JMIR Publications

ABSTRACT

Background:

Autism spectrum disorder (ASD) does not only affect a person’s social communication and behaviours, but also have an impact on their parents who encounter different challenges during caregiving. Interventions developed for parents of children with ASD often focus on improving child outcomes and seldom consider the wellbeing of parents and families. Interventions leveraging mindfulness-based approaches have been developed to support parents of children with ASD, but the costs, inflexibility, and scarcity of resources may limit their accessibility. App-based interventions can be an accessible and economical way of providing interventions on a primary healthcare level.

Objective:

This study aimed to develop an evidence-based digital intervention, named as “TRIP”, for mindfulness-based psychoeducation to support parents of children with ASD, as an accessible and scalable intervention that complements existing, overloaded psychiatric services, and to enhance the mental wellbeing of parents and caregivers.

Methods:

The app development process follows the systematic approach of intervention mapping (IM). Needs assessment was first conducted through semi-structured qualitative interviews with healthcare professionals. Performance and change objectives were specified; theory-based and practical application methods were selected, followed by the design of the curriculum for the structured intervention. A pilot randomised waitlist-controlled trial (RCT) was conducted to evaluate the feasibility, acceptability, and preliminary efficacy of the TRIP app with parents of children with ASD recruited from a tertiary child psychiatric service in Hong Kong.

Results:

The TRIP app is a 6-week structured intervention consisting of six sessions per week, lasting 15-20 minutes each session, covering education on ASD parenting skills and mindfulness practices. The six weekly themes include 1) cultivating curiosity in parenting, 2) mindfulness of the breath and body, 3) management of core and associated features of ASD, 4) managing conflicts and setting boundaries, 5) perspective taking, and 6) cultivating self-compassion. The curriculum and content were designed to target the determinants of parental stress, including knowledge, skills, emotions, and attitudes. App content and features were designed to incorporate behavioural change techniques, social cognitive theory, and elaboration likelihood model, so as to enhance efficacy and promote sustained usage of the app. The app was found to be feasible and acceptable in the pilot RCT (n = 40), with greater sustained usage amongst parents of children who were on the waiting list and were yet to receive services, including their diagnoses, when compared with parents of children who are already receiving clinical care.

Conclusions:

The TRIP app was developed based on existing knowledge and is contextualised to parents’ busy everyday lives. It caters the unmet needs for improving caregiver wellbeing in the holistic care model for families of children with ASD. The clinical efficacy of the TRIP app is yet to be evaluated through clinical trials. Clinical Trial: The protocol for this trial was registered with ClinicalTrials.gov (Trial ID: NCT05927207).