An effectiveness-implementation trial of the Parenting+ program for new parents

INTERVENTION: Parenting+ is an innovative health literacy intervention for new parents that is built on a model of health literacy skill development shown to increase health literacy in disadvantaged and culturally‐diverse adults in Australia. Parenting+ is a free 4‐6 week health literacy program that embeds functional health literacy skills into parenting topics of interest, identified from our previous work, in four core content areas: Topic 1: Child development Topic 2: Healthy eating and physical activity Topic 3: Adjusting for parenthood Topic 4: First aid, medicine and immunization To develop transferable health literacy skills, three core skill sets are included across all topics: 1) skills to access and critically appraise health information; 2) skills for shared decision making and 3) skills for implementing health behaviours. The Parenting+ program will be delivered face‐to‐face or online in small groups of approximately 6‐8 participants by trained facilitators (e.g. Child and Family Health Nurses; bilingual community educators) in community settings (for example, in a community health centre). The Parenting+ program will be delivered as 4 x 2‐hour parenting skill development sessions over a 4‐6 week period depending upon participant availability. Sessions will include presentations on parenting skills, short video demonstrations, interactive exercises, group discussions, and question‐answer. Parenting+ facilitator training: All Parenting+ facilitators will attend a half‐day training session led by the University of Sydney. Training will address adult education theory and practice; behaviour change techniques and health literacy skill development. Training will be conducted at in‐person workshops of up to 12 facilitators at least two CONDITION: New parenthood;Health Literacy Skills;Health education; ; New parenthood ; Health Literacy Skills ; Health education Public Health ‐ Health promotion/education PRIMARY OUTCOME: Parental health literacy skills (specific): We have purpose‐designed a 13‐item performance‐based functional health literacy skills measure (the Parenting Plus Skills Index, PPSI) using a three‐phase validation study with a modified Delphi method and multidimensional Item Response Theory modelling in two independent samples (n=1007) (Ayre et al., 2020) (https://pubmed.ncbi.nlm.nih.gov/31982204/)[Pre‐intervention(baseline) and immediate (end of last session of the parenting program), 6 months, 12 months post‐intervention] ; ‐Self‐reported exclusive breastfeeding rates at 6 months and any breastfeeding ; ‐Self‐reported infant feeding practices (infant age at introduction of solids, frequency of fruit juice consumption). ; ‐Adherence to scheduled health checks (e.g. immunisation and birth weight checks by self‐report at 6, 12 months, immunisation verified against the register at 12 months) INCLUSION CRITERIA: Parent with a child between 4‐26 weeks at time of recruitment. SECONDARY OUTCOME: Paediatric quality of life (parent completed) will be assessed by the 36‐item (ages 1‐12 months) PedsQL™ Infant Scales. It is a generic and widely used health‐related quality of life (HRQOL) instrument for infants (completed by parents), covering the domains of Physical Functioning, Physical Symptoms, Emotional Functioning, Social Functioning and Cognitive Functioning.[6 and 12 months post‐intervention] Parent/caregiver’ awareness and use of health information sources (e.g. Healthdirect’s Pregnancy, Birth and Baby; Get Healthy NSW; MotherSafe; NPS Medicines Line; Save the Date to Vaccinate App) via self‐report. Participants seeking information via Healthdirect website will be recorded by Healthdirect by asking if the parent is part of the Parenting+ program, linking the participant and their child’s first name initials and date of birth.[Immediate (end of last session of the parenting program), 6 months, 12 months post‐intervention] Health service use: Parents will be asked to self‐report the number of times they have visited the a) hospital emergency department and b) Early Childhood Centre for their child after they participated in the parenting group. ; GP and specialist visits and medicines use provided through Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) claims data over 12 months post‐intervention. Child immunisation information will be obtained from Australian Immunisation Register (AIR) data. Number of emergency department (ED) visits (infants) will be assessed using the ED Data Collection (EDDC) Registry over 12 months post‐intervention, with a focus on the % of non‐urgent (ATS‐5) or semi‐urgent (ATS‐4) presentations.[Immediate (end of last session of the parenting program), 6 months, 12 months post‐intervention] Parent’s Health‐related quality of life will be assessed by The Medical Outcomes Study 12‐Item Short Form Version 2 (SF‐12v2; Optum, Eden Prairie, MN). [6 and 12 months post‐intervention] Optimal engagement is a composite score combining breastfeeding, infant feeding, immunisation and attendance at scheduled health checks. Individual variables that will be measured to construct the composite score are as follows: ; ‐Adherence to scheduled health checks (e.g. immunisation and birth weight checks by self‐report at 6, 12 months, immunisation verified against the register at 12 months)[Pre‐intervention(baseline), 6 and 12 months post‐intervention] The cost‐effectiveness of Parenting+ (versus usual care) will be determined from a health funder perspective. Healthcare utilisation will be determined using linked Medicare, Pharmaceutical Benefits Schedule and emergency department (ED) visit data and self‐reported data. Parental quality of life will be determined using the SF‐12v2 and an incremental cost effectiveness ratio will be expressed as incremental cost (AUD) per quality adjusted life year (QALY) gained.[12 months post intervention] Primary caregiver’s competence and attachment anxieties will be assessed by a 15‐item sub‐scale from the validated Postpartum Specific Anxiety Scale (PSAS). This scale asks about the parent’s confidence in their role as the primary caregiver, their relationship with their infant, and their ability to look after their child. The scale Correlates with related measures of general anxiety e.g. STAI and Edinburgh Postnatal Depression Scale.[6 and 12 months post‐intervention. ] Health literacy: The validated Health Literacy Questionnaire (HLQ) (Osbourne et al., 2013) which comprises 9 independent sub scales will be used to assess different aspects of health literacy.[Pre‐intervention(baseline) and immediate (end of last session of the parenting program), 6 months, 12 months post‐intervention]