Effectiveness of a technology-assisted, family volunteers delivered, brief, multicomponent parents' skills training intervention for children with developmental disorders in rural Pakistan: a cluster randomized controlled trial

Syed Usman Hamdani, Zill-E- Huma, Nadia Suleman, Parveen Akhtar, Huma Nazir, Aqsa Masood, Mahjabeen Tariq, Ahmareen Koukab, Erica Salomone, Laura Pacione, Felicity Brown, Stephanie Shire, Siham Sikander, Chiara Servili, Duolao Wang, Fareed Aslam Minhas, Atif Rahman, Syed Usman Hamdani, Zill-E- Huma, Nadia Suleman, Parveen Akhtar, Huma Nazir, Aqsa Masood, Mahjabeen Tariq, Ahmareen Koukab, Erica Salomone, Laura Pacione, Felicity Brown, Stephanie Shire, Siham Sikander, Chiara Servili, Duolao Wang, Fareed Aslam Minhas, Atif Rahman

Abstract

Background: Globally, there is a large documented gap between needs of families and children with developmental disorders and available services. We adapted the World Health Organization's mental health Gap-Intervention Guidelines (mhGAP-IG) developmental disorders module into a tablet-based android application to train caregivers of children with developmental disorders. We aimed to evaluate the effectiveness of this technology-assisted, family volunteers delivered, parents' skills training intervention to improve functioning in children with developmental disorders in a rural community of Rawalpindi, Pakistan.

Methods: In a single-blinded, cluster randomized controlled trial, 30 clusters were randomised (1:1 ratio) to intervention (n = 15) or enhanced treatment as usual (ETAU) arm (n = 15). After screening, 540 children (18 participants per cluster) aged 2-12 years, with developmental disorders and their primary caregivers were recruited into the trial. Primary outcome was child's functioning, measured by Childhood Disability Assessment Schedule for Developmental Disorders (DD-CDAS) at 6-months post-intervention. Secondary outcomes were parents' health related quality of life, caregiver-child joint engagement, socio-emotional well-being of children, family empowerment and stigmatizing experiences. Intention-to-treat analyses were done using mixed-models adjusted for covariates and clusters.

Results: At 6-months post-intervention, no statistically significant mean difference was observed on DD-CDAS between intervention and ETAU (mean [SD], 47.65 [26.94] vs. 48.72 [28.37], Adjusted Mean Difference (AMD), - 2.63; 95% CI - 6.50 to 1.24). However, parents in the intervention arm, compared to ETAU reported improved health related quality of life (mean [SD] 65.56 [23.25] vs. 62.17 [22.63], AMD 5.28; 95% CI 0.44 to 10.11). The results were non-significant for other secondary outcomes.

Conclusions: In the relatively short intervention period of 6 months, no improvement in child functioning was observed; but, there were significant improvements in caregivers' health related quality of life. Further trials with a longer follow-up are recommended to evaluate the impact of intervention. Trial registration Clinicaltrials.gov, NCT02792894. Registered April 4, 2016, https://ichgcp.net/clinical-trials-registry/NCT02792894.

Keywords: Caregivers’ skills training; Developmental disorders; Family Volunteers; Low income settings; Low resource settings; Technology assisted task-shifting; WHO mhGAP-IG.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Master trainer (UH); trainers (had at-least 16 years of education and 1 year of experience in working with children and families with developmental disorders; Family Volunteers (FVs) (parents or caregivers of children with developmental disorders, had at least eight grades of formal education, are voluntarily willing to be trained and supervised by the trainers for at-least 6-months duration of the programme and cascade the training to 4–5 families in their villages) (Adapted from Murray et al. [14])
Fig. 2
Fig. 2
Flow of participants through trial

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