Evaluating the effects of an online parenting program with peer support (PiP-Plus) for parents of adolescents (aged 12 to 17) on parent confidence and parent and adolescent wellbeing during the COVID-19 pandemic

The new program, PiP-Plus, will enhance PiP by adding the following features: 1) COVID-19 specific content, including addition of one new module on parenting during COVID-19, and minor additions to existing modules to ensure relevance during the COVID-19 pandemic; 2) addition of moderated online Peer Support Groups, delivered via Facebook, available for PiP-Plus parent participants to join; and 3) use of a Rapidly Responsive Process to deploy new content to PiP-Plus, to address emergent parent needs identified in the Peer Support Groups. Parents will receive the following as part of the PiP-Plus intervention: 1) Parents first complete an online self-assessment of their current self-efficacy in relation to parenting during the COVID-19 pandemic (COVID-19-PSES), and parenting practices associated with risk of adolescent depression and anxiety disorders (the Parenting to Reduce Adolescent Depression and Anxiety Scale [PRADAS]). The COVID-19-PSES, developed for use in this study, assesses parent confidence across the core domains of parenting during COVID-19 which have been added to the PiP-Plus program. The PRADAS assesses parenting practices in relation to the recommendations in the evidence-base parenting guidelines "How to Prevent Depression and Clinical Anxiety in your Teenager: Strategies for Parents" (Parenting Strategies Program, 2013; henceforth the Guidelines), which form the basis of the existing PiP content. 2) Based on their responses to the COVID-19-PSES and PRADAS, parents receive an individually-tailored feedback report. The feedback highlights areas of parenting strength and/or confidence, and provides practical strategies for identified areas for improvement. The feedback report is displayed to parents online (on their 'personal dashboard' as part of the PiP-Plus program). Parents are also emailed a PDF copy of their feedback, as well as a copy of the Guidelines. 3) Based on the identified areas for improvement (PRADAS) and/or low confidence levels (COVID-19-PSES), parents are recommended up to 10 interactive online modules. The modules provide practical strategies to support parents to make changes to their parenting in order to align more closely with the parenting recommendations in the Guidelines, and the new COVID-19-specific parenting recommendations. Although parents are recommended certain modules based on their initial self-assessment, they can further tailor their program by selecting additional modules or de-selecting modules recommended to them. Parents can select between 1 and 10 modules to add to their personalised program. By default, modules will ‘unlock’ (i.e. become available for parents to complete) at a rate of one module per week, until all selected modules have been unlocked. Parents are notified by email when a new module unlocks. If they prefer, parents can choose to override the default unlock date, and unlock modules at an earlier date. After all initially-selected modules have been unlocked, all remaining modules, including those not initially selected, will become available for parents to complete if they wish. Parents can revisit any modules they have already completed at any time. The interactive modules can be accessed online, from any device with internet access (including smartphones). The modules include illustrations, audio clips, videos, vignettes, interactive activities, goal-setting exercises, and an end-of-module quiz with immediate feedback to consolidate learning. The module topics include: parenting during the COVID-19 pandemic; parent-child relationship; parental involvement and autonomy granting; encouraging supportive relationships; establishing family rules; minimising conflict in the home; encouraging good health habits; problem solving; managing anxiety; and seeking professional help. Each module takes about 15-25 minutes to complete, depending on the topic and how parents engage with the module. Parents are invited to complete their first module immediately after they have completed their baseline survey and received their personalised feedback report. 4) Parents will also be invited to join an online, private and invitation-only Peer Support Group (PSG) via Facebook. This step will be optional, parents can continue to complete the rest of the PiP-Plus program without joining the PSG if they wish. Parents will initially be invited to view an information page (via an invitation-only link) on Facebook that explains what the PSGs will involve, after which parents can choose to either join or not join the PSG. If parents chose to join the PSG, they will be prompted to complete an induction process. The induction process will include an outline of the community rules (including safety, security, code of conduct, moderation and functionalities; and brief information about potential topics offered in the large and small groups). After going through the induction process, parents will join the large PSG Facebook group. The PSG also includes multiple small topic-based Facebook groups created according to parents' shared interests, requested topics and their discussion in the PSG Facebook groups. Parents can choose to join (or not) according to their current preferences, interests and personal goals related to the PiP-Plus program. The key purpose of the large group is to present informational support to parents. The information will include administrator (e.g. dedicated staff from the research team) posts and comments, parent-generated posts or comments, and periodic summaries of topics and discussions created by administrators of the group. It will also include information about the small topic-based groups that parents can join on a voluntary basis. The small groups component of the PSG aims to provide social and emotional support to parents. In these groups, parents can connect with one another, share discussions related to PiP-Plus content and parenting in general. The interactions in the small groups will be facilitated to some degree to maintain the level of engagement from parents. Parents can choose to leave the groups at any stage. When parents choose to leave, their feedback will be sought via Facebook with an option for parents to decide whether or not to respond. New PiP-Plus content will be added throughout the duration of the trial via a Rapidly Responsive Process (RRP). The RRP includes two components: 1) identification of emergent needs from asynchronous interactions between parents in the Peer Support Groups (as outlined above, see point 4); and 2) expert-consensus-based responses via iterative cycles as required to generate actionable strategies and resources to be deployed on PiP-Plus. Two RRP cycles are anticipated to be completed during the trial, with the first commencing approximately two-to-three months after commencement of the trial. Each RRP cycle will commence with the identification of new COVID-19-relevant challenges faced by parents, based on PSG interactions. Topics that are not already addressed by PiP-Plus will be identified as potential new topics to be incorporated into PiP-Plus. A rapid Delphi expert consensus survey will be conducted for each new topic, using expert members of the research team as Delphi expert panel members. The rapid Delphi process will identify new, actionable parenting strategies which will be incorporated into PiP-Plus. New PiP-Plus content will be distributed to parents via the online Peer Support Groups, on the PiP-Plus website and by email and/or SMS to alert parents to the new content. Adherence and completion of the PiP-Plus intervention will be calculated as follows: Adherence = 100% x [(number of participants whose observed usage equals their intended usage) / (number of participants who received the intervention)]. Intervention completion = percentage of program completed, calculated as: 100% x [(observed usage of the program] / (intended usage of the program)]. Where intended usage = total number of modules selected by parent; observed usage = total number of modules completed by parent. Parent engagement in PSGs will be assessed in the form of log data and text-based data. For example, frequency of logging in, frequency and number of posts, post interactions, and questions and messages sent in small group chats. The data will be analysed to provide timely feedback to parents by the facilitator in the group, to understand parents’ engagement, and also to inform the Rapidly Responsive Process (as outlined above). In total, participation in the study will take approximately 3 months, including program completion and completion of evaluation surveys. The baseline and follow-up assessments will take parents approximately 30 to 45-minutes per assessment. Duration will be less than 3 months if parents select less than 10 modules and/or do not complete the 90-day follow-up survey. Parents will be able to participate in the PSGs for the duration of the trial recruitment period, if they wish (up to 6-months for parents who register early in the trial). Duration of participation in the PSGs will be at the discretion of individual parents, who can join and leave at any stage. Although the Partners in Parenting program has been evaluated previously, the program is not currently available to the public. Only participants in this study can access the online program and Peer Support Groups.