Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Objective: The objectives of this analysis were to: 1) assess the impact of sociodemographic factors, and perceived costs and benefits on engagement in a parenting program designed to prevent child maltreatment, 2) determine if perceived costs and benefits mediated the association between sociodemographic factors and engagement, and 3) assess whether or not race/ethnicity moderated the relationship between sociodemographic factors, perceived costs and benefits, and engagement.

Methods: Perceived costs and benefits of the intervention were assessed from parents providing self-reports, including satisfaction/ usefulness of the program (benefits), and time/difficulty associated with the program (costs). Engagement was defined as attendance at both the mid-point and then the number of visits attended throughout the remainder of the intervention. To investigate the direct and indirect effects (through perceived costs and benefits) of parental sociodemographic factors (education, age, gender, number of children, household income) on program engagement, data were analyzed with structural equation modeling (SEM). To assess the potential moderating effect of race/ethnicity, separate models were tested for White and African-American parents.

Results: Perceived benefits positively impacted attendance for both White (n=227) and African-American (n=141) parents, whereas perceived costs negatively influenced attendance only for White parents. Parent education and age directly impacted attendance for White parents, but no sociodemographic factor directly impacted attendance for African-American parents. The indirect impact of sociodemographic characteristics on attendance through perceived costs and perceived benefits differed by race/ethnicity.

Conclusions: Results suggest that White parents participate in a parenting program designed to prevent child maltreatment differently based upon their perceived benefits and costs of the program, and based on benefits only for African-American parents. Parental perception of costs and/or benefits of a program may threaten the effectiveness of interventions to prevent child maltreatment for certain racial/ethnic groups, as it keeps them from fully engaging in empirically validated programs. Different methods may be required to retain participation in violence prevention programs depending upon race/ethnicity.