Principal Findings
INCOMPETENCE, SECONDARY
To the best of our knowledge, this is the first randomized controlled clinical study to target an app-based intervention for families having children with crying, sleeping, and feeding problems as common symptom patterns in early childhood. We found significantly lower levels of parenting stress after app use in the IG compared with the WCG. Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding than the parents in the WCG. However, there were no significant differences between the 2 groups in terms of parental efficacy; perceived social support; and child crying, sleeping, and feeding symptoms.Consistent with other research on families of children with crying, sleeping, and feeding problems [Exploratory analysis revealed a significant reduction in the parental stress (EBI) subscale of social isolation, and in the sensitivity analysis, effects on the EBI subscales of role restriction and spouse-related stress became evident. Regarding social isolation, this finding is in line with Shorey et al [With regard to the secondary outcomes, app use led to an increase in knowledge about crying, sleeping, and feeding problems. As summarized in a systematic review by McDowall et al [In this study sample, no effects of app use on parental perceived self-efficacy, social support, or children’s symptoms were evident. With regard to self-efficacy, the absence of effects contrasts with the findings of Gilkerson et al [One explanation for the missing effects of app use on parental self-efficacy and perceived social support could be that, surprisingly and in contrast with other studies reporting impairment in self-efficacy and social support [Another possible explanation for the absence of the effects on parental self-efficacy, perceived social support, and child problems could be that these constructs may not be as susceptible to short-term influence as parenting stress or knowledge. A meta-analysis by Amin et al [Furthermore, the absence of effects could be anchored in the relevance of child problems to parental outcomes. Self-efficacy theory states that the success of strategies and actions is a major factor in increasing self-efficacy [Finally, we must acknowledge the possibility that an app-based psychoeducational intervention for this clientele is not sufficient to influence child symptoms, self-efficacy, or perceived social support. Parental feelings of helplessness, incompetence, and uncertainty about how to act are crucial therapeutic themes in affected families [Our findings are of specific clinical relevance for the following reasons. First, increased knowledge may, to some extent, lead to altered and more favorable parenting behavior and thus might promote more adequate handling of the child in challenging situations [The effect sizes on parenting stress are considered small in this study. Other studies investigating the effects of psychoeducational interventions on stress have also found small effect sizes [