Rendu, Alison; (2004) Treatment adherence in a behaviourally based parenting program. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Behaviourally based parenting programs have been shown in randomised controlled trials, set in university settings under highly controlled conditions, to reduce conduct problems in children. In contrast, studies in regular clinical practice have found less positive results, questioning the effectiveness of these programs when applied to real world settings. One possible reason for this is that once the controls of the laboratory are removed, programs are not delivered as they are intended, reducing the positive effects observed in the efficacy trials. This study had two aims. The central aim was to design an instrument that could be used by trained raters to rate treatment adherence to the Webster-Stratton BASIC parenting program. A secondary aim was to explore the relationship between treatment adherence and outcome, as measured by a reduction in child conduct difficulties, using the developed instrument to measure adherence. The instrument was designed to rate adherence using global rating scales of leaders’ behaviour, based on videotapes of parenting groups. Inter-rater reliability between two raters was found to be acceptable for nine of the 27 variables included in the instrument. A factor analysis found that these variables loaded onto two separate factors. Regression analyses showed that one of the factors, which included aspects of leaders’ behaviour concerned with group facilitation, was a significant predictor of treatment outcome, but this finding was no longer significant when age of child and hyperactivity were taken into account. Future research in this area needs to further develop the instrument, increasing its reliability on specific variables and accounting for the validity of the measure. The instrument could then be used to assess treatment adherence outside of the research setting, where group leaders are potentially more likely to depart from the intended delivery of the program. This area of research is important as there is currently a need to bridge the gap between the laboratory and the clinic, enabling clinicians to provide treatments that are as effective as they are efficacious.

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