Telephone-supported versus self-directed delivery of an online parenting program: Outcomes, mediators and moderators of change

Abstract

Despite the availability of high quality, evidence-based parent training programs, research suggests that many parents that might benefit from support do not access it. The potential for web-based parenting programs to increase the reach and availability of parenting support is enticing, however relatively few online parenting programs are available and only a small number of randomised studies have so far been conducted exploring their efficacy. Chapter 1 of this dissertation summarises the available literature underlying the current state of web-based parenting support, and provides an introduction to the Triple PmPositive Parenting Program and the recently developed Triple P Online program, used in a randomised controlled trial that forms a focus of this thesis. A rationale is provided for the research questions at the centre of this thesis, including exploring whether brief, regular practitioner support improves outcomes when combined with a web-based parenting intervention, whether measured baseline characteristics, such as participant sociodemographic status, interact with treatment condition to moderate intervention efficacy, and an endeavour to both identify and test hypothesised causal mechanisms. Chapter 2 describes a multisite randomised controlled trial aiming to test the additive benefit of regular, brief clinical telephone consultations provided as an adjunct to Triple P Online. Onehundred and eighty-three participants were randomly assigned to access the online program either on their own, with support from an allocated practitioner who provided up to eight telephone consultations on a weekly basis, or to a computer-use-as-usual control group. Across the 16-week period of online program access, participants in the clinically-supported group engaged in about 4 telephone consultations on average, with a mean call duration of approximately 20 minutes. Intervention effects and program completion rates were significantly improved for these parents when compared to those completing the program without therapist involvement. Chapter 3 describes a process of content analysis used to identify a various theoreticallyderived putative mechanisms of parenting change thought to be causally associated with parenting outcomes during participation in Triple P. Drawing on the experience of Triple P practitioners, mechanisms were ranked for perceived importance, and distilled to eleven key domains through factor analysis, with processes such as positive therapeutic relationships, actively implementing positive parenting strategies, and the development of a positive parent-child relationships rated as having high perceived importance for parenting change. These findings align with prior research, with therapeutic support shown to be a key process for improving outcomes and program engagement in other web-based and self-directed treatments, however no direct comparison have yet been conducted comparing the effects of a self-directed online parenting program with a practitioner-supported model. Chapter 4 is a follow-up study further exploring the mediating and moderating influence of pre-treatment and intervention-induced change processes, drawing on information from the extant literature as well as findings from Chapter 2. Baseline levels of parental depression is posited as a possible moderator of program engagement and intervention outcomes due to its possible adverse effects on parentsr motivation to engage with an online program, particularly when no practitioner support or follow-up is provided. This chapter also explores the hypothesised mediating influence of parental self-efficacy and use of positive parenting strategies on reductions in dysfunctional parenting. Baseline depression is then added as a moderator to the mediation model to determine whether mediation effects are conditional on depressive symptomatology. Finally, Chapter 5 provides a general discussion of the research findings presented in this dissertation, including the overarching limitations of the research and its implications and contribution towards forming a better understanding of how online parenting support can be effectively delivered within a minimally sufficient framework.