Caregiver-Reported Promoters of Home Practice in a Family-Based Preventive Intervention

Caregiver-mediated interventions for preventing child mental and behavioral health problems depend in part on caregivers' use of intervention skills outside of sessions, termed home practice. Strategies to improve home practice engagement and follow through should be based on caregiver needs and input. Parents (225 mothers, M_age = 39.1; 80 fathers, M_age = 41.0) participating in a randomized controlled trial of a family-based preventive intervention wrote in responses to questions about what would help them engage in home practice of skills. Guided by previous research and the COM-B model, we coded responses for common themes, termed promoters of home practice or simply promoters. After calculating the prevalence of each promoter, we conducted a set of multilevel logistic regressions to determine whether specific promoters corresponded to the caregivers' reports of common challenges to home practice, reported in a previous study (Kim et al., 2021). The most common promoters were caregiver attunement (to their or their child's behaviors, cognitions, and emotions), practicing more, and planning-related strategies. When caregivers expressed daily stressors, they were more likely to report planning and less likely to report attunement promoters. When challenges arose related to caregivers' cognitions about the program or home practice, they were more likely to report attunement promoters. Caregiver wellness and self-regulation challenges were also related to higher likelihood of attunement promoters. Caregivers who chose to receive the program in Spanish reported attunement promoters more often than those who received the program in English. Home practice promoters related to caregivers' internal and external contexts, and most promoters centered around modifying caregiver behavior, cognitions, or emotions rather than relying on outside resources. Some promoters corresponded to specific types of challenges to home practice. Findings can guide program providers in developing supports to enhance caregiver home practice, increasing program impact. ClinicalTrials.gov NCT03125291, registered 4/13/2017 https://clinicaltrials.gov/study/NCT03125291.