STRategies for the Identification, enrolment, attendance and retention of families into parenting interVentions in Early life (STRIVE)

BACKGROUND: Early parenting interventions can improve children’s health and development. Disparate UK child outcomes highlight inequity caused by disadvantaged families being less likely to access parenting interventions. Evidence-based strategies to improve the engagement of parents in parenting interventions are currently lacking. MAIN AIM: To build and mobilise an evidence base for strategies that effectively improve engagement (identification and referral, enrolment, attendance, retention) of disadvantaged families in parenting interventions, in order to reduce child health inequalities. RESEARCH QUESTION: What strategies delivered in universal early parenting interventions are effective at improving engagement for disadvantaged and ethnically diverse families, and at what cost? OBJECTIVES: To deliver a series of work packages (WP) over 54 months (M) to: Phase 1 (M1-18) 1) Develop a framework of engagement strategies used in Better Start Bradford and explore perspectives on impact and acceptability (WP1); 2) Evaluate the impact of strategies on engagement outcomes (WP2); 3) Evaluate tools to identify parents (WP3); and 4) Analyse costs and consequences of all strategies (WP4). Phase 2 (M18-24) 5) Translate WP1-4 findings into co-produced recommendations and prioritise engagement strategies for further evaluation (WP5). Phase 3 (M18-54) 6) Explore effectiveness, implementation and cost consequences of up to 3 strategies in sites across England (WP6). All phases (M1-54) 7) Maximise the impact of STRIVE via ongoing, systematic process of dissemination and active knowledge mobilisation (WP7). METHODS: WP1: Framework of engagement strategies developed via document analysis. Framework Analysis of existing qualitative interview data (N=99). WP2: Quantitative analysis using BiBBS (N=5,700). Qualitative Comparative Analysis to identify successful strategies. Multilevel modelling to explore their impact on engagement outcomes for diverse subgroups. WP3: Psychometric analysis of relevant measures, assessing reliability, validity, and invariance. Confirmatory Factor Analysis, Item Response Theory, and invariance testing. Logistic regression and machine learning to explore associations with engagement across subgroups. WP4: Cost-consequence analysis linking strategy costs with engagement outcomes, stratified by inequality measures. WP5: Triangulation of WP1-4 findings in co-production workshops with stakeholders, identify recommendations, and prioritise up to 3 strategies for WP6. WP6: Cluster randomised factorial trial testing up to 3 engagement strategies (alone and combined) on parent retention. Random assignment of 40 Family Hubs to 8 conditions. Statistical analysis using mixed effects models will assess strategy effects and subgroup impacts. Embedded health economic and process evaluations. WP7: Community of Practice tailoring findings for practical implementation, co-production using the Knowledge to Action framework. SETTINGS: WP1-4 will combine 10 years of qualitative and quantitative data from the Born in Bradford’s Better Start (BiBBS) study (N=5,700). WP5-7 has a national focus and will test the identified strategies in local authorities and family hubs across England. ANTICIPATED IMPACTS: Practitioners equipped to successfully engage with parents, parents feel welcomed, equitable access to effective parenting support, reduction in health inequalities, and economic savings to reinvest in prevention/early intervention.