: Md Atiqul Haque, PhD
• Phone: +8801711428141
• Email: atiqulm26[@]bsmmu.edu.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This project addresses the mental health challenges faced by parents caring for children with Neurodevelopmental Disorders (NDDs) in Bangladesh. These parents often experience high levels of stress, anxiety, and depression, impacting family dynamics and the child's development. The project aims to design, implement, and assess an intervention to reduce parenting stress and enhance parental well-being. This intervention focuses on emotional intelligence and will be delivered through in-person training and a mobile app. The study will use a cluster randomized controlled trial methodology, targeting parents of children diagnosed with NDDs.

The study will be conducted in Child Development Centers in public medical college hospitals across Bangladesh. It will assess changes in parental stress, mental well-being, and emotional intelligence. Data collection will occur from April 2024 to October 2024.

The project aims to recruit 480 parents from eight Child Development Centers, ensuring ethical considerations, data integrity, and participant privacy. The findings will be shared through national dissemination seminars, policy briefs, reports, and journal publications.

Description:

Background and Rationale:

Neurodevelopmental disorders (NDDs) are a global public health concern, often causing parents to grapple with increased stress, anxiety, and reduced well-being. This compromised mental health among caregivers persists throughout a child's development, straining family dynamics and making effective parenting more challenging. Research underscores the importance of addressing caregiver's well-being, as it indirectly impacts the child's health and development.

In Bangladesh, where social stigma and limited support exacerbate the challenges, there is a lack of research on stress management to improve parental well-being. Empirical studies are essential to enhance the psychological health of caregivers of children with NDDs in Bangladesh and promote their long-term caregiving abilities.

Objectives:

The project aims to develop an evidence-based intervention to reduce parenting stress and enhance the mental health of parents with children with neurodevelopmental disorders. This intervention will be implemented in healthcare and community settings and evaluated through process and outcome measures, including changes in parenting stress.

Trial design:

The trial will adopt a parallel design and employ a cluster randomized controlled trial (CRCT) methodology.

Methods:

Study settings:

The study is centered around the Institute of Paediatric Neurology and Autism (IPNA) and Child Development Centers or Shishu Bikash Kendra (SBKs) in Bangladesh's eight administrative divisions. IPNA at BSMMU provides care, education, and training, impacting national mental health policy. Additionally, fifteen government medical college hospitals operate SBKs as outdoor services. These centers offer specialized care for children with NDDs through a multidisciplinary team.

Eligibility criteria:

Parents aged 18 to 50 years with children having neurodevelopmental disorders (e.g., Autism, Cerebral Palsy, Intellectual disorders, ADHD, and Down Syndrome) diagnosed at the SBKs are eligible. Exclusions include parents of children with sensory impairments, oxygen-dependent chronic lung disorders, or requiring initial pharmacological care. An implementation guide will be created, facilitators trained in emotional intelligence, and community mobilizers trained for SBK-based campaigns to ensure smooth intervention implementation.

Intervention:

Investigators will develop an intervention module and a mobile app/software for parents of children with NDDs. The intervention will focus on enhancing emotional intelligence and stress reduction, with two interactive sessions covering emotional awareness, regulation, empathy, and interpersonal skills. Two groups will be involved: Group A (Training, diary & app users), and Group B (Control). Group A will receive in-person training and access to the app, and Group B will be in wait-list control group. The wait-list control group will receive the intervention after the intervention period is over. The aim is to improve emotional intelligence to handle life's stress. Morning and evening sessions will be available for working parents, and those needing pharmacological management will be referred to relevant department. The mobile app/software and the diary will support parents in improving their emotional intelligence skills, benefiting family well-being and the child with special needs.

Outcomes:

This study's aim to assess the intervention's feasibility and acceptance in Bangladesh's Child Development Centers and among the targeted parents from April 2024 to October 2024. From April to October 2024, we'll evaluate parenting stress and psychological wellbeing. Secondary outcomes include emotional intelligence, parenting self-efficacy, perceived social support, parenting satisfaction, and marital satisfaction during the same period.

Sample Size and recruitment process:

Investigators used a sample size calculator to determine the sample size. The average cluster size will be 60 and cluster number will be 8. Adjusted for clusters, the maximum sample size is 480 parents. Eight SBKs, one per administrative division, will be randomly assigned to intervention and control groups in a 1:1 ratio. They will provide lists of recently diagnosed children. Investigators will invite both parents and continue recruiting until they reach the required sample size.

Methods:

Data Collection methods and data management:

Data collection steps involve contacting prospective parents to participate. Baseline data collection occurs at selected SBKs with self-administered questionnaires on parenting style, stress, and mental health. Groups A will receive the intervention, while Group B serves as the control. Follow-up evaluations at 8 weeks will measure stress and well-being using TEIQue-SF and WHO-5 wellbeing scale. After 8 weeks, Group B will receive the intervention.

Statistical methods:

Principles of analysis: The population for the primary outcome analysis will consist of all recruited parents who received two sessions of intervention and for whom both baseline and post intervention follow-up data will be available. If a participant moves to the catchment area of another SBK after baseline measure is collected (i.e., crossover from intervention to control, or vice versa), the instances will be documented, and removed from the trial. As the final population in the primary analysis will exclude the participants who will be lost to follow-up (i.e., for whom follow-up data is not available), a sensitivity analysis will be performed to account for all randomized participants.

Descriptive analysis: Socio-demographic data of the participants e.g., gender, occupation, education status, family history of neurodevelopmental disorders, etc. will be obtained. All categorical variables will be summarized in frequency and percentages, and continuous variables in mean and standard deviation. To estimate the association of these characteristics with parenting stress and psychological wellbeing, t-tests and chi-square tests will be done.

Inferential analysis: To estimate the efficacy of the intervention, before-after data will be analyzed, and paired t-test and McNemar's chi-square tests will be done in this regard. A comparison will also be made between the intervention and the control data, both at pre- and post- intervention level. Difference-in-difference analysis will be done to estimate the intervention effects among participants by age groups, sex, socio-economic status, etc.

Association analysis: Binary regression analysis will be done to estimate the association between socio-demographic variables with changes in the outcome variables, change in parenting stress and psychological wellbeing.

Data monitoring:

The Data Monitoring Committee (DMC) plays a vital role in ensuring the study's integrity and security. Comprising impartial specialists in mental health, neurodevelopmental disorders, and research ethics, they independently monitor the study. Their main responsibility is to safeguard participants' rights and well-being by examining data, tracking study progress, and assessing risks or adverse outcomes related to the intervention. The DMC also ensures research techniques and analyses are appropriate and objective, maintaining scientific rigor. Ultimately, they provide essential oversight, enhancing credibility, and upholding ethical standards while advancing knowledge in neurodevelopmental disorders and parental well-being.

Ethics and dissemination:

An informed consent will be sought from each participant prior to the collection of data, detailing the study's objectives, procedures, advantages, risks, and the identity of the lead investigator. This research protocol has received approval from the Institutional Review Board at BSMMU. Participants will be given unique ID numbers, and all information will be encrypted and kept confidential to preserve privacy, anonymity, and secrecy. The information gathered will only be utilized for study.

Confidentiality:

Local-level problems including non-cooperation and non-response are anticipated hurdles and barriers. These issues will be handled by rapport-building, sensitivity, and choosing the right responders. Respondents will be guaranteed of the privacy of their data while confidentiality will be upheld. Following governmental directives, general contextual elements will be managed. The management of capacity issues and team dropout will involve ongoing observation, communication, and additional training.

Dissemination policy:

In this project, Investigators are committed to sharing their research findings widely for maximum impact. Our dissemination strategy includes publishing in open-access academic journals, creating plain language summaries for accessibility, participating in conferences to engage with experts and practitioners, conducting community workshops, developing policy briefs for government agencies, collaborating with NGOs, and responsibly sharing de-identified data with fellow researchers. Our goal is to reach a diverse audience, including parents, healthcare professionals, policymakers, and researchers, to enhance the well-being of parents and children with neurodevelopmental disorders in Bangladesh and beyond.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 480
• Est. completion date: December 31, 2024
• Est. primary completion date: October 31, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 50 Years

Eligibility

Inclusion Criteria:

• Parents of any age having children with neurodevelopmental disorders i.e. Autism Spectrum Disorders, Cerebral Palsy, Intellectual disorders, attention deficit hyperactivity disorders, and Down Syndrome.

• Parents of children whose diagnosis were made within one year (to avoid the time-effect on stress and mental health).

• Parents' age limit will be 18-50 years

Exclusion Criteria:

• Parents having children with serious sensory impairments (e.g., deafness and blindness) and oxygen dependence due to chronic lung diseases.

• Parents who need pharmacological management at initial assessment.

Related Conditions & MeSH terms

• Mental Health Issue
• Neurodevelopmental Disorders

Intervention

Behavioral:
• Parent's Emotional Intelligence Network
A two-day in-person training session will be arranged for the participating parents at least one week apart. The psychologists will conduct the training session on emotional intelligence. A training of the trainer manual will be developed to train the psychologists. The training session will include a power point presentation and certain group and individual activities to practice emotional intelligence. The participants will also be given a diary and a mobile app in order to practice emotional intelligence at home.

Device:
• Diary
A diary will be developed that contain different practice materials regarding emotional intelligence. It will be a personal diary given to the participants to take to home.
• Mobile App
It will be a mobile app, developed based on the concept of emotional intelligence. It will contain different videos, audios, and texts related to emotional intelligence. It will also provide a communication platform where users can communicate through texts and upload documents.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Wellbeing	WHO (five) Well-Being Index will be used to measure mental wellbeing both before and after the intervention.; It is a 5-item tool on the Likert scale from 'all of the time' to 'at no time' range. The answer will be scored from 0 to 5 in a reverse way. The WHO-5 consists of five statements, which respondents rate thinking about the past two weeks.; The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable wellbeing and 100 representing the best imaginable wellbeing. A raw score below 13 indicates poor wellbeing and an indication of testing for depression.	8 weeks after completion of two-day intervention
Primary	Mental Health	Mental health status will be assessed by Depression, Anxiety, and Stress Scale (DASS 9).; Number 0, 1, 2 or 3 that indicates how much the statement applied to you over the past week. There are no right or wrong answers.	8 weeks after completion of two-day intervention
Primary	Parenting stress	Parenting stress will be assessed by Parental Stress Scale, a 18-item Likert scale.; Respondents indicate how much they agree or disagree to each of the 18 statements. Responses are scored as follows: Strongly disagree = 1 Disagree = 2 Undecided = 3 Agree = 4 Strongly agree = 5; To compute the parental stress score, items 1, 2, 5, 6, 7, 8, 17, and 18 should be reverse scored as follows: (1=5) (2=4) (3=3) (4=2) (5=1). The item scores are then summed.; Parental stress scores range from 18 to 90, with lower scores indicating lower levels of parental stress.	8 weeks after completion of two-day intervention
Secondary	Emotional intelligence	Parent's emotional intelligence will be assessed by Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF).; The TEIQue-SF is a 30-item questionnaire designed to measure global trait EI. TEIQue-SF consists of 26 items distributed across the four factors: Well-being (6 items), Self-control (6 items), Emotionality (8 items), and Sociability (6 items). The remaining four items contribute directly to the global trait EI score without being keyed to any one factor.; The response scale is a 7-point Likert scale, ranging from 1 to 7. Greater scores represent better emotional intelligence.	8 weeks after completion of two-day intervention
Secondary	Parenting Self-Efficacy	Parenting Self-Efficacy will be measured by parenting Self-Efficacy scale.; Parenting Self-Efficacy Scale (PSES) is to measure parents' confidence in their ability to talk to their children about sexuality issues.; The scale has two factors: Parental satisfaction - "the quality of affect associated with parenting" Efficacy - "the degree to which a parent feels competent and confident in handling child problems" Each item is worded positively and rated on a 7-point scale anchored with the terms Not Sure at all (1) and Completely Sure (7). The midpoint of the scale is defined as Moderately Sure. All 17 items are positively worded. Total scores are found by summing responses to individual items.	8 weeks after completion of two-day intervention