Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study (Preprint)

Abstract

BACKGROUND Despite innovations to integrate behavioral health practitioners in primary care settings and online adaptations of effective parenting programs, access to care gaps persist for youth and families in need. Behavioral intervention technologies (BITs) represent a modality for targeted prevention with promise for transforming primary care behavioral health by empowering parents to take charge of their child’s behavioral health care. In order to realize the potential of BITs, research is needed to understand parental needs in a BIT, as well as the status quo of parent self-help and parent-provider collaboration to identify and address behavioral health challenges. OBJECTIVE Engage parents and health care providers to better understand unmet needs and current practices to inform continued development of a BIT for parents to address common behavioral health challenges. METHODS We conducted a convergence validation mixed methods study in which parent quantitative surveys (N=385) on preferences and current practices related to behavioral health themes to be addressed in a BIT were integrated with focus group interview data on internal and external contextual factors contributing to parental unmet needs and current practices with 48 health care stakeholders in 9 child-serving clinics within a large, predominantly rural health system. We integrated these data using joint displays and synthesized areas of confirmation, expansion, and discordance between parents and health care stakeholders. RESULTS Parents frequently endorsed about half of the available themes in their “top 3”, indicating that BITs may not be the preferred modality for all targeted prevention. Additionally, parents also frequently endorsed themes that were not related to child psychopathology (e.g., parenting stress and family communication), indicating parents are interested in guidance on parenting beyond challenging child behavior. Health care stakeholders indicated that an online platform aligns with how parents already seek behavioral health guidance and suggested that a BIT may connect families with evidence-based guidance sooner. We identified areas of convergence related to overt behavior problems (e.g., disruptive behavior, nutrition and eating), and areas of divergence related to internalizing problems and cross-cutting issues that may be more difficult for health care providers to detect. Data integration helped to expand our understanding with regard to factors that may lead to more effective parent-provider partnerships, including the impact of limited time pressure office visits and a deeper understanding of how unmitigated parenting stress interrelates with qualities of parent help-seeking behavior. CONCLUSIONS These findings provide a rich understanding of the complexity involved in meeting parents’ needs for behavioral health guidance in a primary care setting using BITs. Further triangulation of these findings in user testing studies for BIT prototypes is needed to refine our understanding of how to successfully develop and implement an effective BIT to guide parents in taking charge of their child’s behavioral health care. CLINICALTRIAL N/A