Online Social Learning Program for Parents With Irritable Bowel Syndrome: Raising Resilient Children

Study Overview
=================
Brief Summary
-----------------
The goal of this clinical trial is to test efficacy of the REACH program in parents with irritable bowel syndrome (IBS) and their young children. The main question it aims to answer is: -How can parents with IBS help their young kids develop healthy habits? Participants will be asked to complete online surveys and to use a website. Researchers will compare results from parents who use one of two websites chosen by chance, like flipping a coin. One website focuses on child health and safety behaviors. The other website focuses on strategies to promote child wellness behaviors.

Detailed Description
-----------------
To date, preventive interventions have not been applied to reduce intergenerational transmission of pain conditions. There are several reasons that abdominal pain presents an ideal model for this important work. Abdominal pain is the second most common recurrent pain complaint of childhood. It is associated with disruption of normal activity, including school attendance and poor quality of life, and is emotionally distressing for both children and parents. Research demonstrates that illness behaviors are linked to development of abdominal pain disorders in children. The investigators hypothesize that a social learning intervention modified toward a preventive focus for parents with IBS who have young children, ages 4-7 years, will reduce risk factors (anxiety, catastrophizing, parenting stress) and increase protective factors (positive affect, social support), resulting in lower parental solicitous behaviors, fewer child abdominal pain symptoms, reduced child health care utilization, and better child physical, psychological, social, and school functioning. The objective of the current application is to test the efficacy of an early preventive intervention targeting parents with IBS whose young children are thus at higher risk for developing abdominal pain. To enhance potential for scalability and dissemination, and meet parental preferences, the intervention is delivered via the internet.

Official Title
-----------------
Randomized Controlled Trial of an Internet-based Prevention Intervention for Parents With Irritable Bowel Syndrome

Conditions
-----------------
Abdominal Pain, Irritable Bowel Syndrome

Intervention / Treatment
-----------------
* Behavioral: Social Learning and Cognitive Behavioral Therapy (SLCBT)
* Behavioral: Attention Education Control


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion criteria for parents and their children (including biological/step-parents or legal guardians): Parent/caregiver at least 18 years old Parent diagnosed with IBS or idiopathic abdominal pain in the last five years Parent meets ROME criteria for IBS (abdominal pain at least weekly; pain related to defecation, change in stool frequency, and change in stool form at least 30% of the time) Is the parent primarily responsible for caring for the child on a day-to-day basis Child is 4 to 6 years old at the time of screening. If multiple children are present in the family, the parent will be asked to select one child for study participation. Child must currently live at least half of the time with the parent involved in intervention. Exclusion criteria for parents and their children: Not able to read/speak/understand English. Child has a developmental disability that requires full-time special education Child has chronic abdominal pain (pain at least 1x/week lasting for more than 3 months) Child has a current doctor's diagnosis of a painful* gastrointestinal disorder like functional constipation, lactose/fructose/gluten intolerance, celiac disease, Inflammatory Bowel Disorder, etc. (*does not include nonpainful disorders like GERD) Child has another severe chronic disease such as juvenile arthritis, cancer, or other severe condition(s) requiring chronic medical treatment. Does not have regular access to the Internet on a desktop, tablet, phone, or laptop computer

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be randomized to either an attention educational control website or social learning cognitive behavioral therapy (SLCBT) prevention intervention. A control arm is necessary in order to evaluate the efficacy of the SLCBT intervention.
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Social Learning and Cognitive Behavioral Therapy (SLCBT)<br> | Behavioral: Social Learning and Cognitive Behavioral Therapy (SLCBT)<br>* Participants assigned to this group will complete an online program with 3 modules, which will include strategies to promote wellness behaviors, use adaptive cognitive coping strategies, model wellness behaviors for their children, and determine when it is appropriate to take further action re: potential illness in their child. The website is interactive and self-guided. All participants will have access to the same resources and content, although based on responses to quizzes and skills practice questions, the automated feedback may differ slightly. The website includes treatment modules that share content via text, images, videos and recordings, a skills library that includes audio recordings of relaxation exercises, videos of other parents, and infographics to support skills practice, and behavioral assignments to record skills practice and receive automated feedback. Participants will review their knowledge at the end of each treatment module with brief quizzes.<br>|
| Placebo Comparator: Attention Education Control<br> | Behavioral: Attention Education Control<br>* Participants assigned to the control group will receive access to a web program and complete 3 modules focused on child health and safety behaviors, such as sports and water safety. These participants will review written/visual content on the above topics, take quizzes to test knowledge gained, and will be provided with brief assignments to increase child safety behaviors. All participants assigned to the control group will have access to the same educational content.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in parental encouragement of child illness behavior | Assesses self-reported parental encouragement of child illness behavior. The Adult Responses to Child Symptoms (ARCS) has 29-items that load onto 3 subscales (Protectiveness, Monitoring/Encouragement, Minimization). Responses are rated on a 5-point scale ranging from never to always. . Higher average scores indicate that the responses are more frequently used, and thus higher scores are less adaptive ways of responding. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in anxiety | Parent self-report. Generalized Anxiety Disorder scale (GAD-7), is one of the most frequently used diagnostic self-report scales for screening, diagnosis and severity assessment of anxiety disorders in adults. The scale is based on seven items which are scored from 0 to 3, with higher scores indicating greater anxiety symptoms. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in pain catastrophizing | Parent self-report. Pain Catastrophizing Scale, is a 13-item measure that assesses catastrophizing thoughts or feelings accompanying the experience of pain. Respondents are asked to reflect on past painful experiences and to indicate the degree to which each of the 13 thoughts or feelings were experienced when in pain. Responses are from 0 (not at all) to 4 (all the time) with higher scores indicating higher levels of catastrophizing. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in positive and negative affect | Parent self-report. Positive and Negative Affect Schedule (PANAS) is a widely used self-report measure that is made up of two mood scales. One 10-item scale measures positive affect and the other 10-item scale measures negative affect on a 5-point Likert scale. Scores range from 10-50 for each scale with higher scores indicating high levels of positive or negative affect. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in perceived social support | Parent self-report. Perceived Social Support will be assessed using the Multidimensional Scale of Perceived Social Support (MSPSS). This scale consists of 12 items that measure the extent of social support received from 3 sources: friends, family, and significant others. Types of social support assessed by the MSPSS include emotional, tangible, informational, social network support, and esteem. Scores range from 12 to 84 with higher scores indicating greater social support. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in somatic symptoms | The Gastrointestinal symptom severity subscale of the Children's Somatization Inventory - Short Form (CSI-24) will be completed via parent proxy report. The CSI-24 assesses the severity of nonspecific somatic symptoms. Items are rated on a 0-4 scale (0 = not at all to 4 = a whole lot) and asks respondents to rate how much their child was bothered by specific symptoms in the previous 2 weeks. There are seven GI symptoms (nausea, pain, food making child sick, bloating, constipation, diarrhea, and vomiting) that measure GI symptom severity. Higher scores indicate greater somatic symptoms. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in abdominal pain severity | Parent proxy report: The Abdominal Pain Index (API) assesses characteristics of children's abdominal pain during the previous 2 weeks. The frequency of abdominal pain episodes during the previous 2 weeks is rated on a 6-point scale ranging from (0) not at all to (5) every day. The typical daily frequency of abdominal pain episodes is rated on a 6-point scale ranging from (0) none to (5) constant during the day. The typical duration of pain episodes is rated on a 9-point scale ranging from (0) none to (8) all day. The typical intensity of abdominal pain in the past two weeks is rated on an 11-point scale ranging from (0) no pain to (10) the most pain possible. To create a composite score for the API, use the following procedure: (1) items that are not already on a 6-point scale are converted to a scale ranging from 0 to 5, (2) the mean of all four items is taken to achieve a score ranging from 0 to 5, with higher scores indicating greater abdominal pain severity. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in health-related quality of life | Parent proxy report and child self-report (ages 7+). The Pediatric Quality of Life Inventory (PedsQL) is a brief measure of health-related quality of life in children. The measure can be completed by parents (the Proxy Report) for children as young as age 2 years. The 23 items in the PedsQL comprise four Generic Core Scales: Physical Functioning (8 items), Emotional Functioning (5 items), Social Functioning (5 items), and School Functioning (5 items). Two Summary Scores can be computed (the Psychosocial Health Summary Score and the Physical Health Summary Score), as well as a Total Scale Score. Scores range from 0-100, with higher scores indicating better quality of life. | Baseline, 4-6 weeks, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Change in health care costs | Parents will complete the Client Service Receipt Inventory (CSRI), a validated comprehensive inventory of health care services incurred due to the child's symptoms that uses a standard response timeframe of the past 6 months. In the CSRI, parents report on three sources of health care costs: direct medical service use, direct non-medical costs, and indirect costs. In order to better estimate costs, monetary values will be assigned to health resources use and productivity time loss data captured in the CSRI. All expenditures will be converted to 2023 dollars using the medical care component of the Consumer Price Index available from the Bureau of Labor Statistics. Costs will be aggregated across the three sources to derive total costs for analyses. | Baseline, 6 months post-intervention, 12 months post-intervention, and 18 months post-intervention | 
| Number of treatment contacts | The administrative backend of the intervention programs has a tracking system for recording use of the program. Specifically, we will measure: 1) logins to the program, 2) completed treatment modules, and 3) completed assignments. | 0-6 weeks | 
| Treatment acceptability | The TEI-SF is a 9-item measure that assesses treatment acceptability and satisfaction. Select items were adapted to be specific to a parenting prevention program (e.g., I find this intervention to be an acceptable way of dealing with young children's health). Items are rated on a 5-point scale (1 = 'strongly disagree', 5 = 'strongly agree') and summed to create a total score, with higher scores indicating higher acceptability and satisfaction. | 4-6 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
social learning, cognitive behavioral therapy, prevention intervention, irritable bowel syndrome, solicitous behavior, protective factors, psychosocial intervention, abdominal pain, risk factors, illness behavior