Examining Parents' Preferences for Varieties and Elements of Behavioral Parenting Programs

Abstract

Though behavioral parent training (BPT) is a successful psychosocial intervention for children's attention-deficit/hyperactivity disorder (ADHD; Pelham & Fabiano, 2008), poor uptake and participation by parents are formidable barriers that impact its effectiveness. Three service delivery questions that have received attention are (1) whether group versus individual BPT options are preferred by parents; (2) whether different media-based programs are predicted to be preferable; and (3) whether educational or skill-based programs are predicted to be preferable. To understand how these factors might influence treatment utilization for families of ADHD, a series of three studies examining parents' preferences for the following types of parent programs were conducted: a group behavioral parenting program versus an individual behavioral parenting program versus an "Opt Out" alternative (Study 1); a self-directed/internet program versus a bibliotherapy program versus a video-group program (Study 2); and an educational program versus a skills-enhancing program versus an "Opt Out" alternative (Study 3). Conjoint analysis was used to study preferences for varieties and elements of BPT among parents of children at risk for ADHD. Preferences of 445 parents who sought Children's Mental Health services in Ontario, Canada were examined using a discrete choice experiment composed of 30, partial-profile, conjoint-choice tasks. Each conjoint task described 20, 4-level attributes (i.e., elements) of BPT content, process/delivery, and outcome. Participants made choices between three options composed of experimentally varied combinations of study attribute levels. Sawtooth's Hierarchical Bayes (CBC/HB) program was used to estimate the response of each parent to all possible attribute combinations (Orme, 2006; Sawtooth Software, 2004b). In each study, three varieties of behavioral parenting programs were modeled, standardized (zero-centered) utility values for each attribute level were computed, and importance scores were calculated. Utility values measured the relative influence of each attribute level on choices of parents; importance scores measured the priority assigned to each attribute relative to others in parents' choices. Results from Study 1 suggested that most parents (59%) were predicted to prefer an individual behavioral parent program; these parents were interested in understanding—not solving—their child's behavior problems and wanted services that would foster confidence. Results from Study 2 revealed that half of the parents (50%) were predicted to prefer a bibliotherapy option making it the most popular program; these parents were interested in understanding their child's emotional and behavior problems as long as meetings occurred individually. Results from Study 3 suggested that most parents (68%) were predicted to prefer a skills-enhancing program over alternatives. Findings are considered with respect to the transtheoretical model of change (Prochaska & DiClemente, 1983) and the theory of planned behavior (Ajzen, 1991). Implications regarding possible redesign of behavioral parenting programs for different subgroups of parents with ADHD children are considered.