Change in participant engagement during a family-based preventive intervention: ups and downs with time and tension

Abstract

The efficacy of preventive interventions is related to both the delivery of content and the uptake of that content. Although much research has focused on the quality of delivery, few studies have examined the factors that influence uptake. This study examines how and why participants' engagement-conceptualized as a dynamic process wherein participants interact with each other, the interventionists, and the intervention curriculum-changes over time. We apply growth curve models to repeated measures of engagement obtained from 252 families during a 7-week intervention trial. In the models, we examine (a) whether and how engagement changes over time, and the extent of between-person differences in change; and (b) how those changes and differences are related to chronic and session-specific aspects of family tension, while also controlling for differences across parent sex and 2 versions of the Strengthening Families Program: For Parents and Youth Ages 10-14 (SFP 10-14). Results show that, on average, engagement increased over time, linearly with some deceleration, with substantial differences in both level and rates of change. Higher in-session chronic family tension was related to lower initial levels of engagement but not rates of change. Sessions when families displayed more session-specific tension were characterized by different levels of engagement for parents, depending on their level of chronic tension. Overall, our results highlight the importance of considering engagement as a dynamic construct that changes over time in complex ways. Further understanding of the many factors that influence engagement can promote both better delivery and better uptake of intervention curriculum.

Figure 1

Changes in Engagement Across Sessions. Lines depict how a randomly selected subset of 35 parents’ engagement changed over seven weekly intervention sessions. Readily apparent are both between-parent differences and within-parent changes (both trends and week-to-week fluctuations).

Figure 2

Changes and Differences in Parent Engagement across Sessions. Predicted trajectory for the prototypical parent is indicated by the solid bold line, indicating increases in engagement across session with some deceleration as the program progressed. Dashed lines indicate how parents with high (+1SD = short dash) levels of chronic family tension have lower initial levels of engagement compared to parents with low (minimum sore of −0.298 = long dash) levels of chronic family tension. Thin, gray lines depict parent-specific predicted trajectories based on final model (Model 2).

Figure 3

Chronic Family Tension Moderates the Extent to which Session-specific family tension Influences Engagement. Each dot represents a parent’s predicted engagement score for each observed level of session-specific family tension. Bold lines represent the extent of the relation between session-specific family tension and engagement for low (minimum sore of −0.298, black) and high (+1SD, grey) levels of chronic family tension.