The Effect of Delivery Modality on Engagement in the Pathways to African American Success (PAAS) Program

Group-based delivery has been the standard format for delivering preventive interventions targeting positive parenting behaviors as a mechanism for reducing youth risk behaviors. In efficacy trials, these programs have been successful at achieving positive outcomes for not only youth, but parents as well. One theory is that assembling a group of parents experiencing similar stressful situations promotes social support, which keep parents coming back to sessions and reduces parental depression. Nonetheless, many barriers are involved in organizing prevention groups, especially in rural communities which are geographically spread out and limited in public and private transportation. Inconsistent work schedules also make scheduling a time that the group can come together each month difficult. An emerging solution to these barriers is the use of technology to deliver the program more conveniently for families. However, comfort with technology use may be more limited in rural communities with lower levels of education, especially in situations where grandparents are primary caregivers. Further, the loss of the group cohesiveness may result in more parents’ disengaging from the program. As such, it is an empirical question as to whether technology-based programs will be able to engage families and produce equivalent outcomes to in person delivery formats.

This study uses data from the 6-session Pathways to African American Success (PAAS) trial in rural Tennessee, which targets the reduction of substance use and sexual risk behavior through adaptive parenting. The design was a 3-arm randomized trial in which 412 primary caregivers and their 6th grader were randomly assigned to: group, technology, or literature control conditions. The technology version of the program includes computer-based modules with components designed to mimic group interactions.

The first set of analyses using Structural Equation Modeling demonstrated that the technology group experienced the highest levels of improvements in targeted parenting outcomes, followed by the group-based version of the program. Next, we will examine indicators of responsiveness, including attendance and satisfaction as mediators for the association between group assignment and outcomes. Finally, we will examine whether demographic characteristics (e.g., parent age) influence parent responsiveness to the program.

This study answers important questions about the potential of technology-based approaches to achieve similar results to the traditional group format and higher rates of engagement that would translate to large scale public health impact. In addition, it will give information important for customizing programs for demographic subgroups.