Peer-reviewed article

A pragmatic randomised controlled trial of the effectiveness and cost‐effectiveness of Well Parent Japan in routine care in Japan: The training and nurturing support for mothers (TRANSFORM) study

Shizuka Shimabukuro, Takashi Oshio, Takahiro Endo, Satoshi Harada, Yushiro Yamashita et al. · 3 Jun 2024

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study tested Well Parent Japan (WPJ), a new group parent training programme that combines sessions to improve mothers' psychological well-being with a culturally adapted parenting programme, against standard care for mothers of children aged 6-12 with ADHD. The programme reduced parental stress, improved parenting practices and family coping compared to standard care, with good cost-effectiveness. The programme was delivered successfully in routine Japanese child mental health services with high fidelity and retention.

Key points

WPJ reduced parent-domain stress post-treatment (mean difference 5.05, p=0.036) and at three-month follow-up (mean difference 4.82, p=0.046)
Significant benefits observed for parenting practices, parenting efficacy and family strain
No significant differences between WPJ and treatment-as-usual for child-domain stress, mood, child behaviour and impairment
Incremental cost of WPJ was 34,202 JPY (USD 315.81) with 92% probability of cost-effectiveness at 20,000 JPY threshold
Programme delivered with high fidelity and excellent retention in routine clinical care

Limitations

The study measured parent-reported outcomes for most secondary outcomes, which may be subject to bias. The study did not find significant effects on child-focused outcomes such as child behaviour and impairment, limiting understanding of direct benefit to children.

Abstract

BACKGROUND: Well Parent Japan (WPJ) is a new hybrid group parent training programme combining sessions to improve mothers' psychological well-being with a culturally adapted version of the New Forest Parenting Programme (NFPP). This study investigates the effectiveness and cost-effectiveness of WPJ against treatment as usual (TAU) within Japanese child mental health services. METHODS: TRANSFORM was a pragmatic multi-site randomised controlled trial (RCT) with two parallel arms. Altogether 124 mothers of 6-12-year-old children with DSM-5 ADHD were randomised to WPJ (n = 65) or TAU (n = 59). Participants were assessed at baseline, post-treatment and three-month follow-up. The primary outcome was parent-domain stress following intervention. Secondary outcomes included maternal reports of child-domain stress, parenting practices, parenting efficacy, mood, family strain, child behaviour and impairment. Objective measures of the parent-child relationship were collected at baseline and post-treatment. Data analysis was intention to treat (ITT) with treatment effects quantified through analysis of covariance (ANCOVA) via multilevel modelling. An incremental cost-effectiveness ratio (ICER) assessed WPJ's cost-effectiveness. RESULTS: WPJ was superior to TAU in reducing parent-domain stress post-treatment (adjusted mean difference = 5.05, 95% CI 0.33 to 9.81, p = .036) and at follow-up (adjusted mean difference 4.82, 95% CI 0.09 to 9.55, p = .046). Significant WPJ intervention effects were also observed for parenting practices, parenting efficacy and family strain. WPJ and TAU were not significantly different post-intervention or at follow-up for the other secondary outcomes. The incremental cost of WPJ was 34,202 JPY (315.81 USD). The probability that WPJ is cost-effective is 74% at 10,000 JPY (USD 108.30) per one-point improvement in parenting stress, 92% at 20,000 JPY (216.60 USD). The programme was delivered with high fidelity and excellent retention. CONCLUSIONS: WPJ can be delivered in routine clinical care at modest cost with positive effects on self-reported well-being of the mothers, parenting practices and family coping. WPJ is a promising addition to psychosocial interventions for ADHD in Japan.

Findings the Hub has extracted

Each claim below is labelled by its type of design and links back to this report.

DevelopmentProtection

Problem

Mothers of children with ADHD experience high parenting stress and psychological burden, which affects family functioning and child outcomes

Intervention: Well Parent Japan (WPJ): a hybrid group parent training programme combining sessions to improve mothers' psychological well-being with a culturally adapted version of the New Forest Parenting Programme
Population: 124 mothers of 6-12-year-old children with DSM-5 ADHD in Japanese child mental health services (WPJ n=65, TAU n=59)

Key finding

WPJ reduced parent-domain stress post-treatment (adjusted mean difference 5.05, 95% CI 0.33-9.81, p=0.036)

Experimental