A Behavior Change Wheel-Based Nursing Intervention to Improve Maternal Management and Child Outcomes Among Preschool...

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders among children and is associated with significant behavioral, academic, and social challenges. Caregiver-focused behavioral interventions have gained increasing attention as effective non-pharmacological approaches for improving child outcomes and enhancing parental management skills. Thus, this study aimed to evaluate the potential effectiveness of behavior change wheel (BCW)-based nursing intervention in improving maternal behavioral management practices, as well as child outcomes involving ADHD symptoms among preschool children aged 3-6 years with attention-deficit/hyperactivity disorder. Methods: A one-group pretest-posttest quasi-experimental design was conducted among 55 mothers and their children diagnosed with ADHD at Thawat Center and King Abdullah Center for Disability Services in Jeddah, Saudi Arabia. The study did not include a control group. Participants were recruited using a convenience sampling technique. Data were collected using a sociodemographic questionnaire, ADHD Rating Scale IV-Preschool Version, the BCW Intervention Compliance Questionnaire, and the Parental Knowledge and Attitude Questionnaire. The intervention was implemented over eight weeks and included educational sessions, behavioral skills training, motivational enhancement, role-play activities, and follow-up reinforcement. Results: The preliminary findings from the one-group pre/posttest quasi-experimental study revealed statistically significant improvements in children's inattentive and hyperactivity symptoms following the intervention (p < 0.001). Mothers also demonstrated significant improvements in perceived knowledge, attitudes, and compliance with BCW components after program implementation (p < 0.001). The proportion of mothers with satisfactory perceived knowledge increased from 21.8% pre-intervention to 94.5% post-intervention, while positive attitudes increased from 23.6% to 98.2%. In addition, compliance with BCW components improved from 30.9% before the intervention to 94.5% after implementation. Conclusions: The BCW-based nursing intervention was associated with pre-post improvement in maternal caregiving outcomes and reduced ADHD symptoms among preschool children. These preliminary findings from the one-group pretest-posttest quasi-experimental study suggest the potential value of theory-informed, caregiver-focused nursing interventions in pediatric and community healthcare settings. However, due to the one-group pretest-posttest design without a control group, causal inferences cannot be made. Further controlled studies are needed to confirm these associations and establish causal inferences.