scholarly journals Mediation pathways for reduced substance use among parents in South Africa: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adeem Ahmad Massarwi ◽  
Lucie Cluver ◽  
Franziska Meinck ◽  
Jenny Doubt ◽  
Jamie M. Lachman ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Controlled Trial ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
Pan African ◽  
Parental Substance Use ◽  
Clinical Trials Registry ◽  
Parents And Caregivers

Abstract Background Substance use is a major public health concern worldwide. Alcohol and drug use have increased during recent decades in many low- and middle-income countries, with South Africa, where this study was conducted, having among the highest rates in the world. Despite existing evidence on the effectiveness of family-based interventions in reducing substance use among parents and caregivers in low- and middle-income countries, little is known about the mechanism of change that contributes to the reduction. This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing substance use among parents and caregivers of adolescents through three potential mediators: parental depression, parenting stress and family poverty. Methods The current study used a pragmatic cluster randomized controlled trial design. The total sample comprised 552 parent and caregiver of adolescents M = 49.37(SD = 14.69) who were recruited from 40 communities in South Africa’s Eastern Cape. Participants completed a structured confidential self-report questionnaire at baseline and a follow-up test 5 to 9 months after the intervention. Structural equation modeling was conducted to investigate direct and indirect effects. Results Analyses indicated that the effect of the PLH intervention on reducing parental substance use was mediated in one indirect pathway: improvement in parental mental health (reduction in parental depression levels). No mediation pathways from the PLH intervention on parental substance use could be associated with parenting stress or family poverty. Conclusions The findings of the study suggest that intervention approaches targeting mental health among parents and caregivers have promise for reducing parental substance use. These findings emphasize the need to create supportive environments and systems for parents who suffer from emotional strain and mental health problems, particularly within families experiencing adversity. Trial registration Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. The trial can be found by searching for the key word ‘Sinovuyo’ on the Pan-African Clinical Trials Registry website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119

scholarly journals Parenting Support: Mediation Pathways for Reduced Substance Use Among Parents and Their Children: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Adeem Massarwi ◽  
Lucie Cluver ◽  
Fraziska Meinck ◽  
Jamie Lachman ◽  
Jenny Doubt ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Controlled Trial ◽  
Parental Mental Health ◽  
Parenting Programme ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
Parental Substance Use ◽  
Family Based

Abstract Background: Substance use is a major public health concern worldwide. Alcohol and drug use have risen over recent decades in many low and middle-income countries, with South Africa among the highest globally.Despite effectiveness of family-based interventions on reducing substance use among adolescents, less is known about the effectiveness of family-based programs on substance use among parents and caregivers, in particular, among families in low- and middle-income countries (LMIC).This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health -PLH) on reduction of substance use among parents and their children through three potential mediators: parental depression, parenting stress and family poverty. In addition, the study examined the correlation between parental substance use and adolescent substance use.Methods: The current study draws on a pragmatic cluster randomized controlled trial design; the total sample comprised 552 parents\caregiver and adolescent dyads (parents\caregivers M = 49.37; SD = 14.69 and adolescents M = 13.84; SD = 2.38) who were recruited from 40 communities in South Africa’s Eastern Cape. Participants completed a structured confidential self-report questionnaire, at baseline and follow-up test (5–9 months following the intervention). Structural equation modeling (SEM) was conducted to investigate direct and indirect effects. Results: Mediation analysis indicated that PLH intervention impact on parental substance use reduction among parents ran through one indirect pathway: Improvement in parental mental health (reduction in parental depression levels). There were no pathways from PLH intervention to parental substance use through parenting stress or family poverty. Furthermore, findings showed a significant positive correlation between parental substance use and adolescents' substance use.Conclusions: The findings of the study highlight the fact that PLH parenting intervention has a significant effect on secondary outcomes, including substance use and depression among parents\caregivers in LMIC. These findings emphasize the need for creating supportive environments and systems for parents who suffer from emotional strain and mental health problems, in particular among families in adversity. Supporting parental mental health as part of a parenting programme serves as a significant pathway for reducing substance use among parents and their children.Trial registration: Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. It can be found by searching for the key word ‘Sinovuyo’ on their website or via the following link:http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119

scholarly journals SMS education for the promotion of diabetes self-management in low & middle income countries: a pilot randomized controlled trial in Egypt

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Haitham Abaza ◽  
Michael Marschollek
Keyword(s):  
Glycemic Control ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Self Management ◽  
Chi Square ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Management Behaviors

Abstract Background Due to the ubiquity of mobile phones in low and middle income countries, we aimed to examine the feasibility of SMS education among diabetic patients in Egypt, and assess the impact of educational text messages, compared to traditional paper-based methods, on glycemic control and self-management behaviors. Methods We conducted a 12-week randomized controlled trial at Misr University for Science & Technology hospital in Cairo-Egypt. Known as MUST diabetes awareness program, patients were included if they had diabetes, owned a mobile phone, and could read SMS messages or lived with someone that could read for them. Intervention patients received daily messages and weekly reminders addressing various diabetes care categories. We expected greater improvement in their glycemic control compared to controls who only received paper-based educational material. The primary outcome was the change in HbA1c, measured by the difference between endpoint and baseline values and by the number of patients who experienced at least 1% reduction from baseline to endpoint. Key secondary outcomes included blood glucose levels, body weight, treatment and medication adherence, self-efficacy, and diabetes knowledge. Data were analyzed using ANCOVA, chi-square, and t-tests. Results Thirty four intervention and 39 control patients completed the study. Over 12 weeks, 3880 messages were sent. Each intervention patient received 84 educational and 12 reminder messages plus one welcome message. Our primary outcome did not differ significantly (Δ 0.290; 95% CI -0.402 to 0.983; p = 0.406) between groups after 3 months, demonstrating a mean drop of −0.69% and −1.05% in the control and intervention group respectively. However, 16 intervention patients achieved the targeted 1% drop versus only 6 controls, suggesting clear association between study group and 1% HbA1c reductions (chi-square = 8.655; df = 1; p = 0.003). Secondary outcomes seemed in favor of intervention patients at endpoint, with considerable improvements in treatment and medication adherence, self-efficacy, and knowledge scores. Participants also indicated full satisfaction with the program. Conclusions SMS education is a feasible and acceptable method for improving glycemic control and self-management behaviors among Egyptian diabetics. However, whether it is more effective than traditional paper-based methods needs further investigation. Trial registration ClinicalTrials.govNCT02868320. Registered 9 August 2016. Retrospectively registered.

scholarly journals mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam (Preprint)

2021 ◽  
Author(s):  
Celine Larkin ◽  
Jessica Wijesundara ◽  
Hoa L Nguyen ◽  
Duc Anh Ha ◽  
Anh Vuong ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Smoking Cessation ◽  
Text Messaging ◽  
Health Workers ◽  
Controlled Trial ◽  
Text Messages ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled

BACKGROUND Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. OBJECTIVE The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. METHODS We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. RESULTS Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. CONCLUSIONS This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. CLINICALTRIAL ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30947

scholarly journals A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study)

10.2196/26796 ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. e26796
Author(s):  
Louise Birrell ◽  
Ainsley Furneaux-Bate ◽  
Cath Chapman ◽  
Nicola C Newton
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
New South ◽  
Controlled Trial ◽  
Anxiety And Depression ◽  
Randomized Controlled ◽  
South Wales ◽  
Peer Intervention ◽  
The Mind ◽  
The Impact

Background Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories. Objective This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents. Methods Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data. Results The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022. Conclusions The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/26796

The importance of trials for global mental health

2015 ◽  
Author(s):  
Graham Thornicroft ◽  
Vikram Patel
Keyword(s):  
Mental Health ◽  
Global Mental Health ◽  
Mental Health Research ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
History Of ◽  
Research Continuum ◽  
Key Terms

This chapter sets the scene for the book as a whole by defining key terms, giving a brief history of randomized controlled trails (RCTs) in mental health research, explaining why RCTs can produce strong forms of evidence, and by locating trials within the translational research continuum. The authors describe criteria with which to judge the quality of pragmatic RCTs. Finally the authors discuss how the results of trials can be used to inform policy, investment, and service delivery decisions in low and middle income countries.

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