Brief, digital, self-directed, and culturally adapted: Developing a parenting intervention for primary care

Preventive positive parenting interventions support healthy outcomes for children and have the potential to buffer the effects of poverty via changes in parent attitudes and behaviors. Delivering digital parenting interventions that have been adapted for the end-user population within pediatric primary care settings has the potential to support fit, acceptability, and reach of such interventions. This study used an experimental mixed-methods design to develop and test a digital, single-session, self-directed preventive parenting intervention in pediatric primary care during well-child visits. The intervention was developed through integration of common elements of evidence-based parenting practices and surface structure adaptations following end-user (i.e., caregiver) prototyping (Phase 1). The adapted intervention, Parenting A to Z, was tested in a beta-testing randomized controlled trial (N = 60) during well-child visits for children ages 2 to 8 years of age in primary care clinics serving primarily low-income Latinx families (Phase 2). Phase 1 results included adaptations to the procedures, content, and aesthetics using end-user feedback. Phase 2 results indicated the feasibility and acceptability of the adapted intervention and its digital delivery format. The effect size of the intervention on parental stress was commensurate with other, higher dose evidence-based preventive interventions. The results demonstrate how a brief, digital, self-directed parenting intervention aligned with the goals of the end-user population increased the reach and access to underserved children and families.