Predictors of Engagement in a Parenting Intervention Designed to Prevent Child Maltreatment

UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Predictors of Engagement in a Parenting Intervention Designed to Prevent Child Maltreatment Permalink https://escholarship.org/uc/item/3q8749kb Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 11(3) ISSN 1936-900X Authors Corso, Phaedra S Fang, Xiangming Begle, Angela M et al. Publication Date 2010 Supplemental Material https://escholarship.org/uc/item/3q8749kb#supplemental License https://creativecommons.org/licenses/by-nc/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Original Research Predictors of Engagement in a Parenting Intervention Designed to Prevent Child Maltreatment Phadedra S. Corso, PhD, MPA* Xiangming Fang, PhD† Angela M. Begle, PhD‡ Jean Dumas, PhD‡ * College of Public Health, University of Georgia, Athens, GA † National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA ‡ Purdue University, Indianapolis, IN Supervising Section Editor: Monica H. Swahn, PhD Submission history: Submitted February 15, 2010; Revision Received April 1, 2010; Accepted April 21, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Objective: The objectives of this analysis were to: 1) assess the impact of socio-demographic factors on parents’ perception of the benefits of attending a parenting program designed to prevent child maltreatment vs. the costs in terms of time and difficulty to attend, 2) determine if perceived costs and benefits affected the association between socio-demographic factors and participation in a parenting program, and 3) assess whether race/ethnicity moderated the relationship between sociodemographic factors, perceived costs and benefits, and program participation. Methods: We assessed perceived costs and benefits of the intervention from parents providing selfreports, including satisfaction/ usefulness of the program (benefits), and time/difficulty associated with the program (costs). We defined attendance at both the mid-point and then the number of classes attended throughout the remainder of the intervention. To investigate the direct and indirect effects (through perceived costs and benefits) of parental socio-demographic factors (education, age, gender, number of children, household income) on program attendance, we analyzed the data with structural equation modeling (SEM). To assess the potential moderating effect of race/ethnicity, separate models were tested for Caucasian and African-American parents. Results: Perceived benefits positively impacted attendance for both Caucasian (n=227) and AfricanAmerican (n=141) parents, whereas perceived costs negatively influenced attendance only for Caucasian parents. Parent education and age directly impacted attendance for Caucasian parents, but no socio-demographic factor directly impacted attendance for African-American parents. The indirect impact of socio-demographic characteristics on attendance through perceived costs and perceived benefits differed by race/ethnicity. Conclusion: Results suggest that Caucasian parents participate in a parenting program designed to prevent child maltreatment differently based upon their perceived benefits and costs of the program, and based on benefits only for African-American parents. Parental perception of costs and/or benefits of a program may threaten the effectiveness of interventions to prevent child maltreatment for certain racial/ethnic groups, as it keeps them from fully engaging in empirically validated programs. Different methods may be required to retain participation in violence-prevention programs depending upon race/ethnicity. [West J Emerg Med. 2010; 11(3):235-241.] INTRODUCTION Behaviorally-oriented parenting programs have consistently shown positive effects in preventing youth problem behaviors and violence, and reducing child Western Journal of Emergency Medicine maltreatment.1-3 However, limited parental participation often threatens the internal and external validity of potentially useful programs and their widespread implementation.4,5 Participation, or “engagement,” has been defined in the 235 Volume XI, no. 3 : August 2010 Corso et al. literature in a number of ways including: stated intent to enroll, actual enrollment, attendance, participation, attrition, graduation, and quality of participation in sessions.6-11 Given the importance of engagement to the validity of program outcomes, several theories and empirical studies provide evidence that parental perception of benefits and costs of behavioral interventions are important determinants of engagement.9-17 There is additional evidence, although mixed, that socio-demographic factors impact engagement in behavioral interventions. For example, caregivers with higher levels of education have been found to be more likely to enroll and attend according to some studies5,7,9,18 but not others.10,11,19,20 Higher household income, which is correlated with education, has been found to directly predict engagement in several studies11,21-23 but not others.5,7 Married or cohabiting caregivers have also been reported to be more engaged than their single counterparts in some studies9,11,19,24 but not others.8,20 The same is true of older caregivers, but again in some studies20 but not others.8,10,11 The challenges of attending parenting programs may also vary by race/ethnicity.19,22,23 Studies suggest that engagement tends to be higher among European Americans (or Caucasian) and Hispanics than among African Americans, Asians, and Native Americans.8,20,22-24 Despite the number of studies that have explored these factors, few have simultaneously explored the direct and indirect effects of socio-demographic factors on engagement in prevention programs through perceived benefits and costs,5,7,18 and even fewer have focused on racial/ethnic differences in these pathways;22,23 or specifically for interventions that are designed to prevent violence, such as child maltreatment.11 In groundbreaking work, Spoth et al.18 expanded the Health Belief Model14 defined by perceived severity, susceptibility, program benefits, and barriers to participation, to include the indirect effects of several socio-demographic variables. They found that perceived program benefits and program barriers showed the strongest influence on parents’ intent to enroll in a parenting skills program. Although the initial model did not include direct effects of sociodemographic variables on inclination to enroll, they reported that parent education significantly influenced perception of program benefits and that household income and number of children significantly influenced perception of program costs. In a follow-up study, Spoth et al.7 used the same model to prospectively predict actual program attendance. They found that only (...truncated)