Recruitment in an indicated prevention program for externalizing behavior - parental participation decisions

BACKGROUND: Parents are the ones who decide whether or not to participate in parent focused prevention trials. Their decisions may be affected by internal factors (e.g., personality, attitudes, sociodemographic characteristics) or external barriers. Some of these barriers are study-related and others are intervention-related. Internal as well as external barriers are especially important at the screening stage, which aims to identify children and families at risk and for whom the indicated prevention programs are designed. Few studies have reported their screening procedure in detail or analyzed differences between participants and dropouts or predictors of dropout. Rates of participation in prevention programs are also of interest and are an important contributor to the efficacy of a prevention procedure. METHODS: In this study, we analyzed the process of parent recruitment within an efficacy study of the indicated Prevention Program for Externalizing Problem behavior (PEP). We determined the retention rate at each step of the study, and examined differences between participants and dropouts/decliners. Predictors of dropout at each step were identified using logistic regression. RESULTS: Retention rates at the different steps during the course of the trial from screening to participation in the training ranged from 63.8% (pre-test) to 81.1% (participation in more than 50% of the training sessions). Parents who dropped out of the study were characterized by having a child with lower symptom intensity by parent rating but higher ratings by teachers in most cases. Low socioeconomic status and related variables were also identified as predictors of dropout in the screening (first step) and for training intensity (last step). CONCLUSIONS: Special attention should be paid to families at increased risk for non-participation when implementing the prevention program in routine care settings. TRIAL REGISTRATION: ISRCTN12686222