Mindfulness-Based Psychoeducation App to Improve the Well-Being of Parents and Caregivers of Children With Autism: Development and Usability Study.

Background: Autism spectrum disorder (ASD) not only affects a person's social communication and behaviors, but also has an impact on their parents, who encounter different challenges during caregiving. Interventions developed for parents of children with ASD often focus on improving child outcomes and seldom consider the well-being of parents and families. Interventions leveraging mindfulness-based approaches have been developed to support parents of children with ASD, but the costs, inflexibility, and scarcity of resources may limit their accessibility. App-based interventions can be an accessible, scalable, and economical way of providing interventions at a primary health care level. Objective: The aim of this study was to develop an evidence-based digital intervention that complements existing, overloaded psychiatric services, to provide mindfulness-based psychoeducation for parents of children with ASD to improve their mental well-being. Methods: The app development process follows the systematic approach of intervention mapping. Needs assessment was first conducted through semistructured qualitative interviews with health care professionals. Performance and change objectives were specified; theory-based and practical application methods were selected, followed by the design of the curriculum for a structured intervention. A pilot waitlist randomized controlled trial was conducted to evaluate the feasibility, acceptability, and preliminary efficacy of the app with parents of children with ASD recruited from a tertiary child psychiatric service in Hong Kong. Results: The resulting intervention, the TRIP app, is a 6-week structured intervention consisting of 6 sessions per week (each session lasting 15-20 minutes), covering topics on ASD parenting skills and mindfulness practices. The six weekly themes include (1) cultivating curiosity in parenting, (2) mindfulness of the breath and body, (3) management of core and associated features of ASD, (4) managing conflicts and setting boundaries, (5) perspective taking, and (6) cultivating self-compassion. The curriculum was designed to target the determinants of parental stress, including parents' knowledge, skills, emotions, and attitudes. App content and features were designed to incorporate behavioral change techniques, social cognitive theory, and elaboration likelihood model, to enhance efficacy and promote long-term usage. The app was found to be feasible and acceptable in the pilot randomized controlled trial (n=40), with greater long-term usage among parents of children on the waiting list who were yet to receive diagnostic assessment and clinical management, when compared with parents of children who have already been receiving clinical care. Conclusions: The TRIP app was developed based on knowledge and expertise across psychiatry, public health, behavioral science, and implementation science. It caters to the unmet needs for improving caregiver well-being in the holistic care model for families of children with ASD. The clinical efficacy of the TRIP app is yet to be evaluated through clinical trials.