Trial Outcomes & Findings for Integrated Smart Speaker Promoting Positive Parenting Among Caregivers of Youth With Challenging Behaviors (NCT NCT05535387)

Assessed (parents): 29. Excluded pre-enrollment: 3 ineligible; 5 declined. Entered study (baseline complete): 21 families (21 parents; 21 adolescents). Of these, 18 initiated app use. Note: youth had no T1 measures; first outcomes at T2. "Started" = entered study.

Integrated Smart Speaker Promoting Positive Parenting Among Caregivers of Youth With Challenging Behaviors

Strengths and Difficulties Questionnaire 4-17 (SDQ; Goodman, 1997) is used to measure the child's overall adjustment. The SDQ is a brief, valid, reliable, and commonly used parent-report questionnaire about child behavior. The instrument includes 25 items that assess child challenging behaviors (emotional symptoms, conduct problems, hyperactivity/inattention), peer relationships, and prosocial behavior, with 5 items measuring each subscale. Respondents answer on a 3-point scale from 0 to 2 (0 = "Not true;" 2 = "Certainly true"). For the Emotional Problems Subscale, scores for the 5 items are summed together; the subscale score can range from 0 to 10. Higher scores indicate worse adjustment (worse outcome).

Strengths and Difficulties Questionnaire 4-17 (SDQ; Goodman, 1997) is used to measure the child's overall adjustment. The SDQ is a brief, valid, reliable, and commonly used parent-report questionnaire about child behavior. The instrument includes 25 items that assess child challenging behaviors (emotional symptoms, conduct problems, hyperactivity/inattention), peer relationships, and prosocial behavior, with 5 items measuring each subscale. Respondents answer on a 3-point scale from 0 to 2 (0 = "Not true;" 2 = "Certainly true"). For the Conduct Problems Subscale, scores for the 5 items are summed together; the subscale score can range from 0 to 10. Higher scores indicate worse adjustment (worse outcome).

Strengths and Difficulties Questionnaire 4-17 (SDQ; Goodman, 1997) is used to measure the child's overall adjustment. The SDQ is a brief, valid, reliable, and commonly used parent-report questionnaire about child behavior. The instrument includes 25 items that assess child challenging behaviors (emotional symptoms, conduct problems, hyperactivity/inattention), peer relationships, and prosocial behavior, with 5 items measuring each subscale. Respondents answer on a 3-point scale from 0 to 2 (0 = "Not true;" 2 = "Certainly true"). For the Hyperactivity Subscale, scores for the 5 items are summed together; the subscale score can range from 0 to 10. Higher scores indicate worse adjustment (worse outcome).

Strengths and Difficulties Questionnaire 4-17 (SDQ; Goodman, 1997) is used to measure the child's overall adjustment. The SDQ is a brief, valid, reliable, and commonly used parent-report questionnaire about child behavior. The instrument includes 25 items that assess child challenging behaviors (emotional symptoms, conduct problems, hyperactivity/inattention), peer relationships, and prosocial behavior, with 5 items measuring each subscale. Respondents answer on a 3-point scale from 0 to 2 (0 = "Not true;" 2 = "Certainly true"). For the Peer Problems Subscale, scores for the 5 items are summed together; the subscale score can range from 0 to 10. Higher scores indicate worse adjustment (worse outcome).

Strengths and Difficulties Questionnaire 4-17 (SDQ; Goodman, 1997) is used to measure the child's overall adjustment. The SDQ is a brief, valid, reliable, and commonly used parent-report questionnaire about child behavior. The instrument includes 25 items that assess child challenging behaviors (emotional symptoms, conduct problems, hyperactivity/inattention), peer relationships, and prosocial behavior, with 5 items measuring each subscale. Respondents answer on a 3-point scale from 0 to 2 (0 = "Not true;" 2 = "Certainly true"). For the Prosocial Subscale, scores for the 5 items are summed together; the subscale score can range from 0 to 10. Higher scores indicate better adjustment (better outcome).

Strengths and Difficulties Questionnaire 4-17 (SDQ; Goodman, 1997) is used to measure the child's overall adjustment. The SDQ is a brief, valid, reliable, and commonly used parent-report questionnaire about child behavior. The instrument includes 25 items that assess child challenging behaviors (emotional symptoms, conduct problems, hyperactivity/inattention), peer relationships, and prosocial behavior, with 5 items measuring each subscale. Respondents answer on a 3-point scale from 0 to 2 (0 = "Not true;" 2 = "Certainly true"). For the Total Difficulties Score, subscale scores for the Emotional Problems, Conduct Problems, Hyperactivity, and Peer Problems items are summed together; the Total Difficulties score can range from 0 to 40. Higher scores indicate worse adjustment (worse outcome).

Measure Description: Parents' perceptions of improvement in their child's behavior was measured with 4 items of the Program Acceptability - Parent Perception of Improvement Subscale measure at T2, 4 weeks after baseline. Parents indicate their perceptions of recent change in their child's positive behavior and their relationship with their child. Respondents answer items on a 5-point scale (e.g. 1 = Considerably worse; 5 = Greatly improved). Scores on these 4 items are averaged together; subscale scores range from 1 to 5. Higher scores indicate parent perceptions of more improvement (better outcome).

Parent Satisfaction was measured with 10 items of the Program Acceptability - Parent Satisfaction Subscale measure at T2, 4 weeks after baseline, asking the extent to which parents found that the FamilyNet program was helpful, enjoyable, addressed important issues, helped them follow through on their behavior change plan, helped them manage their child's behavior more effectively, was the type of help they wanted, and their overall satisfaction with the program. Respondents answer items on a 7-point scale (e.g. 1 = Not at all; 7 = Very much). Scores on these 10 items are averaged together; subscale scores range from 1 to 7. Higher scores indicate better parent satisfaction.

Child Satisfaction was measured with 5 items of the Program Acceptability - Child Satisfaction Subscale measure at post-treatment, asking the extent to which the child found that the FamilyNet program was helpful and enjoyable, and their overall satisfaction with the program. Respondents answer items on a 7-point scale (e.g. 1 = Not at all; 7 = Very much). Scores on these 5 items are averaged together; subscale scores range from 1 to 7. Higher scores indicate better child satisfaction.

Parents' perceptions of the usability of the FamilyNet program is measured with the System Usability Scale (SUS), a commonly used 10-item scale that measures subjective perceptions of usability. Items are answered on a 5-point scale (0=Strongly disagree; 4=Strongly agree); scores on the scale are summed and multiplied by 2.5, such that they range from 0 to 100, with higher scores indicating better usability. The SUS has been normed, and scoring produces an overall usability "grade" (Brooke, 1996; Sauro, 2011). This measure is obtained from the parents at post-test.

Child perceptions of the usability of the FamilyNet program is measured with the System Usability Scale (SUS), a commonly used 10-item scale that measures subjective perceptions of usability. Items are answered on a 5-point scale (0=Strongly disagree; 4=Strongly agree); scores on the scale are summed and multiplied by 2.5, such that they range from 0 to 100, with higher scores indicating better usability (better outcome). The SUS has been normed, and scoring produces an overall usability "grade" (Brooke, 1996; Sauro, 2011). This measure is obtained from the youth at post-test.

The Parenting Practices Inventory (PPI) - Inconsistent Discipline Subscale (Metzler, Taylor, \& Foster, 2006) was used to measure the degree to which the parents are inconsistent in their discipline practices. Parents answer 4 items about inconsistent discipline practices on a 7-point frequency scale (1 = Never; 7 = Always). Scores on these 4 items are averaged together; the subscale scores range from 1 to 7. Higher scores indicate more inconsistent discipline practices (worse outcome).

The Parenting Practices Inventory (PPI) - Positive Reinforcement Subscale (Metzler, Taylor, \& Foster, 2006) was used to measure how much parents utilize positive reinforcement to promote positive behavior in their children. Parents answer 6 items about their likelihood of using different positive reinforcement techniques when their child behaves well or does a good job, on a 7-point scale (1 = Not at all likely; 7 = Extremely likely), 1 item about how often in an average week they praise or reward their child for doing a good job at home or school, on a 7-point scale (1 = Less than once per week; 7 = More than 10 times per day), and 2 items about how many times they have used positive reinforcement in the past 2 days for anything their child did well, on a 7-point scale (1 = Never; 7 = More than 7 times). Scores on these 9 items are averaged together; the Positive Reinforcement subscale scores range from 1 to 7. Higher scores indicate more positive reinforcement (better outcome).

The CASY Parent-Child Relationship Scales - Parent-Child Conflict Subscale (Metzler, Biglan, Ary, \& Li, 1998) is used to measure conflict between the parent and child. Items were originally adapted from Prinz, Foster, Kent, \& O'Leary (1979). For the Parent-Child Conflict Subscale, 4 items ask parents how often four different conflict situations happened over the past week; parents answer on a 7-point frequency scale (1= Never; 7 = more than 7 times). Scores on these 4 items are averaged together; subscale scores range from 1 to 7. Higher scores indicate more parent-child conflict (worse outcome).

The CASY Parent-Child Relationship Scales - Positive Family Relations Subscale (Metzler, Biglan, Ary, \& Li, 1998) is used to measure positive relationships between the parent and child. Items were originally adapted from Moos and Moos (1986). For the Positive Family Relations Subscale, 6 items ask parents about the degree to which they have had a positive relationship with their child (3 items) and in the family in general (3 items) over the past month; parents answer on a 7-point "how true" scale (1= Never true; 7 = Always true). Scores on these 6 items are averaged together; subscale scores range from 1 to 7. Higher scores indicate a more positive relationship (better outcome).

The frequency of parents' engagement in the parenting practices targeted by the FamilyNet intervention is measured via the Program-Targeted Parenting Practices - Frequency Subscale (Metzler, Smith, Feil, \& Marquez, 2023). Created for this study, these 8 items ask parents to report the frequency with which they have engaged in target parenting practices in the past 4 weeks; parents report their frequency on a 6-point scale (0 = "Never in the past month;" 5 = "Every day"). Averaged scores range from 0 to 5, with higher scores indicating more frequent parental engagement in the target activities (better outcome).

Parents' self-efficacy for engaging in the parenting practices targeted by the FamilyNet intervention is measured via the Program-Targeted Parenting Practices - Parental Self-Efficacy Subscale (Metzler, Smith, Feil, \& Marquez, 2023). Created for this study, these 6 items ask parents to rate how confident they are that they know how to do a series of parenting practices targeted by the program, on a scale of 1 to 10 (1 = Not confident at all; 10 = Highly confident). Averaged scores range from 1 to 10, with higher scores indicating greater parental self-efficacy in doing the targeted behavior (better outcome).

The Parent Daily Report (PDR; Chamberlain \& Reid, 1987) is used to measure parents' report of their children's positive and negative behaviors over the past 24 hours. For the PDR Positive Behavior Subscale, parents are asked to indicate the extent to which 7 positive behaviors occurred in the past 24 hours on a 4-point scale (0 = Not at all; 3 = A lot). The scores from these 7 items are averaged together, and the average score ranges from 0 to 3. Higher scores indicate more positive behavior (better outcome).

The Parent Daily Report (PDR; Chamberlain \& Reid, 1987) is used to measure parents' report of their children's positive and negative behaviors over the past 24 hours. For the PDR Negative Behavior Subscale, parents are asked to indicate the extent to which 19 negative behaviors occurred in the past 24 hours on a 7-point scale (0 = 0; 6 = 6 or more). The scores from these 19 items are averaged together, and the average score ranges from 0 to 6. Higher scores indicate more negative behavior (worse outcome).

Families' usage of the FamilyNet program is measured through usage metrics collected on the back-end database, including the number of families that used the program and the number of times the program was used by families. For the Number of Families that Used the Program metric, families are identified either as (a) used the program at least once, or (b) did not use the program at all. "Usage" is defined as either the parent or the child used the program at least once during the program period (after the initial monitoring period). Higher levels for all usage metrics indicate greater program use.

Families' usage of the FamilyNet program is measured through usage metrics collected on the back-end database, including the number of families that used the program and the number of times the program was used by families. For number of Times the Program was Used, each instance of a family's "usage," defined as either the parent or the child using the program, was counted over the course of the intervention period (after the initial monitoring period). Higher levels for all usage metrics indicate greater program use.