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10 Problem Solving Training Courses for Better Solutions

Problems are almost always inevitable in your organization. Your team may end up getting into a conflict with co-workers, and customers may have problems with your product or services, among others. Luckily, we’ve listed the best problem solving training courses to help your team come up with better solutions when faced with these problems.

1. Problem Solver by EdApp

At the heart of every problem is the desire of each side to solve the problem together and come up with solutions agreeable to everyone. EdApp’s Problem Solver teaches them how to do precisely that.

This problem solving training course gives your team creative conflict resolution solutions that are structured, reasonable, and data-driven. This program begins with an explanation of the significance of problem-solving and creativity, as well as not being bound by functional fixedness.

It also dives into many concepts and types of collaboration, as well as innovative problem-solving tactics, to better equip your teams for any challenges that may arise during problem discussions. Finally, it covers how to tackle the problem by identifying the main cause to avoid implementing band-aid approaches.

The great thing about taking an EdApp course is that there’ll be a series of quizzes included for better retention. They're presented in game formats, such as matching words, true or false, missing words, the traditional multiple-choice format, and more. These strategies make sure your team will have an enjoyable and engaging learning experience.

• Scope: Creative problem solving, principles of problem-solving, different kinds of problem-solving, kinds of decision making

Created by EdApp

2. Creating a Problem Statement for Your Organization by EdApp

The core mission of a nonprofit organization is to solve societal, environmental, and ethical problems. But as a budding organization, it can be tough to choose which problem you and your team want to address and solve. EdApp’s Creating a Problem Statement for Your Organization can help narrow down your organization’s choices.

This problem solving training course dives into the heart of a problem statement each organization should have. It talks about the importance of narrowing down what your organization aims to solve, which can help your team focus on issues better. It also gives different examples of problem statements to help you and your team identify the strengths and weaknesses of each. This will also give them a better idea of what to use and what not to use for your organization’s problem statement.

• Scope: Importance of a problem statement, how to write a problem statement, creating a problem statement

Created By EdApp

3. Improving Your First Call Resolution (FCR) by EdApp

The first call resolution is a critical indicator in the customer service sector. If your support employees can fix your customers' concerns at the initial point of contact, they’ll be able to build stronger relationships with them and have a more positive experience with your company. Improving Your First Call Resolution by EdApp walks your learners through the process of reaching that goal.

This problem solving training course explains what FCR is and why it is vital for them to get one. It then supplies your team with an understanding of how to determine whether or not a problem was truly handled and how well the client experience was throughout the conversation. Finally, it offers advice on how to enhance and optimize their conversations so that any customer conflicts are handled on the first contact.

• Scope: First call resolution overview, how to calculate FCR, how to improve FCR

4. Handling Irate Customers (Call Center) by EdApp

Handling Irate Customers (Call Center) by EdApp educates your staff on how to handle and resolve client calls. This problem solving training course is ideal for your support workers that are dealing with difficult clients and tough problems. It covers how to listen to upset customers so that they can learn how to give them better solutions to their problems and even build a better relationship with your organization.

This training also includes call resolution suggestions and tactics that your team may use on their next difficult call. At the end of the course, they’ll have the opportunity to practice several mock call conversations and hone their communication skills so they can better implement these approaches in their day-to-day support interactions.

• Scope: Call resolutions, mock call conversations examples

5. Managing Difficult Conversations by EdApp

This EdApp problem solving training teaches your employees the vital information and resources they need to handle challenging and problematic talks. When a problem arises, everyone's voice should be heard. Managing Difficult Conversations teaches them how to actively listen to those they’re speaking with and check that everyone is heard. It covers subjects including prioritizing tough talks, addressing and tackling awkward interactions, offering constructive feedback, and apologizing honestly. It also teaches them how to spot frequent blunders during dispute resolution discussions.

• Scope: Handling difficult conversations, offering negative feedback, delivering authentic apologies

Explore our library including problem solving training courses.

6. Handling Objections with Emotional Intelligence by EdApp

Keeping a cool head can go a long way toward solving problems within and outside your organization. EdApp’s Handling Objections with Emotional Intelligence will teach your team how to do just that.

This problem solving training will teach them how emotional intelligence can help them resolve collective difficulties and arguments professionally and respectfully. It demonstrates how paying attention to another person's body language and attentively listening may help them have more productive conversations. Learners will also get a module on problem resolution and constructive criticism using the appropriate emotional approach.

• Scope: Active listening, body language, resolving conflicts

7. Active Listening by EdApp

Problems can only be solved if your team knows how to actively listen to the people they’re interacting with. EdApp’s Active Listening details the steps and techniques they can take today to improve their active listening skills.

This problem solving training program teaches the principles of active listening to your team, which is great if they lack a basic grasp of this ability. It reviews the important listening strategies that can help people in improving their communication and relationship with one another. The second half of this course is dedicated to avoiding bad listening habits at all costs. These poor behaviors include listening to what isn't being said and speaking without making direct eye contact. It also digs into the difficulties of active listening and suggests ways to overcome them while dealing with conflict and problems.

• Scope: Active listening strategies, bad listening practices

8. Retail Services - Communication by EdApp

Communication is key to being able to smoothly navigate through problematic situations. This is especially true in retail services. That’s why EdApp designed a communication course dedicated to helping your retail teams get out of sticky situations.

In this course, your employees will learn how to actively listen to customers to better understand them and the possible issues they may have. They'll also become acquainted with open and closed-type inquiries, allowing them to select the best question type for various scenarios and interaction goals.

By the end of this training, your retail teams will be more engaged and strategic in their work. Observe how they engage and communicate with clients more effectively and often, resulting in greater sales and happier customers.

• Scope: Active listening, differences betweenopen vs closed questions, how to use open questions

9. Effective Communication in Customer Service by EdApp

EdApp's Effective Communication in Customer Service course was developed to improve customer service workers' listening abilities for better and faster problem resolution. So, if you manage a team in a similar field, this is an ideal course to consider.

This problem solving program comprises three short sessions that address themes, such as empathy, the function of active listening in developing a great customer connection, and the impediments to successful listening. It walks your team through the process of active listening and presents listening tips and tactics. Some examples are using verbal signals to demonstrate attention while interacting with customers and clarifying by summarizing and asking open-ended questions. There's also a lesson that emphasizes some of the typical issues that will keep your team from actively listening, even if they're using the strategies you've taught them.

• Scope: Active listening, active listening in customer interactions

10. Expectations Setting by EdApp

Knowing how to properly set different people’s expectations can go a long way in solving and avoiding problems in your organization. EdApp’s Expectations Setting will teach your team the tips and tricks for how to appropriately set expectations.

The problem solving course helps your learners avoid the pitfalls of having unreasonable expectations, which typically lead to disappointment, problems, frustration, and broken relationships. They'll learn how to deal with collaborative goal setting so that everyone feels consulted and heard, including outlining expectations for each party.

• Scope: Elements of expectations, avoiding unrealistic expectations

Create better solutions with problem solving training courses

In both a professional and personal setting, problems are almost always unavoidable. People with different opinions, backgrounds, and personalities can clash and create problems and conflicts inside and outside your organization. As a leader, it’s vital to equip your team with the right problem solving skills so they know how to get themselves out of sticky situations and create better solutions for everyone. Read our list of problem solving courses to get started on problem solving skills training today.

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How to Train Your Problem-Solving Skills

From the hiccups that disrupt your morning routines to the hurdles that define your professional paths, there is always a problem to be solved. 

The good news is that every obstacle is an opportunity to develop problem-solving skills and become the best version of yourself. That’s right: It turns out you can get better at problem-solving, which will help you increase success in daily life and long-term goals.  

Read on to learn how to improve your problem-solving abilities through scientific research and practical strategies.

Understanding Problem-Solving Skills

You may be surprised to learn that your problem-solving skills go beyond just trying to find a solution. Problem-solving skills involve cognitive abilities such as analytical thinking, creativity, decision-making, logical reasoning, and memory. 

Strong problem-solving skills boost critical thinking, spark creativity, and hone decision-making abilities. For you or anyone looking to improve their mental fitness , these skills are necessary for career advancement, personal growth, and positive interpersonal relationships. 

Core Components of Problem-Solving Skills Training

To effectively train your problem-solving skills, it’s important to practice all of the steps required to solve the problem. Think of it this way: Before attempting to solve a problem, your brain has already been hard at work evaluating the situation and picking the best action plan. After you’ve worked hard preparing, you’ll need to implement your plan and assess the outcome by following these steps:  

• Identify and define problems: Recognizing and clearly articulating issues is the foundational step in solving them.
• Generate solutions: Employing brainstorming techniques helps you develop multiple potential solutions.
• Evaluate and select solutions: Using specific criteria to assess solutions helps you choose the most effective one.
• Implement solutions: Developing and executing action plans, including preparing for potential obstacles, guides you to positive outcomes.
• Review and learn from outcomes: Assessing the success of solutions and learning from the results for future improvement facilitates future success. 

Strategies for Developing Problem-Solving Skills

There are many practical exercises and activities that can improve problem-solving abilities.

Cultivate a Problem-Solving Mindset

• Adopt a growth mindset: A growth mindset involves transforming phrases like “I can’t” into “I can’t yet.” Believing in the capacity to improve your skills through effort and perseverance can lead to greater success in problem-solving.
• Practice mindfulness: Mindfulness can enhance cognitive flexibility , allowing you to view problems from multiple perspectives and find creative solutions.

Enhance Core Cognitive Skills 

• Strengthen your memory: Engage in activities that challenge your memory since accurately recalling information is crucial in problem-solving. Techniques such as mnemonic devices or memory palaces can be particularly effective.
• Build your critical thinking: Regularly question assumptions, evaluate arguments, and engage in activities that require reasoning, such as strategy games or debates.

Apply Structured Problem-Solving Techniques

• Use the STOP method: This stands for Stop , Think , Observe , and Plan . It's a simple yet effective way to approach any problem methodically, ensuring you consider all aspects before taking action.
• Try reverse engineering: Start with the desired outcome and work backward to understand the steps needed to achieve that result. This approach can be particularly useful for complex problems with unclear starting points.

Incorporate Technology into Your Training

• Engage with online courses and workshops: Many platforms offer courses specifically designed to enhance problem-solving skills, ranging from critical thinking to creative problem-solving techniques.
• Use cognitive training apps: Apps like Elevate provide targeted, research-backed games and workouts to improve cognitive skills including attention, processing speed, and more. 

Practice with Real-World Applications and Learn from Experience

• Tackle daily challenges: Use everyday issues as opportunities to practice problem-solving. Whether figuring out a new recipe or managing a tight budget, applying your skills in real-world situations can reinforce learning.
• Keep a problem-solving journal: Record the challenges you face, the strategies you employ, and the outcomes you achieve. Reflecting on your problem-solving process over time can provide insights into your strengths and areas for improvement.

Embracing Problem-Solving as a Lifelong Journey

Since problems arise daily, it’s important to feel confident in solving them. 

And you can do just that by downloading the Elevate brain training app. Elevate offers 40+ games and activities designed to improve problem-solving, communication, and other cognitive skills in a personalized way that’s backed by science. Pretty cool, right? 

Consider downloading the Elevate app on Android or iOS now—it’ll be the easiest problem you solve all day. 

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• Mental fitness refers to your ability to sustain your overall well-being. Learn tips to improve yours.  

How to improve your problem solving skills and build effective problem solving strategies

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Effective problem solving is all about using the right process and following a plan tailored to the issue at hand. Recognizing your team or organization has an issue isn’t enough to come up with effective problem solving strategies. 

To truly understand a problem and develop appropriate solutions, you will want to follow a solid process, follow the necessary problem solving steps, and bring all of your problem solving skills to the table.  

We’ll first guide you through the seven step problem solving process you and your team can use to effectively solve complex business challenges. We’ll also look at what problem solving strategies you can employ with your team when looking for a way to approach the process. We’ll then discuss the problem solving skills you need to be more effective at solving problems, complete with an activity from the SessionLab library you can use to develop that skill in your team.

Let’s get to it! 

What is a problem solving process?

• What are the problem solving steps I need to follow?

Problem solving strategies

What skills do i need to be an effective problem solver, how can i improve my problem solving skills.

Solving problems is like baking a cake. You can go straight into the kitchen without a recipe or the right ingredients and do your best, but the end result is unlikely to be very tasty!

Using a process to bake a cake allows you to use the best ingredients without waste, collect the right tools, account for allergies, decide whether it is a birthday or wedding cake, and then bake efficiently and on time. The result is a better cake that is fit for purpose, tastes better and has created less mess in the kitchen. Also, it should have chocolate sprinkles. Having a step by step process to solve organizational problems allows you to go through each stage methodically and ensure you are trying to solve the right problems and select the most appropriate, effective solutions.

What are the problem solving steps I need to follow? 

All problem solving processes go through a number of steps in order to move from identifying a problem to resolving it.

Depending on your problem solving model and who you ask, there can be anything between four and nine problem solving steps you should follow in order to find the right solution. Whatever framework you and your group use, there are some key items that should be addressed in order to have an effective process.

We’ve looked at problem solving processes from sources such as the American Society for Quality and their four step approach , and Mediate ‘s six step process. By reflecting on those and our own problem solving processes, we’ve come up with a sequence of seven problem solving steps we feel best covers everything you need in order to effectively solve problems.

1. Problem identification 

The first stage of any problem solving process is to identify the problem or problems you might want to solve. Effective problem solving strategies always begin by allowing a group scope to articulate what they believe the problem to be and then coming to some consensus over which problem they approach first. Problem solving activities used at this stage often have a focus on creating frank, open discussion so that potential problems can be brought to the surface.

2. Problem analysis 

Though this step is not a million miles from problem identification, problem analysis deserves to be considered separately. It can often be an overlooked part of the process and is instrumental when it comes to developing effective solutions.

The process of problem analysis means ensuring that the problem you are seeking to solve is the right problem . As part of this stage, you may look deeper and try to find the root cause of a specific problem at a team or organizational level.

Remember that problem solving strategies should not only be focused on putting out fires in the short term but developing long term solutions that deal with the root cause of organizational challenges. 

Whatever your approach, analyzing a problem is crucial in being able to select an appropriate solution and the problem solving skills deployed in this stage are beneficial for the rest of the process and ensuring the solutions you create are fit for purpose.

3. Solution generation

Once your group has nailed down the particulars of the problem you wish to solve, you want to encourage a free flow of ideas connecting to solving that problem. This can take the form of problem solving games that encourage creative thinking or problem solving activities designed to produce working prototypes of possible solutions. 

The key to ensuring the success of this stage of the problem solving process is to encourage quick, creative thinking and create an open space where all ideas are considered. The best solutions can come from unlikely places and by using problem solving techniques that celebrate invention, you might come up with solution gold. 

4. Solution development

No solution is likely to be perfect right out of the gate. It’s important to discuss and develop the solutions your group has come up with over the course of following the previous problem solving steps in order to arrive at the best possible solution. Problem solving games used in this stage involve lots of critical thinking, measuring potential effort and impact, and looking at possible solutions analytically. 

During this stage, you will often ask your team to iterate and improve upon your frontrunning solutions and develop them further. Remember that problem solving strategies always benefit from a multitude of voices and opinions, and not to let ego get involved when it comes to choosing which solutions to develop and take further.

Finding the best solution is the goal of all problem solving workshops and here is the place to ensure that your solution is well thought out, sufficiently robust and fit for purpose. 

5. Decision making 

Nearly there! Once your group has reached consensus and selected a solution that applies to the problem at hand you have some decisions to make. You will want to work on allocating ownership of the project, figure out who will do what, how the success of the solution will be measured and decide the next course of action.

The decision making stage is a part of the problem solving process that can get missed or taken as for granted. Fail to properly allocate roles and plan out how a solution will actually be implemented and it less likely to be successful in solving the problem.

Have clear accountabilities, actions, timeframes, and follow-ups. Make these decisions and set clear next-steps in the problem solving workshop so that everyone is aligned and you can move forward effectively as a group. 

Ensuring that you plan for the roll-out of a solution is one of the most important problem solving steps. Without adequate planning or oversight, it can prove impossible to measure success or iterate further if the problem was not solved. 

6. Solution implementation 

This is what we were waiting for! All problem solving strategies have the end goal of implementing a solution and solving a problem in mind. 

Remember that in order for any solution to be successful, you need to help your group through all of the previous problem solving steps thoughtfully. Only then can you ensure that you are solving the right problem but also that you have developed the correct solution and can then successfully implement and measure the impact of that solution.

Project management and communication skills are key here – your solution may need to adjust when out in the wild or you might discover new challenges along the way.

7. Solution evaluation 

So you and your team developed a great solution to a problem and have a gut feeling its been solved. Work done, right? Wrong. All problem solving strategies benefit from evaluation, consideration, and feedback. You might find that the solution does not work for everyone, might create new problems, or is potentially so successful that you will want to roll it out to larger teams or as part of other initiatives. 

None of that is possible without taking the time to evaluate the success of the solution you developed in your problem solving model and adjust if necessary.

Remember that the problem solving process is often iterative and it can be common to not solve complex issues on the first try. Even when this is the case, you and your team will have generated learning that will be important for future problem solving workshops or in other parts of the organization. 

It’s worth underlining how important record keeping is throughout the problem solving process. If a solution didn’t work, you need to have the data and records to see why that was the case. If you go back to the drawing board, notes from the previous workshop can help save time. Data and insight is invaluable at every stage of the problem solving process and this one is no different.

Problem solving workshops made easy

Problem solving strategies are methods of approaching and facilitating the process of problem-solving with a set of techniques , actions, and processes. Different strategies are more effective if you are trying to solve broad problems such as achieving higher growth versus more focused problems like, how do we improve our customer onboarding process?

Broadly, the problem solving steps outlined above should be included in any problem solving strategy though choosing where to focus your time and what approaches should be taken is where they begin to differ. You might find that some strategies ask for the problem identification to be done prior to the session or that everything happens in the course of a one day workshop.

The key similarity is that all good problem solving strategies are structured and designed. Four hours of open discussion is never going to be as productive as a four-hour workshop designed to lead a group through a problem solving process.

Good problem solving strategies are tailored to the team, organization and problem you will be attempting to solve. Here are some example problem solving strategies you can learn from or use to get started.

Use a workshop to lead a team through a group process

Often, the first step to solving problems or organizational challenges is bringing a group together effectively. Most teams have the tools, knowledge, and expertise necessary to solve their challenges – they just need some guidance in how to use leverage those skills and a structure and format that allows people to focus their energies.

Facilitated workshops are one of the most effective ways of solving problems of any scale. By designing and planning your workshop carefully, you can tailor the approach and scope to best fit the needs of your team and organization. 

Problem solving workshop

• Creating a bespoke, tailored process
• Tackling problems of any size
• Building in-house workshop ability and encouraging their use

Workshops are an effective strategy for solving problems. By using tried and test facilitation techniques and methods, you can design and deliver a workshop that is perfectly suited to the unique variables of your organization. You may only have the capacity for a half-day workshop and so need a problem solving process to match. 

By using our session planner tool and importing methods from our library of 700+ facilitation techniques, you can create the right problem solving workshop for your team. It might be that you want to encourage creative thinking or look at things from a new angle to unblock your groups approach to problem solving. By tailoring your workshop design to the purpose, you can help ensure great results.

One of the main benefits of a workshop is the structured approach to problem solving. Not only does this mean that the workshop itself will be successful, but many of the methods and techniques will help your team improve their working processes outside of the workshop. 

We believe that workshops are one of the best tools you can use to improve the way your team works together. Start with a problem solving workshop and then see what team building, culture or design workshops can do for your organization!

Run a design sprint

Great for: 

• aligning large, multi-discipline teams
• quickly designing and testing solutions
• tackling large, complex organizational challenges and breaking them down into smaller tasks

By using design thinking principles and methods, a design sprint is a great way of identifying, prioritizing and prototyping solutions to long term challenges that can help solve major organizational problems with quick action and measurable results.

Some familiarity with design thinking is useful, though not integral, and this strategy can really help a team align if there is some discussion around which problems should be approached first. 

The stage-based structure of the design sprint is also very useful for teams new to design thinking.  The inspiration phase, where you look to competitors that have solved your problem, and the rapid prototyping and testing phases are great for introducing new concepts that will benefit a team in all their future work. 

It can be common for teams to look inward for solutions and so looking to the market for solutions you can iterate on can be very productive. Instilling an agile prototyping and testing mindset can also be great when helping teams move forwards – generating and testing solutions quickly can help save time in the long run and is also pretty exciting!

Break problems down into smaller issues

Organizational challenges and problems are often complicated and large scale in nature. Sometimes, trying to resolve such an issue in one swoop is simply unachievable or overwhelming. Try breaking down such problems into smaller issues that you can work on step by step. You may not be able to solve the problem of churning customers off the bat, but you can work with your team to identify smaller effort but high impact elements and work on those first.

This problem solving strategy can help a team generate momentum, prioritize and get some easy wins. It’s also a great strategy to employ with teams who are just beginning to learn how to approach the problem solving process. If you want some insight into a way to employ this strategy, we recommend looking at our design sprint template below!

Use guiding frameworks or try new methodologies

Some problems are best solved by introducing a major shift in perspective or by using new methodologies that encourage your team to think differently.

Props and tools such as Methodkit , which uses a card-based toolkit for facilitation, or Lego Serious Play can be great ways to engage your team and find an inclusive, democratic problem solving strategy. Remember that play and creativity are great tools for achieving change and whatever the challenge, engaging your participants can be very effective where other strategies may have failed.

LEGO Serious Play

• Improving core problem solving skills
• Thinking outside of the box
• Encouraging creative solutions

LEGO Serious Play is a problem solving methodology designed to get participants thinking differently by using 3D models and kinesthetic learning styles. By physically building LEGO models based on questions and exercises, participants are encouraged to think outside of the box and create their own responses. 

Collaborate LEGO Serious Play exercises are also used to encourage communication and build problem solving skills in a group. By using this problem solving process, you can often help different kinds of learners and personality types contribute and unblock organizational problems with creative thinking. 

Problem solving strategies like LEGO Serious Play are super effective at helping a team solve more skills-based problems such as communication between teams or a lack of creative thinking. Some problems are not suited to LEGO Serious Play and require a different problem solving strategy.

Card Decks and Method Kits

• New facilitators or non-facilitators 
• Approaching difficult subjects with a simple, creative framework
• Engaging those with varied learning styles

Card decks and method kids are great tools for those new to facilitation or for whom facilitation is not the primary role. Card decks such as the emotional culture deck can be used for complete workshops and in many cases, can be used right out of the box. Methodkit has a variety of kits designed for scenarios ranging from personal development through to personas and global challenges so you can find the right deck for your particular needs.

Having an easy to use framework that encourages creativity or a new approach can take some of the friction or planning difficulties out of the workshop process and energize a team in any setting. Simplicity is the key with these methods. By ensuring everyone on your team can get involved and engage with the process as quickly as possible can really contribute to the success of your problem solving strategy.

Source external advice

Looking to peers, experts and external facilitators can be a great way of approaching the problem solving process. Your team may not have the necessary expertise, insights of experience to tackle some issues, or you might simply benefit from a fresh perspective. Some problems may require bringing together an entire team, and coaching managers or team members individually might be the right approach. Remember that not all problems are best resolved in the same manner.

If you’re a solo entrepreneur, peer groups, coaches and mentors can also be invaluable at not only solving specific business problems, but in providing a support network for resolving future challenges. One great approach is to join a Mastermind Group and link up with like-minded individuals and all grow together. Remember that however you approach the sourcing of external advice, do so thoughtfully, respectfully and honestly. Reciprocate where you can and prepare to be surprised by just how kind and helpful your peers can be!

Mastermind Group

• Solo entrepreneurs or small teams with low capacity
• Peer learning and gaining outside expertise
• Getting multiple external points of view quickly

Problem solving in large organizations with lots of skilled team members is one thing, but how about if you work for yourself or in a very small team without the capacity to get the most from a design sprint or LEGO Serious Play session? 

A mastermind group – sometimes known as a peer advisory board – is where a group of people come together to support one another in their own goals, challenges, and businesses. Each participant comes to the group with their own purpose and the other members of the group will help them create solutions, brainstorm ideas, and support one another. 

Mastermind groups are very effective in creating an energized, supportive atmosphere that can deliver meaningful results. Learning from peers from outside of your organization or industry can really help unlock new ways of thinking and drive growth. Access to the experience and skills of your peers can be invaluable in helping fill the gaps in your own ability, particularly in young companies.

A mastermind group is a great solution for solo entrepreneurs, small teams, or for organizations that feel that external expertise or fresh perspectives will be beneficial for them. It is worth noting that Mastermind groups are often only as good as the participants and what they can bring to the group. Participants need to be committed, engaged and understand how to work in this context. 

Coaching and mentoring

• Focused learning and development
• Filling skills gaps
• Working on a range of challenges over time

Receiving advice from a business coach or building a mentor/mentee relationship can be an effective way of resolving certain challenges. The one-to-one format of most coaching and mentor relationships can really help solve the challenges those individuals are having and benefit the organization as a result.

A great mentor can be invaluable when it comes to spotting potential problems before they arise and coming to understand a mentee very well has a host of other business benefits. You might run an internal mentorship program to help develop your team’s problem solving skills and strategies or as part of a large learning and development program. External coaches can also be an important part of your problem solving strategy, filling skills gaps for your management team or helping with specific business issues. 

Now we’ve explored the problem solving process and the steps you will want to go through in order to have an effective session, let’s look at the skills you and your team need to be more effective problem solvers.

Problem solving skills are highly sought after, whatever industry or team you work in. Organizations are keen to employ people who are able to approach problems thoughtfully and find strong, realistic solutions. Whether you are a facilitator , a team leader or a developer, being an effective problem solver is a skill you’ll want to develop.

Problem solving skills form a whole suite of techniques and approaches that an individual uses to not only identify problems but to discuss them productively before then developing appropriate solutions.

Here are some of the most important problem solving skills everyone from executives to junior staff members should learn. We’ve also included an activity or exercise from the SessionLab library that can help you and your team develop that skill. 

If you’re running a workshop or training session to try and improve problem solving skills in your team, try using these methods to supercharge your process!

Active listening

Active listening is one of the most important skills anyone who works with people can possess. In short, active listening is a technique used to not only better understand what is being said by an individual, but also to be more aware of the underlying message the speaker is trying to convey. When it comes to problem solving, active listening is integral for understanding the position of every participant and to clarify the challenges, ideas and solutions they bring to the table.

Some active listening skills include:

• Paying complete attention to the speaker.
• Removing distractions.
• Avoid interruption.
• Taking the time to fully understand before preparing a rebuttal.
• Responding respectfully and appropriately.
• Demonstrate attentiveness and positivity with an open posture, making eye contact with the speaker, smiling and nodding if appropriate. Show that you are listening and encourage them to continue.
• Be aware of and respectful of feelings. Judge the situation and respond appropriately. You can disagree without being disrespectful.   
• Observe body language. 
• Paraphrase what was said in your own words, either mentally or verbally.
• Remain neutral. 
• Reflect and take a moment before responding.
• Ask deeper questions based on what is said and clarify points where necessary.   

Active Listening   #hyperisland   #skills   #active listening   #remote-friendly   This activity supports participants to reflect on a question and generate their own solutions using simple principles of active listening and peer coaching. It’s an excellent introduction to active listening but can also be used with groups that are already familiar with it. Participants work in groups of three and take turns being: “the subject”, the listener, and the observer.

Analytical skills

All problem solving models require strong analytical skills, particularly during the beginning of the process and when it comes to analyzing how solutions have performed.

Analytical skills are primarily focused on performing an effective analysis by collecting, studying and parsing data related to a problem or opportunity. 

It often involves spotting patterns, being able to see things from different perspectives and using observable facts and data to make suggestions or produce insight. 

Analytical skills are also important at every stage of the problem solving process and by having these skills, you can ensure that any ideas or solutions you create or backed up analytically and have been sufficiently thought out.

Nine Whys   #innovation   #issue analysis   #liberating structures   With breathtaking simplicity, you can rapidly clarify for individuals and a group what is essentially important in their work. You can quickly reveal when a compelling purpose is missing in a gathering and avoid moving forward without clarity. When a group discovers an unambiguous shared purpose, more freedom and more responsibility are unleashed. You have laid the foundation for spreading and scaling innovations with fidelity.

Collaboration

Trying to solve problems on your own is difficult. Being able to collaborate effectively, with a free exchange of ideas, to delegate and be a productive member of a team is hugely important to all problem solving strategies.

Remember that whatever your role, collaboration is integral, and in a problem solving process, you are all working together to find the best solution for everyone. 

Marshmallow challenge with debriefing   #teamwork   #team   #leadership   #collaboration   In eighteen minutes, teams must build the tallest free-standing structure out of 20 sticks of spaghetti, one yard of tape, one yard of string, and one marshmallow. The marshmallow needs to be on top. The Marshmallow Challenge was developed by Tom Wujec, who has done the activity with hundreds of groups around the world. Visit the Marshmallow Challenge website for more information. This version has an extra debriefing question added with sample questions focusing on roles within the team.

Communication  

Being an effective communicator means being empathetic, clear and succinct, asking the right questions, and demonstrating active listening skills throughout any discussion or meeting. 

In a problem solving setting, you need to communicate well in order to progress through each stage of the process effectively. As a team leader, it may also fall to you to facilitate communication between parties who may not see eye to eye. Effective communication also means helping others to express themselves and be heard in a group.

Bus Trip   #feedback   #communication   #appreciation   #closing   #thiagi   #team   This is one of my favourite feedback games. I use Bus Trip at the end of a training session or a meeting, and I use it all the time. The game creates a massive amount of energy with lots of smiles, laughs, and sometimes even a teardrop or two.

Creative problem solving skills can be some of the best tools in your arsenal. Thinking creatively, being able to generate lots of ideas and come up with out of the box solutions is useful at every step of the process. 

The kinds of problems you will likely discuss in a problem solving workshop are often difficult to solve, and by approaching things in a fresh, creative manner, you can often create more innovative solutions.

Having practical creative skills is also a boon when it comes to problem solving. If you can help create quality design sketches and prototypes in record time, it can help bring a team to alignment more quickly or provide a base for further iteration.

The paper clip method   #sharing   #creativity   #warm up   #idea generation   #brainstorming   The power of brainstorming. A training for project leaders, creativity training, and to catalyse getting new solutions.

Critical thinking

Critical thinking is one of the fundamental problem solving skills you’ll want to develop when working on developing solutions. Critical thinking is the ability to analyze, rationalize and evaluate while being aware of personal bias, outlying factors and remaining open-minded.

Defining and analyzing problems without deploying critical thinking skills can mean you and your team go down the wrong path. Developing solutions to complex issues requires critical thinking too – ensuring your team considers all possibilities and rationally evaluating them. 

Agreement-Certainty Matrix   #issue analysis   #liberating structures   #problem solving   You can help individuals or groups avoid the frequent mistake of trying to solve a problem with methods that are not adapted to the nature of their challenge. The combination of two questions makes it possible to easily sort challenges into four categories: simple, complicated, complex , and chaotic .  A problem is simple when it can be solved reliably with practices that are easy to duplicate.  It is complicated when experts are required to devise a sophisticated solution that will yield the desired results predictably.  A problem is complex when there are several valid ways to proceed but outcomes are not predictable in detail.  Chaotic is when the context is too turbulent to identify a path forward.  A loose analogy may be used to describe these differences: simple is like following a recipe, complicated like sending a rocket to the moon, complex like raising a child, and chaotic is like the game “Pin the Tail on the Donkey.”  The Liberating Structures Matching Matrix in Chapter 5 can be used as the first step to clarify the nature of a challenge and avoid the mismatches between problems and solutions that are frequently at the root of chronic, recurring problems.

Data analysis 

Though it shares lots of space with general analytical skills, data analysis skills are something you want to cultivate in their own right in order to be an effective problem solver.

Being good at data analysis doesn’t just mean being able to find insights from data, but also selecting the appropriate data for a given issue, interpreting it effectively and knowing how to model and present that data. Depending on the problem at hand, it might also include a working knowledge of specific data analysis tools and procedures. 

Having a solid grasp of data analysis techniques is useful if you’re leading a problem solving workshop but if you’re not an expert, don’t worry. Bring people into the group who has this skill set and help your team be more effective as a result.

Decision making

All problems need a solution and all solutions require that someone make the decision to implement them. Without strong decision making skills, teams can become bogged down in discussion and less effective as a result. 

Making decisions is a key part of the problem solving process. It’s important to remember that decision making is not restricted to the leadership team. Every staff member makes decisions every day and developing these skills ensures that your team is able to solve problems at any scale. Remember that making decisions does not mean leaping to the first solution but weighing up the options and coming to an informed, well thought out solution to any given problem that works for the whole team.

Lightning Decision Jam (LDJ)   #action   #decision making   #problem solving   #issue analysis   #innovation   #design   #remote-friendly   The problem with anything that requires creative thinking is that it’s easy to get lost—lose focus and fall into the trap of having useless, open-ended, unstructured discussions. Here’s the most effective solution I’ve found: Replace all open, unstructured discussion with a clear process. What to use this exercise for: Anything which requires a group of people to make decisions, solve problems or discuss challenges. It’s always good to frame an LDJ session with a broad topic, here are some examples: The conversion flow of our checkout Our internal design process How we organise events Keeping up with our competition Improving sales flow

Dependability

Most complex organizational problems require multiple people to be involved in delivering the solution. Ensuring that the team and organization can depend on you to take the necessary actions and communicate where necessary is key to ensuring problems are solved effectively.

Being dependable also means working to deadlines and to brief. It is often a matter of creating trust in a team so that everyone can depend on one another to complete the agreed actions in the agreed time frame so that the team can move forward together. Being undependable can create problems of friction and can limit the effectiveness of your solutions so be sure to bear this in mind throughout a project. 

Team Purpose & Culture   #team   #hyperisland   #culture   #remote-friendly   This is an essential process designed to help teams define their purpose (why they exist) and their culture (how they work together to achieve that purpose). Defining these two things will help any team to be more focused and aligned. With support of tangible examples from other companies, the team members work as individuals and a group to codify the way they work together. The goal is a visual manifestation of both the purpose and culture that can be put up in the team’s work space.

Emotional intelligence

Emotional intelligence is an important skill for any successful team member, whether communicating internally or with clients or users. In the problem solving process, emotional intelligence means being attuned to how people are feeling and thinking, communicating effectively and being self-aware of what you bring to a room. 

There are often differences of opinion when working through problem solving processes, and it can be easy to let things become impassioned or combative. Developing your emotional intelligence means being empathetic to your colleagues and managing your own emotions throughout the problem and solution process. Be kind, be thoughtful and put your points across care and attention. 

Being emotionally intelligent is a skill for life and by deploying it at work, you can not only work efficiently but empathetically. Check out the emotional culture workshop template for more!

Facilitation

As we’ve clarified in our facilitation skills post, facilitation is the art of leading people through processes towards agreed-upon objectives in a manner that encourages participation, ownership, and creativity by all those involved. While facilitation is a set of interrelated skills in itself, the broad definition of facilitation can be invaluable when it comes to problem solving. Leading a team through a problem solving process is made more effective if you improve and utilize facilitation skills – whether you’re a manager, team leader or external stakeholder.

The Six Thinking Hats   #creative thinking   #meeting facilitation   #problem solving   #issue resolution   #idea generation   #conflict resolution   The Six Thinking Hats are used by individuals and groups to separate out conflicting styles of thinking. They enable and encourage a group of people to think constructively together in exploring and implementing change, rather than using argument to fight over who is right and who is wrong.

Flexibility 

Being flexible is a vital skill when it comes to problem solving. This does not mean immediately bowing to pressure or changing your opinion quickly: instead, being flexible is all about seeing things from new perspectives, receiving new information and factoring it into your thought process.

Flexibility is also important when it comes to rolling out solutions. It might be that other organizational projects have greater priority or require the same resources as your chosen solution. Being flexible means understanding needs and challenges across the team and being open to shifting or arranging your own schedule as necessary. Again, this does not mean immediately making way for other projects. It’s about articulating your own needs, understanding the needs of others and being able to come to a meaningful compromise.

The Creativity Dice   #creativity   #problem solving   #thiagi   #issue analysis   Too much linear thinking is hazardous to creative problem solving. To be creative, you should approach the problem (or the opportunity) from different points of view. You should leave a thought hanging in mid-air and move to another. This skipping around prevents premature closure and lets your brain incubate one line of thought while you consciously pursue another.

Working in any group can lead to unconscious elements of groupthink or situations in which you may not wish to be entirely honest. Disagreeing with the opinions of the executive team or wishing to save the feelings of a coworker can be tricky to navigate, but being honest is absolutely vital when to comes to developing effective solutions and ensuring your voice is heard. 

Remember that being honest does not mean being brutally candid. You can deliver your honest feedback and opinions thoughtfully and without creating friction by using other skills such as emotional intelligence. 

Explore your Values   #hyperisland   #skills   #values   #remote-friendly   Your Values is an exercise for participants to explore what their most important values are. It’s done in an intuitive and rapid way to encourage participants to follow their intuitive feeling rather than over-thinking and finding the “correct” values. It is a good exercise to use to initiate reflection and dialogue around personal values.

Initiative 

The problem solving process is multi-faceted and requires different approaches at certain points of the process. Taking initiative to bring problems to the attention of the team, collect data or lead the solution creating process is always valuable. You might even roadtest your own small scale solutions or brainstorm before a session. Taking initiative is particularly effective if you have good deal of knowledge in that area or have ownership of a particular project and want to get things kickstarted.

That said, be sure to remember to honor the process and work in service of the team. If you are asked to own one part of the problem solving process and you don’t complete that task because your initiative leads you to work on something else, that’s not an effective method of solving business challenges.

15% Solutions   #action   #liberating structures   #remote-friendly   You can reveal the actions, however small, that everyone can do immediately. At a minimum, these will create momentum, and that may make a BIG difference.  15% Solutions show that there is no reason to wait around, feel powerless, or fearful. They help people pick it up a level. They get individuals and the group to focus on what is within their discretion instead of what they cannot change.  With a very simple question, you can flip the conversation to what can be done and find solutions to big problems that are often distributed widely in places not known in advance. Shifting a few grains of sand may trigger a landslide and change the whole landscape.

Impartiality

A particularly useful problem solving skill for product owners or managers is the ability to remain impartial throughout much of the process. In practice, this means treating all points of view and ideas brought forward in a meeting equally and ensuring that your own areas of interest or ownership are not favored over others. 

There may be a stage in the process where a decision maker has to weigh the cost and ROI of possible solutions against the company roadmap though even then, ensuring that the decision made is based on merit and not personal opinion. 

Empathy map   #frame insights   #create   #design   #issue analysis   An empathy map is a tool to help a design team to empathize with the people they are designing for. You can make an empathy map for a group of people or for a persona. To be used after doing personas when more insights are needed.

Being a good leader means getting a team aligned, energized and focused around a common goal. In the problem solving process, strong leadership helps ensure that the process is efficient, that any conflicts are resolved and that a team is managed in the direction of success.

It’s common for managers or executives to assume this role in a problem solving workshop, though it’s important that the leader maintains impartiality and does not bulldoze the group in a particular direction. Remember that good leadership means working in service of the purpose and team and ensuring the workshop is a safe space for employees of any level to contribute. Take a look at our leadership games and activities post for more exercises and methods to help improve leadership in your organization.

Leadership Pizza   #leadership   #team   #remote-friendly   This leadership development activity offers a self-assessment framework for people to first identify what skills, attributes and attitudes they find important for effective leadership, and then assess their own development and initiate goal setting.

In the context of problem solving, mediation is important in keeping a team engaged, happy and free of conflict. When leading or facilitating a problem solving workshop, you are likely to run into differences of opinion. Depending on the nature of the problem, certain issues may be brought up that are emotive in nature. 

Being an effective mediator means helping those people on either side of such a divide are heard, listen to one another and encouraged to find common ground and a resolution. Mediating skills are useful for leaders and managers in many situations and the problem solving process is no different.

Conflict Responses   #hyperisland   #team   #issue resolution   A workshop for a team to reflect on past conflicts, and use them to generate guidelines for effective conflict handling. The workshop uses the Thomas-Killman model of conflict responses to frame a reflective discussion. Use it to open up a discussion around conflict with a team.

Planning 

Solving organizational problems is much more effective when following a process or problem solving model. Planning skills are vital in order to structure, deliver and follow-through on a problem solving workshop and ensure your solutions are intelligently deployed.

Planning skills include the ability to organize tasks and a team, plan and design the process and take into account any potential challenges. Taking the time to plan carefully can save time and frustration later in the process and is valuable for ensuring a team is positioned for success.

3 Action Steps   #hyperisland   #action   #remote-friendly   This is a small-scale strategic planning session that helps groups and individuals to take action toward a desired change. It is often used at the end of a workshop or programme. The group discusses and agrees on a vision, then creates some action steps that will lead them towards that vision. The scope of the challenge is also defined, through discussion of the helpful and harmful factors influencing the group.

Prioritization

As organisations grow, the scale and variation of problems they face multiplies. Your team or is likely to face numerous challenges in different areas and so having the skills to analyze and prioritize becomes very important, particularly for those in leadership roles.

A thorough problem solving process is likely to deliver multiple solutions and you may have several different problems you wish to solve simultaneously. Prioritization is the ability to measure the importance, value, and effectiveness of those possible solutions and choose which to enact and in what order. The process of prioritization is integral in ensuring the biggest challenges are addressed with the most impactful solutions.

Impact and Effort Matrix   #gamestorming   #decision making   #action   #remote-friendly   In this decision-making exercise, possible actions are mapped based on two factors: effort required to implement and potential impact. Categorizing ideas along these lines is a useful technique in decision making, as it obliges contributors to balance and evaluate suggested actions before committing to them.

Project management

Some problem solving skills are utilized in a workshop or ideation phases, while others come in useful when it comes to decision making. Overseeing an entire problem solving process and ensuring its success requires strong project management skills. 

While project management incorporates many of the other skills listed here, it is important to note the distinction of considering all of the factors of a project and managing them successfully. Being able to negotiate with stakeholders, manage tasks, time and people, consider costs and ROI, and tie everything together is massively helpful when going through the problem solving process. 

Record keeping

Working out meaningful solutions to organizational challenges is only one part of the process.  Thoughtfully documenting and keeping records of each problem solving step for future consultation is important in ensuring efficiency and meaningful change. 

For example, some problems may be lower priority than others but can be revisited in the future. If the team has ideated on solutions and found some are not up to the task, record those so you can rule them out and avoiding repeating work. Keeping records of the process also helps you improve and refine your problem solving model next time around!

Personal Kanban   #gamestorming   #action   #agile   #project planning   Personal Kanban is a tool for organizing your work to be more efficient and productive. It is based on agile methods and principles.

Research skills

Conducting research to support both the identification of problems and the development of appropriate solutions is important for an effective process. Knowing where to go to collect research, how to conduct research efficiently, and identifying pieces of research are relevant are all things a good researcher can do well. 

In larger groups, not everyone has to demonstrate this ability in order for a problem solving workshop to be effective. That said, having people with research skills involved in the process, particularly if they have existing area knowledge, can help ensure the solutions that are developed with data that supports their intention. Remember that being able to deliver the results of research efficiently and in a way the team can easily understand is also important. The best data in the world is only as effective as how it is delivered and interpreted.

Customer experience map   #ideation   #concepts   #research   #design   #issue analysis   #remote-friendly   Customer experience mapping is a method of documenting and visualizing the experience a customer has as they use the product or service. It also maps out their responses to their experiences. To be used when there is a solution (even in a conceptual stage) that can be analyzed.

Risk management

Managing risk is an often overlooked part of the problem solving process. Solutions are often developed with the intention of reducing exposure to risk or solving issues that create risk but sometimes, great solutions are more experimental in nature and as such, deploying them needs to be carefully considered. 

Managing risk means acknowledging that there may be risks associated with more out of the box solutions or trying new things, but that this must be measured against the possible benefits and other organizational factors. 

Be informed, get the right data and stakeholders in the room and you can appropriately factor risk into your decision making process. 

Decisions, Decisions…   #communication   #decision making   #thiagi   #action   #issue analysis   When it comes to decision-making, why are some of us more prone to take risks while others are risk-averse? One explanation might be the way the decision and options were presented.  This exercise, based on Kahneman and Tversky’s classic study , illustrates how the framing effect influences our judgement and our ability to make decisions . The participants are divided into two groups. Both groups are presented with the same problem and two alternative programs for solving them. The two programs both have the same consequences but are presented differently. The debriefing discussion examines how the framing of the program impacted the participant’s decision.

Team-building 

No single person is as good at problem solving as a team. Building an effective team and helping them come together around a common purpose is one of the most important problem solving skills, doubly so for leaders. By bringing a team together and helping them work efficiently, you pave the way for team ownership of a problem and the development of effective solutions. 

In a problem solving workshop, it can be tempting to jump right into the deep end, though taking the time to break the ice, energize the team and align them with a game or exercise will pay off over the course of the day.

Remember that you will likely go through the problem solving process multiple times over an organization’s lifespan and building a strong team culture will make future problem solving more effective. It’s also great to work with people you know, trust and have fun with. Working on team building in and out of the problem solving process is a hallmark of successful teams that can work together to solve business problems.

9 Dimensions Team Building Activity   #ice breaker   #teambuilding   #team   #remote-friendly   9 Dimensions is a powerful activity designed to build relationships and trust among team members. There are 2 variations of this icebreaker. The first version is for teams who want to get to know each other better. The second version is for teams who want to explore how they are working together as a team.

Time management 

The problem solving process is designed to lead a team from identifying a problem through to delivering a solution and evaluating its effectiveness. Without effective time management skills or timeboxing of tasks, it can be easy for a team to get bogged down or be inefficient.

By using a problem solving model and carefully designing your workshop, you can allocate time efficiently and trust that the process will deliver the results you need in a good timeframe.

Time management also comes into play when it comes to rolling out solutions, particularly those that are experimental in nature. Having a clear timeframe for implementing and evaluating solutions is vital for ensuring their success and being able to pivot if necessary.

Improving your skills at problem solving is often a career-long pursuit though there are methods you can use to make the learning process more efficient and to supercharge your problem solving skillset.

Remember that the skills you need to be a great problem solver have a large overlap with those skills you need to be effective in any role. Investing time and effort to develop your active listening or critical thinking skills is valuable in any context. Here are 7 ways to improve your problem solving skills.

Share best practices

Remember that your team is an excellent source of skills, wisdom, and techniques and that you should all take advantage of one another where possible. Best practices that one team has for solving problems, conducting research or making decisions should be shared across the organization. If you have in-house staff that have done active listening training or are data analysis pros, have them lead a training session. 

Your team is one of your best resources. Create space and internal processes for the sharing of skills so that you can all grow together. 

Ask for help and attend training

Once you’ve figured out you have a skills gap, the next step is to take action to fill that skills gap. That might be by asking your superior for training or coaching, or liaising with team members with that skill set. You might even attend specialized training for certain skills – active listening or critical thinking, for example, are business-critical skills that are regularly offered as part of a training scheme.

Whatever method you choose, remember that taking action of some description is necessary for growth. Whether that means practicing, getting help, attending training or doing some background reading, taking active steps to improve your skills is the way to go.

Learn a process 

Problem solving can be complicated, particularly when attempting to solve large problems for the first time. Using a problem solving process helps give structure to your problem solving efforts and focus on creating outcomes, rather than worrying about the format. 

Tools such as the seven-step problem solving process above are effective because not only do they feature steps that will help a team solve problems, they also develop skills along the way. Each step asks for people to engage with the process using different skills and in doing so, helps the team learn and grow together. Group processes of varying complexity and purpose can also be found in the SessionLab library of facilitation techniques . Using a tried and tested process and really help ease the learning curve for both those leading such a process, as well as those undergoing the purpose.

Effective teams make decisions about where they should and shouldn’t expend additional effort. By using a problem solving process, you can focus on the things that matter, rather than stumbling towards a solution haphazardly. 

Create a feedback loop

Some skills gaps are more obvious than others. It’s possible that your perception of your active listening skills differs from those of your colleagues. 

It’s valuable to create a system where team members can provide feedback in an ordered and friendly manner so they can all learn from one another. Only by identifying areas of improvement can you then work to improve them. 

Remember that feedback systems require oversight and consideration so that they don’t turn into a place to complain about colleagues. Design the system intelligently so that you encourage the creation of learning opportunities, rather than encouraging people to list their pet peeves.

While practice might not make perfect, it does make the problem solving process easier. If you are having trouble with critical thinking, don’t shy away from doing it. Get involved where you can and stretch those muscles as regularly as possible. 

Problem solving skills come more naturally to some than to others and that’s okay. Take opportunities to get involved and see where you can practice your skills in situations outside of a workshop context. Try collaborating in other circumstances at work or conduct data analysis on your own projects. You can often develop those skills you need for problem solving simply by doing them. Get involved!

Use expert exercises and methods

Learn from the best. Our library of 700+ facilitation techniques is full of activities and methods that help develop the skills you need to be an effective problem solver. Check out our templates to see how to approach problem solving and other organizational challenges in a structured and intelligent manner.

There is no single approach to improving problem solving skills, but by using the techniques employed by others you can learn from their example and develop processes that have seen proven results. 

Try new ways of thinking and change your mindset

Using tried and tested exercises that you know well can help deliver results, but you do run the risk of missing out on the learning opportunities offered by new approaches. As with the problem solving process, changing your mindset can remove blockages and be used to develop your problem solving skills.

Most teams have members with mixed skill sets and specialties. Mix people from different teams and share skills and different points of view. Teach your customer support team how to use design thinking methods or help your developers with conflict resolution techniques. Try switching perspectives with facilitation techniques like Flip It! or by using new problem solving methodologies or models. Give design thinking, liberating structures or lego serious play a try if you want to try a new approach. You will find that framing problems in new ways and using existing skills in new contexts can be hugely useful for personal development and improving your skillset. It’s also a lot of fun to try new things. Give it a go!

Encountering business challenges and needing to find appropriate solutions is not unique to your organization. Lots of very smart people have developed methods, theories and approaches to help develop problem solving skills and create effective solutions. Learn from them!

Books like The Art of Thinking Clearly , Think Smarter, or Thinking Fast, Thinking Slow are great places to start, though it’s also worth looking at blogs related to organizations facing similar problems to yours, or browsing for success stories. Seeing how Dropbox massively increased growth and working backward can help you see the skills or approach you might be lacking to solve that same problem. Learning from others by reading their stories or approaches can be time-consuming but ultimately rewarding.

A tired, distracted mind is not in the best position to learn new skills. It can be tempted to burn the candle at both ends and develop problem solving skills outside of work. Absolutely use your time effectively and take opportunities for self-improvement, though remember that rest is hugely important and that without letting your brain rest, you cannot be at your most effective. 

Creating distance between yourself and the problem you might be facing can also be useful. By letting an idea sit, you can find that a better one presents itself or you can develop it further. Take regular breaks when working and create a space for downtime. Remember that working smarter is preferable to working harder and that self-care is important for any effective learning or improvement process.

Want to design better group processes?

Over to you

Now we’ve explored some of the key problem solving skills and the problem solving steps necessary for an effective process, you’re ready to begin developing more effective solutions and leading problem solving workshops.

Need more inspiration? Check out our post on problem solving activities you can use when guiding a group towards a great solution in your next workshop or meeting. Have questions? Did you have a great problem solving technique you use with your team? Get in touch in the comments below. We’d love to chat!

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Problem-Solving Training Course Materials for the Workplace

Last updated April 2, 2024

Our Problem-Solving training course materials are for freelance and corporate trainers to run sessions on how to solve fairly complex problems as workplace training. These materials are suitable to train leaders, managers, and employees at any level.

The materials guide the participants through a seven-step problem-solving process and introduce them to some useful techniques (some creative and some more analytical) they can apply to help them find solutions to their problems.

This training package is:

• Fully customizable and editable
• US English & British English compatible
• Downloadable immediately
• Can also be  adapted to use for online teaching  and training in virtual classrooms.
• and you will own the rights to edit and reuse it for as many of ‘ your own courses’  as you wish

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British GBP £127 (approx. USD$159)

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Why Problem-Solving Skills Are Essential for Leaders in Any Industry

• 17 Jan 2023

Any organization offering a product or service is in the business of solving problems.

Whether providing medical care to address health issues or quick convenience to those hungry for dinner, a business’s purpose is to satisfy customer needs .

In addition to solving customers’ problems, you’ll undoubtedly encounter challenges within your organization as it evolves to meet customer needs. You’re likely to experience growing pains in the form of missed targets, unattained goals, and team disagreements.

Yet, the ubiquity of problems doesn’t have to be discouraging; with the right frameworks and tools, you can build the skills to solve consumers' and your organization’s most challenging issues.

Here’s a primer on problem-solving in business, why it’s important, the skills you need, and how to build them.

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What Is Problem-Solving in Business?

Problem-solving is the process of systematically removing barriers that prevent you or others from reaching goals.

Your business removes obstacles in customers’ lives through its products or services, just as you can remove obstacles that keep your team from achieving business goals.

Design Thinking

Design thinking , as described by Harvard Business School Dean Srikant Datar in the online course Design Thinking and Innovation , is a human-centered , solutions-based approach to problem-solving and innovation. Originally created for product design, design thinking’s use case has evolved . It’s now used to solve internal business problems, too.

The design thinking process has four stages :

• Clarify: Clarify a problem through research and feedback from those impacted.
• Ideate: Armed with new insights, generate as many solutions as possible.
• Develop: Combine and cull your ideas into a short list of viable, feasible, and desirable options before building prototypes (if making physical products) and creating a plan of action (if solving an intangible problem).
• Implement: Execute the strongest idea, ensuring clear communication with all stakeholders about its potential value and deliberate reasoning.

Using this framework, you can generate innovative ideas that wouldn’t have surfaced otherwise.

Creative Problem-Solving

Another, less structured approach to challenges is creative problem-solving , which employs a series of exercises to explore open-ended solutions and develop new perspectives. This is especially useful when a problem’s root cause has yet to be defined.

You can use creative problem-solving tools in design thinking’s “ideate” stage, which include:

• Brainstorming: Instruct everyone to develop as many ideas as possible in an allotted time frame without passing judgment.
• Divergent thinking exercises: Rather than arriving at the same conclusion (convergent thinking), instruct everyone to come up with a unique idea for a given prompt (divergent thinking). This type of exercise helps avoid the tendency to agree with others’ ideas without considering alternatives.
• Alternate worlds: Ask your team to consider how various personas would manage the problem. For instance, how would a pilot approach it? What about a young child? What about a seasoned engineer?

It can be tempting to fall back on how problems have been solved before, especially if they worked well. However, if you’re striving for innovation, relying on existing systems can stunt your company’s growth.

Related: How to Be a More Creative Problem-Solver at Work: 8 Tips

Why Is Problem-Solving Important for Leaders?

While obstacles’ specifics vary between industries, strong problem-solving skills are crucial for leaders in any field.

Whether building a new product or dealing with internal issues, you’re bound to come up against challenges. Having frameworks and tools at your disposal when they arise can turn issues into opportunities.

As a leader, it’s rarely your responsibility to solve a problem single-handedly, so it’s crucial to know how to empower employees to work together to find the best solution.

Your job is to guide them through each step of the framework and set the parameters and prompts within which they can be creative. Then, you can develop a list of ideas together, test the best ones, and implement the chosen solution.

Related: 5 Design Thinking Skills for Business Professionals

4 Problem-Solving Skills All Leaders Need

1. problem framing.

One key skill for any leader is framing problems in a way that makes sense for their organization. Problem framing is defined in Design Thinking and Innovation as determining the scope, context, and perspective of the problem you’re trying to solve.

“Before you begin to generate solutions for your problem, you must always think hard about how you’re going to frame that problem,” Datar says in the course.

For instance, imagine you work for a company that sells children’s sneakers, and sales have plummeted. When framing the problem, consider:

• What is the children’s sneaker market like right now?
• Should we improve the quality of our sneakers?
• Should we assess all children’s footwear?
• Is this a marketing issue for children’s sneakers specifically?
• Is this a bigger issue that impacts how we should market or produce all footwear?

While there’s no one right way to frame a problem, how you do can impact the solutions you generate. It’s imperative to accurately frame problems to align with organizational priorities and ensure your team generates useful ideas for your firm.

To solve a problem, you need to empathize with those impacted by it. Empathy is the ability to understand others’ emotions and experiences. While many believe empathy is a fixed trait, it’s a skill you can strengthen through practice.

When confronted with a problem, consider whom it impacts. Returning to the children’s sneaker example, think of who’s affected:

• Your organization’s employees, because sales are down
• The customers who typically buy your sneakers
• The children who typically wear your sneakers

Empathy is required to get to the problem’s root and consider each group’s perspective. Assuming someone’s perspective often isn’t accurate, so the best way to get that information is by collecting user feedback.

For instance, if you asked customers who typically buy your children’s sneakers why they’ve stopped, they could say, “A new brand of children’s sneakers came onto the market that have soles with more traction. I want my child to be as safe as possible, so I bought those instead.”

When someone shares their feelings and experiences, you have an opportunity to empathize with them. This can yield solutions to their problem that directly address its root and shows you care. In this case, you may design a new line of children’s sneakers with extremely grippy soles for added safety, knowing that’s what your customers care most about.

Related: 3 Effective Methods for Assessing Customer Needs

3. Breaking Cognitive Fixedness

Cognitive fixedness is a state of mind in which you examine situations through the lens of past experiences. This locks you into one mindset rather than allowing you to consider alternative possibilities.

For instance, your cognitive fixedness may make you think rubber is the only material for sneaker treads. What else could you use? Is there a grippier alternative you haven’t considered?

Problem-solving is all about overcoming cognitive fixedness. You not only need to foster this skill in yourself but among your team.

4. Creating a Psychologically Safe Environment

As a leader, it’s your job to create an environment conducive to problem-solving. In a psychologically safe environment, all team members feel comfortable bringing ideas to the table, which are likely influenced by their personal opinions and experiences.

If employees are penalized for “bad” ideas or chastised for questioning long-held procedures and systems, innovation has no place to take root.

By employing the design thinking framework and creative problem-solving exercises, you can foster a setting in which your team feels comfortable sharing ideas and new, innovative solutions can grow.

How to Build Problem-Solving Skills

The most obvious answer to how to build your problem-solving skills is perhaps the most intimidating: You must practice.

Again and again, you’ll encounter challenges, use creative problem-solving tools and design thinking frameworks, and assess results to learn what to do differently next time.

While most of your practice will occur within your organization, you can learn in a lower-stakes setting by taking an online course, such as Design Thinking and Innovation . Datar guides you through each tool and framework, presenting real-world business examples to help you envision how you would approach the same types of problems in your organization.

Are you interested in uncovering innovative solutions for your organization’s business problems? Explore Design Thinking and Innovation —one of our online entrepreneurship and innovation courses —to learn how to leverage proven frameworks and tools to solve challenges. Not sure which course is right for you? Download our free flowchart .

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7 Steps to Improve Your Problem Solving Skills

Our lives are full of problems. And the biggest problem is finding an effective solution to any problem. Seems funny, right? But it’s true. Every day, from your personal to professional life, you have to deal with different kinds of problems, and it’s not unnatural that sometimes you struggle to solve them. Though in the end, you find a solution, it takes too much effort and time. Don’t you think it would be better if you could find the solution in the first place? That’s where problem-solving skills would help you a way out. 

Problem-solving skills are vital to have in professional life. Many issues arise in the workplace and giving a quick touch up on them is an unwritten duty for you. In a professional setting, it doesn’t matter that much what solution you find to a problem. Rather it matters how you find that solution and how much time it takes. In this case, another skill which is Problem Solving Skills  merges up with problem-solving skills. Both are important for your regular duties in the workplace and your job growth, especially when you’re in a leadership or management position. f

7 Key Steps to Improve Your Problem Solving Skills

However, everyone is by born a problem solver. But the thing that counts is how efficiently the problem is being solved. That’s why you should nurture problem-solving skills to become an ultimate problem solver. In this article, you’re going to explore seven effective steps that will help you improve your problem-solving skills. So, without further ado, let’s dig deeper.

Step 1: Define The Problem

The first thing that comes when solving a problem is identifying and defining the problem. Without knowing the problem, you can’t move further. So, have a clear understanding of the problem for which you’re going to find a solution. Define the problem and make it precise. Since you won’t be working alone, describe the context, and make sure it is understandable by others who are involved in the decision-making process. However, different people have different perspectives on what a problem is, and you should keep it in your mind. 

If the problem involves software development or coding challenges, don’t hesitate to get coding help to ensure you’re on the right track and can communicate solutions effectively.

Step 2: Analyse The Problem

The second step to solving a problem is analysing the problem. It helps you understand the nature of the problem and find the possible ways out. Develop some creative problem-solving questions in this stage, such as why it is a problem, why it is required to solve it, how to find the solution, what barriers and opportunities lie within the problem, what effect it will cause if the problem isn’t resolved, etc. 

Develop these questions and assign answers to them. In the end, you’ll find a clear picture of the whole situation. This will help you prepare your strategy to solve the problem. 

Step 3: Develop Potential Solutions

Once you’re done with analysing the problem, you have to look for potential solutions to the problem. Note that I said solutions, not a solution. It’s essential to come up with multiple viable solutions to a problem. Because you don’t know yet what outcomes the action is going to bring about. That’s why you should have alternatives in all possible ways to solve the problem so that you can compare them and pick the best one. 

In this regard, you have to set a standard with which you will compare the expected outcomes of the potential solutions. However, don’t use the standard to judge the solutions, instead, use it only for coming up with ideas. 

Step 4: Evaluate The Options

After listing down the potential solutions to the problem, your next task is to analyse and evaluate the options. This will help you determine the most effective and suitable solution to the problem. Now it comes how to evaluate the options. Do it almost in the same way you’ve analysed the problem before. This means asking some questions and comparing the answers for different options. So, the creative problem-solving questions that you’ll make to evaluate the problem may look like the followings:

• Is the solution easily achievable?
• How much effort and resources it will take?
• Does it fit the organizational processes and cultures?
• What are the pros and cons of the solution?
• What is the possible outcome of this solution?
• Is it well suited to the time and budget?

Prepare the answers for each of the options and compare them. Then eliminate those which don’t pass the criteria and tailor the list for further action.

Step 5: Select The Best Option

After evaluating all the possible solutions and tailoring the list, you have a concise list of solutions to the problem. Now you have to choose the best solution among these options. Select the solution that is best fitted to the organizational cultures and goals, and meets all the criteria that you set for evaluating the options. In this case, your experience, courage, and decision-making skills will help you to determine the option.  

However, you may consult your peers as it would give you different insights into the situation. After selecting the best-suited solution, make the necessary documentation, and submit to the authority for approval.

Step 6: Implement The Solution

You’ve selected the solution to the problem and got it approved by the higher authority. Now it’s time to go for action and showcase your problem-solving skills. So, at first, you have to prepare a detailed work plan putting all the necessary things into it. You have to ensure that every one of your team understands the plan and what are their responsibilities to make the plan fruitful. So, you should communicate well with everyone involved in the plan. 

Also, your plan should include actions to be taken if something goes wrong or doesn’t go just like as you thought it would. This is important to make a concrete plan. After setting the plan, arrange everything you require and put your solution into action, and wait for the results. 

Step 7: Measure The Results

Your duty isn’t finished with the implementation of your solution. You have to keep track to measure the results and make sure the plan is performing well to solve the problem. Great leaders always keep follow-ups and proper documentation of their actions. It’s helpful in their future challenges and acts as a guideline for their successors. Moreover, it will help you show a scalable and notable outcome of your plan to the authority. 

Now it’s time to wrap up. Following these seven simple steps will strengthen your problem-solving skills and make you an efficient problem solver in your organization. However, problem-solving is a vast topic, and there are even more things to explore about it which aren’t possible to include in a single article. If you want to explore more and develop your problem-solving skills, it will be better to take training on this. 

But how can you attend formal training when you’ve lots of duties to do? In this case, you can consider taking online training where you can learn anytime from anywhere, and most importantly, without juggling your regular schedule. To help you in this regard, Training Express is offering an online course on problem-solving skills where you’ll be learning from experts. So what are you waiting for? Have a look at this. 

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What Is Problem-Solving Therapy?

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

• Applying a positive problem-solving orientation to your life
• Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

• Knowing how to identify a problem
• Defining the problem in a helpful way
• Trying to understand the problem more deeply
• Setting goals related to the problem
• Generating alternative, creative solutions to the problem
• Choosing the best course of action
• Implementing the choice you have made
• Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

• Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
• Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
• Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
• Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

• Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
• Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
• Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

• Chronic stress due to accumulating minor issues
• Complications associated with traumatic brain injury (TBI)
• Emotional distress
• Post-traumatic stress disorder (PTSD)
• Problems associated with a chronic disease like cancer, heart disease, or diabetes
• Self-harm and feelings of hopelessness
• Substance use
• Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

• Death of a loved one
• Dissatisfaction at work
• Everyday life stressors
• Family problems
• Financial difficulties
• Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

• Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
• Confidence that you can handle problems that you face
• Having a systematic approach on how to deal with life's problems
• Having a toolbox of strategies to solve the issues you face
• Increased confidence to find creative solutions
• Knowing how to identify which barriers will impede your progress
• Knowing how to manage emotions when they arise
• Reduced avoidance and increased action-taking
• The ability to accept life problems that can't be solved
• The ability to make effective decisions
• The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

• Older adults
• People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

• Introduction
• Conclusions
• Article Information

GRADE indicates Grading of Recommendations, Assessment, Development, and Evaluations; SMD, standardized mean difference.

a For meta-analysis of parental problem-solving skills, quality of life, pediatric quality of life, and social functioning, the problem-solving skills training (PSST) group was preferable when the effect size was greater than 0, while the value of effect size for other outcomes less than 0 indicated a favor of PSST.

b For meta-analysis of parental posttraumatic stress, quality of life, pediatric mental problems, and parent-child conflict, the values of I 2 were less than 50%, and the inverse variance method was therefore used.

c Downgraded 1 level for serious inconsistency due to statistical heterogeneity.

d Downgraded 1 level for serious risk of bias of included studies.

e Downgraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 1 level for serious imprecision due to limited sample size.

f Downgraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 2 levels for very serious imprecision due to limited sample size and wide CIs.

g Downgraded 2 levels for very serious imprecision due to limited sample size and data from only 2 studies.

h Downgraded 1 level for serious inconsistency due to statistical heterogeneity and downgraded 1 level for serious imprecision due to wide CIs.

i Downgraded 1 level for serious imprecision due to limited sample size.

j Downgraded 1 level for serious risk of bias of included studies and downgraded 1 level for serious imprecision due to limited sample size.

eTable 1. Study Search Strategies

eTable 2. Intervention Characteristics of Included Studies

eTable 3. Author Judgments of Risk of Bias Across All Included Studies

eTable 4. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile

eFigure 1. Forest Plot Meta-Analyses for Different Psychosocial Outcomes

eFigure 2. Subgroup Analyses of Each Outcome According to Children- and Intervention-Level Factors

eFigure 3. Funnel Plot Analyses

eFigure 4. Leave-One-Out Sensitivity Analyses

Data Sharing Statement

• Enhancing the Interpretation of Continuous Outcomes and Subgroup Analyses in Systematic Reviews JAMA Pediatrics Comment & Response April 22, 2024 Jing Wu, PhD; Qi Wang, PhD; Xiaoning He, PhD

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Zhou T , Luo Y , Xiong W , Meng Z , Zhang H , Zhang J. Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions : A Systematic Review and Meta-Analysis . JAMA Pediatr. 2024;178(3):226–236. doi:10.1001/jamapediatrics.2023.5753

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Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions : A Systematic Review and Meta-Analysis

• 1 Xiangya School of Nursing, Central South University, Changsha, Hunan, China
• 2 Xiangya Hospital, Central South University, Changsha, Hunan, China
• Comment & Response Enhancing the Interpretation of Continuous Outcomes and Subgroup Analyses in Systematic Reviews Jing Wu, PhD; Qi Wang, PhD; Xiaoning He, PhD JAMA Pediatrics

Question   What is the association between problem-solving skills training (PSST) for parents of children with chronic health conditions and psychosocial outcomes of the parents, their children, and their families?

Findings   In this systematic review and meta-analysis of 23 randomized clinical trials including 3141 parents, PSST was associated with improvements in parental problem-solving skills; decreased parental depression, distress, posttraumatic stress, and parenting stress; better quality of life for both parents and children; fewer pediatric mental problems; and less parent-child conflict.

Meaning   These findings suggest that PSST should be an active component of and serve as an emerging perspective for psychosocial interventions for parents of children with chronic health conditions.

Importance   Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but such evidence has not been fully systematically synthesized.

Objective   To evaluate the associations of PSST with parental, pediatric, and family psychosocial outcomes.

Data Sources   Six English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library), 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang), gray literature, and references were searched from inception to April 30, 2023.

Study Selection   Randomized clinical trials (RCTs) that performed PSST for parents of children with CHCs and reported at least 1 parental, pediatric, or family psychosocial outcome were included.

Data Extraction and Synthesis   Study selection, data extraction, and quality assessment were conducted independently by 2 reviewers. Data were pooled for meta-analysis using the standardized mean difference (SMD) by the inverse variance method or a random-effects model. Subgroup analyses of children- and intervention-level characteristics were conducted.

Main Outcomes and Measures   The psychosocial outcomes of the parents, their children, and their families, such as problem-solving skills, negative affectivity, quality of life (QOL), and family adaptation.

Results   The systematic review included 23 RCTs involving 3141 parents, and 21 of these trials were eligible for meta-analysis. There was a significant association between PSST and improvements in parental outcomes, including problem-solving skills (SMD, 0.43; 95% CI, 0.27-0.58), depression (SMD, −0.45; 95% CI, −0.66 to −0.23), distress (SMD, −0.61; 95% CI, −0.81 to −0.40), posttraumatic stress (SMD −0.39; 95% CI, −0.48 to −0.31), parenting stress (SMD, −0.62; 95% CI, −1.05 to −0.19), and QOL (SMD, 0.45; 95% CI, 0.15-0.74). For children, PSST was associated with better QOL (SMD, 0.76; 95% CI, 0.04-1.47) and fewer mental problems (SMD, −0.51; 95% CI, −0.68 to −0.34), as well as with less parent-child conflict (SMD, −0.38; 95% CI, −0.60 to −0.16). Subgroup analysis showed that PSST was more efficient for parents of children aged 10 years or younger or who were newly diagnosed with a CHC. Significant improvements in most outcomes were associated with PSST delivered online.

Conclusions and Relevance   These findings suggest that PSST for parents of children with CHCs may improve the psychosocial well-being of the parents, their children, and their families. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence.

Childhood chronic health conditions (CHCs) include physical, developmental, behavioral, or emotional conditions with an expected duration of more than 3 months or the impossibility of cure. 1 Approximately 37% of children have at least 1 current or lifelong health condition. 2 The diagnosis of a childhood CHC and its prolonged treatments are profoundly unsettling experiences for children and their families, especially their parents. 3 - 5 Compared with parents of healthy children, parents of children with CHCs have reported worse mental health (more depression, anxiety, and posttraumatic stress), 6 - 8 significant stress and burden, 9 , 10 and a poorer quality of life (QOL). 6 , 11 Considering that parental psychosocial outcomes are strongly associated with children’s health and family adaptation, 12 - 14 interventions to improve parents’ well-being may have synergistic benefits for the whole family. Parental problem-solving skills, which are associated with parents’ well-being, are general coping skills applicable to a variety of difficult situations commonly encountered during the treatment of childhood CHCs. 15 With better problem-solving skills, parents could become more self-assured to address children’s health concerns, fully use resources to cope with stress, and collaborate to address challenges presented by daily care, thereby improving family adaptation and children’s health outcomes. 16 However, nearly one-half of parents lack problem-solving skills, especially the ability to solve daily problems related to their children’s complex treatment processes, 3 which may eventually perpetuate negative outcomes for parental and child well-being. 17 , 18

Problem-solving skills training (PSST) is an effective intervention to improve problem-solving skills and decrease negative affectivity. 19 , 20 Based on the problem-solving therapy approaches of D’Zurilla and colleagues, 20 , 21 PSST includes 2 essential components: establishing a positive problem orientation and mastering the systematic steps to solve problems. The training has long been established as being effective in adults with chronic illness and their caregivers, 22 , 23 which theoretically could have broad outcomes for parents of children with CHCs due to the long-term nature and equally multiple, intensive, and ongoing stressors across childhood CHCs. Problem-solving skills training is a cognitive-behavioral process by which parents can identify and create problem-focused strategies to buffer the outcomes of stressful events and improve coping, thus preventing episodes of negative affectivity by effectively solving various children’s disease-related problems. 15 , 21 These problem-solving strategies, while possibly differing in specifics, are beneficial in helping parents to cope with significant stressors inherent to each CHC. Preliminary studies have shown the efficacy of PSST in enhancing problem-solving skills and alleviating depression symptoms for parents, although the majority of such studies have had small sample sizes. Moreover, these studies only considered improved parental well-being, and most did not show significant changes in pediatric or family adaptation outcomes. 15 , 24 In addition, although previous reviews of PSST have explored the effectiveness of psychosocial interventions for parents of children with CHCs, they had limited specificity. 19 , 25 - 28 To address these gaps, we evaluated the associations between PSST for parents of children with CHCs and parental, pediatric, and family psychosocial outcomes.

The study protocol for this systematic review and meta-analysis has been registered with PROSPERO ( CRD42023424077 ). The revised Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA ) guideline 29 was followed to report the findings.

A systematic search was performed across 6 English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library) and 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) from inception to April 30, 2023. The search strategies applied a combination of Medical Subject Heading terms and keywords, and the following constructs were used: child AND chronic health conditions AND parents AND PSST. The full search string for each database is provided in eTable 1 in Supplement 1 . Gray literature was searched using OpenGrey, Mednar, and the World Health Organization’s search portal. We also screened reference lists of included studies to identify potentially eligible articles.

The population, intervention, comparator, outcomes, and study design framework was used to define the inclusion and exclusion criteria ( Table 1 ). Eligible studies were RCTs that performed PSST for parents of children with CHCs and reported at least 1 psychosocial outcome of parents, children, or their families.

All identified articles were imported into EndNote, version 20.0 (Clarivate Analytics) to eliminate duplications. Title and abstract screening and full-text review were performed independently using the web-based software Rayyan 30 by 2 reviewers (T.Z. and W.X.). Data extraction was conducted in duplicate by the 2 reviewers and checked by another reviewer (Y.L.). Information was extracted using a predesigned worksheet, including publication details, population demographics (pediatric [age, medical condition, and illness duration] and parental [age, sex, race and ethnicity]), intervention and control group details (approach, mode, number of sessions, and duration), and psychosocial outcomes and measures.

We included only the postintervention data in the meta-analysis, as follow-up data were not reported consistently enough to achieve proper homogeneity. When both parents and children reported a psychosocial outcome of children, we prioritized extracting the parent-reported data, as they were more reliable. If multiple records were available for the same trial, we collected all relevant data and analyzed them as a single study. Corresponding authors were contacted via email to retrieve missing data.

The risk of bias for the included studies was assessed independently by 2 reviewers (T.Z. and W.X.) according to the revised Cochrane risk-of-bias tool, version 2.0, 31 which includes 5 domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. We judged the studies to be low risk, of some concern, or high risk. Additionally, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) 32 framework was applied to assess the certainty of the evidence for all outcomes. The certainty was categorized as high, moderate, low, or very low based on the risk of bias, inconsistency, imprecision, indirectness, and publication bias. 33 , 34 Any disagreements in the study selection, data extraction, and quality assessment processes were resolved through discussion to reach a consensus, and if conflicts persisted, they were arbitrated by a third reviewer (Y.L.).

Statistical analyses were performed using Stata, version 16 software (StataCorp LLC). We conducted a meta-analysis only when 2 or more intervention studies were available with similar participants and outcomes. The psychosocial outcomes included in this review were measured by different scales; therefore, the effect size is presented as the standardized mean difference (SMD) with 95% CI. 35 Statistical heterogeneity was assessed using both the χ 2 test and I 2 statistic. 36 The inverse variance method ( P  ≥ .10 and I 2 <50%) or a random-effects model ( P  < .10 or I 2 ≥50%) was applied based on the P and I 2 values. Subgroup analyses were performed for children’s and intervention characteristics. In addition, we conducted leave-one-out sensitivity analyses to examine the consistent associations between PSST and all identified outcomes. We also used funnel plots and Egger test to evaluate the publication bias for analyses with at least 10 studies. 37 The threshold for statistical significance was set at a 2-sided P  < .05. The most recent analysis update was performed between October 10 and 20, 2023.

The initial comprehensive search yielded 2665 publications: 2641 from 9 databases and an additional 24 from gray literature and reference list review. After removing 1195 duplicates and screening 1470 titles and abstracts, 227 full-text articles were assessed for eligibility. Ultimately, 23 eligible RCTs 38 - 60 were included in the review, and 21 studies 38 - 42 , 44 - 48 , 50 - 60 were included in the meta-analysis ( Figure 1 ). Almost perfect agreement on the study selection was achieved (97%; κ = 0.89). 61

Table 2 summarizes the characteristics of the included 23 RCTs published between 2002 and 2021. Most were conducted in the US (21 studies 38 , 40 - 44 , 46 - 60 ), with 1 study each in Australia 45 and Jamaica. 39 Twenty-one studies 38 - 48 , 50 - 59 used a 2-arm RCT design. In addition, most studies (12 [52%]) 39 , 42 , 45 - 48 , 50 , 53 - 57 reported that a control group received usual care.

A total of 3141 parents were included in this review. Twenty-one studies 38 - 47 , 49 - 58 , 60 reported on parent sex, which totaled 2799 mothers (94%) and 185 fathers (6%), and 6 studies 38 , 39 , 42 , 53 - 55 only recruited mothers. The age of the parents ranged from 20 to 67 years, with an estimated mean (SD) age of 38.3 (9.0) years. Of 2914 parents who reported race and ethnicity, 38 , 41 - 44 , 46 - 60 569 (19%) were Hispanic, 316 (11%) were non-Hispanic Black, 1708 (59%) were non-Hispanic White, and 321 (11%) were of other race or ethnicity. The CHC diagnoses were traumatic brain injury (6 studies), 49 , 51 , 57 - 60 cancer (5 studies), 38 , 52 - 55 sickle cell disease (2 studies), 39 , 40 autism spectrum disorder (2 studies), 41 , 42 epilepsy (2 studies), 46 , 47 mental health problems (1 study), 43 inflammatory bowel disease (1 study), 44 first-episode psychosis (1 study), 45 diabetes (1 study), 48 chronic pain (1 study), 50 and asthma (1 study). 56 The mean (SD) age of the children was 10.0 (5.5) years, with the illness duration ranging from 2 weeks to 8 years.

Problem-solving skills training was confirmed as the primary focus of the intervention across the 23 RCTs, all of which were developed based on problem-solving therapy that emphasized positive problem orientation and covered the 5 core problem-solving steps (eTable 2 in Supplement 1 ). The number of PSST sessions included ranged from 2 to 21, with the duration of PSST varying from 5 weeks to 12 months. Most studies (18 [78%]) 38 - 43 , 45 - 48 , 50 , 52 - 57 , 60 involved interventions that required parents to attend face-to-face sessions, 6 of which integrated telephone-based online support. 40 , 43 , 45 - 48 In the remaining studies, 38 , 44 , 49 , 51 , 52 , 58 - 60 PSST was delivered entirely online, including via telephone sessions, web-based didactic modules, and videoconferences. Three interventions 39 - 41 were group-based, 9 interventions 38 , 42 , 43 , 45 , 50 , 52 - 55 were delivered to individuals 1 on 1, and 11 interventions 44 , 46 - 49 , 51 , 56 - 60 included both parents and children.

The methodological quality assessment resulted in 96% mutual agreement (κ = 0.93). 61 Seven studies (30%) 39 , 42 , 45 , 47 , 50 , 51 , 56 were classified as low risk, 8 studies (35%) 40 , 44 , 46 , 52 , 55 , 57 , 58 , 60 raised some concerns, and 8 studies (35%) 38 , 41 , 43 , 48 , 49 , 53 , 54 , 59 were identified as having a high risk ( Figure 2 ). Two studies 41 , 48 reported neither random sequence generation nor allocation concealment and hence were considered high risk for the randomization process. For 5 trials (22%), 38 , 49 , 53 , 54 , 59 there was a high risk of reporting bias, as the prespecified outcomes were not fully reported (eTable 3 in Supplement 1 ).

Figure 3 illustrates the meta-analysis summary for all outcomes. Forest plots and GRADE ratings are presented in eFigure 1 and eTable 4 in Supplement 1 , respectively.

Overall, PSST had a significant positive effect on problem-solving skills (12 studies including 1887 parents 38 - 42 , 46 , 50 , 52 - 55 , 58 ; SMD, 0.43; 95% CI, 0.27-0.58; I 2  = 64.28%), depression (12 studies including 2036 parents 38 , 39 , 41 , 42 , 50 - 52 , 54 , 55 , 57 , 58 , 60 ; SMD, −0.45; 95% CI, −0.66 to −0.23; I 2  = 85.29%), and distress (12 studies including 2038 parents 38 , 45 , 50 - 55 , 57 - 60 ; SMD, −0.61; 95% CI, −0.81 to −0.40; I 2  = 83.88%), all of which indicated a medium effect size and moderate certainty evidence. The studies also showed that PSST significantly alleviated posttraumatic stress (5 studies including 1469 parents 38 , 50 , 52 , 54 , 55 ; SMD, −0.39; 95% CI, −0.48 to −0.31; I 2  = 44.93%) and parenting stress (5 studies including 391 parents 39 , 41 , 42 , 45 , 50 ; SMD, −0.62; 95% CI, −1.05 to −0.19; I 2  = 76.24%). The levels of evidence for the associations of PSST with lower posttraumatic stress and parenting stress were moderate and low, respectively. The meta-analysis of parental anxiety showed a positive but nonsignificant effect. In addition, 2 studies 45 , 50 including 175 parents indicated a significant improvement in QOL among parents in the PSST group (SMD, 0.45; 95% CI, 0.15-0.74; I 2  = 0.00%), with low-certainty evidence and no heterogeneity ( Figure 3 ).

There was an association between PSST and better pediatric QOL compared with control groups (6 studies including 590 parents 40 , 44 , 47 , 48 , 56 , 60 ; SMD, 0.76; 95% CI, 0.04-1.47; I 2  = 94.90%). Data for 436 parents showed a significant association between PSST and fewer children’s mental problems (6 studies 50 , 51 , 57 - 60 ; SMD −0.51; 95% CI, −0.68 to −0.34; I 2  = 34.54%) ( Figure 3 ). We found that PSST had both medium effect sizes for improving pediatric QOL and mental health, with low- and moderate-certainty evidence, respectively, whereas no association was found for social functioning. Four RCTs 41 , 48 , 51 , 57 including 314 parents provided low-certainty evidence that PSST may reduce parent-child conflict (SMD, −0.38; 95% CI, −0.60 to −0.16), with moderate heterogeneity ( I 2  = 36.98%).

Subgroup analyses were conducted according to child- and intervention-level characteristics (eFigure 2 in Supplement 1 ). Subgroup analysis by child age indicated that PSST was associated with significant changes in parental depression (SMD, −0.39; 95% CI, −0.52 to −0.26), problem-solving skills (SMD, 0.36; 95% CI, 0.24-0.48), posttraumatic stress (SMD, −0.40; 95% CI, −0.49 to −0.31), and parenting stress (SMD, −0.43; 95% CI, −0.72 to −0.13) for the parents of children who were 10 years or younger compared with the parents of older children (>10 years). Regarding changes in parental depression and posttraumatic stress, PSST had no association for parents of children who had not been newly diagnosed with a CHC but was associated with significant changes (reductions) for parents of children with newly diagnosed CHCs (depression: SMD, −0.40 [95% CI, −0.52 to −0.28]; posttraumatic stress: SMD, −0.40 [95% CI, −0.49 to −0.31]). Furthermore, compared with other medical conditions, PSST was associated with significant improvement in all psychosocial outcomes in parents of children diagnosed with cancer.

Overall, PSST delivered online yielded larger effects on all outcomes except for parent-child conflict than only face-to-face PSST. There was a significant improvement in depression (SMD, −0.39; 95% CI, −0.52 to −0.27) and problem-solving skills (SMD, 0.37; 95% CI, 0.24-0.50) among parents who received individual-based PSST. However, the parent-child interventions showed significant changes in pediatric and family psychosocial outcomes. As for intervention duration, PSST for 5 to 8 weeks had stronger effects on reducing parental depression and parenting stress and improving problem-solving skills than PSST with durations exceeding 8 weeks. The number of sessions followed a similar pattern, with significant improvements in depression (SMD, −0.48; 95% CI, −0.67 to −0.28) and problem-solving skills (SMD, 0.50; 95% CI, 0.29-0.70) among parents who underwent 8 to 12 sessions.

We assessed the publication bias for outcomes that included more than 10 trials (problem-solving skills, parental depression, and distress). Overall, the funnel plots were mostly symmetrical (eFigure 3 in Supplement 1 ); Egger tests were not significant for problem-solving skills ( z  = 1.64, P  = .10), depression ( z  = −1.21, P  = .23), and distress ( z  = −0.46, P  = .65), thus indicating no publication bias. The leave-one-out sensitivity analyses yielded similar results to those of the primary analyses, indicating the robustness of key outcomes (eFigure 4 in Supplement 1 ).

This systematic review and meta-analysis of 23 RCTs is the first to our knowledge to adequately examine the positive association of PSST with improved parental, pediatric, and family psychosocial outcomes. The findings show that PSST was associated with improved problem-solving skills, less negative affectivity, and better QOL for parents. Positivity and problem-solving throughout PSST is achieved by refining problems and effectively troubleshooting obstacles commonly encountered during the treatment of childhood CHCs, thus contributing to parental well-being. 15 , 41 Additionally, PSST was associated with improvements in pediatric QOL, mental health, and parent-child conflict, in accordance with previous review results that psychological interventions for parents may facilitate their ability to scaffold behavioral and emotional changes in their children and thus reduce conflicts between parents and children. 19 , 27 , 62 Our findings extend this evidence by suggesting that PSST is also associated with better psychosocial outcomes for children and families, showing promise for the use of PSST to increase the well-being of all family members and promote family adaptation.

Problem-solving skills training is an emerging and promising area of research, with 17 (74%) included studies published in 2010 or later. 39 - 47 , 49 - 52 , 55 , 56 , 59 , 60 A total of 3141 patients were included in this review, and there were sufficient sample sizes for most outcomes. Although the included RCTs were conducted in only 3 countries, which may decrease the representativeness of the results in terms of dissemination capability, the ethnic and linguistic diversity of parents across included studies showed equally positive responses to PSST when presented in various contexts. Across all psychosocial outcomes, the certainty of the evidence varied from moderate to very low. Despite the suggested effectiveness of PSST in this review, some heterogeneity remains. On one hand, the included studies used diverse definitions and instruments to measure psychosocial outcomes; on the other hand, the studies included parents of children with 11 different CHCs, all of which may have introduced clinical heterogeneity. However, the diversity may also suggest a better clinical fitness of the evidence in this review. Additionally, the current evidence on the long-term effects of PSST is limited by the small number of follow-up studies. Overall, although our review provides relatively high certainty of evidence, further research on higher-level evidence with sustained follow-up is warranted. Furthermore, it is necessary to expand the range of outcomes (eg, physical and clinical) to fully reflect the effectiveness of PSST, as most relevant studies have only reported psychosocial outcomes.

Our subgroup analysis revealed a significant decrease in negative affectivity among the parents of children aged 10 years or younger and who had been newly diagnosed with CHCs, as younger children are more reliant on their parents for daily life and disease management. 63 These findings are compatible with broader evidence supporting early PSST’s improvement of parental well-being when children are newly diagnosed. 64 A significant decrease in negative emotions was also found among parents of children with cancer compared with the parents of children with other medical conditions, possibly because cancer is a leading cause of death in children 65 and their parents may experience a substantial care burden. 8 , 66 The subgroup analysis according to intervention characteristics indicated that online intervention yielded larger effects on most outcomes than the in-person approach, which may be due to the flexibility and wider dissemination of an online approach. 52 , 67 With the rapid development of internet and mobile technologies in pediatric nursing, 68 future research could combine in-person PSST with enhanced online materials. Additionally, individual-based PSST was preferable for parental well-being, whereas the parent-child intervention favored pediatric and family psychosocial outcomes. The participants had more opportunities to receive personalized feedback in the individual-based interventions that included 1-on-1 activities 69 and to enhance family communication and cohesion in the parent-child intervention. 26 Hence, it may be worthwhile to integrate parent-child interaction when tailoring PSST according to families’ needs. Finally, PSST delivered for 5 to 8 weeks and consisting of 8 to 12 sessions had stronger associations in terms of parental psychosocial outcomes. This finding highlights the importance of shorter periods and less complexity to higher engagement in PSST, as parents’ busy schedules may interfere with long-term interventions. 70

This review had several limitations. First, we limited our search to articles in English and Chinese, which might have led to selection bias and affected the reliability of the results. Second, some of the findings must be interpreted with caution, as they were based on only 2 or 3 studies. Third, the assessment could differ across people due to the methodological subjectivity of the risk-of-bias tool and GRADE. Fourth, the psychosocial outcomes identified in this review were measured using multiple scales, and despite using SMD as recommended, the heterogeneity of most outcomes was high. Hence, the interpretability and application of the results were diminished. Finally, only the postintervention data were analyzed, as follow-up data were not reported consistently and sufficiently, and the long-term outcomes remain unclear.

The findings of this systematic review and meta-analysis suggest that PSST is associated with improvements in parental psychosocial outcomes (problem-solving skills, depression, distress, posttraumatic stress, parenting stress, and QOL) as well as pediatric (QOL and mental problems) and family psychosocial outcomes (parent-child conflict). Moreover, our findings on children- and intervention-level characteristics may guide the design and delivery of future PSST by presenting information on factors associated with effectiveness. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence for PSST. In conclusion, PSST should be an active component of psychosocial interventions for parents of children with CHCs.

Accepted for Publication: October 25, 2023.

Published Online: January 2, 2024. doi:10.1001/jamapediatrics.2023.5753

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Zhou T et al. JAMA Pediatrics .

Corresponding Author: Yuanhui Luo, PhD, Xiangya School of Nursing, Central South University, No. 172, Tongzipo Rd, Changsha City 410013, Hunan Province, China ( [email protected] ).

Author Contributions: Drs Zhou and Luo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zhou, Luo, J. Zhang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Zhou, Luo, H. Zhang.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Zhou, Xiong, Meng, H. Zhang.

Obtained funding: Luo.

Administrative, technical, or material support: Luo, J. Zhang.

Supervision: Luo, J. Zhang.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant CMB-OC-22-462 from the China Medical Board (Dr Luo).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions

Tianji zhou.

1 Xiangya School of Nursing, Central South University, Changsha, Hunan, China

Yuanhui Luo

Wenjin xiong, zhenyu meng, hanyi zhang.

2 Xiangya Hospital, Central South University, Changsha, Hunan, China

Jingping Zhang

Accepted for Publication: October 25, 2023.

Published Online: January 2, 2024. doi:10.1001/jamapediatrics.2023.5753

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Zhou T et al. JAMA Pediatrics .

Author Contributions: Drs Zhou and Luo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zhou, Luo, J. Zhang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Zhou, Luo, H. Zhang.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Zhou, Xiong, Meng, H. Zhang.

Obtained funding: Luo.

Administrative, technical, or material support: Luo, J. Zhang.

Supervision: Luo, J. Zhang.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant CMB-OC-22-462 from the China Medical Board (Dr Luo).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

Associated Data

eTable 2. Intervention Characteristics of Included Studies

eTable 3. Author Judgments of Risk of Bias Across All Included Studies

eTable 4. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile

eFigure 1. Forest Plot Meta-Analyses for Different Psychosocial Outcomes

eFigure 2. Subgroup Analyses of Each Outcome According to Children- and Intervention-Level Factors

eFigure 3. Funnel Plot Analyses

eFigure 4. Leave-One-Out Sensitivity Analyses

What is the association between problem-solving skills training (PSST) for parents of children with chronic health conditions and psychosocial outcomes of the parents, their children, and their families?

In this systematic review and meta-analysis of 23 randomized clinical trials including 3141 parents, PSST was associated with improvements in parental problem-solving skills; decreased parental depression, distress, posttraumatic stress, and parenting stress; better quality of life for both parents and children; fewer pediatric mental problems; and less parent-child conflict.

These findings suggest that PSST should be an active component of and serve as an emerging perspective for psychosocial interventions for parents of children with chronic health conditions.

This systematic review and meta-analysis evaluates the association of problem-solving skills training with psychosocial outcomes for parents of children with chronic health conditions.

Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but such evidence has not been fully systematically synthesized.

To evaluate the associations of PSST with parental, pediatric, and family psychosocial outcomes.

Data Sources

Six English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library), 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang), gray literature, and references were searched from inception to April 30, 2023.

Study Selection

Randomized clinical trials (RCTs) that performed PSST for parents of children with CHCs and reported at least 1 parental, pediatric, or family psychosocial outcome were included.

Data Extraction and Synthesis

Study selection, data extraction, and quality assessment were conducted independently by 2 reviewers. Data were pooled for meta-analysis using the standardized mean difference (SMD) by the inverse variance method or a random-effects model. Subgroup analyses of children- and intervention-level characteristics were conducted.

Main Outcomes and Measures

The psychosocial outcomes of the parents, their children, and their families, such as problem-solving skills, negative affectivity, quality of life (QOL), and family adaptation.

The systematic review included 23 RCTs involving 3141 parents, and 21 of these trials were eligible for meta-analysis. There was a significant association between PSST and improvements in parental outcomes, including problem-solving skills (SMD, 0.43; 95% CI, 0.27-0.58), depression (SMD, −0.45; 95% CI, −0.66 to −0.23), distress (SMD, −0.61; 95% CI, −0.81 to −0.40), posttraumatic stress (SMD −0.39; 95% CI, −0.48 to −0.31), parenting stress (SMD, −0.62; 95% CI, −1.05 to −0.19), and QOL (SMD, 0.45; 95% CI, 0.15-0.74). For children, PSST was associated with better QOL (SMD, 0.76; 95% CI, 0.04-1.47) and fewer mental problems (SMD, −0.51; 95% CI, −0.68 to −0.34), as well as with less parent-child conflict (SMD, −0.38; 95% CI, −0.60 to −0.16). Subgroup analysis showed that PSST was more efficient for parents of children aged 10 years or younger or who were newly diagnosed with a CHC. Significant improvements in most outcomes were associated with PSST delivered online.

Conclusions and Relevance

These findings suggest that PSST for parents of children with CHCs may improve the psychosocial well-being of the parents, their children, and their families. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence.

Introduction

Childhood chronic health conditions (CHCs) include physical, developmental, behavioral, or emotional conditions with an expected duration of more than 3 months or the impossibility of cure. 1 Approximately 37% of children have at least 1 current or lifelong health condition. 2 The diagnosis of a childhood CHC and its prolonged treatments are profoundly unsettling experiences for children and their families, especially their parents. 3 , 4 , 5 Compared with parents of healthy children, parents of children with CHCs have reported worse mental health (more depression, anxiety, and posttraumatic stress), 6 , 7 , 8 significant stress and burden, 9 , 10 and a poorer quality of life (QOL). 6 , 11 Considering that parental psychosocial outcomes are strongly associated with children’s health and family adaptation, 12 , 13 , 14 interventions to improve parents’ well-being may have synergistic benefits for the whole family. Parental problem-solving skills, which are associated with parents’ well-being, are general coping skills applicable to a variety of difficult situations commonly encountered during the treatment of childhood CHCs. 15 With better problem-solving skills, parents could become more self-assured to address children’s health concerns, fully use resources to cope with stress, and collaborate to address challenges presented by daily care, thereby improving family adaptation and children’s health outcomes. 16 However, nearly one-half of parents lack problem-solving skills, especially the ability to solve daily problems related to their children’s complex treatment processes, 3 which may eventually perpetuate negative outcomes for parental and child well-being. 17 , 18

Problem-solving skills training (PSST) is an effective intervention to improve problem-solving skills and decrease negative affectivity. 19 , 20 Based on the problem-solving therapy approaches of D’Zurilla and colleagues, 20 , 21 PSST includes 2 essential components: establishing a positive problem orientation and mastering the systematic steps to solve problems. The training has long been established as being effective in adults with chronic illness and their caregivers, 22 , 23 which theoretically could have broad outcomes for parents of children with CHCs due to the long-term nature and equally multiple, intensive, and ongoing stressors across childhood CHCs. Problem-solving skills training is a cognitive-behavioral process by which parents can identify and create problem-focused strategies to buffer the outcomes of stressful events and improve coping, thus preventing episodes of negative affectivity by effectively solving various children’s disease-related problems. 15 , 21 These problem-solving strategies, while possibly differing in specifics, are beneficial in helping parents to cope with significant stressors inherent to each CHC. Preliminary studies have shown the efficacy of PSST in enhancing problem-solving skills and alleviating depression symptoms for parents, although the majority of such studies have had small sample sizes. Moreover, these studies only considered improved parental well-being, and most did not show significant changes in pediatric or family adaptation outcomes. 15 , 24 In addition, although previous reviews of PSST have explored the effectiveness of psychosocial interventions for parents of children with CHCs, they had limited specificity. 19 , 25 , 26 , 27 , 28 To address these gaps, we evaluated the associations between PSST for parents of children with CHCs and parental, pediatric, and family psychosocial outcomes.

The study protocol for this systematic review and meta-analysis has been registered with PROSPERO ( CRD42023424077 ). The revised Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA ) guideline 29 was followed to report the findings.

Data Sources and Search Strategies

A systematic search was performed across 6 English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library) and 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) from inception to April 30, 2023. The search strategies applied a combination of Medical Subject Heading terms and keywords, and the following constructs were used: child AND chronic health conditions AND parents AND PSST. The full search string for each database is provided in eTable 1 in Supplement 1 . Gray literature was searched using OpenGrey, Mednar, and the World Health Organization’s search portal. We also screened reference lists of included studies to identify potentially eligible articles.

Eligibility Criteria

The population, intervention, comparator, outcomes, and study design framework was used to define the inclusion and exclusion criteria ( Table 1 ). Eligible studies were RCTs that performed PSST for parents of children with CHCs and reported at least 1 psychosocial outcome of parents, children, or their families.

Abbreviation: CHC, chronic health condition.

Study Selection and Data Extraction

All identified articles were imported into EndNote, version 20.0 (Clarivate Analytics) to eliminate duplications. Title and abstract screening and full-text review were performed independently using the web-based software Rayyan 30 by 2 reviewers (T.Z. and W.X.). Data extraction was conducted in duplicate by the 2 reviewers and checked by another reviewer (Y.L.). Information was extracted using a predesigned worksheet, including publication details, population demographics (pediatric [age, medical condition, and illness duration] and parental [age, sex, race and ethnicity]), intervention and control group details (approach, mode, number of sessions, and duration), and psychosocial outcomes and measures.

We included only the postintervention data in the meta-analysis, as follow-up data were not reported consistently enough to achieve proper homogeneity. When both parents and children reported a psychosocial outcome of children, we prioritized extracting the parent-reported data, as they were more reliable. If multiple records were available for the same trial, we collected all relevant data and analyzed them as a single study. Corresponding authors were contacted via email to retrieve missing data.

Quality Assessment

The risk of bias for the included studies was assessed independently by 2 reviewers (T.Z. and W.X.) according to the revised Cochrane risk-of-bias tool, version 2.0, 31 which includes 5 domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. We judged the studies to be low risk, of some concern, or high risk. Additionally, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) 32 framework was applied to assess the certainty of the evidence for all outcomes. The certainty was categorized as high, moderate, low, or very low based on the risk of bias, inconsistency, imprecision, indirectness, and publication bias. 33 , 34 Any disagreements in the study selection, data extraction, and quality assessment processes were resolved through discussion to reach a consensus, and if conflicts persisted, they were arbitrated by a third reviewer (Y.L.).

Statistical Analysis

Statistical analyses were performed using Stata, version 16 software (StataCorp LLC). We conducted a meta-analysis only when 2 or more intervention studies were available with similar participants and outcomes. The psychosocial outcomes included in this review were measured by different scales; therefore, the effect size is presented as the standardized mean difference (SMD) with 95% CI. 35 Statistical heterogeneity was assessed using both the χ 2 test and I 2 statistic. 36 The inverse variance method ( P  ≥ .10 and I 2 <50%) or a random-effects model ( P  < .10 or I 2 ≥50%) was applied based on the P and I 2 values. Subgroup analyses were performed for children’s and intervention characteristics. In addition, we conducted leave-one-out sensitivity analyses to examine the consistent associations between PSST and all identified outcomes. We also used funnel plots and Egger test to evaluate the publication bias for analyses with at least 10 studies. 37 The threshold for statistical significance was set at a 2-sided P  < .05. The most recent analysis update was performed between October 10 and 20, 2023.

The initial comprehensive search yielded 2665 publications: 2641 from 9 databases and an additional 24 from gray literature and reference list review. After removing 1195 duplicates and screening 1470 titles and abstracts, 227 full-text articles were assessed for eligibility. Ultimately, 23 eligible RCTs 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 were included in the review, and 21 studies 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 were included in the meta-analysis ( Figure 1 ). Almost perfect agreement on the study selection was achieved (97%; κ = 0.89). 61

Study Characteristics

Table 2 summarizes the characteristics of the included 23 RCTs published between 2002 and 2021. Most were conducted in the US (21 studies 38 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ), with 1 study each in Australia 45 and Jamaica. 39 Twenty-one studies 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 used a 2-arm RCT design. In addition, most studies (12 [52%]) 39 , 42 , 45 , 46 , 47 , 48 , 50 , 53 , 54 , 55 , 56 , 57 reported that a control group received usual care.

Abbreviations: ASD, autism spectrum disorder; CHC, chronic health condition; CG, control group; F2F, face-to-face; IBD, inflammatory bowel disease; IG, intervention group; IRC, internet resource comparison (families were encouraged to spend 1 hour each week using the internet to access information); NA, not available; Pre/post, preintervention/postintervention; PSS, problem-solving skills; PSST, problem-solving skills training; PTS, posttraumatic stress; QOL, quality of life; SCD, sickle cell disease; TBI, traumatic brain injury; UC, usual care (including routine health maintenance for pediatric chronic health conditions [medication instruction and rehabilitation care], medical consultation [various presentations and complications], and supportive care [routine psychological care and health education]); WC, wait-list control.

A total of 3141 parents were included in this review. Twenty-one studies 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 60 reported on parent sex, which totaled 2799 mothers (94%) and 185 fathers (6%), and 6 studies 38 , 39 , 42 , 53 , 54 , 55 only recruited mothers. The age of the parents ranged from 20 to 67 years, with an estimated mean (SD) age of 38.3 (9.0) years. Of 2914 parents who reported race and ethnicity, 38 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 569 (19%) were Hispanic, 316 (11%) were non-Hispanic Black, 1708 (59%) were non-Hispanic White, and 321 (11%) were of other race or ethnicity. The CHC diagnoses were traumatic brain injury (6 studies), 49 , 51 , 57 , 58 , 59 , 60 cancer (5 studies), 38 , 52 , 53 , 54 , 55 sickle cell disease (2 studies), 39 , 40 autism spectrum disorder (2 studies), 41 , 42 epilepsy (2 studies), 46 , 47 mental health problems (1 study), 43 inflammatory bowel disease (1 study), 44 first-episode psychosis (1 study), 45 diabetes (1 study), 48 chronic pain (1 study), 50 and asthma (1 study). 56 The mean (SD) age of the children was 10.0 (5.5) years, with the illness duration ranging from 2 weeks to 8 years.

Problem-solving skills training was confirmed as the primary focus of the intervention across the 23 RCTs, all of which were developed based on problem-solving therapy that emphasized positive problem orientation and covered the 5 core problem-solving steps (eTable 2 in Supplement 1 ). The number of PSST sessions included ranged from 2 to 21, with the duration of PSST varying from 5 weeks to 12 months. Most studies (18 [78%]) 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 50 , 52 , 53 , 54 , 55 , 56 , 57 , 60 involved interventions that required parents to attend face-to-face sessions, 6 of which integrated telephone-based online support. 40 , 43 , 45 , 46 , 47 , 48 In the remaining studies, 38 , 44 , 49 , 51 , 52 , 58 , 59 , 60 PSST was delivered entirely online, including via telephone sessions, web-based didactic modules, and videoconferences. Three interventions 39 , 40 , 41 were group-based, 9 interventions 38 , 42 , 43 , 45 , 50 , 52 , 53 , 54 , 55 were delivered to individuals 1 on 1, and 11 interventions 44 , 46 , 47 , 48 , 49 , 51 , 56 , 57 , 58 , 59 , 60 included both parents and children.

Risk of Bias

The methodological quality assessment resulted in 96% mutual agreement (κ = 0.93). 61 Seven studies (30%) 39 , 42 , 45 , 47 , 50 , 51 , 56 were classified as low risk, 8 studies (35%) 40 , 44 , 46 , 52 , 55 , 57 , 58 , 60 raised some concerns, and 8 studies (35%) 38 , 41 , 43 , 48 , 49 , 53 , 54 , 59 were identified as having a high risk ( Figure 2 ). Two studies 41 , 48 reported neither random sequence generation nor allocation concealment and hence were considered high risk for the randomization process. For 5 trials (22%), 38 , 49 , 53 , 54 , 59 there was a high risk of reporting bias, as the prespecified outcomes were not fully reported (eTable 3 in Supplement 1 ).

Meta-Analysis

Figure 3 illustrates the meta-analysis summary for all outcomes. Forest plots and GRADE ratings are presented in eFigure 1 and eTable 4 in Supplement 1 , respectively.

GRADE indicates Grading of Recommendations, Assessment, Development, and Evaluations; SMD, standardized mean difference.

a For meta-analysis of parental problem-solving skills, quality of life, pediatric quality of life, and social functioning, the problem-solving skills training (PSST) group was preferable when the effect size was greater than 0, while the value of effect size for other outcomes less than 0 indicated a favor of PSST.

b For meta-analysis of parental posttraumatic stress, quality of life, pediatric mental problems, and parent-child conflict, the values of I 2 were less than 50%, and the inverse variance method was therefore used.

c Downgraded 1 level for serious inconsistency due to statistical heterogeneity.

d Downgraded 1 level for serious risk of bias of included studies.

e Downgraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 1 level for serious imprecision due to limited sample size.

f Downgraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 2 levels for very serious imprecision due to limited sample size and wide CIs.

g Downgraded 2 levels for very serious imprecision due to limited sample size and data from only 2 studies.

h Downgraded 1 level for serious inconsistency due to statistical heterogeneity and downgraded 1 level for serious imprecision due to wide CIs.

i Downgraded 1 level for serious imprecision due to limited sample size.

j Downgraded 1 level for serious risk of bias of included studies and downgraded 1 level for serious imprecision due to limited sample size.

Parental Outcomes

Overall, PSST had a significant positive effect on problem-solving skills (12 studies including 1887 parents 38 , 39 , 40 , 41 , 42 , 46 , 50 , 52 , 53 , 54 , 55 , 58 ; SMD, 0.43; 95% CI, 0.27-0.58; I 2  = 64.28%), depression (12 studies including 2036 parents 38 , 39 , 41 , 42 , 50 , 51 , 52 , 54 , 55 , 57 , 58 , 60 ; SMD, −0.45; 95% CI, −0.66 to −0.23; I 2  = 85.29%), and distress (12 studies including 2038 parents 38 , 45 , 50 , 51 , 52 , 53 , 54 , 55 , 57 , 58 , 59 , 60 ; SMD, −0.61; 95% CI, −0.81 to −0.40; I 2  = 83.88%), all of which indicated a medium effect size and moderate certainty evidence. The studies also showed that PSST significantly alleviated posttraumatic stress (5 studies including 1469 parents 38 , 50 , 52 , 54 , 55 ; SMD, −0.39; 95% CI, −0.48 to −0.31; I 2  = 44.93%) and parenting stress (5 studies including 391 parents 39 , 41 , 42 , 45 , 50 ; SMD, −0.62; 95% CI, −1.05 to −0.19; I 2  = 76.24%). The levels of evidence for the associations of PSST with lower posttraumatic stress and parenting stress were moderate and low, respectively. The meta-analysis of parental anxiety showed a positive but nonsignificant effect. In addition, 2 studies 45 , 50 including 175 parents indicated a significant improvement in QOL among parents in the PSST group (SMD, 0.45; 95% CI, 0.15-0.74; I 2  = 0.00%), with low-certainty evidence and no heterogeneity ( Figure 3 ).

Pediatric and Family Outcomes

There was an association between PSST and better pediatric QOL compared with control groups (6 studies including 590 parents 40 , 44 , 47 , 48 , 56 , 60 ; SMD, 0.76; 95% CI, 0.04-1.47; I 2  = 94.90%). Data for 436 parents showed a significant association between PSST and fewer children’s mental problems (6 studies 50 , 51 , 57 , 58 , 59 , 60 ; SMD −0.51; 95% CI, −0.68 to −0.34; I 2  = 34.54%) ( Figure 3 ). We found that PSST had both medium effect sizes for improving pediatric QOL and mental health, with low- and moderate-certainty evidence, respectively, whereas no association was found for social functioning. Four RCTs 41 , 48 , 51 , 57 including 314 parents provided low-certainty evidence that PSST may reduce parent-child conflict (SMD, −0.38; 95% CI, −0.60 to −0.16), with moderate heterogeneity ( I 2  = 36.98%).

Subgroup Analysis

Subgroup analyses were conducted according to child- and intervention-level characteristics (eFigure 2 in Supplement 1 ). Subgroup analysis by child age indicated that PSST was associated with significant changes in parental depression (SMD, −0.39; 95% CI, −0.52 to −0.26), problem-solving skills (SMD, 0.36; 95% CI, 0.24-0.48), posttraumatic stress (SMD, −0.40; 95% CI, −0.49 to −0.31), and parenting stress (SMD, −0.43; 95% CI, −0.72 to −0.13) for the parents of children who were 10 years or younger compared with the parents of older children (>10 years). Regarding changes in parental depression and posttraumatic stress, PSST had no association for parents of children who had not been newly diagnosed with a CHC but was associated with significant changes (reductions) for parents of children with newly diagnosed CHCs (depression: SMD, −0.40 [95% CI, −0.52 to −0.28]; posttraumatic stress: SMD, −0.40 [95% CI, −0.49 to −0.31]). Furthermore, compared with other medical conditions, PSST was associated with significant improvement in all psychosocial outcomes in parents of children diagnosed with cancer.

Overall, PSST delivered online yielded larger effects on all outcomes except for parent-child conflict than only face-to-face PSST. There was a significant improvement in depression (SMD, −0.39; 95% CI, −0.52 to −0.27) and problem-solving skills (SMD, 0.37; 95% CI, 0.24-0.50) among parents who received individual-based PSST. However, the parent-child interventions showed significant changes in pediatric and family psychosocial outcomes. As for intervention duration, PSST for 5 to 8 weeks had stronger effects on reducing parental depression and parenting stress and improving problem-solving skills than PSST with durations exceeding 8 weeks. The number of sessions followed a similar pattern, with significant improvements in depression (SMD, −0.48; 95% CI, −0.67 to −0.28) and problem-solving skills (SMD, 0.50; 95% CI, 0.29-0.70) among parents who underwent 8 to 12 sessions.

Publication Bias and Sensitivity Analyses

We assessed the publication bias for outcomes that included more than 10 trials (problem-solving skills, parental depression, and distress). Overall, the funnel plots were mostly symmetrical (eFigure 3 in Supplement 1 ); Egger tests were not significant for problem-solving skills ( z  = 1.64, P  = .10), depression ( z  = −1.21, P  = .23), and distress ( z  = −0.46, P  = .65), thus indicating no publication bias. The leave-one-out sensitivity analyses yielded similar results to those of the primary analyses, indicating the robustness of key outcomes (eFigure 4 in Supplement 1 ).

This systematic review and meta-analysis of 23 RCTs is the first to our knowledge to adequately examine the positive association of PSST with improved parental, pediatric, and family psychosocial outcomes. The findings show that PSST was associated with improved problem-solving skills, less negative affectivity, and better QOL for parents. Positivity and problem-solving throughout PSST is achieved by refining problems and effectively troubleshooting obstacles commonly encountered during the treatment of childhood CHCs, thus contributing to parental well-being. 15 , 41 Additionally, PSST was associated with improvements in pediatric QOL, mental health, and parent-child conflict, in accordance with previous review results that psychological interventions for parents may facilitate their ability to scaffold behavioral and emotional changes in their children and thus reduce conflicts between parents and children. 19 , 27 , 62 Our findings extend this evidence by suggesting that PSST is also associated with better psychosocial outcomes for children and families, showing promise for the use of PSST to increase the well-being of all family members and promote family adaptation.

Problem-solving skills training is an emerging and promising area of research, with 17 (74%) included studies published in 2010 or later. 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 55 , 56 , 59 , 60 A total of 3141 patients were included in this review, and there were sufficient sample sizes for most outcomes. Although the included RCTs were conducted in only 3 countries, which may decrease the representativeness of the results in terms of dissemination capability, the ethnic and linguistic diversity of parents across included studies showed equally positive responses to PSST when presented in various contexts. Across all psychosocial outcomes, the certainty of the evidence varied from moderate to very low. Despite the suggested effectiveness of PSST in this review, some heterogeneity remains. On one hand, the included studies used diverse definitions and instruments to measure psychosocial outcomes; on the other hand, the studies included parents of children with 11 different CHCs, all of which may have introduced clinical heterogeneity. However, the diversity may also suggest a better clinical fitness of the evidence in this review. Additionally, the current evidence on the long-term effects of PSST is limited by the small number of follow-up studies. Overall, although our review provides relatively high certainty of evidence, further research on higher-level evidence with sustained follow-up is warranted. Furthermore, it is necessary to expand the range of outcomes (eg, physical and clinical) to fully reflect the effectiveness of PSST, as most relevant studies have only reported psychosocial outcomes.

Our subgroup analysis revealed a significant decrease in negative affectivity among the parents of children aged 10 years or younger and who had been newly diagnosed with CHCs, as younger children are more reliant on their parents for daily life and disease management. 63 These findings are compatible with broader evidence supporting early PSST’s improvement of parental well-being when children are newly diagnosed. 64 A significant decrease in negative emotions was also found among parents of children with cancer compared with the parents of children with other medical conditions, possibly because cancer is a leading cause of death in children 65 and their parents may experience a substantial care burden. 8 , 66 The subgroup analysis according to intervention characteristics indicated that online intervention yielded larger effects on most outcomes than the in-person approach, which may be due to the flexibility and wider dissemination of an online approach. 52 , 67 With the rapid development of internet and mobile technologies in pediatric nursing, 68 future research could combine in-person PSST with enhanced online materials. Additionally, individual-based PSST was preferable for parental well-being, whereas the parent-child intervention favored pediatric and family psychosocial outcomes. The participants had more opportunities to receive personalized feedback in the individual-based interventions that included 1-on-1 activities 69 and to enhance family communication and cohesion in the parent-child intervention. 26 Hence, it may be worthwhile to integrate parent-child interaction when tailoring PSST according to families’ needs. Finally, PSST delivered for 5 to 8 weeks and consisting of 8 to 12 sessions had stronger associations in terms of parental psychosocial outcomes. This finding highlights the importance of shorter periods and less complexity to higher engagement in PSST, as parents’ busy schedules may interfere with long-term interventions. 70

Limitations

This review had several limitations. First, we limited our search to articles in English and Chinese, which might have led to selection bias and affected the reliability of the results. Second, some of the findings must be interpreted with caution, as they were based on only 2 or 3 studies. Third, the assessment could differ across people due to the methodological subjectivity of the risk-of-bias tool and GRADE. Fourth, the psychosocial outcomes identified in this review were measured using multiple scales, and despite using SMD as recommended, the heterogeneity of most outcomes was high. Hence, the interpretability and application of the results were diminished. Finally, only the postintervention data were analyzed, as follow-up data were not reported consistently and sufficiently, and the long-term outcomes remain unclear.

Conclusions

The findings of this systematic review and meta-analysis suggest that PSST is associated with improvements in parental psychosocial outcomes (problem-solving skills, depression, distress, posttraumatic stress, parenting stress, and QOL) as well as pediatric (QOL and mental problems) and family psychosocial outcomes (parent-child conflict). Moreover, our findings on children- and intervention-level characteristics may guide the design and delivery of future PSST by presenting information on factors associated with effectiveness. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence for PSST. In conclusion, PSST should be an active component of psychosocial interventions for parents of children with CHCs.

Supplement 1.

eTable 1. Study Search Strategies

Supplement 2.

Data Sharing Statement

The California Evidence-Based Clearinghouse for Child Welfare

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• Topic Areas
• Rating Scales
• Implementation-Specific Tools & Resources
• Implementation Guide
• Implementation Examples

Problem-Solving Skills Training (PSST)

About this program.

Target Population: 7 to 14 year olds with behavioral problems, particularly children who struggle to handle disappointments, frustrations, or problems calmly

For children/adolescents ages: 7 – 14

Program Overview

PSST is aimed at decreasing inappropriate or disruptive behavior in children. The program teaches that problem behaviors arise because children lack constructive ways to deal with thoughts and feelings and instead resort to dysfunctional ones. It is designed to help children learn to slow down, stop and think, and generate multiple solutions to any given problem. The program uses a cognitive-behavioral approach to teach techniques in managing thoughts and feelings, and interacting appropriately with others. Specific techniques include modeling, role-playing, positive reinforcement of appropriate behavior, and teaching alternative behaviors. Children are typically given homework to help them practice implementing these skills. Most sessions are individual, but parents may be brought in to observe and to learn how to assist in reinforcing new skills.

Program Goals

The goals of Problem-Solving Skills Training (PSST) are:

• Train the child to think differently about situations and behave differently in diverse situations
• Help the child internalize the problem solving steps so that they are able to use them to evaluate potential solutions to problems occurring outside of therapy
• Learn and generalize problem solving skills and how to apply problem solving skills using self-instruction
• Learn how to generate positive solutions that would enable the child to avoid physical aggression, resolve the conflict, and keep themselves out of trouble

Logic Model

The program representative did not provide information about a Logic Model for Problem-Solving Skills Training (PSST) .

Essential Components

The essential components of Problem-Solving Skills Training (PSST) include:

• Sessions that are fun for children as they play various games and have the opportunity to earn prizes as they learn the following:
• The 5 Problem Solving Steps used to handle any problem situation
• How to use these problem solving steps for hypothetical problems
• How to use these problem solving steps for simple problems outside of session
• How to use these steps to solve challenging hypothetical situations
• How to ultimately use these steps to solve problems that come up in their own life
• Individual treatment with one of the staff of certified clinicians who will keep the child's goals in mind throughout the therapy
• A number of sessions with the parent before beginning with the child so that the parents will know how to encourage and maintain the child's growth

Program Delivery

Child/adolescent services.

Problem-Solving Skills Training (PSST) directly provides services to children/adolescents and addresses the following:

• Oppositional behavior, aggressive behavior, antisocial behavior

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Parents are involved sporadically during treatment to help support their child in implementing Problem-Solving Skills Training .

Recommended Intensity:

Weekly 50-minute sessions

Recommended Duration:

Approximately 8 to 14 weeks

Delivery Settings

This program is typically conducted in a(n):

• Outpatient Clinic

Problem-Solving Skills Training (PSST) includes a homework component:

The child is given homework to help them learn to apply problem solving skills to everyday situations. Homework is a natural extension of treatment where learned problem solving skills are applied to real life situations.

Resources Needed to Run Program

The typical resources for implementing the program are:

PSST requires a standard clinical treatment room.

Manuals and Training

Prerequisite/minimum provider qualifications.

PSST providers must be Master's level mental health professionals.

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:

• Bernadette Lecza, MS, CKPMT [email protected]

Training Type/Location:

Training is occasionally available either online or onsite.

Number of days/hours:

Total training time is about 8 hours.

Implementation Information

Pre-implementation materials.

There are no pre-implementation materials to measure organizational or provider readiness for Problem-Solving Skills Training (PSST) .

Formal Support for Implementation

There is no formal support available for implementation of Problem-Solving Skills Training (PSST) .

Fidelity Measures

There are no fidelity measures for Problem-Solving Skills Training (PSST) .

Implementation Guides or Manuals

There are implementation guides or manuals for Problem-Solving Skills Training (PSST) as listed below:

A comprehensive overview of Problem Solving Skills Training is available. For more information, please contact the program representative who is listed at the bottom of the page.

Research on How to Implement the Program

Research has not been conducted on how to implement Problem-Solving Skills Training (PSST) .

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Kazdin, A., Esveldt-Dawson, K., French, N., & Unis, A. (1987). Problem-Solving Skills Training and relationship therapy in the treatment of antisocial child behavior. Journal of Consulting and Clinical Psychology, 55 (1), 76–85. https://doi.org/10.1037/0022-006X.55.1.76

Type of Study: Randomized controlled trial Number of Participants: 56

Population:

• Age — 7–13 years
• Race/Ethnicity — 77% White and 23% Black
• Gender — 45 Male and 11 Female
• Status — Participants were inpatients at a psychiatric facility.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the effects of cognitive-behavioral Problem-Solving Skills Training (PSST) and nondirective relationship therapy (RT) for the treatment of antisocial child behavior. Participants were randomly assigned to PSST , relationship therapy (RT), or a control group that had therapist contact with no directed focus on the elements of the two treatment conditions. Measures utilized include the Child Behavior Checklist (CBCL), Therapist Evaluation Inventory, and the Child Evaluation Inventory . Results indicate that children in the PSST condition had greater decreases in aggression, externalizing behaviors, and overall behavior problems and greater increases in pro-social behavior at follow-up than did the RT and control groups. Limitations include the use of a hospitalized sample and reliance on a small number and type of evaluations.

Length of controlled postintervention follow-up: 1 year.

Kazdin, A. E., Bass, D., Siegel, T., & Thomas, C. (1989). Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior. Journal of Consulting and Clinical Psychology, 57 (4), 522–535. https://doi.org/10.1037/0022-006X.57.4.522

Type of Study: Randomized controlled trial Number of Participants: 112

• Race/Ethnicity — Not specified
• Gender — 87 Male and 25 Female
• Status — Participants were children receiving inpatient or outpatient treatment at a child conduct clinic.

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate alternative treatments for children referred for severe antisocial behavior. Participants were randomized to receive one of two Problem-Solving Skills Training (PSST) treatment conditions: standard PSST or PSST-P which included a set of planned activities and "homework" to be performed outside of therapeutic sessions, or to a relationship therapy (RT) control condition. Measures utilized include the Child Behavior Checklist (CBCL), the School Behavior Checklist, the Parent Daily Report, Interview for Antisocial Behavior, the Children's Action Tendency Scale,  and the Self-Esteem Inventory . Results indicate that both PSST groups showed significantly higher improvement in behavior than the RT group. Improvement in PSST-P children's school-related behaviors were shown to be stronger in comparison with standard PSST . Limitations include no direct assessment of the cognitive processes that problem-solving skills training were designed to change and relationship therapy may not have been well or fairly tested.

Kazdin, A. E., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60 (5), 733–747. https://doi.org/10.1037/0022-006X.60.5.733

Type of Study: Randomized controlled trial Number of Participants: 97

• Race/Ethnicity — 69% White and 31% Black
• Gender — 76 Male and 21 Female
• Status — Participants were children referred for treatment to a psychiatric facility.

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the effects of Problem-Solving Skills Training (PSST) and parent management training (PMT) on children referred for severe antisocial behavior. Participants were randomly assigned to receive PSST , PMT, or a combination of PSST + PMT. Measures utilized include the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Health Resources Inventory, the Interview for Antisocial Behavior, the Children's Action Tendency Scale, the Self-Report Delinquency Checklist, the Parent Daily Report, the Parenting Stress Index (PSI), the Beck Depression Inventory (BDI) (mothers), and the Family Environment Scale . Results indicate that children in all conditions showed significant improvement at home and school, which was maintained at follow-up. PSST + PMT had the greatest effects on children's aggressive, delinquent, and antisocial behavior; and was also associated with greater improvements in parental stress and depression. Limitations include lack of an untreated comparison group, large attrition rate, and the small sample size.

Bushman, B. B., & Gimpel Peacock, G. (2010). Does teaching problem-solving skills matter? An evaluation of Problem-Solving Skills Training for the treatment of social and behavioral problems in children. Child & Family Behavior Therapy, 32 (2), 103–124. https://doi.org/10.1080/07317101003776449

Type of Study: Randomized controlled trial Number of Participants: 26

• Age — Mean=8.27 years
• Race/Ethnicity — 23 Caucasian, 1 Asian, and 2 Biracial
• Gender — 17 Male and 9 Female
• Status — Participants were families with children with social and behavioral problems.

Location/Institution: Utah

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the effectiveness of Problem-Solving Skills Training (PSST) for the treatment of social and behavioral problems in children. Participants were randomly assigned to either a PSST treatment group or a nondirective comparison group. Measures utilized include the Skills Rating System (SSRS), the Parent Daily Report (PDR), Child Behavior Checklist for Ages 6-18 (CBCL/6-18), Parenting Stress Index-Short Form (PSI-SF) , and a parent questionnaire at baseline, post-treatment, and at a 6-week follow-up. Results indicate that children in both the treatment and comparison group showed similar improvement, with PSST showing a minor advantage on several PDR and SSRS scales. Limitations include the small sample size and short-term follow-up.

Length of controlled postintervention follow-up: 6 weeks.

Additional References

Kazdin, A. E. (2010). Problem-Solving Skills Training and Parent Management Training for Oppositional Defiant Disorder and Conduct Disorder. In J. R. Weisz & A. E. Kazdin (Eds.). Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 211-226). Guilford Press.

Kazdin, A. E. (2011). Problem-Solving Skills Training for children and adolescents: Overview. Yale Parenting Center.

Kazdin, A. E. (2017). Parent Management Training and Problem-Solving Skills Training for child and adolescent conduct problems. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (pp.142–158). Guilford Press.

Contact Information

Date Research Evidence Last Reviewed by CEBC: December 2023

Date Program Content Last Reviewed by Program Staff: November 2021

Date Program Originally Loaded onto CEBC: April 2009

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The CEBC is funded by the California Department of Social Services’ (CDSS’) Office of Child Abuse Prevention and is one of their targeted efforts to improve the lives of children and families served within child welfare system.

© copyright 2006-2024 The California Evidence-Based Clearinghouse for Child Welfare www.cebc4cw.org

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• Published: 22 April 2024

The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study

• Chayanid Teerawongpairoj 1 ,
• Chanita Tantipoj 1 &
• Kawin Sipiyaruk 2  

Scientific Reports volume  14 , Article number:  9216 ( 2024 ) Cite this article

Metrics details

• Health care
• Health services
• Public health

To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play ( P  < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.

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Introduction

Telehealth has gained significant attention from various organization due to its potential to improve healthcare quality and accessibility 1 . It can be supportive in several aspects in healthcare, including medical and nursing services, to enhance continuous monitoring and follow-up 2 . Its adoption has increased substantially during the COVID-19 pandemic, aiming to provide convenient healthcare services 3 . Even though the COVID-19 outbreak has passed, many patients still perceive telehealth as an effective tool in reducing a number of visits and enhancing access to health care services 4 , 5 . This supports the use of telehealth in the post-COVID-19 era.

Teledentistry, a form of telehealth specific to dentistry, has been employed to improve access to dental services 6 . This system offers benefits ranging from online history taking, oral diagnosis, treatment monitoring, and interdisciplinary communication among dental professionals, enabling comprehensive and holistic treatment planning for patients 7 . Teledentistry can also reduce travel time and costs associated with dental appointments 8 , 9 , 10 . There is evidence that teledentistry serves as a valuable tool to enhance access to dental care for patients 11 . Additionally, in the context of long-term management in patients, telehealth has contributed to patient-centered care, by enhancing their surrounding environments 12 . Therefore, teledentistry should be emphasized as one of digital dentistry to enhance treatment quality.

Albeit the benefits of teledentistry, available evidence demonstrates challenges and concerns in the implementation of telehealth. Lack of awareness and knowledge in the use of telehealth can hinder the adoption of telehealth 13 . Legal issues and privacy concerns also emerge as significant challenges in telehealth use 14 . Moreover, online communication skills and technology literacy, including competency in using technological tools and applications, have been frequently reported as challenges in teledentistry 15 , 16 . Concerns regarding limitations stemming from the lack of physical examination are also significant 17 . These challenges and complexities may impact the accuracy of diagnosis and the security and confidentiality of patient information. Therefore, telehealth training for dental professionals emerges as essential prerequisites to effectively navigate the use of teledentistry, fostering confidence and competence in remote oral healthcare delivery.

The feasibility and practicality of telehealth in dental education present ongoing challenges and concerns. Given the limitations of teledentistry compared to face-to-face appointments, areas of training should encompass the telehealth system, online communication, technical issues, confidentiality concerns, and legal compliance 18 . However, there is currently no educational strategy that effectively demonstrates the importance and application of teledentistry 19 . A role-play can be considered as a teaching strategy where learners play a role that closely resembles real-life scenarios. A well-organized storytelling allows learner to manage problematic situations, leading to the development of problem-solving skill 20 , 21 . When compared to traditional lecture-based learning, learners can also enhance their communication skills through conversations with simulated patients 22 , 23 . In addition, they could express their thoughts and emotions during a role-play through experiential learning 20 , 24 , 25 . Role-play through video teleconference would be considered as a distance learning tool for training dental professionals to effectively use teledentistry.

While there have been studies supporting online role-play as an effective learning tool due to its impact of flexibility, engagement, and anonymity 26 , 27 , no evidence has been yet reported whether or not this learning strategy could have potential for training teledentistry. Given the complicated issues in telehealth, role-play for training teledentistry should incorporate different learning aspects compared to face-to-face communication with patients. In addition, game components have proved to be supportive in dental education 28 , 29 . Consequently, this research aimed to evaluate user perceptions and educational impact of gamified online role-play to enhance learner competence and awareness in using teledentistry as well as to construct a conceptual framework highlighting how to design and implement this interactive learning strategy. This research would introduce and promote the design and implementation of gamified online role-play as a learning tool for training teledentistry. To achieve the aim, specific objectives were established as follows:

1. To design a gamified online role-play for teledentistry training.

2. To investigate learner perceptions regarding their confidence and awareness in the use of teledentistry after completing the gamified online role-play.

3. To explore user satisfactions toward the use of gamified online role-play.

4. To develop a conceptual framework for designing and implementing a gamified online role-play for teledentistry training.

Materials and methods

Research design.

This research employed an explanatory sequential mixed-methods design, where a quantitative phase was firstly performed followed by a qualitative phase 30 , 31 . The quantitative phase was conducted based on pre-experimental research using one-group pretest–posttest design. Participants were requested to complete self-perceived assessments toward confidence and awareness in the use of teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire in using a gamified online role-play for training teledentistry. The qualitative phase was afterwards conducted to explore in-depth information through semi-structured interviews, in order to enhance an understanding of the quantitative phase, and to develop a conceptual framework for designing and implementing an online role-play for training teledentistry.

A gamified online role-play for training teledentistry

A gamified online role-play was designed and developed by the author team. To ensure its educational impact was significant, the expected learning outcomes were formulated based on insights gathered from a survey with experienced instructors from the Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University. These learning outcomes covered areas of online communication skill, technical issues, technology literacy of patients, limitations of physical examination, and privacy concerns of personal information. Learning scenario and instructional content were subsequently designed to support learners in achieving the expected learning outcomes, with their alignments validated by three experts in dental education. A professional actress underwent training to role-play a patient with a dental problem, requesting a virtual consultation or teledentistry. Before conducting data collection, the simulated patient was required to undergo a training and adjusting process with a pilot group under supervision of two experts in advanced general dentistry and dental education who had experience with teledentistry to ensure realism and completeness of learning content.

According to the role-play scenario, an actress was assigned to portray a 34-year-old female with chief complaints of pain around both ears, accompanied by difficulties in chewing food due to tooth loss. She was instructed to express her anxiety and nervousness about addressing these issues. Additionally, it was specified that she could not take a day off from work during this period. Despite this constraint, she required a dental consultation to receive advice for initial self-care, as her symptoms significantly impacted her daily life. Furthermore, she was designated to encounter difficulties with the technological use of the teledentistry platform.

The game components were implemented into the online role-play to enhance motivation and engagement. As challenge and randomness appear to be game elements 32 , 33 , five challenge cards were designed and embedded into the online role-play, where a participant was asked to randomly select one of them before interacting with the simulated patient. The challenging situations were potential technical concerns which could occur frequently during video conferencing, including network problems (e.g., internet disconnection and poor connection) and audiovisual quality issues. The participants were blinded to the selected card, while it was revealed to only the simulated patient. The challenging conditions were mimicked by the organizers and simulated patient, allowing learners to deal with difficulties. Therefore, both challenges and randomness were implemented into this learning intervention not only to create learning situations but also to enhance engagement.

A feedback system was carefully considered and implemented into the gamified online role-play. Immediate feedback appears to be a key feature of interactive learning environments 29 . Formative feedback was instantly delivered to learners through verbal and non-verbal communication, including words (content), tone of voice, facial expressions, and gestures of the simulated patient. This type of feedback allowed participants to reflect on whether or not their inputs were appropriate, enabling them to learn from their mistakes, or so-called the role of failure 34 . Summative feedback was also provided at the end of the role-play through a reflection from a simulated patient and suggestions from an instructor.

Learners were able to interact with the simulated patient using an online meeting room by Cisco WebEx. According to the research setting (Fig.  1 ), a learner was asked to participate in the role-play activity using a computer laptop in a soundproof room, while a simulated patient was arranged in a prepared location showing her residential environment. The researcher and instructor also joined the online meeting room and observed the interaction between the simulated patient and learners during the role-play activity whether or not all necessary information was accurately obtained. The role-play activity took around 30 minutes.

A diagram demonstrating the setting of gamified online role-play.

Research participants

Quantitative phase.

The participants in this research were postgraduate students from the Residency Training Program in Advanced General Dentistry at Mahidol University Faculty of Dentistry in academic year 2022, using a volunteer sampling. This program was selected because its objective was to develop graduates capable of integrating competencies from various dental disciplines to provide comprehensive dental care for both normal patients and those with special needs. Therefore, teledentistry should be a supportive component of their service. The recruitment procedure involved posting a recruiting text in the group chat of the residents. Those interested in participating in the research were informed to directly contact us to request more information, and they were subsequently allowed to decide whether they would like to participate. This approach ensured that participation was voluntary. Although there could be a non-response bias within this non-probability sampling technique 35 , it was considered as appropriate for this study, as participants were willing to have contribution in the learning activity, and therefore accurate and reliable research findings with no dropout could be achieved 36 .

The inclusion and exclusion criteria were established to determine the eligibility of prospective participants for this research. This study included postgraduate students from Years 1 to 3 in the Residency Training Program in Advanced General Dentistry at Mahidol University Faculty of Dentistry, enrolled during the academic year 2022. They were also required to at least complete the first semester to be eligible for this research to ensure familiarity with comprehensive dental care. However, they were excluded if they had previous involvement in the pilot testing of the gamified online role-play or if they were not fluent in the Thai language. The sample size was determined using a formula for two dependent samples (comparing means) 37 . To detect a difference in self-perceived confidence and awareness between pre- and post-assessments at a power of 90% and a level of statistical significance of 1%, five participants were required. With an assumed dropout rate of 20%, the number of residents per year (Year 1–3) was set to be 6. Therefore, 18 residents were required for this research.

Qualitative phase

The participants from the quantitative phase were selected for semi-structured interviews using a purposive sampling. This sampling method involved the selection of information-rich participants based on specific criteria deemed relevant to the research objective and to ensure a diverse representation of perspectives and experiences within the sample group 38 . In this research, the information considered for the purposive sampling included demographic data (e.g., sex and year of study), along with self-perceived assessment scores. By incorporating perceptions from a variety of participants, a broad spectrum of insights from different experiences in comprehensive dental practice and diverse improvement levels in self-perceived confidence and awareness could inform the design and implementation of the training program effectively. The sample size for this phase was determined based on data saturation, wherein interviews continued until no new information or emerging themes were retrieved. This method ensured thorough exploration of the research topic and maximized the richness of the qualitative data obtained.

Outcome assessments

To evaluate the gamified online role-play, a triangular design approach was employed, enabling the researchers to compare the research outcomes from different assessment methods. In this research, self-perceived assessments (confidence and awareness) in teledentistry, satisfactions toward gamified online role-play, and learner experience were assessed to assure the quality and feasibility of the gamified online role-play.

Self-perceived confidence and awareness toward teledentistry

All participants were requested to rate their perceptions of teledentistry before and after participating in the gamified online role-play (Supplementary material 1 ). The self-perceived assessment was developed based on previous literature 39 , 40 , 41 , 42 . The assessment scores would inform whether or not the participants could improve their self-perceived confidence and awareness through a learning activity. The assessment consisted of two parts, which were (1) self-perceived confidence and (2) self-perceived awareness. Each part contained six items, which were similar between the pre- and post-assessments. All items were designed using a 5-point Likert scale, where 1 being ‘strongly disagree’ and 5 being ‘strongly agree’.

Satisfactions toward the gamified online role-play

All participants were asked to complete the satisfaction questionnaire after participating in the gamified online role-play, to investigate whether or not they felt satisfied with their learning (Supplementary material 2 ). The questionnaire was developed based on previous literature regarding gamification and role-play 41 , 42 , 43 , 44 . Most of the items were designed using a 5-point Likert scale, where 1 being ‘very dissatisfied’ and 5 being ‘very satisfied’. They were grouped into three aspects, which were (1) Perceived usefulness, (2) Perceived ease of use, and (3) Perceived enjoyment.

Learner experiences within the gamified online role-play

Semi-structured interviews were conducted with the purposively selected participants to gather in-depth information regarding their learning experiences within the gamified online role-play. This technique allowed researchers to ask additional interesting topics raised from the responses of participants. A topic guide for interviews were constructed based on the findings of previous literature 45 , 46 , 47 . The interview was conducted in a private room by a researcher who was trained in conducting qualitative research including interviews. The interview sessions took approximately 45–60 minutes, where all responses from participants were recorded using a digital audio recorder with their permission. The recorded audios were transcribed using a verbatim technique by a transcription service under a confidential agreement.

Validity and reliability of data collection tools

To enhance the quality of self-perceived assessment and satisfaction questionnaire, they were piloted and revised to assure their validity and reliability. According to the content validity, three experts in advanced general dentistry were asked to evaluate the questionnaire, where problematic items were iteratively revised until they achieved the index of item-objective congruence (IOC) higher than 0.5. To perform a test–retest reliability, the validated versions of both self-perceived assessment and satisfaction questionnaire were afterwards piloted in residents from other programs, and the data were analyzed using an intraclass correlation coefficient (ICC), where the values of all items were 0.7 or greater. The data from the first pilot completion of both data collection tools were analyzed using Cronbach’s alpha to ensure the internal consistency of all constructs. The problematic items were deleted to achieve the coefficient alpha of 0.7 or greater for all constructs, which was considered as acceptable internal consistency.

Data analysis

The quantitative data retrieved from self-perceived assessment and satisfaction questionnaire were analyzed with the Statistical Package for Social Sciences software (SPSS, version 29, IBM Corp.). Descriptive statistics were performed to present an overview of the data. The scores from pre- and post-assessments were analyzed using a paired sample t-test to evaluate whether or not the participants would better self-perceive their confidence and awareness in teledentistry after participating in the gamified online role-play. One-way analysis of variance (ANOVA) was conducted to compare whether or not there were statistically significant differences in self-perceived assessment and satisfaction scores among the three academic years.

The qualitative data retrieved from semi-structured interviews were analyzed using a framework analysis, where its procedure involved transcription, familiarization with the interview data, coding, developing an analytical framework, indexing, charting, and data interpreting qualitative findings 48 . In this research, the initial codes had been pre-defined from previous literature and subsequently adjusted following the analysis of each transcript to develop an analytical framework (themes and subthemes), requiring several iterations until no additional codes emerged. Subsequently, the established categories and codes were applied consistently across all transcripts (indexing). The data from each transcript were then charted to develop a matrix, facilitating the management and summarization of qualitative findings. This method enabled the researchers to compare and contrast differences within the data and to identify connections between categories, thereby exploring their relationships and informing data interpretation.

The procedure of framework analysis necessitated a transparent process for data management and interpretation of emerging themes to ensure the robustness of research 49 . The transparency of this analytic approach enabled two researchers (C.Te. and K.S.) to independently analyze the qualitative data, and the emerging themes afterwards were discussed to obtain consensus among the researchers. This technique can be considered as a triangular approach to assure the intercoder reliability and internal validity of this research. The transparent process also allowed an external expert in dental education to verify the accuracy of the analysis. All emerging themes and the decision on data saturation were based on a discussion of all researchers until an agreement was made. NVivo (version 14, QSR International) was used to performed the qualitative data analysis. Subsequently, a conceptual framework was constructed to demonstrate emerging themes and subthemes together with their relationships.

Ethical consideration

The ethical approval for the study was approved by the Institutional Review Board of Faculty of Dentistry and Faculty of Pharmacy, Mahidol University on 29 th September 2022, the ethical approval number: MU-DT/PY-IRB 2022/049.2909. All methods were performed in accordance with the relevant guidelines and regulations. Although the data were not anonymous in nature as they contained identifiable data, they were coded prior to the analysis to assure confidentiality of participants.

Informed consent

Informed consent was obtained from all participants.

There were 18 residents from Year 1 to 3 of the Residency Training Program in Advanced General Dentistry who participated in this research (six from each year). Of these, there were 14 females and 4 males. There was no participant dropout, as all of them completed all required tasks, including the pre- and post-perceived assessments, gamified online role-play, and satisfaction questionnaire. According to the purposive sampling, the participants from the quantitative phase were selected for semi-structured interviews by considering sex, year of study, and self-perceived assessment scores. Twelve students (ten females and two males) participated in semi-structured interviews, where their characteristics are presented in Table 1 .

Internal consistency of all constructs

The data collected from the research participants, in addition to the pilot samples, were analyzed with Cronbach’s alpha to confirm the internal consistency. The coefficient alpha of all constructs demonstrated high internal consistency, as demonstrated in Table 2 .

Self-perceived assessments toward confidence and awareness of teledentistry

There were statistically significant increases in the assessment scores of self-perceived confidence and awareness after participating in the gamified online role-play ( P  < 0.001). According to Table 3 , there was an increase in self-perceived confidence from 3.38 (SD = 0.68) for the pre-assessment to 4.22 (SD = 0.59) for the post-assessment ( P  < 0.001). The findings of self-perceived awareness also showed score improvement from 4.16 (SD = 0.48) to 4.55 (SD = 0.38) after interacting with the simulated patient ( P  < 0.001).

According to Fig.  2 , participants demonstrated a higher level of self-perceived assessments for both self-confidence and awareness in all aspects after participating in the gamified online role-play for teledentistry training.

Self-perceived assessments toward confidence and awareness of teledentistry.

When comparing the self-perceived assessment scores toward confidence and awareness in the use of teledentistry among the three years of study (Year 1–3), there were no statistically significant differences in the pre-assessment, post-assessment score, and score difference (Table 4 ).

Satisfactions toward the use of gamified online role-play

According to Fig.  3 , participants exhibited high levels of satisfaction with the use of gamified online role-play across all three aspects. The aspect of usefulness received the highest satisfaction rating with a score of 4.44 (SD = 0.23) out of 5, followed by ease of use and enjoyment, scoring 4.40 (SD = 0.23) and 4.03 (SD = 0.21), respectively. Particularly, participants expressed the highest satisfaction levels regarding the usefulness of gamified online role-play for identifying their role (Mean = 4.72, SD = 0.46) and developing problem-solving skills associated with teledentistry (Mean = 4.61, SD = 0.50). Additionally, they reported satisfaction with the learning sequence presented in the gamified online role-play (Mean = 4.61, SD = 0.50). However, participants did not strongly perceive that the format of the gamified online role-play could engage them with the learning task for an extended period (Mean = 3.72, SD = 0.83).

Satisfactions toward the use of gamified online role-play.

When comparing the satisfaction levels perceived by participants from different academic years (Table 5 ), no statistically significant differences were observed among the three groups for all three aspects ( P  > 0.05).

Following the framework analysis of qualitative data, there were five emerging themes, including: (1) learner profile, (2) learning settings of the gamified online role-play, (3) pedagogical components, (4) interactive functions, and (5) educational impact.

Theme 1: Learner profile

Learner experience and preferences appeared to have impact on how the participants perceived the use of gamified online role-play for teledentistry training. When learners preferred role-play or realized benefits of teledentistry, they were likely to support this learning intervention. In addition, they could have seen an overall picture of the assigned tasks before participating in this research.

“I had experience with a role-play activity when I was dental undergraduates, and I like this kind of learning where someone role-plays a patient with specific personalities in various contexts. This could be a reason why I felt interested to participate in this task (the gamified online role-play). I also believed that it would be supportive for my clinical practice.” Participant 12, Year 1, Female “Actually, I' have seen in several videos (about teledentistry), where dentists were teaching patients to perform self-examinations, such as checking their own mouth and taking pictures for consultations. Therefore, I could have thought about what I would experience during the activity (within the gamified online role-play).” Participant 8, Year 2, Female

Theme 2: Learning settings of the gamified online role-play

Subtheme 2.1: location.

Participants had agreed that the location for conducting a gamified online role-play should be in a private room without any disturbances, enabling learners to focus on the simulated patient. This could allow them to effectively communicate and understand of the needs of patient, leading to a better grasp of lesson content. In addition, the environments of both learners and simulated patient should be authentic to the learning quality.

“The room should be a private space without any disturbances. This will make us feel confident and engage in conversations with the simulated patient.” Participant 10, Year 1, Female “… simulating a realistic environment can engage me to interact with the simulated patient more effectively ...” Participant 8, Year 2, Female

Subtheme 2.2: Time allocated for the gamified online role-play

The time allocated for the gamified online role-play in this research was considered as appropriate, as participants believed that a 30-minutes period should be suitable to take information and afterwards give some advice to their patient. In addition, a 10-minutes discussion on how they interact with the patient could be supportive for participants to enhance their competencies in the use of teledentistry.

“… it would probably take about 20 minutes because we would need to gather a lot of information … it might need some time to request and gather various information … maybe another 10-15 minutes to provide some advice.” Participant 7, Year 1, Female “I think during the class … we could allocate around 30 minutes for role-play, … we may have discussion of learner performance for 10-15 minutes ... I think it should not be longer than 45 minutes in total.” Participant 6, Year 2, Female

Subtheme 2.3: Learning consequence within a postgraduate curriculum

Most participants suggested that the gamified online role-play in teledentistry should be arranged in the first year of their postgraduate program. This could maximize the effectiveness of online role-play, as they would be able to implement teledentistry for their clinical practice since the beginning of their training. However, some participants suggested that this learning approach could be rearranged in either second or third year of the program. As they already had experience in clinical practice, the gamified online role-play would reinforce their competence in teledentistry.

"Actually, it would be great if this session could be scheduled in the first year … I would feel more comfortable when dealing with my patients through an online platform." Participant 11, Year 2, Male "I believe this approach should be implemented in the first year because it allows students to be trained in teledentistry before being exposed to real patients. However, if this approach is implemented in either the second or third year when they have already had experience in patient care, they would be able to better learn from conversations with simulated patients." Participant 4, Year 3, Male

Theme 3: Pedagogical components

Subtheme 3.1: learning content.

Learning content appeared to be an important component of pedagogical aspect, as it would inform what participants should learn from the gamified online role-play. Based on the interview data, participants reported they could learn how to use a video teleconference platform for teledentistry. The conditions of simulated patient embedded in an online role-play also allowed them to realize the advantages of teledentistry. In addition, dental problems assigned to the simulated patient could reveal the limitations of teledentistry for participants.

“The learning tasks (within the gamified online role-play) let me know how to manage patients through the teleconference.” Participant 5, Year 2, Female “… there seemed to be limitations (of teledentistry) … there could be a risk of misdiagnosis … the poor quality of video may lead to diagnostic errors … it is difficult for patients to capture their oral lesions.” Participant 3, Year 2, Female

Subtheme 3.2: Feedback

During the use of online role-play, the simulated patient can provide formative feedback to participants through facial expressions and tones of voice, enabling participants to observe and learn to adjust their inquiries more accurately. In addition, at the completion of the gamified online role-play, summative feedback provided by instructors could summarize the performance of participants leading to further improvements in the implementation of teledentistry.

“I knew (whether or not I interacted correctly) from the gestures and emotions of the simulated patient between the conversation. I could have learnt from feedback provided during the role-play, especially from the facial expressions of the patient.” Participant 11, Year 2, Male “The feedback provided at the end let me know how well I performed within the learning tasks.” Participant 2, Year 1, Female

Theme 4: Interactive functions

Subtheme 4.1: the authenticity of the simulated patient.

Most participants believed that a simulated patient with high acting performance could enhance the flow of role-play, allowing learners to experience real consequences. The appropriate level of authenticity could engage learners with the learning activity, as they would have less awareness of time passing in the state of flow. Therefore, they could learn better from the gamified online role-play.

"It was so realistic. ... This allowed me to talk with the simulated patient naturally ... At first, when we were talking, I was not sure how I should perform … but afterwards I no longer had any doubts and felt like I wanted to explain things to her even more." Participant 3, Year 2, Female "At first, I believed that if there was a factor that could influence learning, it would probably be a simulated patient. I was impressed by how this simulated patient could perform very well. It made the conversation flow smoothly and gradually." Participant 9, Year 3, Female

Subtheme 4.2: Entertaining features

Participants were likely to be satisfied with the entertaining features embedded in the gamified online role-play. They felt excited when they were being exposed to the unrevealed challenge which they had randomly selected. In addition, participants suggested to have more learning scenarios or simulated patients where they could randomly select to enhance randomness and excitement.

“It was a playful experience while communicating with the simulated patient. There are elements of surprise from the challenge cards that make the conversation more engaging, and I did not feel bored during the role-play.” Participant 4, Year 3, Male “I like the challenge card we randomly selected, as we had no idea what we would encounter … more scenarios like eight choices and we can randomly choose to be more excited. I think we do not need additional challenge cards, as some of them have already been embedded in patient conditions.” Participant 5, Year 2, Female

Subtheme 4.3: Level of difficulty

Participants suggested the gamified online role-play to have various levels of difficulty, so learners could have a chance to select a suitable level for their competence. The difficulties could be represented through patient conditions (e.g., systemic diseases or socioeconomic status), personal health literacy, and emotional tendencies. They also recommended to design the gamified online role-play to have different levels where learners could select an option that is suitable for them.

“The patient had hidden their information, and I needed to bring them out from the conversation.” Participant 12, Year 1, Female “Patients' emotions could be more sensitive to increase level of challenges. This can provide us with more opportunities to enhance our management skills in handling patient emotions.” Participant 11, Year 2, Male “… we can gradually increase the difficult level, similar to playing a game. These challenges could be related to the simulated patient, such as limited knowledge or difficulties in communication, which is likely to occur in our profession.” Participant 6, Year 2, Female

Theme 5: Educational impact

Subtheme 5.1: self-perceived confidence in teledentistry, communication skills.

Participants were likely to perceive that they could learn from the gamified online role-play and felt more confident in the use of teledentistry. This educational impact was mostly achieved from the online conversation within the role-play activity, where the participants could improve their communication skills through a video teleconference platform.

“I feel like the online role-play was a unique form of learning. I believe that I gained confidence from the online communication the simulated patient. I could develop skills to communicate effectively with real patients.” Participant 11, Year 2, Male “I believe it support us to train communication skills ... It allowed us to practice both listening and speaking skills more comprehensively.” Participant 4, Year 3, Male

Critical thinking and problem-solving skills

In addition to communication skills, participants reported that challenges embedded in the role-play allowed them to enhance critical thinking and problem-solving skills, which were a set of skills required to deal with potential problems in the use of teledentistry.

"It was a way of training before experiencing real situations … It allowed us to think critically whether or not what we performed with the simulated patients was appropriate." Participant 7, Year 1, Female “It allowed us to learn how to effectively solve the arranged problems in simulated situation. We needed to solve problems in order to gather required information from the patient and think about how to deliver dental advice through teledentistry.” Participant 11, Year 2, Male

Subtheme 5.2: Self perceived awareness in teledentistry

Participants believed that they could realize the necessity of teledentistry from the gamified online role-play. The storytelling or patient conditions allowed learners to understand how teledentistry could have both physical and psychological support for dental patients.

“From the activity, I would consider teledentistry as a convenient tool for communicating with patients, especially if a patient cannot go to a dental office”. Participant 5, Year 2, Female “I learned about the benefits of teledentistry, particularly in terms of follow-up. The video conference platform could support information sharing, such as drawing images or presenting treatment plans, to patients.” Participant 8, Year 2, Female

A conceptual framework of learning experience within a gamified online role-play

Based on the qualitative findings, a conceptual framework was developed in which a gamified online role-play was conceptualized as a learning strategy in supporting learners to be able to implement teledentistry in their clinical practice (Fig.  4 ).

The conceptual framework of key elements in designing a gamified online role-play.

The conceptual framework has revealed key elements to be considered in designing a gamified online role-play. Learner profile, learning settings, pedagogical components, and interactive functions are considered as influential factors toward user experience within the gamified online role-play. The well-designed learning activity will support learners to achieve expected learning outcomes, considered as educational impact of the gamified online role-play. The contributions of these five key elements to the design of gamified online role-play were interpreted, as follows:

Learner profile: This element tailors the design of gamified online role-plays for teledentistry training involves considering the background knowledge, skills, and experiences of target learners to ensure relevance and engagement.

Learning settings: The element focuses the planning for gamified online role-plays in teledentistry training involves selecting appropriate contexts, such as location and timing, to enhance accessibility and achieve learning outcomes effectively.

Pedagogical components: This element emphasizes the alignment between learning components and learning outcomes within gamified online role-plays, to ensure that the content together with effective feedback design can support learners in improving their competencies from their mistakes.

Interactive functions: This element highlights interactivity features integrated into gamified online role-plays, such as the authenticity and entertaining components to enhance immersion and engagement, together with game difficulty for optimal flow. All these features should engage learners with the learning activities until the achievement of learner outcomes.

Educational impact: This element represents the expected learning outcomes, which will inform the design of learning content and activities within gamified online role-plays. In addition, this element could be considered to evaluate the efficacy of gamified online role-plays, reflecting how well learning designs align with the learning outcomes.

A gamified online role-play can be considered as a learning strategy for teledentistry according to its educational impact. This pedagogical approach could mimic real-life practice, where dental learners could gain experience in the use of teledentistry in simulated situations before interacting with actual patients. Role-play could provide learners opportunities to develop their required competencies, especially communication and real-time decision-making skills, in a predictable and safe learning environment 20 , 23 , 46 . Potential obstacles could also be arranged for learners to deal with, leading to the enhancement of problem-solving skill 50 . In addition, the recognition of teledentistry benefits can enhance awareness and encourage its adoption and implementation, which could be explained by the technology acceptance model 51 . Therefore, a gamified online role-play with a robust design and implementation appeared to have potential in enhancing self-perceived confidence and awareness in the use of teledentistry.

The pedagogical components comprised learning content, which was complemented by assessment and feedback. Learners could develop their competence with engagement through the learning content, gamified by storytelling of the online role-play 52 , 53 . Immediate feedback provided through facial expression and voice tone of simulated patients allowed participants to learn from their failure, considered as a key feature of game-based learning 29 , 45 . The discussion of summative feedback provided from an instructor at the end of role-play activity could support a debriefing process enabling participants to reflect their learning experience, considered as important of simulation-based game 54 . These key considerations should be initially considered in the design of gamified online role-play.

The interactive functions can be considered as another key component for designing and evaluating the gamified online role-play 45 . Several participants enjoyed with a learning process within the gamified online role-play and suggested it to have more learning scenarios. In other words, this tool could engage learners with an instructional process, leading to the achievement of learning outcomes 29 , 45 . As challenge and randomness appear to be game elements 32 , 33 , this learning intervention assigned a set of cards with obstacle tasks for learners to randomly pick up before interacting with simulated patients, which was perceived by participants as a feature to make the role-play more challenging and engaging. This is consistent with previous research, where challenging content for simulated patients could make learners more engaged with a learning process 55 . However, the balance between task challenges and learner competencies is certainly required for the design of learning activities 56 , 57 . The authenticity of simulated patient and immediate feedback could also affect the game flow, leading to the enhancement of learner engagement 45 . These elements could engage participants with a learning process, leading to the enhancement of educational impact.

The educational settings for implementing gamified online role-play into dental curriculum should be another concern. This aspect has been recognized as significant in existing evidence 45 . As this research found no significant differences in all aspects among the three groups of learners, this learning intervention demonstrated the potential for its implementation at any time of postgraduate dental curriculum. This argument can be supported by previous evidence where a role-play could be adaptable for learning at any time, as it requires a short learning period but provides learners with valuable experience prior to being exposed in real-life scenarios 58 . This strategy also provides opportunities for learners who have any question or concern to seek advice or guidance from their instructors 59 . Although the gamified online role-play can be arranged in the program at any time, the first academic year should be considered, as dental learners would be confidence in implementing teledentistry for their clinical practice.

While a gamified online role-play demonstrated its strengths as an interactive learning strategy specifically for teledentistry, there are a couple of potential drawbacks that need to be addressed. The requirement for synchronous participation could limit the flexibility of access time for learners (synchronous interactivity limitation). With only one learner able to engage with a simulated patient at a time (limited participants), more simulated patients would be required if there are a number of learners, otherwise they would need to wait for their turn. Time and resources are significantly required for preparing simulated patients 60 . Despite the use of trained and calibrated professional actors/actresses, inauthenticity may be perceived during role-plays, requiring a significant amount of effort to achieve both interactional and clinical authenticities 46 . Future research could investigate asynchronous learning approaches utilizing non-player character (NPC) controlled by an artificial intelligence system as a simulated patient. This setup would enable multiple learners to have the flexibility to engage with the material at their own pace and at times convenient to them 29 . While there are potential concerns about using gamified online role-plays, this interactive learning intervention offers opportunities for dental professionals to enhance their teledentistry competency in a safe and engaging environment.

Albeit the robust design and data collection tools to assure reliability and validity as well as transparency of this study, a few limitations were raised leading to a potential of further research. While this research recruited only postgraduate students to evaluate the feasibility of gamified online role-play in teledentistry training, further research should include not only experienced dental practitioners but also undergraduate students to confirm its potential use in participants with different learner profiles. More learning scenarios in other dental specialties should also be included to validate its effectiveness, as different specialties could have different limitations and variations. Additional learning scenarios from various dental disciplines should be considered to validate the effectiveness of gamified online role-plays, as different specialties may present unique limitations and variations. A randomized controlled trial with robust design should be required to compare the effectiveness of gamified online role-play with different approaches in training the use of teledentistry.

Conclusions

This research supports the design and implementation of a gamified online role-play in dental education, as dental learners could develop self-perceived confidence and awareness with satisfaction. A well-designed gamified online role-play is necessary to support learners to achieve expected learning outcomes, and the conceptual framework developed in this research can serve as a guidance to design and implement this interactive learning strategy in dental education. However, further research with robust design should be required to validate and ensure the educational impact of gamified online role-play in dental education. Additionally, efforts should be made to develop gamified online role-play in asynchronous learning approaches to enhance the flexibility of learning activities.

Data availability

The data that support the findings of this study are available from the corresponding author, up-on reasonable request. The data are not publicly available due to information that could compromise the privacy of research participants.

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Acknowledgements

The authors would like to express our sincere gratitude to participants for their contributions in this research. We would also like to thank the experts who provided their helpful suggestions in the validation process of the data collection tools.

This research project was funded by the Faculty of Dentistry, Mahidol University. The APC was funded by Mahidol University.

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Conceptualization, C.Te., C.Ta., and K.S.; methodology, C.Te., C.Ta., and K.S.; validation, C.Te., C.Ta., and K.S.; investigation, C.Te. and K.S.; formal analysis, C.Te., C.Ta., and K.S.; resources, C.Te., C.Ta., and K.S.; data curation, C.Ta. and K.S.; writing-original draft preparation, C.Te., C.Ta., and K.S.; writing-review and editing, C.Te., C.Ta., and K.S. All authors have read and agreed to the published version of the manuscript.

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Teerawongpairoj, C., Tantipoj, C. & Sipiyaruk, K. The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study. Sci Rep 14 , 9216 (2024). https://doi.org/10.1038/s41598-024-58425-9

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