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Optimizing the Better Nights, Better Days for Children with Neurodevelopmental Disorders program for large scale
Alzena Ilie1, Matt Orr1, Shelly Weiss2
1Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
Insights
Parents found the Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) program helpful, though some needed more support. Optimizing BNBD-NDD can improve its large-scale implementation for pediatric insomnia.
Area of Science:
- Pediatric Sleep Medicine
- Digital Health Interventions
- Neurodevelopmental Disorders
Background:
- Pediatric insomnia is prevalent, particularly in children with neurodevelopmental disorders (NDDs).
- The Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is an eHealth intervention for parents of children (ages 4-12) with NDDs and insomnia.
Purpose of the Study:
- To identify barriers and facilitators impacting the reach, effectiveness, adoption, implementation, and maintenance of the BNBD-NDD program.
- To assess differences in these factors based on engagement levels and NDD type (ASD vs. ADHD).
Main Methods:
- Qualitative interviews were conducted with 20 parents randomized to the BNBD-NDD treatment arm.
- Rapid analysis using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was employed.
Main Results:
- Facilitators generally outweighed barriers for Reach, Effectiveness, Implementation, and Maintenance.
- Engaged parents highlighted program design and behavior change facilitators; unengaged parents desired more support.
- Parents of children with Autism Spectrum Disorder (ASD) reported more facilitators and barriers than parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD).
Conclusions:
- Participant feedback provides insights for optimizing BNBD-NDD for wider implementation.
- Modifications can enhance parent support, strategy implementation, and accessibility of this evidence-based treatment.
Objective:
Pediatric insomnia is one of the most commonly reported disorders, especially in children with neurodevelopmental disorders. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a transdiagnostic, self-guided, eHealth behavioral sleep intervention developed for parents of children with NDDs ages 4-12 years with insomnia. After usability testing, a randomized controlled trial (RCT) was conducted to evaluate the effectiveness of the BNBD-NDD program. By interviewing RCT participants after their outcome measures were collected, we sought to determine the barriers and facilitators that affect the reach, effectiveness, adoption, implementation, and maintenance of the BNBD-NDD intervention, as well as to assess whether barriers and facilitators differ across levels of engagement with the program and NDD groups.
Method:
Twenty parents who had been randomized to the treatment condition of the RCT participated in this study. These parents participated in virtual semi-structured qualitative interviews about their experiences with the BNBD-NDD program. Rapid analysis was used, in which one researcher facilitated the interview, and another simultaneously coded the interview using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Results:
Overall, more facilitators than barriers were identified for Reach, Effectiveness, Implementation, and Maintenance, whereas for Adoption more barriers emerged. Participants who were engaged reported more facilitators about the BNBD-NDD program design and behavior change, while unengaged participants mentioned needing more support to help facilitate their use of the program. Lastly, parents of children with ASD reported more facilitators and more barriers than did parents of children with ADHD.
Conclusion:
With this feedback from participants, we can optimize BNBD-NDD for large-scale implementation, by modifying the program to better support parents, helping them implement the strategies effectively at home, and increasing the accessibility of this evidence-based treatment.
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