Parents' Engagement with a Novel mHealth Intervention for Strengthening Families: A Feasibility Study
Open Access
- Author:
- Sloan, Carlie
- Graduate Program:
- Human Development and Family Studies
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 04, 2024
- Committee Members:
- Douglas Teti, Program Head/Chair
Steffany Fredman, Major Field Member
Gregory Fosco, Chair & Dissertation Advisor
Janet Welsh, Major Field Member
Stephanie Lanza, Outside Unit & Field Member - Keywords:
- mHealth
family-based intervention
parenting
adolescents - Abstract:
- Family-based interventions to enhance relationships and parenting have shown promising effects in promoting healthy youth development. However, family-based interventions delivered using in-person modalities face considerable challenges in reaching families in need, participant retention, and maintaining program fidelity. These challenges bear consequences for program reach, effectiveness, and participant satisfaction. Many family intervention developers have recently turned to digital platforms as an adjunct or alternative approach for in-person family intervention programming. mHealth intervention approaches – those that use mobile technology to implement or enhance intervention programs—can eliminate or reduce many of the key challenges to in-person implementation. However, much is still to be learned about the feasibility of emerging mHealth approaches for family-based intervention. In this dissertation, I assessed the feasibility of a novel family-strengthening mobile application-based intervention, the Family Relationships Toolkit. The intervention consists of three components, which target skills and family processes that have emerged as critical intervention targets for parents of emerging adolescents: morning routines, parental monitoring, and positive family relationships. This dissertation had 4 aims. Aim 1 was to report general and daily user impressions of a novel mHealth application in terms of user engagement, acceptability, usability, and satisfaction. Aim 2 was to examine whether general user acceptability and usability ratings of each component correspond to passively recorded measures of engagement with each component (e.g., number of uses). Aim 3 was to assess whether initial family demographic characteristics, whole-family relationships, and parent well-being were related to differential usage of the app or impressions of it. Aim 4 was to assess whether daily family climate and parent mood were related to differential daily engagement with and impressions of the app (Aim 4a), as well as to report daily barriers to usage of each intervention component (Aim 4b). Along with study team members, I recruited 36 parents (MAge = 41.8, SD = 4.9; 92.7% women) of adolescents between 11-16 years old (MAge = 12.9, SD = 1.6; 44.4% girls). Parents were mostly white and had high levels of education and income. Parents completed a series of baseline assessments and then used the Family Relationships Toolkit app for four weeks, before completing a set of posttest assessments. While using the app, parents completed daily assessments of family climate, parenting, and daily mood, as well as reporting their daily app usage, for a period of 14 consecutive days. Parents rated the app’s components as generally acceptable, user-friendly, and reported that they were satisfied with the app, but responses varied by app component. Additionally, parents’ engagement with and perceptions of the app varied by initial family and individual functioning indices, with patterns suggesting that those with poorer initial functioning both utilized the app more and found it more relevant and likeable. I also evaluated whether daily family climate and parent mood were related to daily usage and perceptions of each component. Specific patterns varied across the three components and suggested that engaging parents on more difficult days remains a challenge. The most common barriers to daily usage of each component of the app were that parents felt they did not need the component on a given day, and that the component was not relevant on a given day, with some variation across the three components. The findings from this dissertation indicate that the Family Relationships Toolkit is as an acceptable and user-friendly approach for family-based prevention programming, while also highlighting room for improvement in future versions of this tool. These findings largely converge with prior work suggesting that mHealth alternatives and adjuncts to in-person family-based intervention programs have been well-received by parents. This study adds nuance to our current understanding about why and when parents engage with digital parenting intervention content, in addition to shedding light on how measurement sequencing and timing affect our understanding of the feasibility of mHealth tools. Future work should assess the effectiveness of the Family Relationships Toolkit for cultivating structured morning routines, enhancing parental monitoring, and promoting positive family relationships. Additionally, more research is needed to assess long-term engagement with and perceptions of this intervention program and how these impact program effectiveness.