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      Barriers and facilitators in the delivery of a proportionate universal parenting program model (E-SEE Steps) in community family services

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          Abstract

          Background

          A proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs).

          Methods

          An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions.

          Results

          The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents—particularly those with low mood—taking up the targeted programs. Service providers struggled to align the PU model with their commissioned service contracts and with their staff capacity to engage appropriate parents, including tackling common barriers to attendance.

          Conclusions

          Despite general enthusiasm and support for delivering high-quality parenting programs in community services in the England, several barriers exist to successfully delivering IY in a proportionate universal model within current services/systems.

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          Most cited references39

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Using the framework method for the analysis of qualitative data in multi-disciplinary health research

              Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                13 June 2022
                2022
                : 17
                : 6
                : e0265946
                Affiliations
                [1 ] College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom
                [2 ] Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
                [3 ] School of Nursing, University of Central Lancashire, Preston, Lancashire, United Kingdom
                [4 ] Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co Kildare, Republic of Ireland
                Flinders University, AUSTRALIA
                Author notes

                Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: TB is a Trustee for Children’s Early Intervention Trust (CEIT). Early Intervention Wales Training (EIWT) is owned by CEIT and offers training courses, including Incredible Years® (IY). Trustees do not benefit financially from trainings or CEIT/EIWT activities. ESEE study trainings were arranged via the IY developer in the U.S. KWh is a Trustee at the Institute of Health Visiting, a charity that supports the professional development of health visitors/public health nurses through the provision of training, publications and conferences. Trustees do not benefit financially from trainings, publications or conferences. The remaining authors claim no competing interests. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0001-6438-3731
                https://orcid.org/0000-0001-8962-0991
                https://orcid.org/0000-0003-0988-3201
                https://orcid.org/0000-0001-6972-0100
                Article
                PONE-D-21-24756
                10.1371/journal.pone.0265946
                9191704
                35696375
                ae3e8449-0ca7-4843-9601-bf7a29ce6ed0
                © 2022 Berry et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 July 2021
                : 10 March 2022
                Page count
                Figures: 1, Tables: 3, Pages: 22
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001921, public health research programme;
                Award ID: 13/93/10
                Award Recipient :
                Role of the Funding Source The authors confirm the independence of researchers from funders and that all authors had full access to the study data (including statistical reports and tables) and take responsibility for the integrity of the data and the accuracy of the analysis. All authors were supported by the grant, National Institute for Health Research (NIHR) Public Health Research (PHR) (ref 13/93/10) (see https://fundingawards.nihr.ac.uk/award/13/93/10). TB and SB are also supported by the NIHR Yorkshire and Humber Applied Research Collaboration (ARC-YH, ref NIHR200166; see https://www.arc-yh.nihr.ac.uk); VB by the NIHR Applied Research Collaboration South West Peninsula ARC (PenARC, ref NIHR200167; see https://arc-swp.nihr.ac.uk).The study sponsor (University of York) and funders (with additional support from Public Health England for site’s excess treatment costs, see https://www.gov.uk/government/organisations/public-health-england/about), were not involved in the study design; data collection, analysis, and interpretation; in the writing of the report; or in the decision to submit the article for publication. The views in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.”
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                People and Places
                Population Groupings
                Age Groups
                Children
                Toddlers
                People and Places
                Population Groupings
                Families
                Children
                Toddlers
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Medicine and Health Sciences
                Pediatrics
                Child Development
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Custom metadata
                The E-SEE data sharing plan follows a controlled access model as described in Good Practice Principles for Sharing Individual Participant Data from Publicly Funded Clinical Trials. Qualitative data is contained within the paper and the accompanying Supporting Information. Anonymized quantitative data is available upon request via the ‘Research Data York’ data repository: https://doi.org/10.15124/41fd35ba-bd9c-4c2f-bb50-c8c92b8661ee. To request access to this dataset please email Research Data York repository at lib-open-research@ 123456york.ac.uk . Sharing of this data set will be subject to the completion of a data access request form and, if approved, subject to a data sharing agreement, due to: a) Data containing potentially sensitive participant information such as mental health and domestic violence. b) Ethical concerns around using the data in a way that is not consistent with the PIS, e.g. for research that does not have ethical approval. Data requests will be reviewed by a 'data access committee' which will include members of the trial management team and independent members from ARC-YH Best Start Steering Committee. A data sharing agreement will be required to ensure data is used in accordance with the trial funder, and ethical guidelines.

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