But Who Does It Work for? Impacts of Executive Function on Healthy Relationships Program Efficacy

Introduction: Promoting healthy relationships is increasingly recognized as key to violence prevention; however, evaluation of healthy relationships programs for youth is limited. Further, the majority of existing evaluations only consider if the program works (i.e., main effects), and not for whom the program works best, information that is critical for better understanding the program theory of change, and for targeting intervention offerings in environments with limited resources. One characteristic that is important to consider when examining differential responsiveness to program is executive functioning (EF), or the mental processes involved in reasoning, planning, problem-solving and self-control. Given the focus of many healthy relationships programs on skill-building, it is possible that youth with deficits in EF will not fully benefit from such programming. As youth with EF deficits are also more likely to engage in risk behaviors, it is important to understand potential limits of universal programs for this more vulnerable population. Thus, the present study evaluated whether deficits in EF were associated with the efficacy of a small-groups healthy relationships program for youth.

Methods: Data are from a randomized controlled trial of the Fourth R: Healthy Relationships Plus Program. Data were collected at five occasions from 211 adolescents aged 14-16 in Southwestern Ontario (67.0% female, 76.7% White). Retention over the study was 90.6%. Primary outcomes for this study included mental well-being, substance use, and bullying perpetration/victimization. EF was assessed using an online battery that taps verbal processing, reasoning and short-term memory abilities. Data were analyzed using structural equation models controlling for school, grade, sex, race/ethnicity, IQ and the outcome variable at pre-test. Moderation was explored in MPlus v7, with probing of simple slopes for dichotomous outcomes conducted using PROCESS (v.16) for SPSS.

Results: In this study, a main effect was found for physical bullying victimization. Considering this main effect, participants with lower scores on verbal processing (bottom 37% of the sample) and reasoning abilities (bottom 26% of the sample), as well as those with higher levels of reasoning (top 39% of the sample), did not benefit as much from the program. Thus, the program most strongly benefitted those with moderate to high verbal processing scores and moderate reasoning abilities. Interactions with other outcomes are currently being explored.

Conclusions: Findings from this study suggest the importance of considering individual differences, such as EF, when understanding response to universal prevention programs. Implications of this study for program design and implementation will be discussed.