Examining the Mediating Effects of a Motivational Engagement Call on Relations between Parent Factors and Initiation in a Family-Based Preventive Intervention

Introduction: Despite significant health benefits of family-based preventive interventions, initiation rates (i.e., % attending at least one session) are often low. Families from low socioeconomic (SES) backgrounds and some ethnic minority subgroups (e.g., highly acculturated Mexican Americans) have been particularly difficult to engage. We used an evidence-based engagement call to increase initiation among families randomly assigned and enrolled in the 4-session optimized version of the Bridges program, a family-based preventive intervention for middle school students designed to increase academic engagement and achievement and decrease mental health and substance use problems. We hypothesized that parents’ completion of the engagement call made by group leaders would mediate relations between sociocultural factors and initiation, such that low-SES parents would be more likely to complete the engagement call and consequently more likely to initiate. We also explored whether call completion mediated relations between parental perceptions of need (i.e., child and family problems) and initiation.

Methods: The current study is part of a larger effectiveness trial of the Bridges intervention. Our sample included 415 families randomized to Bridges: 41% were Spanish-speaking Hispanic, 22% English-speaking Hispanic, 16% Non-Hispanic White (NHW), 9% African-American, 7% Native American, and 5% another race/ethnicity. Income averaged $37,500. Group leaders attempted to contact parents assigned to Bridges to conduct a manualized engagement call; 82% of calls were completed. During the call, group leaders showed parents how Bridges would help meet their family goals and problem solved attendance obstacles.

Results: Mediation analyses showed that engagement call completion mediated the effects of sociocultural factors on initiation: household income; mediation effect (ab) = -.07, 95% CI [-.11, -.03], parent education; ab = -.10, 95% CI [-.18, -.04], and cultural group (NHW; ab = -1.07, 95% CI [-2.03, -.25], Native American; ab = -1.98, 95% CI [-2.14, -.35], English-speaking Hispanic; ab = -0.96, 90% CI [-1.92, -.01]). Also, the engagement call mediated the effects of parent-adolescent communication; ab = -.50, 90% CI [-.94, -.05], and parental positive reinforcement; ab = -.61, 90% CI [-1.20, -.02] on initiation.

Conclusions: Findings revealed that Spanish-speaking Hispanics, parents with lower income and education, and those with more parenting difficulties were more likely to complete the engagement call and consequently more likely to initiate. Thus, the engagement call helped reduce disparities in initiation for low-SES and high-need families, which suggests that using the engagement call could increase the public health impact of family-based interventions.