Trajectories of Caregiver Motivation and Engagement in Family-Centered Prevention Programs: A Group-Based Modeling Approach

Family-centered interventions have demonstrated great promise for reducing child and adolescent emotional, behavioral, and substance use problems (Eyeberg et al., 2008). Despite considerable progress in the study of intervention development and implementation, the “human element” is often overlooked. Indeed, intervention participants' engagement is a multifaceted process, including attention, motivation, and participation (Nock & Kazdin, 2005); such processes play a play a key role in the degree to which families benefit from interventions (Fosco et al., 2014). Yet, little is known about how parent motivation and engagement change over the course of an intervention. Motivation and engagement may decrease for some families, while other families maintain or increase in engagement. Understanding differences in these processes would inform best practices in the implementation of interventions.

We analyzed 209 parents (118 mothers, 91 fathers) who participated in the Strengthening Families Program (SFP 10-14), or a mindfulness enhanced version of SFP 10-14 (MSFP; Coatsworth et al., 2009). Caregivers completed assessments after sessions on their motivation and positive reactions to the sessions. Motivation to change related to changing their parenting, family relationships, and child behavior. Positive reactions to the intervention was measured to capture the degree to which sessions kept their interest, were a good use of their time, and elicited a positive reaction.

We used a group-based semiparametric mixture modeling approach implemented in Proc Traj within SAS (Nagin, 2005). Following a model fitting, we arrived at a 5-group solution for caregiver motivation to change. A stable low group (16%) of parents emerged, who consistently endorsed “thinking about change”. A stable moderate motivation group (24%) endorsed their motivation as “wanting to change”. Two other groups were actively working to change, with a stable high group (34%) and an extremely high group (16%) that were consistently “taking action to change” or “working hard to change” respectively. Interestingly, a rising motivation group emerged (10%) that increased in motivation over the first 3 weeks, starting at a contemplative “thinking about change” and moving to an active state of motivation.

Regarding positive reactions to the intervention, 3 groups emerged. A low-declining group emerged in about 29% of the sample. This group was generally lower in their reactions to the intervention, and declined over time. A moderate-positive group also emerged for 54% of the sample that evidenced moderate increases over time. Finally, an increasingly positive group emerged that generally rated a strongly positive reaction to the group (17%).