Abstract
Group-format parenting interventions are effective at reducing challenging child behaviour. However, there is significantly less evidence about the performance of these interventions for parents with significant emotional and interpersonal difficulties, including personality disorder diagnoses. Parent emotional and interpersonal difficulties are a substantial risk factor for inconsistent parenting practices and the development of emotional and behavioural difficulties during childhood. Therefore, developing evidence-based parenting interventions for parents with significant emotional and interpersonal difficulties is potentially important in improving and maintaining positive child developmental outcomes and reducing the intergenerational transmission of mental health difficulties. Following the MRC framework for complex intervention development, this PhD aimed to develop and evaluate a novel peer-led, group parenting intervention, Being a Parent-Enjoying Family Life, for parents with significant emotional and interpersonal difficulties and who have concerns about their child’s (aged 2-11 years) behaviour.First, a systematic review was conducted to examine the impact of parental personality disorders and symptoms on parenting of children aged 2-12 years. Second, systematic review findings, wider evidence synthesis and consultation with stakeholders were used to identify targets for intervention and develop the programme theory for a novel intervention (Being a Parent (BaP)-Enjoying Family Life) specifically designed for parents with significant emotional and interpersonal difficulties. The programme theory was used to adapt a well-established peer-led group intervention, the Empowering Parents Empowering Communities- Being A Parent intervention (BaP-Standard), for parents with significant emotional and interpersonal difficulties. Third, this PhD reports findings from a two-arm, parallel groups Feasibility Randomized Controlled Trial (RCT), comparing BaP-Enjoying Family life to an active control of BaP-Standard. Quantitative findings are evaluated using pre-specified feasibility criteria related to trial recruitment and retention, and intervention fidelity and acceptability. Initial indicators of intervention effect are presented based on descriptive analysis of questionnaire and observational clinical outcome data collected across three time points (baseline, post-intervention, and 6 months post intervention). Fourth, the results of a reflexive thematic analysis of participant experience of trial methods and intervention was conducted. Finally, a mixed-method integration of quantitative and qualitative findings was performed to address key uncertainties around the feasibility, acceptability, intervention implementation and impact. Further hypothesis for research and areas for intervention development are articulated.
The findings from this PhD indicate that parents with personality disorder diagnoses or characteristics may inconsistently use positive parenting strategies; demonstrate greater use of negative and hostile parenting responses and behaviours; and experience greater parenting stress and parent-child conflict. Interventions which target parent emotion regulation and reflective function, support consistent use of positive parenting strategies, and use a strengths-focused, experiential learning methods may significantly benefit parents and their children. Furthermore, peer-led, group delivery and community recruitment methods may increase access for parents who experience stigma and whose needs may not adequately be met by services.
The findings also demonstrate the feasibility and acceptability RCT trial methods for evaluating the effectiveness of two peer-led, low-intensity, group-based interventions, one specifically adapted for parents with significant emotional and interpersonal difficulties. The underpowered feasibility RCT indicated that both interventions show promise in improving parent and child outcomes for the target population and differences between interventions appear to be negligible. Qualitative findings indicate participant’s experience of intervention and trial methods was informed by how relatable the intervention and trial aims were to the individual’s & family contexts; the qualities of the relationships formed in the intervention and research; the information they received and their interaction with the intervention and trial methods. Based on integration of quantitative and qualitative findings, options for future evaluations and intervention refinement are outlined. Implications of this PhD include identifying intervention targets to improve parent and child outcomes in families with a high-risk of chronic mental health difficulties; investigating recruitment and engagement strategies for parents with significant emotional and interpersonal difficulties in clinical and research settings; and evaluating the use of peer-led support and multi-method research designs for this population.
| Date of Award | 1 Jun 2024 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Crispin Day (Supervisor) & Patrick Smith (Supervisor) |