The "make or break" impact of family dynamics on psychological outcomes in focal epilepsy.

OBJECTIVE: Living with epilepsy can shape the dynamics of the whole family unit. The first objective of this study was to establish the reliability and validity of our purpose-built online family mapping tool: "Living with Epilepsy." Our second objective was to identify distinct patterns of emotional closeness between family members (family typologies), and to explore (1) whether family typologies are shaped by epilepsy-related factors, and (2) which typologies confer optimal psychological outcomes to people with epilepsy. METHODS: Ninety-one adults with chronic epilepsy and their caregivers (n = 56) participated and 70 similarly aged healthy controls and 36 caregiver controls (N = 253). Purpose-built software assessed a range of epilepsy-specific psychosocial issues, including family mapping. Questionnaires validated for epilepsy evaluated mood and quality of life (QOL). RESULTS: The reliability and validity of the family mapping tool was established. Family maps revealed three typologies varying in emotional closeness, each with distinct patterns of healthy vs maladaptive family behavior: Extremely Close (32%), Close (54%), and Fractured (14%). There was no difference in the frequency of typology between epilepsy and control families (p > .05). Within the epilepsy cohort, however, patients with seizure onset in childhood largely belonged to the extreme typologies: Extremely Close (47%) or Fractured (42%). In comparison, those with adolescent or adult onset commonly belonged to the moderate typology: Close (53%). People with epilepsy from Extremely Close families reported significantly higher QOL (p = .013) and lower mood symptoms (p = .008) relative to other typologies; no such association was found for controls or caregivers (p > .05). SIGNIFICANCE: These findings suggest that adults whose epilepsy commenced in childhood are likely to have extreme family dynamics characterized by either being brought closer together or driven apart. Extremely close families appear highly adaptive for people with epilepsy, bringing benefits for mood and QOL not seen in their caregivers or controls. The results provide strong empirical support for the value of an emotionally supportive family when living with epilepsy and suggest that fostering healthy connections within epilepsy families can optimize long-term patient well-being.

Socioeconomic factors and parents' preferences for internet- and mobile-based parenting interventions to prevent youth mental health problems: A discrete choice experiment.

Background: The positive impact of parenting programs for youth mental health is undermined by difficulties engaging parents. Low engagement disproportionately impacts parents of lower-socioeconomic positions (SEPs). Internet- and mobile-based interventions hold potential for overcoming barriers to enrolment, but additional research is needed to understand how programs can appropriately meet the needs of parents across SEPs. Consumer preference methods such as discrete choice experiments may be valuable in this endeavour. Method: A discrete choice experiment was used to determine the relative influence of modifiable program features on parents' intent to enrol. 329 Australian parents of children aged 0-18 repeatedly selected their preferred program from randomized sets of hypothetical programs in an online survey. Each hypothetical program was unique, varying across four program features: module duration, program platform, user control, and program cost. Cumulative link models were used to predict choices, with education, household income, and community advantage used as indicators of SEP. Results: Overall, parents preferred cheaper programs and briefer modules. Parents' preferences differed based on their socioeconomic challenges. Lower-income parents preferred briefer modules, cheaper programs and application-based programs compared to higher-income parents. Parents with less education preferred briefer modules and a predefined module order. Parents living in areas of less advantage preferred website-based programs, user choice of module order, and more expensive programs. Conclusions: This study offers program developers evidence-based strategies for tailoring internet- and mobile-based parenting interventions to increase lower-SEP parent enrolment. Findings also highlight the importance of considering parents' socioeconomic challenges to ensure programs do not perpetuate existing mental health inequalities, as "one-size-fits-all" approaches are likely insufficient for reaching lower-SEP parents.

Engaging Parents of Lower-Socioeconomic Positions in Internet- and Mobile-Based Interventions for Youth Mental Health: A Qualitative Investigation.

Growing literature supports the use of internet- and mobile-based interventions (IMIs) targeting parenting behaviours to prevent child and adolescent mental health difficulties. However, parents of lower-socioeconomic positions (SEP) are underserved by these interventions. To avoid contributing to existing mental health inequalities, additional efforts are needed to understand the engagement needs of lower-SEP parents. This study qualitatively explored lower-SEP parents' perspectives on how program features could facilitate their engagement in IMIs for youth mental health. We conducted semi-structured interviews with 16 lower-SEP parents of children aged 0-18 to identify important program features. Participants were mostly female (81.3%) and aged between 26 and 56 years. Transcriptions were analysed using inductive thematic analysis. Twenty-three modifiable program features important to lower-SEP parents' engagement in IMIs were identified. These features aligned with one of three overarching themes explaining their importance to parents' willingness to engage: (1) It will help my child; (2) I feel like I can do it; (3) It can easily fit into my life. The relative importance of program features varied based on parents' specific social and economic challenges. These findings offer initial directions for program developers in optimising IMIs to overcome barriers to engagement for lower-SEP parents.