Barriers to, and facilitators of, parenting programmes for childhood behaviour problems: a qualitative synthesis of studies of parents’ and professionals’ perceptions

Abstract

Disruptive behaviour problems (DBPs) during childhood exert a high burden on individuals, families and the community as a whole. Reducing this impact is a major public health priority. Early parenting interventions are recommended as valuable ways to target DBPs; however, low take-up of, and high drop-out rates from, these programmes seriously reduce their effectiveness. We present a review of published qualitative evidence relating to factors that block or facilitate access and engagement of parents with such programmes using a thematic synthesis approach. 12 papers presenting views of both parents and professionals met our inclusion and quality criteria. A large number of barriers were identified highlighting the array of challenges parents can face when considering accessing and engaging with treatment for their child with behavioural problems. Facilitating factors in this area were also identified. A series of recommendations were made with regard to raising awareness of programmes and recruiting parents, providing flexible and individually tailored support, delivering programmes through highly skilled, trained and knowledgeable therapists, and highlighting factors to consider when delivering group-based programmes. Clinical guidelines should address barriers and facilitators of engagement as well as basic efficacy of treatment approaches.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-013-0401-2) contains supplementary material, which is available to authorized users.

Report of an equity-focused health impact assessment of a proposed universal parenting program in Manitoba

“…[13][14][15] Differences in access or uptake can be related to structural factors such as availability of programs, location, hours, availability of childcare, program content (cultural, literacy level) or perceptual factors such as previous negative experiences with health and social systems, belief that the program is intrusive or irrelevant, or shame about needing help or fear of being labelled or judged. 16,17 In a preliminary report 18 on implementation of the early-years Triple P program in Manitoba, released in the fall of 2010, factors that kept practitioners from using Triple P with families included literacy levels (17%), language barriers (13%) and racial or cultural concerns (7%). However there are no details about the specific nature of these issues or specific populations concerned.…”

The relevance of family variables in child and adolescent mental health

“…Few studies address the barriers for these interventions in real world clinical settings from the perspective of parents. In this issue, Koerting et al [6] present a systematic review addressing this topic. Among several factors, family characteristics such as number of children in the family, parental symptoms like shyness emerged as important barriers to overcome.…”

Broadening the reach of evidence-based parenting interventions: Evaluation of a brief online version of the Triple P – Positive Parenting Program

“…Additional barriers to program enrolment and completion include logistical difficulties (Spoth, Redmond, Hockaday, & Shin, 1996;Whittaker & Cowley, 2012) (e.g., transportation, work-schedule conflicts, availability and affordability of child care) and the financial cost of programs. Moreover, it is still not socially normative to request help with parenting, so there is often stigma attached to attending any type of parenting program (Koerting et al, 2013). Barriers to attendance are often particularly pronounced for 'high-risk' families, where parenting problems are coupled with other forms of adversity, including low income, single parenthood, parental mental health problems, high levels of stress or ethnic minority status.…”

“…Availability of evidencebased parenting programs in the community is often sparse, and programs on offer are usually in group or individual formats, delivered face-to-face. The reach of face-to-face parenting programs is restricted by substantial challenges in recruiting, engaging, and retaining parents, who face numerous barriers to attendance (Koerting et al, 2013;Spoth & Redmond, 2000). This failure to engage with families means that parenting interventions are falling short of their potential to deliver population level improvement in children's mental health and long-term outcomes.…”

“…Unfortunately only low numbers of parents participate in parenting programs (Sanders et al, 1999), and participation rates are particularly low for parents of children with significant behaviour problems (Haggerty et al, 2002) or families that face additional challenges like parental adjustment or relationship problems, living in adverse socioeconomic circumstances, belonging to an ethnic minority group, or being affected by other physical or mental health problems (Kazdin & Wassell, 2000). Additionally, it is still not socially normative to seek assistance with parenting, so there is often stigma attached to attending any type of parenting program (Koerting et al, 2013). Finally, the logistics of attending sessions (e.g., timing difficulties, cost, transport, child care) may prevent many parents from participating in programs (Spoth et al, 1996;Whittaker & Cowley, 2012).…”