This project was a pilot evaluation of the Motivational Boost mobile and SMS-based patient adherence tool’s promise to increase Medicaid patient engagement in the Triple P Online positive parenting program.
Sixty-eight low SES caregivers of children ages 2-12 were recruited to participate in the Motivational Boost for Triple P Online study. As part of a community sample of Medicaid subscribers eligible to receive the Triple P Online parenting program free of cost, study participants were recruited from Lane County Women Infants and Children Supplemental Nutrition Program (WIC), Head Start of Lane County, and Willamette Family Treatment Center between August and December 2018. Study participants were randomized to one of two study conditions: 1) Motivational Boost (treatment condition) whereby participants completed a brief avatar-led mobile session with follow-up SMS “boosts” containing personalized Triple P Online activation link, or 2) SMS Reminders only (active control condition) whereby participants completed a brief avatar-led mobile session with follow-up SMS “boosts” containing personalized Triple P Online activation link, or 2) SMS Reminders only (active control condition) whereby participants received text reminders with personalized link to activate Triple P Online, but without our motivational component. Level of engagement in the Triple P Online parent training program was tracked for sixty-seven study participants via the web-based Triple P Central Management System registration and tracking system.
Study participants completed a battery of self-report questionnaires at two timepoints; 1) pre-assessment prior to study randomization, and 2) post-assessment four months after completing pre-assessment measures. The battery of assessments included validated self-report measures: Parenting Skills Ladder (PSL), Child Adjustment and Parent Efficacy Scale (CAPES), and Parent and Family Adjustment Scales (PAFAS), as well as demographic and consumer satisfaction measures. Fifty-eight participants completed post-assessment measures. One participant was removed from the study for “faking” responses. Nine participants had not completed post-assessment measures at the time of this preliminary report, though data collection is ongoing. Utilizing an intent to treat design, participant data were included in the analyses regardless of Motivational Boost treatment engagement.
Our primary hypothesis was that Motivational Boost would significantly increase caregiver engagement in the Triple P Online parent training program compared to standard SMS reminders. Additionally, we hypothesized that increased engagement in the Triple P Online program would predict greater self-reported parent efficacy and reduced child emotional and behavioral maladjustment at four- month follow-up.
Treatment group participants were directed via text message to begin by completing the Motivational Boost module first and then were directed to Triple P Online. Active control group participants were sent directly to Triple P Online (no Motivational Boost). All participants received both email and text reminders that included a personalized link to register Triple P Online.
Results indicate that 9% of participants randomly assigned to receive Motivational Boost (treatment group) failed to activate their Triple P Online accounts, whereas 29% of participants randomly assigned to the active control group (Triple P Online only) failed to activate their Triple P Online accounts. All Motivational Boost Completers activated their Triple P Online accounts. Results indicate that 71% of participants randomly assigned to the active control group (Triple P Online only/no Motivational Boost) activated their Triple P Online accounts, whereas, 91% of treatment group participants activated their Triple P Online accounts. Results from a chi square analysis indicate that Motivational Boost significantly increases Triple P Online activation compared to active control ( X(1) = 4.169, p = .041) . Eighty-one percent of the overall sample activated their Triple P Online accounts.
Child Adjustment and Parent Efficacy Scale (CAPES)
Fifty five study participants completed the Child Adjustment and Parent Efficacy Scale (CAPES) post-assessment measure which were summarized into two subscales, Parent Efficacy and Child Behavior Problems. Higher scores on the CAPES Parent Efficacy Scale indicate greater self-reported levels of parent efficacy. There was no significant between group difference in pre-assessment levels of parent efficacy on the CAPES between treatment and control conditions (p=.803). Results of a multiple regression analysis indicate that when accounting for pre-assessment parent efficacy levels, Motivational Boost significantly increased self-reported parent efficacy at post assessment (p=.031). We did not detect an effect of level of Triple P Online engagement (e.g, number of modules completed) on increases in caregiver-reported parent efficacy pre- to post-assessment (p=.426). Lower scores on the CAPES Child Emotional and Behavioral Problem Scale indicate lower caregiver-reported levels of child emotional or behavioral problems. There was no significant between-group difference in pre-assessment levels of child emotional and behavioral problems on the CAPES between treatment and control conditions (p=.604). Regardless of randomized condition, eighty-one percent of the overall sample activated their Triple P Online accounts. Results from a sample-wide multiple regression analysis indicate that increases in level of Triple P Online engagement (e.g, number of modules completed) predicts significant improvements in caregiver-reported child emotional and behavioral problems pre- to post-assessment (p = .048). Participants randomized to the Motivational Boost condition reported steeper declines in child behavior problems at post-assessment compared to control group participants, however, when accounting for pre-assessment levels of child behavior problems, results did not reach statistical significance (p=.1).
Parenting and Family Adjustment Scales (PAFAS)
Fifty-five study participants completed the Parenting and Family Adjustment Scales (PAFAS) post-assessment measure which is divided into two subscales, Parent Adjustment and Family Adjustment. Lower scores on the PAFAS subscales indicate increased levels of caregiver-reported parent and family adjustment. Eighty-one percent of study participants activated their Triple P Online accounts regardless of randomized condition. Results from a sample-wide Paired Samples Test indicate significant increases in parenting adjustment between pre- and post-assessment (p<.000), and significant increases in family adjustment between pre- and post-assessment (p<.000). There was no significant between-group difference in pre-assessment levels of parent adjustment between treatment and control conditions (p=.102). Accounting for pre-assessment parent adjustment levels, no significant difference in post-assessment parent adjustment levels was observed by study condition (p = .822).
Results from a sample-wide Paired Samples Test indicate significant increases in family adjustment between pre- and post-assessment (p=.001). There was no significant between-group difference in pre-assessment levels of family adjustment between treatment and control conditions (p=.637). Accounting for pre-assessment family adjustment levels, no significant difference in post-assessment family adjustment levels was observed by study condition (p = .854).
Parenting Skills Ladder (PSL)
Fifty-eight study participants completed the PSL post-assessment measure which is divided into two subscales, Parenting Skills, and Child Skills. Higher PSL Parent scores indicate greater caregiver-reported parenting skills. Eighty-one percent of study participants activated their Triple P Online accounts regardless of randomized condition. Results from a Paired Samples Test indicate that sample-wide, parents rated their parenting skills significantly higher at post-assessment when compared to pre-assessment (p < .000) and when compared to retro pre-assessment (p = .045). Accounting for pre-assessment parenting skills, no significant difference in post-assessment parenting skills was observed by study condition (p = .822). Higher PSL Child scores indicate greater parent-reported child skills. Parents rated their child’s skills significantly higher at post-assessment when compared to pre-assessment (p < .000) and when compared to retro pre-assessment (p < .000). Accounting for pre-assessment child skills, no significant difference in post-assessment child skills was observed by study condition (p = .059).
Consumer Satisfaction: Triple P Online (TPOL)
Fifty-eight participants completed measures of Consumer Satisfaction regarding the Triple P Online (TPOL) parent training program. Three-quarters of study participants rated the TPOL information and resources received as somewhat or very helpful, and seventy-six percent of them reported that they would recommend TPOL to other parents.