Adherence and Dosage Contributions to Parenting Program Quality

Abstract

Objective The 3 most frequently examined elements of treatment fidelity are adherence, dosage, and quality. The relationships between these fidelity elements are complex, and additional research is needed to provide clarity. Improving clarity may be especially relevant to parenting programs, which tend to include direct explicit instruction (DEI) elements (i.e., instruction, modeling, and practice). The adherence to and dosage of these DEI elements are frequently assumed to improve program quality; however, little information is available to determine if such adherence and dosage affect program quality. This study examines whether adherence to and dosage of DEI elements predict quality ratings for a widely disseminated, manualized parenting program. Method Adherence is defined as the percentage of intervention tasks completed for each DEI element. Dosage is defined as the number of minutes and seconds spent in each intervention DEI element. Treatment fidelity is assessed for 36 of 144 sessions across 10 program facilitators. A hierarchical linear regression analysis examines the contributions of adherence and dosage in the prediction of session quality ratings. Results The analysis indicates that adherence accounts for a significant proportion of the variance (26%), whereas dosage contributes a nonsignificant proportion of variance (11%). Adherence to skill practice was the strongest individual predictor (β = .445, p < .01). Conclusions Findings suggest that ensuring a high degree of adherence can contribute to quality program delivery. However, more exploration is needed to better understand the ways in which adherence and dosage of DEI elements affect program quality.

Enhancing Engagement of Fathers in Web-Based Preventive Parenting Programs for Adolescent Mental Health: A Discrete Choice Experiment

“…This is of concern, as systematic reviews of ongoing engagement in preventive parenting programs indicate that on average parents actually attend between 3 and 7 sessions, or in the range of 40.6–87.5% of intended modules for technology-assisted parenting programs [ 68 , 69 ], which was consistent with fathers’ preference for a program comprising four sessions. An alternative explanation, however, is that the benefits of a program may be conferred more by receiving an adequate proportion of active intervention components than they are by completing a higher number of sessions [ 70 ]. If this is the case, increasing the density of active intervention components within a program may allow the time commitment to be reduced and improve adherence rates, whilst maintaining the maximal benefits conferred by the program.…”

The Practice of Family Life Education: Toward an Implementation Framework

“…Dosage and adherence are two components of program design and delivery that contribute to program fidelity (Carroll et al, ). Dosage refers to the intensity of the program as measured by the number and length of sessions, the amount and quality of content that is provided, and the total length of the program (Nation et al, ), whereas adherence refers to the proportion of program elements that are implemented as intended (Gross et al, ). Research suggests that dosage matters in achieving program outcomes (Alvarez et al, ; Maher, Marcynyszyn, Corwin, & Hodnett, ; Nygren, Green, Winters, & Rockhill, ), and booster sessions or brief follow‐up sessions may be a necessary program component to maintain positive outcomes (Cordova et al, ; Nation et al, ).…”

“…Relying too much on building knowledge alone and not including a skills component may not result in behavior change (Nation et al, ). Specific to parent education programs, including a skills component and providing parents time to practice with their child during the program seems to yield more positive outcomes (Gross et al, ; Kaminski et al, ), even if resulting in a longer program (Cotter et al, ).…”