Supporting Caregivers Remotely During a Pandemic: Comparison of WHO Caregiver Skills Training Delivered Online Versus in Person in Public Health Settings in Italy.
Camilla Ferrante, Paola Sorgato, Mariachiara Fioravanti and 6 others
PMID 36454366WHAT IT FOUND
Remote caregiver training was feasible and increased caregivers' knowledge and skills similarly to in-person training, but caregivers found content less comprehensible and applicable.
Parent stress and self-efficacy did not differ from usual care.
Key findings
01Virtual CST had similar attendance and dropout to in-person CST, but caregivers rated content less comprehensible, less applicable, and less aligned with their values.
02Caregiver knowledge and skills improved more with both virtual and in-person CST than with usual care, and did not differ between the two CST modes; parent stress and self-efficacy did not differ among the three groups.
03Poor internet connection and limited technology skills made delivery difficult, while the virtual format was described as more flexible than in-person services.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The virtual CST group was not randomly assigned, and the in-person comparison came from a separate pilot randomised trial conducted in a different historical period. The virtual and in-person groups differed at baseline: children in the virtual group had a mean age of 55.76 months, versus 45.56 months in the in-person group; 68% of virtual caregivers had non-Italian nationality, versus 32.6% in the in-person group; and 50% of virtual children were minimally verbal, versus 78.6% in the in-person group. Sample sizes were small and uneven: 25 virtual caregivers, 43 in-person caregivers, and 43 treatment as usual caregivers. The study did not collect direct observational child data or clinician direct assessments, so child-level effects cannot be confirmed. The remote intervention was a bundle of adapted and standard components, including brief wellness activities, home practice review, caregiver stories, group discussions, video-recorded modelling, enhanced home practice planning, guided caregiver/child practice, video feedback, one in-person clinic visit, and two remote home visits, so the contribution of any single component cannot be separated. The virtual group was studied during lockdown, school closures, working from home arrangements, and limited face-to-face services, so feasibility and barriers may not apply in usual conditions. Many caregivers already thought telehealth had less value, and that perception did not change during the intervention. Video feedback was not delivered in all home visits because of technical difficulties, and 41% of caregivers could not share a home video at least once.
Declared interests
Funding: Compagnia di San Paolo. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not conclude that remote caregiver training is equivalent to in-person training or that any single remote component caused the caregiver competence gain. The virtual group was not randomly assigned, was studied during lockdown, differed at baseline, and received a bundle of adapted group sessions, video-recorded modelling, enhanced home practice review, enhanced home practice planning, one in-person clinic visit, and two remote home visits. The contribution of any single component cannot be separated.