1. Angelika H. Claussen, PhD,
Who comes to groups? Barriers to participation in a longitudinal parenting group intervention
Angelika H. Claussen, PhD,
D. Camille Smith, EDS,
Susanna N. Visser, MS,
Ruth Perou, PhD
NCBDDD/CDC
The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention. They do not represent and should not be construed to represent any agency determination or policy.

2. Background
Enhancing parenting skills in at-risk populations is a process that takes time.
Longitudinal interventions may be needed
Barriers to attendance and participation may make them difficult to implement

3. Research Question:
What factors influence participation in Legacy for Children(TM) parenting groups?
Baseline Characteristics
Program Response Factors

4. Method Baseline Assessment Parent Satisfaction Survey
Conducted annually in the summer
All mothers who attend at least one session in 6 months prior to interview are eligible
Telephone survey
Data analyzed to date:
Baseline: Demographic and maternal characteristics such as social and emotional functioning collected at the baseline assessment prior to intervention start.

5. Analysis
Comparison of mothers who participated across 3 study years with those who did not
Eligibility for survey as a proxy for participation
Comparisons
Ever participated vs. never participated
Participated throughout vs. participated in one year but did not continue the following year
So we can compare mothers who participated in 2005 vs those who did not, and mothers who participated in 2006 vs those who did not.

6. PSS Sample Eligibility Across Years
This slide shows the mothers who were eligible based on participating at least once in the 6 months prior to the survey.
’ ’ ‘06
Miami
’ ’ ‘06
UCLA

7. Changes in Eligibility
Eligible in 2005 but not 2004: 21 mothers
Eligible in 2006 but not 2005: 10 mothers
Mothers attendance did not always decrease, some mothers also returned after some breaks in attendance

8. Demographic Factors (assessed at baseline)
Who Comes to Groups?
Demographic Factors
(assessed at baseline)

9. Gender of Child * Difference statistically significant
In these analyses, we are select participants who were enrolled into the intervention groups, and examining differences between those who met the eligibility criteria for the survey, i.e., participating in at least one group during the 6 months prior to the survey, with those who did not meet the criteria
* Difference statistically significant

10. * Difference statistically significant
Home Environment *
The scale is showing mean number of people
People per room is a measure of crowding or density *
* Difference statistically significant

11. No differences Income Marital status Mother’s education
Number of moves
Race/ethnicity
Marginal effect- African American were less likely, Hispanic and Caucasian evenly, and non-Hispanic other were more likely to attend
Marginal effect for language spoken in home- mothers who spoke English were less likely to participate
2 Asian both attended, and 29 out of 32 Haitian Creole attended

12. Maternal Characteristics (assessed at baseline)
Who Comes to Groups?
Maternal Characteristics
(assessed at baseline)

13. Significant Differences
Mothers who ever participated
Higher social self-efficacy
Lower social confidant support

14. Not Significant Affective or instrumental support
Knowledge of child development
Parenting attitudes
Stress
Coping
Dyadic adjustment
Perception of neighborhood

15. Who Continues to Come to Group? Changes over time
Mothers who continued attending in 2005 and 2006
Lower in self-efficacy
No differences in other factors
While the previous slides were comparing mothers who ‘never’ vs ‘ever participated’, the following analyses are only about mothers who participated at least once based on the survey criteria
, comparing those who continued participating vs those who did not continue

16. Who Continues to Come to Group?
For the following analyses, we utilized the answers on the Parent Satisfaction Survey.
Two limitations: This does not include all mothers who participated, only those who were reached for the survey
Also, although the interview was done by RTI, the outside evaluators, response biases such as social desirability factors likely played a role- we only have mothers’ reported perceptions to analyze.
Program Response Factors

17. * Difference statistically significant
Survey Response Rate + *
These data show that there is some meaning to not responding: Of the mothers who continued in 2005, ~80% took part in the survey, whereas of the mothers who did not continue, only 68% responded. Conversely- of the mothers who did not respond to the survey in 2004, 47% were not eligible in 2005, whereas only 32% of those who did respond ended up not continuing.
* Difference statistically significant
+ Difference statistically marginal

18. PSS Questions Attendance Perception of Legacy for ChildrenTM
Satisfaction with attendance
Barriers to attendance
Perception of Legacy for ChildrenTM
Overall expectations and satisfaction
Helpfulness of program components
Perception of the Groups
Difference to other groups
Feelings about the groups
Perception of Group Leader/Information Specialist
Leadership and communication skills
Effect of Legacy on Mothers
Changes in parenting views
Changes in confidence about parenting
We looked at the data across the years, viewing whether mothers responses in a given year were related to participation in the following year

19. * Difference statistically significant
Attendance * *
This slide is not about frequency of attendance per se, instead, it is about how satisfied mothers were with their own level of attendance. We asked mothers ‘did you attend as often as you wanted’.
The data show that among those mothers who continued attending into 2005, 80% reported having attended as frequently as they wanted in 2004, whereas among those who did not continue, only 40% were satisfied with their attendance and would have liked to come more often.
* Difference statistically significant

20. Barriers to Attendance*
Any barriers: Mothers report at least one barrier to attendance
Presence/absence of any barriers in 2005 not significant, work still is * *
2004
2005
* Difference statistically significant

21. Satisfaction with Groups+
Overall satisfaction with Legacy groups. Very or satisfied vs somewhat or not. These chart indicate that overall satisfaction is very high, on average around 90% of the mothers were satisfied. The others almost all said ‘somewhat satisfied’, only one mother was ‘not satisfied’ with the program in 2004, none were not satisfied in 2005
+ Difference statistically marginal

22. Expectations About Groups*
Were the groups exactly as or better than expected, vs not as good as expected.
There were no significant predictions regarding mothers who said their expectations were met vs exceeded for the following year, but significantly more mothers whose expectations were exceeded in 2004 still were with the program in 2006
* Difference statistically significant

23. * Difference statistically significant
Group is Unique *
Mothers were asked whether Legacy was different from other groups of mothers
Looking at the qualitative answers that mothers gave when asked how Legacy was different: Different explanations for why Legacy differs:
Mothers who stopped coming: tended to mention no explanations, general differences, or commonality
Mothers who continued: closeness, being understood
* Difference statistically significant

24. Perception of Group and Leader
Unrelated to continued attendance:
No difference in
Leader’s skills, knowledge, feedback, attentiveness
Feeling close, supported, important, belonging, being self.
No differences when comparing mothers who endorsed any negative answer to group related question, versus those who did not
Overall ratings were very favorable, not much variability

25. Perception of Program Effects
Mostly unrelated to continued attendance:
No difference in
Perceived changes in parenting views
Confidence in parenting, disciplining, child safety, or helping child learn
Perceived helpfulness of program activities
Self-efficacy
Mothers who stayed eligible in 2005 reported increased confidence about their influence on child’s future in 2004
Not significant the following year
Note:
confidence self-efficacy, parenting, and child safety, 1 responded each chose ‘less confident’, and she maintained eligibility
confidence in disciplining: 7 respondents chose ‘less confident’, 6 of whom maintained eligibility.

26. Summary
The most significant barrier to continued program participation were external factors like work
Expectations and satisfaction affected whether mothers continued in the second year, but did not affect participation in the third year
Many mothers stop coming because of barriers. What about those who were satisfied with their attendance? Among them,
Mothers who continued were more likely to state that they were feeling important
Mothers who continued rated the GL/IS higher on leadership skills.
No further differences

27. Conclusions
The findings suggest that external attendance barriers more than program aspects may determine longitudinal participation.
Public health interventions may benefit from addressing external barriers to the extent feasible.
Many mothers stop coming because of barriers. What about those who were satisfied with their attendance? Among them,
Mothers who continued were more likely to state that they were feeling important
Mothers who continued rated the GL/IS higher on leadership skills.
No further differences

28. Thank You