Evaluation of an Intensive Education Program on the Treatment of Tobacco-use Disorder for Pharmacists: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Maguy El Hajj ◽  
Ahmed Awaisu ◽  
Nadir Kheir ◽  
Mohamad Haniki ◽  
Rula Shami ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Education Program ◽  
Self Efficacy ◽  
Tobacco Cessation ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Tobacco Education ◽  
Intensive Education

Tobacco use is one of the main causes of premature deaths and preventable diseases in Qatar. The aim of this randomized controlled trial (RCT) is to design, implement, and evaluate an intensive education program on tobacco-use treatment for pharmacists in Qatar. The study objectives are to assess the effectiveness of the program on pharmacists’ knowledge, skills, attitudes and perceived self-efficacy toward tobacco cessation. Methods: Community pharmacists practicing in Qatar were eligible for participation in the study. Consenting participants were randomly allocated to intervention or control groups. Participants in the intervention group received an intensive education program on treatment of tobacco-use disorder. A short didactic session on a non-tobacco-related topic was delivered to pharmacists in the control group. Outcomes were assessed using survey instruments. Results: Participants in the intervention group (n=57) achieved significantly higher total tobacco-related knowledge scores (mean=33 points) than those in the control group (n=37) (mean=24.5 points) with a p-value of <0.001. Post-intervention total knowledge scores were significantly higher than the baseline scores for participants who received intensive tobacco education with a mean difference of 6.6 points (p-value <0.001). Overall attitudes toward tobacco cessation and self-efficacy in tobacco cessation interventions were better in the group of pharmacists who received tobacco education compared to those who did not. For instance, 43.4% of pharmacists in the intervention group “strongly agreed” that their counseling will increase a patient’s likelihood of quitting tobacco use compared to 14.7% in the control group (p-value=0.014). Furthermore, 20.4% of pharmacists in the intervention group reported that they are “extremely confident” to use appropriate questions to ask patients when providing tobacco cessation counseling versus 5.9% in the control group (p-value=0.005). Conclusion: The findings of this study suggest that provision of an intensive educational program on the treatment of tobacco use disorders results in improved tobacco-related knowledge and self-efficacy in tobacco cessation interventions.

Assessment of an Intensive Education Program on the Treatment of Tobacco-Use Disorder for Pharmacists using OSCE (Objective Structured Clinical Examination)

2020 ◽  
Author(s):  
Maguy El Hajj ◽  
Ahmed Awaisu ◽  
Nadir Kheir ◽  
Mohamad Haniki ◽  
Rula Shami ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Clinical Examination ◽  
Education Program ◽  
Global Assessment ◽  
Tobacco Cessation ◽  
Intervention Group ◽  
Objective Structured Clinical Examination ◽  
Control Group ◽  
Tobacco Use Disorder ◽  
Intensive Education

Tobacco use is one of the main causes of morbidity and mortality in Qatar. The aim of this randomized controlled trial (RCT) is to design, implement, and evaluate an intensive education program on tobacco-use treatment for pharmacists in Qatar. The study objectives are to assess the effectiveness of the program on pharmacists’ skills toward tobacco cessation. Methods: A random sample of community pharmacists in Qatar was selected for participation. Consenting participants were randomly allocated to intervention or control groups. Participants in the intervention group received an intensive education program on treatment of tobacco-use disorder. A short didactic session on a non-tobacco-related topic was delivered to pharmacists in the control group. The pharmacists’ tobacco cessation skills were assessed using an Objective Structured Clinical Examination (OSCE). Six-station OSCE targeting core smoking cessation competencies and skills was completed by participants in both groups. Performance of participants was assessed using validated assessment checklists that comprised analytical and global assessment sections. Results: A total of 54 and 32 participants in the intervention and the control group respectively completed the OSCE. Overall, pharmacists in the intervention group performed better in the analytical and global assessment sections than those in the control group. For example, for case 1, mean scores for developing rapport, data gathering and management were 2.76 vs 0.97 (p-<0.001), 5 vs 2.81 (p <0.001), and 3.5 vs 2.25 (p=0.001) respectively for the intervention group compared to the control group. Mean total analytical scores were 12.06 vs 6.4 (p-<0.001) for intervention compared to the control group for case 1. Furthermore, mean global assessment scores for case 1 were 3.19 vs 2.41 (p=0.009) for the intervention compared to the control group. Conclusion: The study results suggest that provision of an intensive educational program on the treatment of tobacco use results in improved skills toward tobacco cessation.

scholarly journals Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 463
Author(s):  
Mar Gomis-Pastor ◽  
Sonia Mirabet Perez ◽  
Eulalia Roig Minguell ◽  
Vicenç Brossa Loidi ◽  
Laura Lopez Lopez ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Patient Experience ◽  
Mobile Application ◽  
Standard Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
P Value ◽  
Adherence Score

Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.

scholarly journals Effect of a breastfeeding educational intervention: a randomized controlled trial

2020 ◽  
Vol 28 ◽  
Author(s):  
Erdnaxela Fernandes do Carmo Souza ◽  
Alfredo Almeida Pina-Oliveira ◽  
Antonieta Keiko Kakuda Shimo
Keyword(s):  
Randomized Controlled Trial ◽  
Educational Intervention ◽  
Exclusive Breastfeeding ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Postpartum Women ◽  
Significance Level ◽  
Randomized Controlled

Objective: to assess the effect of a breastfeeding educational intervention on the counseling provided to postpartum women. Method: this is a randomized controlled trial including 104 postpartum women (intervention group = 52 and control group = 52) from a private hospital, whose educational intervention was based on the pragmatic theory and on the use of a soft-hard technology called Breastfeeding Educational Kit (Kit Educativo para Aleitamento Materno, KEAM). Women were followed-up for up to 60 days after childbirth. Chi-Squared Test, Fischer’s Exact Test, and Generalized Estimating Equation were used, with a significance level of 5% (p-value <0.05). The analyses were performed using the Statistical Package for the Social Sciences, version 24. Results: the postpartum women in the intervention group had fewer breastfeeding difficulties and a higher percentage of exclusive breastfeeding at all time points compared with those in the control group. Conclusion: the educational intervention based on active methodologies and stimulating instructional resources was effective in developing greater practical mastery among postpartum women with regard to adherence and maintenance of exclusive breastfeeding. Registry REBEC RBR – 8p9v7v.

scholarly journals Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): A Pragmatic Randomized Controlled Trial

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1289-1289
Author(s):  
Hayford Avedzi ◽  
Allison Soprovich ◽  
Stephanie Ramage ◽  
Abdulrhman Alghamdi ◽  
Kate Storey ◽  
...  
Keyword(s):  
Nutrition Education ◽  
Glycemic Index ◽  
Self Efficacy ◽  
Text Messaging ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Dietary Intakes ◽  
Web Based ◽  
Phone Calls

Abstract Objectives Rigorous evidence is needed to support uptake of recommendations to include low glycemic index (GI) foods in daily meal planning as an effective dietary self-care strategy for people with type 2 diabetes (T2D). We evaluated the effectiveness of a 12-week web-based GI-targeted nutrition education intervention on dietary intakes and GI-related knowledge among adults with T2D. Methods Participants were randomized to a control group (n = 34) that received standard printed copies of Canada's Food Guide and Diabetes Canada's GI resources or an intervention group (n = 33) that received those same materials, plus an online platform with six self-directed learning modules and supplementary print material. Each module consisted of a customized video, links to reliable websites, chat rooms, and quizzes. Evidence-based GI concept information included GI values of foods and advice for low-GI shopping, recipes, and cooking tips by a Registered Dietitian. Preferred supports through email, text messaging, phone calls, or postal mail to reinforce participants’ learning were also provided. The primary outcome, average daily dietary GI intake, was assessed using 3-day food records. Additional measures including GI knowledge and self-efficacy, glycated hemoglobin A1c, lipids, systolic blood pressure, body mass index, waist circumference, and computer proficiency, were assessed at baseline and at three months post-intervention. Results Participants (N = 67) were 64% men; mean (standard deviation [SD]) age 69.5 (9.3) years, with mean diabetes duration of 19.0 (13.7) years, BMI 30.1 (5.7) kg/m2 and A1c 7.1 (1.2)% at baseline. Mean daily GI intake decreased in the intervention group by 2.79 (7.77) compared to a 0.76 (6.48) increase in the control group (adjusted mean difference [95% CI]; −3.77 [−6.95, −0.58]). Mean GI knowledge 2.14 [0.59, 3.69], understanding of GI concept 1.65 [0.85, 2.44] and self-efficacy for consuming low-GI foods 1.29 [0.51, 2.07] increased among the intervention group (P &lt; 0.01) compared with the control group. Conclusions Web-based GI-targeted education program improved the quality of carbohydrate consumption among adults with T2D and may have been mediated through increases in knowledge and self-efficacy. Web-based nutrition education may be an effective alternative in this population. Funding Sources Canadian Foundation for Dietetic Research.

Effects of the Rango Cards game intervention on food consumption, nutritional knowledge and self-efficacy in the adoption of healthy eating practices of high school students: a cluster randomised controlled trial

2020 ◽  
Vol 23 (13) ◽  
pp. 2424-2433 ◽  
Author(s):  
Carolina Martins dos Santos Chagas ◽  
Giselle Rhai-Sa Melo ◽  
Raquel Braz Assunção Botelho ◽  
Natacha Toral
Keyword(s):  
High School Students ◽  
Healthy Eating ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cluster Randomised Controlled Trial ◽  
Control Group ◽  
Nutritional Knowledge ◽  
School Students ◽  
Eating Practices

AbstractObjective:The study aimed to assess the impact of a game-based nutritional intervention on food consumption, nutritional knowledge and self-efficacy in the adoption of healthy eating practices.Design:This cluster randomised controlled trial included both male and female high school students from private schools in the Federal District, Brazil. Four schools were randomly selected for each group. Investigated variables were age, sex, monthly family income, maternal education level, dietary perceptions and practices, nutritional knowledge and self-efficacy in the adoption of healthy eating practices.Setting:Intervention group participants were instructed to play Rango Cards, a digital game developed for the study, on their own, for a period of 7–17 d, while the control group was not provided with any game or material during the study.Participants:The study included 319 adolescents (mean age = 15·8 (sd 0·7) years).Results:Significant reductions were observed in the intervention group compared with the control group for the following variables: habit of eating while watching TV or studying and having meals at fast food restaurants. The intervention group showed increased knowledge of the effects of fruit and vegetable consumption as well as improved self-efficacy in the adoption of healthy eating practices such as reducing Na intake and preparing healthy meals.Conclusions:The design of Rango Cards is potentially capable of effecting positive changes. Therefore, the digital game promotes autonomy and self-care among adolescents with regard to healthy eating.

User-driven design of child restraint information to reduce errors in use: a pilot randomised controlled trial

2019 ◽  
Vol 26 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Alexandra B Hall ◽  
Catherine Ho ◽  
Bianca Albanese ◽  
Lisa Keay ◽  
Kate Hunter ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Instructional Materials ◽  
Control Group ◽  
P Value ◽  
Point Increase ◽  
Comprehension Score ◽  
Child Restraint ◽  
Randomised Controlled

BackgroundIncorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored.MethodsWe used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial.ResultsThere was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p<0.001). The mean error percentage in the control group was 23% (95% CI 16% to 31%) compared with 14% in the intervention group (95% CI 8% to 20%, p=0.056). For every one point increase in comprehension, there was an almost 2% (95% CI −2.7% to −1.0%) reduction in errors (y=45.5–1.87x, p value for slope <0.001).ConclusionsConsumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.

scholarly journals Atorvastatin in Helicobacter Pylori Treatment: A Randomized Controlled Trial and Review

2021 ◽  
Author(s):  
Mohammad Reza Mohammad Hoseini Azar ◽  
Parham Porteghali ◽  
Amin Sedokani
Keyword(s):  
Helicobacter Pylori ◽  
Standard Treatment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Trial Registration ◽  
Control Group ◽  
P Value ◽  
Bismuth Subcitrate ◽  
Significant Difference ◽  
H Pylori

Abstract Background: Considering the increase in drug resistance over time to Helicobacter pylori treatment relying on the anti-inflammatory and antibacterial effects of atorvastatin to increase the success rate of H. pylori eradication, we examined the effect of adding atorvastatin to standard treatment of H. pylori eradication.Results: A total of 186 symptomatic patients who had been diagnosed with Helicobacter pylori infection and tested for H. pylori eradication were examined by a pathological response or positive urea breath test. Patients who received atorvastatin in addition to standard treatment were also identified based on a table of random numbers. Standard treatment included a 240mg bismuth subcitrate tablet, a 40mg pantoprazole tablet, a 500mg metronidazole tablet, and 2 capsules of 500mg amoxicillin, all taken BID for 14 days. After 4 weeks of treatment, all patients underwent stool testing for H. pylori fecal antigen. If the test was positive, the request was considered a failure of treatment, and if the test was negative, it was considered a successful eradication of H. pylori. The clinical trial registration code for this study is IRCT20190823044589N1. The eradication rate of H. pylori was 80% in the control group and 80.9% in the intervention group, which did not show a statistically significant difference between the two groups (P-value=0.971).Conclusion: Adding atorvastatin to 4-drug regimen of PPI, bismuth subcitrate, amoxicillin, and metronidazole as the first line of treatment for H. pylori eradication is ineffective.Trial registration: IRCT, IRCT20190823044589N1. Registered 28 December 2019 - Retrospectively registered, https://en.irct.ir/trial/41734

scholarly journals Effects of barefoot walking on the flat foot in school going children: A Randomised control trial

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1805-1812
Author(s):  
Sharath Hullumani V ◽  
Purusotham Chippala
Keyword(s):  
Controlled Trial ◽  
Intervention Group ◽  
Well Being ◽  
Randomised Control Trial ◽  
Control Group ◽  
P Value ◽  
Foot And Ankle ◽  
Flat Foot ◽  
Study Results ◽  
Arch Index

Flat foot is also called Plano-valgus foot, and it is a term, that is commonly used in describing flat foot. Some studies have suggested, that certain foot-specific exercises and barefoot weight bear walking can change foot function like flat foot, and also confirm that shoed walking children are more likely to get a flat foot. An Assessor blinded, Randomized controlled trial with thirty-eight children with flat foot aged 6 – 14 years, both male and female were randomised to the control group (n= 19) and intervention group (n=19). The control group had performed barefoot walking for 45 minutes a day for eight weeks, and the intervention group had received foot-specific exercises with barefoot walking for eight weeks. Foot posture was evaluated by the arch index, while the Oxford foot and ankle questionnaire was used to measure the subjective well-being of children. Measurements were taken before and after the eight weeks of intervention. The outcome of the randomised control trial showed that the barefoot walking group faired far better than that which didn't (p-value <0.05). The intervention group outcomes measure Arch Index, and Oxford Foot and Ankle Questionnaire were p-values is <0.05 from seventh and eight weeks. This study results suggest that barefoot walking and specific foot exercises are effective in improving the flat foot in school-going children.

scholarly journals EVALUASI INTERVENSI MEDIA BOOKLET TERHADAP TINGKAT PENGETAHUAN DAN KEPATUHAN PASIEN DIABETES MELITUS TIPE 2 DI PUSKESMAS BANJARBARU SELATAN

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Valentina Meta Srikartika ◽  
M. Rasyid Akbar ◽  
Herningtyas Nautika Lingga
Keyword(s):  
Diabetes Mellitus ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Level Of Knowledge ◽  
Diabetes Melitus

ABSTRAKKeberhasilan pengobatan diabetes melitus tidak hanya dipengaruhi oleh kualitas pelayanan kesehatan, keterampilan petugasnya, sikap, dan pola hidup pasien, tetapi dipengaruhi juga oleh kepatuhan pasien terhadap pengobatannya. Tingkat kepatuhan minum obat pasien diabetes mellitus di Indonesia mayoritas masih berada dibawah 50%. Tujuan dari penelitian ini adalah mengukur pengaruh edukasi melalui media booklet terhadap pengetahuan dan kepatuhan pasien diabetes melitus tipe 2. Jenis penelitian yang digunakan adalah Randomized Controlled Trial (RCT). Populasi yang didapat dari penelitian ini sebanyak 40 orang dengan kelompok kontrol 20 orang dan kelompok intervensi 20 orang. Kelompok kontrol merupakan kelompok yang tidak mendapatkan booklet, sedangkan kelompok intervensi adalah kelompok yang mendapatkan booklet sebagi media edukasi. Pengetahuan dan kepatuhan responden diukur melalui kuesioner yang diberikan sebelum (pretest) dan 2 minggu kemudian (posttest). Rata-rata skor pengetahuan dan kepatuhan pre-test dibandingkan dengan skor post-test dengan menggunakan uji Wilcoxon. Berdasarkan hasil analisis, terjadi perbedaan tingkat pengetahuan dan kepatuhan yang signifikan (p value < 0,001) antara sebelum dan sesudah pemberian booklet pada kelompok intervensi dan tidak ada perbedaan yang signifikan pada tingkat pengetahuan (p value = 0,83) dan kepatuhan (p value = 0,317) pada kelompok kontrol. Oleh karena itu, dapat disimpulkan bahwa media booklet dapat meningkatkan tingkat pengetahuan dan kepatuhan pada pasien diabetes melitus.Kata-kata kunci: Diabetes melitus, pengetahuan, kepatuhan, bookletABSTRACTThe success of a treatment of diabetes mellitus is not only influenced by the quality of health services, the skills of its officers, attitudes, and lifestyle of patients, but it is also influenced by patient adherence to treatment. The level of medication compliance among diabetes patients in Indonesia were still below 50%. The purpose of this study was to measure the effect of education through booklet media on the knowledge and compliance of patients with type 2 diabetes mellitus. The type of research used was Randomized Controlled Trial (RCT). The population obtained from this study were 40 people with a control group of 20 people and an intervention group of 20 people. The control group was the group that did not get the booklet, while the intervention group was the group that received the booklet as an educational medium. Knowledge and compliance of respondents was measured through questionnaires given before (pretest) and 2 weeks later (posttest). The average score of knowledge and adherence between pretest and posttest will be compared using Wilcoxon analysis. Based on the results of data analysis with the Wilcoxon test, there was a significant difference in the level of knowledge and compliance (p value < 0.001) between before and after booklet administration in the intervention group and no significant difference in knowledge level (p value = 0.83) and compliance (p value = 0.317) in the control group. It can be concluded that the booklet media can increase the level of knowledge and compliance in diabetes mellitus patients.Keywords: Diabetes mellitus, knowledge, compliance, booklet

scholarly journals Effects of an attachment-based parent intervention on mothers of children with autism spectrum disorder: preliminary findings from a non-randomized controlled trial

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nobuyo Kubo ◽  
Megumi Kitagawa ◽  
Sayaka Iwamoto ◽  
Toshifumi Kishimoto
Keyword(s):  
Mental Health ◽  
Randomized Controlled Trial ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Control Group ◽  
Randomized Controlled ◽  
Children With Asd

Abstract Background Caregivers of children with autism spectrum disorders (ASD) often experience difficulties in responding appropriately to the needs of those children, who typically express attachment in distinct and nonconventional ways. This highlights the need for an attachment-based approach targeted at caregivers of children with ASD. Circle of Security Parenting (COSP), an attachment-based parenting program, is designed to increase caregivers’ sensitivity to children’s attachment needs. The aim of this study was to provide verification of the effectiveness of COSP in mothers of children with ASD. Methods This study was a non-randomized controlled trial. Sixty mothers of children with ASD aged 4–12 were recruited. Twenty mothers received the COSP intervention, while 40 did not. The characteristics of children in the control group were matched with those of the intervention group. To evaluate the outcomes of the intervention, changes in parental self-efficacy and mental health were assessed using the Tool to Measure Parenting Self-Efficacy (TOPSE) and the General Health Questionnaire-30 (GHQ-30). The children’s improvement in emotional and behavioral problems was assessed from the mothers’ perspective using the Child Behavior Checklist (CBCL). Both groups completed the assessments in parallel. Evaluations were compared between baseline (T1) and 6-month follow-up (T2). Results Scores for self-efficacy and mental health of mothers and behavior of children were significantly improved from T1 to T2 in the intervention group, but not in the control group. Participants’ mental health was markedly worsened in the control group. Conclusion This study demonstrated that the COSP program for mothers of children with ASD improved their parental self-efficacy and mental health, and reduced their subjective sense of difficulties related to their children’s behaviors. Our findings support the effectiveness of the attachment-based program for mothers of children with ASD, providing the groundwork for further studies of the attachment-based intervention for children with ASD and their families. Future studies with larger samples and randomization are also needed for direct evaluation of the improvement of children's attachment security, and for exploration of the synergistic relationship between various family support strategies and COSP. Trial Registration This trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (No. UMIN000039574)

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