What Influences Parental Engagement in Early Intervention? Parent, Program and Community Predictors of Enrolment, Retention and Involvement

Prevention Science https://doi.org/10.1007/s11121-018-0897-2 What Influences Parental Engagement in Early Intervention? Parent, Program and Community Predictors of Enrolment, Retention and Involvement Naomi J. Hackworth 1,2,3 & Jan Matthews 1 & Elizabeth M. Westrupp 1,2,3 & Cattram Nguyen 2,3,4 & Tracey Phan 1 & Amanda Scicluna 1 & Warren Cann 1 & Donna Bethelsen 5 & Shannon K. Bennetts 1,2,3,4 & Jan M. Nicholson 1,2,3,5 # The Author(s) 2018 Abstract Poor participant engagement undermines individual and public health benefits of early intervention programs. This study assessed the extent to which three types of engagement (participant enrolment, retention and involvement) were influenced by individual, program and contextual factors. Data were from a cluster randomised controlled trial (N = 1447) of a communitybased parenting program, delivered at two levels of intensity (group sessions with and without individualised home coaching) conducted in Victoria, Australia. Individual (parent and family) factors and program factors were assessed by parent report and administrative records, and contextual factors by area-level population statistics. Data were analysed using multilevel logistic or linear regression models. Individual and contextual factors predicted enrolment, while family and program factors were more influential on program retention and parents’ active involvement. Provision of individualised support was important to all forms of engagement, particularly for families experiencing the greatest barriers to participation. These findings indicate that different strategies are required to effectively support families in the processes of enrolling, continuing to attend and actively participating in early intervention programs. Keywords Parent engagement . Parenting programs . Enrolment . Retention . Involvement Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11121-018-0897-2) contains supplementary material, which is available to authorized users. * Naomi J. Hackworth Donna Bethelsen Shannon K. Bennetts Jan Matthews Jan M. Nicholson Elizabeth M. Westrupp 1 Parenting Research Centre, Level 5, 232 Victoria Parade, East Melbourne, VIC 3003, Australia 2 Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia 3 Murdoch Children’s Research Institute, Parkville, VIC, Australia Amanda Scicluna 4 Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia Warren Cann 5 School of Early Childhood, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia Cattram Nguyen Tracey Phan Prev Sci Governments in developed countries are investing in early intervention and prevention programs to enhance the life chances of developmentally vulnerable children. Paradoxically, family risk factors that contribute to children’s vulnerability (e.g. socio-economic disadvantage, very young or single parenting, low parent education, minority background, parent mental health problems) are also associated with increased likelihood that parents will not enrol, actively participate or remain in prevention programs for their full duration (Axford et al. 2012; Miller and Prinz 2003; Morawska and Sanders 2006a). This presents a major challenge — effective programs will have limited individual and public health benefits and cost-effectiveness if they fail to engage the target population (Spoth et al. 2000). Previous studies of parental engagement with prevention programs have focused on recruitment, enrolment and attendance, with less attention on parents’ active engagement with the program content. Additionally, few studies have gone beyond assessing the individual socio-demographic determinants of engagement to include program and community factors (Axford et al. 2012; Whittaker and Cowley 2010). The current study addresses these limitations using data from the active intervention arms of a large randomised controlled trial of a community-based parenting program for disadvantaged families in Victoria, Australia (Nicholson et al. 2016). Specifically, this paper explores the individual, program and community factors associated with three aspects of parental engagement: enrolment, retention and involvement in program activities. Children from socially and economically disadvantaged families have elevated risk for poor developmental outcomes (Bradley and Corwyn 2002; Victorino and Gauthier 2009), particularly in the areas of language, communication, literacy and longer term academic outcomes (Hart and Risley 1995; Nicholson et al. 2010). While a quality home learning environment protects against these risks (Landry et al. 2008), parents’ capacity to engage in development-enhancing interactions with their children may be compromised by the multiple challenges posed by socio-economic disadvantage (Garvey et al. 2006). Parenting programs that aim to mitigate the developmental risks associated with socio-economic disadvantage have had only modest effects, attributed in part to poor uptake and high attrition (see Axford et al. 2012). Up to two thirds of families offered parenting programs do not enrol (Baker et al. 2011; Garvey et al. 2006), and a further 40–60% stop attending part way through the program (Axford et al. 2012; Morawska and Sanders 2006a). This may reflect the preventative focus with parents failing to see the need for assistance with a problem that does not currently exist, and to prioritise this over other competing demands (Axford et al. 2012; Garvey et al. 2006). A greater understanding of the factors that enhance or impede engagement is crucial to the effective provision of early intervention and prevention, particularly for low-income families. An Integrated Model of Participant Engagement Research examining the patterns and determinants of parental engagement in prevention programs has been hampered by inconsistent terminology. Terms such as ‘recruitment’, ‘enrolment’, ‘attendance’, ‘retention’ and ‘completion’ are inconsistently defined and used somewhat interchangeably (Baker et al. 2011; Whittaker and Cowley 2010). For this paper, we build on the integrated conceptual model of participant engagement proposed by Matthews et al. (2011) to identify four distinct types of engagement. Recruitment may be defined as a population-level measure that considers the reach of the program to the target population, assessed as the proportion of the eligible target population who are approached and indicate an intention to attend. Enrolment refers to the proportion of those recruited who actually participate by turning up at least once; retention is the extent to which participants continue to attend across the duration of the program, and involvement is the extent to which participants actively practice and apply what they have learnt from the program. In the absence of data regarding program reach, the current paper focuses on the three latter measures of engagement (...truncated)