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Title: Does Social and Economic Disadvantage Predict Lower Engagement with Parenting Interventions? An Integrative Analysis Using Individual Participant Data
Authors: Berry, Vashti
Melendez-Torres, G. J.
Axford, Nick
Axberg, Ulf
de Castro, Bram Orobio
Gardner, Frances
Gaspar, Maria Filomena 
Handegård, Bjørn Helge
Hutchings, Judy
Menting, Ankie
McGilloway, Sinéad
Scott, Stephen
Leijten, Patty
Keywords: Socioeconomic status; Social disadvantage; Engagement; IPD meta-analysis
Issue Date: 23-Jul-2022
Publisher: Springer
Project: National Institute of Health Research (NIHR), Public Health Research Program 
NIHR Applied Research Collaboration South West Peninsula (NIHR PenARC) 
Serial title, monograph or event: Prevention Science
Abstract: There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Resesearch 5, 1-144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs-an 8-19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.
ISSN: 1389-4986
DOI: 10.1007/s11121-022-01404-1
Rights: openAccess
Appears in Collections:I&D CES - Artigos em Revistas Internacionais

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