title: An interactive health communication application for supporting parents managing childhood long-term conditions: outcomes of a randomized controlled feasibility trial.
abstract: BACKGROUND
  Families living with chronic or long-term conditions such as chronic kidney disease (CKD), stages 3-5, face multiple challenges and respond to these challenges in various ways. Some families adapt well while others struggle, and family response to a condition is closely related to outcome. With families and professionals, we developed a novel condition-specific interactive health communication app to improve parents' management ability-the online parent information and support (OPIS) program. OPIS consists of a comprehensive mix of clinical caregiving and psychosocial information and support.
  
  
  OBJECTIVE
  The purpose of this study was to (1) assess feasibility of a future full-scale randomized controlled trial (RCT) of OPIS in terms of recruitment and retention, data collection procedures, and psychometric performance of the study measures in the target population, and (2) investigate trends in change in outcome measures in a small-scale RCT in parents of children with CKD stages 3-5.
  
  
  METHODS
  Parents were recruited from a pediatric nephrology clinic and randomly assigned to one of two treatment groups: usual support for home-based clinical caregiving (control) or usual support plus password-protected access to OPIS for 20 weeks (intervention). Both groups completed study measures at study entry and exit. We assessed feasibility descriptively in terms of recruitment and retention rates overall; assessed recruitment, retention, and uptake of the intervention between groups; and compared family condition management, empowerment to deliver care, and fathers' involvement between groups.
  
  
  RESULTS
  We recruited 55 parents of 39 children (42% of eligible families). Of those, about three-quarters of intervention group parents (19/26, 73%) and control group parents (22/29, 76%) were retained through completion of 20-week data collection. The overall retention rate was 41/55 (75%). The 41 parents completing the trial were asked to respond to the same 10 questionnaire scales at both baseline and 20 weeks later; 10 scores were missing at baseline and nine were missing at 20 weeks. Site user statistics provided evidence that all intervention group parents accessed OPIS. Analysis found that intervention group parents showed a greater improvement in perceived competence to manage their child's condition compared to control group parents: adjusted mean Family Management Measure (FaMM) Condition Management Ability Scale intervention group 44.5 versus control group 41.9, difference 2.6, 95% CI -1.6 to 6.7. Differences between the groups in the FaMM Family Life Difficulty Scale (39.9 vs 36.3, difference 3.7, 95% CI -4.9 to 12.2) appeared to agree with a qualitative observation that OPIS helped parents achieve understanding and maintain awareness of the impact of their child's condition.
  
  
  CONCLUSIONS
  A full-scale RCT of the effectiveness of OPIS is feasible. OPIS has the potential to beneficially affect self-reported outcomes, including parents' perceived competence to manage home-based clinical care for children with CKD stage 3-5. Our design and methodology can be transferred to the management of other childhood conditions.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 84283190; http://www.controlled-trials.com/ISRCTN84283190 (Archived by WebCite at http://www.webcitation.org/6TuPdrXTF).
authors.affiliation: School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom. veronica.swallow@manchester.ac.uk.
authors.forename: Veronica M
authors.identifier: http://orcid.org/0000-0001-8504-4704
authors.initials: VM
authors.lastname: Swallow
authors.forename: Kathleen
authors.identifier: http://orcid.org/0000-0003-2623-2515
authors.initials: K
authors.lastname: Knafl
authors.forename: Sheila
authors.identifier: http://orcid.org/0000-0001-8713-8069
authors.initials: S
authors.lastname: Santacroce
authors.forename: Malcolm
authors.identifier: http://orcid.org/0000-0002-6125-5731
authors.initials: M
authors.lastname: Campbell
authors.forename: Andrew G
authors.identifier: http://orcid.org/0000-0001-9620-6625
authors.initials: AG
authors.lastname: Hall
authors.forename: Trish
authors.identifier: http://orcid.org/0000-0003-1214-7205
authors.initials: T
authors.lastname: Smith
authors.forename: Ian
authors.identifier: http://orcid.org/0000-0003-0683-9897
authors.initials: I
authors.lastname: Carolan
keywords: child; chronic condition; chronic kidney disease, CKD; family; feasibility; interactive health communication application; long-term condition; online; parent; randomized controlled trial