A cluster randomised controlled trial and process evaluation of the early years DELTA parenting programme
Introduction
There is a substantial body of evidence to indicate that parenting programmes are effective in improving outcomes for both parents and children. Parenting programmes can help to improve: parent responsiveness; parent child interactions and parenting confidence (Barlow, Smailagic, Huband, Roloff, & Bennett, 2014). They have been shown to contribute to a reduction in negative parenting practices, parent anxiety and depression (Barlow, Coren, & Stewart-Brown, 2003; Barlow et al., 2011, Furlong et al., 2012) as well as positively impact on the emotional and behavioural adjustment of children (Barlow, Smailagic, Ferriter, Bennett, & Jones, 2010; Barlow & Parsons, 2005). Over the past decade there has been a new sense of urgency around the importance of promoting healthy family and parenting practices. This is reflected in current UK and Northern Irish government agendas which acknowledge the vital role of parenting in aiding children to be emotionally, socially, behaviorally and physically healthy into adulthood (Allen, 2011, Department of Education, 2010, Marmot et al., 2010). Consequently, there has been a surge of new initiatives and parenting programmes, many of which are aimed at parents of children from birth to five, in recognition that the early years of a child’s life are the most important for shaping their future (Barlow et al., 2010, Fonagy, 1998, Bandura, 1969, Bowlby, 1988).
Parenting programmes are delivered in a variety of formats, some are universal but many are aimed at specific groups of children or parents who are likely to be more vulnerable, for example families living in socioeconomically deprived areas (Belsky et al., 2006), children who are at risk of developing conduct disorders (Leijten, Raaijmakers, de Castro, van den Ban, & Matthys, 2015) or teenage mothers (e.g. Olds, 2006). Programmes can also be delivered in a variety of contexts such as in the family home, delivered during home visits by a nurse or family visitor (e.g. the Nurse Family Partnership; Olds, 2006) or in a group setting for example in a school, community or clinic (e.g. Surestart; Belsky et al., 2006). Programmes frequently utilise standardized manuals or curriculums, booklets and handout materials, as well as discussion, role-play and video modelling techniques.
In response to the growing number of parenting programmes available, a considerable evidence-base regarding their effectiveness has also built up. Consequently, a number of systematic reviews – aimed at summarising this research – have been carried out (Barlow et al., 2014, Barlow et al., 2010, Barlow and Underdown, 2005, Barlow and Parsons, 2005, Thomas et al., 1999) providing convincing evidence that parenting programmes are an effective way of improving both parent and child outcomes. Fostering a strong, good quality parent-child relationship in the very early years – based on a secure attachment relationship (Fonagy, 1998, Bowlby, 1988) – is key to the healthy social, emotional and behavioural development of the child, and to the child forming secure relationships later in life (Barlow et al., 2010, Barlow and Parsons, 2005; Warren, Huston, Egeland, & Sroufe, 1997). Thus, parenting programmes which directly support the parent-child relationship in the early years can be particularly effective in promoting improved child outcomes (Barlow et al., 2010; Barlow, Parsons, & Stewart-Brown, 2005; Barlow and Parsons, 2005, Regalado and Halfon, 2001). Similarly, many programmes aim to improve and support parental psychosocial health (for example, depression, stress, anxiety and confidence), which in turn impacts on child outcomes through improving the parent-child relationship and the effectiveness of parenting (Miller, Maguire, & Macdonald, 2011; Barlow et al., 2003; Kaminski, Valle, Filene, & Boyle, 2008).
A range of theoretical frameworks are commonly used as the underpinning for parenting programmes. These include; behavioural, cognitive-behavioural, attachment theory and family systems. The theoretical framework a particular programme adopts is influenced by the outcomes it aims to address for parents and children, and this in turn often influences the techniques used to deliver the programme. An important part of being a ‘good parent’ is how you think about yourself as a parent and this cognitive appraisal can have a measurable impact on parenting behaviour (Coleman & Karraker, 1998). As such, many researchers have drawn on self-efficacy theory (Bandura, 1977, Bandura, 1982) to better understand this cognitive dimension of parenting (see for example, Cutrona and Troutman, 1986, Teti and Gelfancd, 1991, Coleman and Karraker, 1998, Coleman and Karraker, 2000, Coleman and Karraker, 2003, Jones and Prinz, 2005).
Self-efficacy relates to an individual’s perception and expectation of how well they think they will cope in a given situation. It influences how much effort a person will expend and how long they will persevere with a task when challenges get in the way (Bandura, 1977, Bandura, 1982). Individuals with high self-efficacy tend to be persistent, not blame themselves for failure and report lower stress and anxiety than those with low self-efficacy (ibid). Self-efficacy beliefs specific to the parenting role are referred to as parenting (or parental) self-efficacy (PSE) (Cutrona & Troutman, 1986). Parental self-efficacy relates to a parent’s belief that they can be a competent, effective parent (Teti & Gelfancd, 1991) and positively influence the development of their child (Coleman & Karraker, 1998). Independent of other variables, maternal self-efficacy is directly related to maternal behaviour and can mediate and explain the association normally observed between the behavioural competence of the mother and other known psychosocial correlates of parenting quality such as economic background, infant temperament, social support and depression (Teti & Gelfancd, 1991).
The process through which self-efficacy beliefs affect parenting competence and quality of care is through affective, motivational, cognitive and behavioural pathways (Coleman & Karraker, 1998). High parental self-efficacy is correlated with competent parenting behaviour and positive parenting practices (Jones & Prinz, 2005; Machida, Taylor, & Kim, 2002) and is known to play an important role in parents’ psychological functioning. It is inversely related to both maternal depression (Cutrona & Troutman, 1986; Teti & Gelfancd, 1991) and parental stress (Gross, Fogg, & Tucker, 2005; Scheel & Rieckmann, 1998) and there is further evidence that it is positively associated with role satisfaction (Coleman & Karraker, 2000) and influenced by the parents’ personal characteristics (Sevigny & Loutzenhiser, 2010). The direction of these associations remains relatively unclear however and the specific role of parental self-efficacy as an antecedent, consequence or transactional variable has still to be established (Jones & Prinz, 2005). Parental self-efficacy can also positively impact on child behaviour (Bohlin & Hagekull, 2009; Day, Factor, & Szkibaday, 1994; Bogenschneider, Small, & Tsay, 1997; Coleman & Karraker, 2003), social-emotional functioning (Murry & Brody, 1999) and school achievement (Bogenschneider et al., 1997, Ardelt and Eccles, 2001)—both directly and indirectly through parenting behaviour, parental adjustment and parental involvement. Of course, self-efficacy is not the only correlate of parenting competency; other maternal factors are also involved, including: personality, stress and depression, knowledge of child development, attitudes and beliefs about parenting, desires and expectations (Coleman & Karraker, 1998). However, given the evidence summarised above which indicates a direct and indirect effect of parental self-efficacy on both parent and child outcomes, improving parental self-efficacy through intervention is a valid approach to improving a range of outcomes for both parents and children.
The DELTA parenting programme is a universal, group-based programme whose mission is ‘to promote partnership with parents and carers on a multi-disciplinary basis through group and individual programmes by imparting parenting information and advice’. The programme is usually delivered in the school setting and is divided into five age ranges, from birth to 16 years. The focus of the current evaluation is the early years (EYS) strand of the programme, which is aimed specifically at parents of pre-school children and comprises six weekly meetings. Each group consists of approximately 14 parents and meetings last between one and two hours with tea and coffee provided. The meetings are parent focused and are orientated around six themes:
- 1.
Promoting learning and thinking skills,
- 2.
Health and routines,
- 3.
Language and literacy skills,
- 4.
Learning through play,
- 5.
Maths all around us, and
- 6.
Positive parenting and managing behaviour.
The DELTA programme aims to provide parents with information appropriate to the developmental stage of their child through short talks, demonstrations and written booklets. In addition, the programme provides and encourages a relaxed social context through which parents can meet and engage with each other and the group facilitator. It is this provision of practical information and advice, in an informal supportive context that is thought to increase parents’ confidence in their parental role and enhance their support networks.
It is clear from the research literature that parenting quality is essential for the development of positive child outcomes (e.g. Gross et al., 2005). The early years DELTA programme aims to improve the quality of parenting by providing developmentally relevant information, modelling appropriate behaviours and techniques, and providing support and advice (through the group facilitator as well as peer support via other attending parents). This combination of information and support is thought to lead to an increase in parents’ confidence in their parenting ability, specifically parental self-efficacy which is an important factor in achieving behavioural change. Thus, an improvement in parental self-efficacy might be one of the first steps towards some of the more behavioural changes described above such as healthy life choices, increased activities with the child, using positive parenting styles and using appropriate behaviour management techniques. This can be broadly thought of as a simple logic model, which depicts how the programme might work, namely, that the activities that make up the programme result in changes in parents’ feelings of efficacy and confidence as well as their perceived social experiences.
It is with the above in mind that the current study, conducted between September 2012 and June 2013, sought to provide an impact evaluation to determine, in a methodologically rigorous way, whether the early years DELTA programme improves the parental self-efficacy (primary outcome) and social experiences (secondary outcome) of parents who take part compared to those who do not.
The study aimed to answer the following research questions:
- 1.
Does the early years DELTA parenting programme improve parental self-efficacy for those parents who take part in the programme?
- 2.
Does the early years DELTA parenting programme improve parenting perceived support for those parents who take part in the programme?
- 3.
What is the experience of parents who take part in the programme?
Section snippets
Methodology
To address the research questions, the evaluation consisted of two elements:
- 1.
A cluster randomised controlled trial (RCT) to evaluate the effectiveness of the DELTA parenting programme in improving parent outcomes,
- 2.
A qualitative process evaluation, which was conducted alongside the RCT and explored parent (and child) outcomes in more depth as well as the process of programme delivery.
This combined approach to evaluation provides a robust method of determining whether a programme works whilst also
Sample characteristics
In total 334 parents (22%) completed a pre-test questionnaire, 231 were in the intervention group and 103 were in the control group. At post-test 125 parents (37%) returned a post-test questionnaire: 76 were in the intervention group and 45 were in the control group (see Fig. 1).
Overall, 93% of the respondents were mothers or a female legal guardian and 7% were fathers. On average respondents had 2.5 children. Thirty seven per cent (37%) of mothers and 27% of fathers in the sample had a
Design
A process evaluation was conducted alongside the RCT in order to provide more in-depth data on both the outcomes and implementation of the early years DELTA parenting programme. The interviews were conducted by the research team and took place once post-test data collection for the RCT was complete. Specifically, the following research questions were addressed and explored from the perspective of parents who had taken part in the RCT:
- •
What is the experience of parents who take part in the
Sample characteristics and reasons for taking part in DELTA
Of the 11 parents who took part in the interviews, nine of them had two children or more, all of whom were primary school age or younger. In terms of the number of DELTA programme sessions attended by parents, the majority of parents attended all six of the sessions, with two parents attending only two sessions out the possible six due to sickness and a lack of childcare cover. In response to being asked why they chose to participate in the DELTA programme, the majority of parents interviewed
Parental self-efficacy
Overall this evaluation has shown that parental self-efficacy improved as a result of taking part in the DELTA programme. Whilst the positive change in total parental self-efficacy did not achieve statistical significance in this sample, a positive effect of g = 0.15 cannot be disregarded and a difference of this magnitude in a larger sample might well have achieved statistical significance. Nevertheless, certain specific domains of parental self-efficacy did show statistically significant
Acknowledgements
This study was funded by the DELTA Parenting Partnership Service, the Southern Education and library Board (SELB) and the Southern Health and Social Care Trust (SHSCT).
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