This study examined similarities and differences in predictors of intervention retention for African American and Hispanic parents to help explain why ethnicity predicted retention in prior studies. Results revealed important ethnic differences in attendance patterns and in the predictors of those patterns. These findings have important practical implications for front-line intervention staff with respect to predicting who is not likely to retain, what factors may be good targets for intervention strategies designed to retain participants, and whether those strategies need to be different across the ethnic groups.
The pattern approach used in this study and in others (Coatsworth et al., in press
; Gorman-Smith et al., 2002
) provides important information about the variability of intervention attendance that is not captured by more commonly used binary classification schemes (e.g., dropout vs. completer). Our results indicate that subgroups showing different patterns of variable attenders are evident and that more attention should be given to these participants because decreasing high attenders received approximately three times as many intervention sessions as decreasing low attenders. Many of our models were best at discriminating these two groups. It may be that shifting participants from the decreasing low attenders group to the decreasing high attenders group is the most effective way of increasing intervention attendance.
Based on prior empirical evidence (Coatsworth et al., in press
; Perrino et al., 2001
) and on propositions of the ecodevelopmental framework, we anticipated that factors from different levels of the social ecology (i.e., sociodemographics, family processes, and child functioning) would predict retention. Overall, results supported this contention but with relatively weaker effects for the child-level variables than for sociodemographics or family variables. Variables from each level also showed differential prediction for African American and Hispanic families.
Child disability and child aggression, which may signal parents’ perceived need for the intervention, predicted broad attendance patterns for Hispanic and African American families, respectively. Similar to findings on engagement (Perrino et al., 2001
), Hispanic families whose child had an emotional and/or learning disability were less likely to attend the intervention. Although these parents may have perceived a need for intervention services and therefore agreed to participate in this study, the program was probably not a good match for their needs, so they did not continue to attend. In contrast, higher levels of adolescent aggression predicted greater retention for African American families. This perceived need was a better match with the services of the intervention.
Because most programs address multiple facets of adolescent functioning (e.g., academics, aggression and other problem behaviors, family problems, and poor peer relations), parents may consciously elect to attend the sessions that most clearly address their immediate concerns. Alternatively, when parents perceived needs are not being met early in the intervention, they may drop out and end up not receiving the services that would have been most helpful to them (Pantin, Prado, Schwartz, & Sullivan, 2005
). Retention may be enhanced by ensuring that parents clearly understand the possible benefits and expectations of the intervention using preintervention screenings or techniques such as motivational interviewing (Dishion & Kavanagh, 2003
). Additionally, designing more flexible preventive interventions (Collins, Murphy, & Bierman, 2004
), with interchangeable modules that are tailored to the needs of participants, may also enhance retention.
Compared to child variables, sociodemographics were stronger predictors of retention, and this was especially true for Hispanics and the variable attender groups. Hispanic families with higher socioeconomic status (SES), as indicated by household income, education level, and fewer household members, attended more groups. These variables did not predict retention for African American families. We speculate that, at least for the Hispanic families, income provided the economic capital that allowed them to attend more often. Alternatively, these demographic variables may represent a clearer connection to mainstream society, which could engender greater willingness to participate.
Attention to the educational or literacy needs of families is a special consideration when working with low-SES immigrant families or other high-risk populations (Gross et al., 2001
). Parent education predicted retention, even though the intervention was primarily discussion based. Facilitators were trained to convey concepts in simple words using participants’ preferred language, and relatively few written materials or home assignments were involved. Perhaps more attention should have been given to parents’ understanding and comfort with the intervention’s content. Alternatively, within-group variability in SES may have created tensions, with lower SES families feeling uncomfortable sharing their family and parenting concerns with higher SES families. The networks of low-income families are often built on trust, on the understanding and sympathy regarding daily needs, and on clear expectations of reciprocity (Dominguez & Watkins, 2003
). If low-SES participants felt that their new relationships with other members of the group did not contain these elements, they may have been less willing to continue attending.
A common goal of family-centered interventions is to create social support networks that empower parents to improve their life circumstances. The social networks of low- and middle-income families clearly differ in resources and opportunities (Waldinger & Der-Martirosian, 2001
). Mixed SES networks can help low-SES minority families build social capital that provides support and connects them with opportunities for improving life conditions (Dominguez & Watkins, 2003
). Effective networks, however, are unlikely to be automatically created. Facilitators must actively encourage and nurture the formation of ties between participants of different SES levels. In many immigrant communities, like the one from which Hispanic participants in this study were recruited, members of the middle class often have experienced the strains and challenges of poverty. Strategies that connect higher SES participants with their past, engender empathy, and build generativity may help form lasting bonds and create an empowering social network characterized by both social support and leverage.
As we proposed, family-level variables emerged as the most powerful predictors for both Hispanic and African American participants. Barriers and organization showed strong effects for both the ethnic groups while having multiple family members attending sessions predicted only for Hispanics. The findings for family organization are especially interesting because this also was an important predictor of engagement, but only for African American families (Perrino et al., 2001
). In this study, family organization was not
a good predictor of engagement
for Hispanic families but was strongly related to retention
African Americans and Hispanics. This distinction may be vital to advancing the study of retention (vs. engagement) and to furthering the development of culturally specific preventive interventions. If the variables that can be used to predict engagement
prove to be categorically different from those that best distinguish retention,
then the repertoire of variables that are tested in intervention implementation research ought to be expanded and the implications for practice are considerable. In the present case, less organized Hispanic families may be able to make it to at least one session (engagement) but are not able to consistently attend sessions (retention) and ultimately benefit from the intervention.
One clear intervention implication of this finding is that assessing and addressing these family dynamics early in the intervention may help families attend more sessions. Disorganized families may be experiencing significant strain already, and the system cannot tolerate a caregiver’s attendance at a weekly intervention session. Strategies of giving Hispanic families specific homework tasks that will help improve the family structure and organization, and help overcome some forms of resistance to coming to treatment, have been shown to be helpful in getting families to come to and, remain in, family therapy (Santisteban et al., 1996
). Adaptation of these strategies for preventive interventions are likely to help retention rates.
Another set of important findings was regarding families who had more than one caregiver attending sessions. Because of the Hispanic cultural value of “compadrazgo” and the use of fictive kin networks in African American communities, we anticipated that the variable of multiple attenders would predict retention for both the ethnic groups. However, it was an important discriminating variable only for Hispanic families and was rare in African American families. Interestingly, of the Hispanic families who had multiple attenders, relatively few participants were extended kin, whereas 87% were mothers and fathers. In this study, relatively few fathers served as the family’s primary intervention participant, yet many served active supportive roles, and those families tended to receive more intervention. Compared to African Americans, Hispanics could rely on a broader in-home adult network, which may have freed parents to attend intervention sessions together. Although sometimes parents attended jointly, a common pattern was that the mother attended most sessions and father attended only when mother could not.
These results also suggest the importance of actively engaging fathers to participate in services, at least as a “back-up.” Many family-focused preventive interventions invite fathers to participate, and may be attentive to paternal authority, but emphasize mother attendance and are generally less attentive to family and nonfamily barriers to father participation (e.g., parenting role expectations, work schedule). Family intervention researchers have recently developed improved strategies to actively encourage father involvement (Gavazzi & Schock, 2004
), and these may also be helpful to interventions with Hispanic families.
Limitations and Future Directions
The moderate sample size forced us to collapse the variable attendance pattern groups described in Coatsworth et al. (in press)
; to cluster fathers, mothers, and grandparents into a single group of “primary caregivers”; and to cluster Hispanic families from different origins (e.g., Cuban, Nicaraguan), rather than examine these groups separately. We are aware of the potential for different effects across Hispanic subgroups on engagement or retention in interventions (Santisteban et al., 1996
) and hypothesize that parent gender or generation might influence retention, but sample size precluded these analyses. A larger sample may have yielded more specific results regarding predictors of more fine-grained attendance pattern groups and Hispanic subgroups. The sample is also drawn from a specific region of the country and was not intended to be broadly representative of the United States. Replication with larger diverse samples is necessary for verifying the validity of these findings for Hispanic and African American families residing in other regions. Future investigations should include more direct assessment of cultural values and beliefs about participation (e.g., cultural suspicion) and focus on within–session group processes such as therapeutic alliance/engagement (Orrell-Valente et al., 1999
) or group cohesion (Budman et al., 1989
). These proximal intervention processes, reflective of participants’ “giving and getting,” are likely to be important predictors of retention.
In conclusion, delivering the most efficacious preventive interventions to ethnic minority families is of little value if they are not culturally sound or if participants for whom they were intended are either not present or not participating fully in the intervention sessions. The present study helps to fill a gap in the literature by adding to a small number of studies that have investigated ethnic differences in predictors of engagement, participation, and retention in family-focused preventive interventions. The next step for prevention research is to draw upon empirical studies to develop culturally specific and sound strategies for engaging and retaining participants. Then, as has been done in family therapy, theoretically based, empirically informed, and clinically sound intervention strategies to improve engagement and/or retention can be embedded and tested empirically within randomized clinical trials (Szapocznik et al., 1988
). Results from such trials will inform prevention staff regarding the most effective, culturally sensitive strategies for retaining ethnic minority participants.