Attendance Patterns and Links to Non-Response on Child Report of Internalizing among Mexican-Americans Randomized to a Universal Preventive Intervention

Abstract

We examined attendance trajectory profiles among 335 Mexican-American families participating in an 11-week universal intervention to explore if heterogeneity in attendance and thus dosage was associated with intervention response, defined as pre-to-2-year post (T2) reductions in child report of internalizing symptoms. We estimated trajectories accounting for the influence of baseline covariates, selected based on the Health Belief Model (HBM) and Latino family research, to understand covariate associations with trajectories. Results supported six attendance trajectory groups: non-attenders (NA), early dropouts-low internalizing (EDO-LI), early dropouts-high internalizing (EDO-HI), mid-program dropouts (MPDO), sustained attenders-low internalizing (SA-LI), and sustained attenders-high internalizing (SA-HI). All groups except EDO-HI showed significant pre-to-post change on child report of internalizing; however, trajectory groups reflecting more attendance did not have greater pre-to-post change. Nonetheless, child report of internalizing differentiated two subgroups of sustained attenders and two subgroups of early dropouts. These results suggest heterogeneity among families with similar patterns of attendance and highlight the importance of modeling this heterogeneity. Although life stress was a barrier to participation, there was minimal support for the HBM. Cultural influences, acculturation, and familism, played a more prominent role in distinguishing trajectories. As expected, the EDO-HI group was less acculturated than both sustained attender groups and reported weaker familism values than the SA-HI group. However, unexpectedly, the SA-LI group had lower familism than the EDO-LI group. The results suggest that the influence of culture on participation is nuanced and may depend on child symptomatology.

Keywords: Attendance patterns; Internalizing; Mexican-American; Non-response; Universal intervention.

Figure 1

An illustration of GMM. Model accounts for parent, child, family, and cultural covariates at baseline and mean levels of our targeted outcome, child report of child internalizing symptomatology, at pretest (T1) and two-years post intervention (T2). S1–S11 represents the binary variables for Session 1 to Session 11.

Figure 2

CONSORT Diagram: Illustration of recruitment, enrollment, and randomization in the Bridges to High School randomized control trial (RCT) and RCT families represented in this study’s sample. ¹ The numbers in these cells vary slightly from Gonzales et al., 2012 and Gonzales et al., 2014 because they include 38 families that are from a school that was excluded from the RCT. The 38 families are distributed in the following way: 12 = Unable to Randomize; 11 = Control; 15 =Intervention condition; 14 of the 15 families in the intervention condition had a participating primary female caregiver and were included in this study.

Figure 3

Graphs for GMM results for 2, 3, 4, 5, and 6-class solutions Note: NA = Non-Attenders, ET = Early Dropouts, MPDO = Mid-Program Dropouts, SA = Sustained attenders. LI = Low Internalizing, HI = High Internalizing. Horizontal axis = session number, Vertical axis = probability of session attendance. Thirteen percent (n=43) of the 335 female caregivers in this study did not attend any sessions based on observed data; in every k-class solution, except the 1-class solution, we modeled a "Non-attendance" class (i.e., class 1) by constraining growth factors in this class to zero to account for this pattern of non-participation. We employed no constraints in the 1-class solution. In the 6-class solution, 4 of the 43 female caregivers with observed zeros were classified in the EDO-HI class because, although their attendance was consistent with NAs, their scores on predictors of class membership and on T1 and T2 child report of internalizing were more consistent with the EDO-HI class.

Figure 4

Mean levels of child self-report of child internalizing at Time 1 and Time 2 Note: NA = Non-Attenders, ET-LI = Early Dropouts-Low Internalizing, ET-HI = Early Dropouts-High Internalizing, MPDO = Mid-Program Dropouts, SA-LI = Sustained Attenders-.Low Internalizing, SA-HI = Sustained Attenders-High Internalizing. Time 1 = Pretest; Time 2 = 2 years post-intervention.