A Hybrid Design Study of the Grow! Parenting Program

Introduction:  Examining treatment outcomes has long been an integral part of the evaluation process. Recently, however, the importance of examining implementation outcomes to gain a better understanding of the mechanisms that may undergird treatment effects has gained traction. Evaluating treatment and implementation outcomes are not mutually exclusive; a hybrid research design can be used to gain insight into both types of outcomes. This paper describes the results of a recent hybrid design study of the Grow! parenting program that was conducted in two Northeastern communities.

Methods:  Grow! was implemented by two trained delivery facilitators at each site who were overseen by trained coordinating facilitators. Twenty-six individuals began the program with 20 attending four or more sessions. Participants completed a pre- and post-test, a three- and six-month follow-up, weekly exit surveys, weekly one-item text-based surveys, weekly two-item online surveys, and participated in a focus group. Delivery facilitators completed weekly exit surveys and participated in an interview; coordinating facilitators completed fidelity observation forms and an end-of-program survey, and participated in an interview. Implementation outcomes included acceptability, appropriateness, fidelity, and feasibility. Treatment outcomes pertained to positive parenting, stress management, and health promotion.

Results: Participants found the program acceptable with 99% indicating they were satisfied with delivery across all weeks, and 80% discussing acceptability during the focus groups. Participants also found the program appropriate with more than 50% stating the curriculum was the most helpful part of each session, and 80% discussing the program’s relevance to them during the focus groups. Fidelity indicators were positive: 94% curriculum adherence rating; 93% of participants reported high engagement, 75% attended all five sessions, and 91% reported frequent skill usage. Coordinating facilitators’ interview responses suggested that it was feasible to implement Grow!. In addition, statistically significant (p < .05) pre-post differences were found for stress management and health promotion outcomes with some evidence of maintenance at three- and six-months.

Conclusions: The results of this hybrid study are promising. Overall, participants and facilitators viewed the program as acceptable and appropriate. The Grow! curriculum was implemented with fidelity; participant attendance, engagement, and skill usage were high; and program feasibility was evident. In addition, some evidence was found for the program’s potential to impact stress management and health promotion outcomes. These findings have informed program improvement features as well as preparations for a large-scale evaluation study involving U.S. Military families.