introductionepubs.surrey.ac.uk/845754/1/parenting programmes thesis.docx · web viewword count:...

PARENTAL OPINION ON PARENTING PROGRAMMES

Exploring parental opinion on parenting programmes.

By

Abigail Lucas

Submitted in partial fulfilment of the degree of Doctor of Psychology (Clinical Psychology)

School of PsychologyFaculty of Health and Medical Sciences

University of SurreyJuly 2017

© Abigail Rose Lucas 2017


Declaration

I confirm that the submitted work is my own work and that I have clearly identified

and fully acknowledged all material that is entitled to be attributed to others (whether

published or unpublished) using the referencing system set out in the programme

handbook/other programme research guidance. I agree that the University may

submit my work to means of checking this, such as the plagiarism detection service

Turnitin® UK. I confirm that I understand that assessed work that has been shown

to have been plagiarised will be penalised.

Signature:

Name:

Date:


Table of Contents

Acknowledgements.................................................................................................................5

Overview of Portfolio...............................................................................................................6

Part 4 - Major research project............................................................................................114

Exploring parental opinion on parenting programmes........................................................114

Statement of Journal Choice................................................................................................114

Abstract...............................................................................................................................115

Introduction.........................................................................................................................117

Method................................................................................................................................132

Results.................................................................................................................................137

Discussion...........................................................................................................................152

Limitations..........................................................................................................................159

Future research and implications.........................................................................................160

Conclusion..........................................................................................................................161

References...........................................................................................................................162

Appendix A. Clinical Psychology Review author guidelines..................................................167

Appendix B: Q-sort statements...........................................................................................182

Appendix C: Screen shots of the online Q-sort study..........................................................185

Appendix D: Favourable ethical approval............................................................................192

Appendix E: description of Q Methodology.........................................................................193

PARENTAL OPINION ON PARENTING PROGRAMMES4

Acknowledgements

As I reflect on this process, I am extremely grateful to a number of people. I would

like to thank my research supervisors, Mary John, Kate Gleeson and Robert

Patterson. They have provided me with continual support and encouragement

throughout this process. I would also like to thank Dr. Melanie Orchard for her role

as my mentor. She has been pivotal in me getting to this point in the doctorate

and encouraging and motivating me.

I would also like to thank my partner David who, with his unconditional love and

support I have managed to achieve this part of my journey as a Trainee Clinical

Psychologist. I also want to thank my two children, Edith and Audrey for providing

me with a meaningful, fun and welcome experience away from the intensity of the

project.

Part 4 - Major research project.


Exploring parental opinion on parenting programmes.

Word count: 9954Statement of Journal Choice

This article will target Children and Society based on the content covered within the

study. This study considers literature relevant to children, parents and the wider

society and the views from parents on what they want from parenting programmes.

This study provides an innovative exploration of the currently under researched area

of parental opinion on parenting programmes outlined in the Children and Society

Journal aims and scope. The journal’s guidelines for authors is outlined in Appendix

A.


Abstract

Introduction: Research into parenting programmes has typically found that parental

wellbeing, parenting practices and child wellbeing are linked, with increased parental

wellbeing and supportive parenting practices resulting in better wellbeing and

outcomes for children. As such, parenting programmes have focussed on supporting

parents in how to best manage their child’s behaviour. However, these programmes

have been largely based on professional opinion and ignore parental perspective.

Research has suggested that what parents want and need from a programme may be

different to what is being offered (Hill et al., 2007).

Aims: The research aimed to understand what a group of parents thought about

elements within current parenting programmes.

Method: A q-sort methodology was used to elucidate parental opinion about the parts

of a programme that would have the most impact on their ability to parent effectively.

64 parents were asked to sort a number of statements about current parenting

programmes on offer using an online tool.

Results: A principal components analysis was undertaken with 60 statements and 64

q-sorts. This yielded three factors that were interpreted to represent three different

understandings of parenting programmes. “A parenting toolkit of skills”, “Fix me

first” and “Nurture the nurturer”. The factors shared some similarities of what parents

report with current programmes on offer (e.g. therapeutic relationship, universal,

childcare provision) but also highlighted areas w here parents wanted different

things. The results are discussed in light of the demographics of the individuals

assessed and how this may impact on future parenting programmes.


Conclusion: the results indicated that the main theme overlapped with the typical

concepts embedded in well-established programmes in services. There are however a

small group of parents where these concepts did not meet their needs. Consideration

needs to be given to more mature parents, single parents and fathers.


Introduction

Parenting programmes have a well-established place within health and social care

services with evidence that they play an effective role in supporting parents. This

position has been supported by the evidenced based literature (Hill, Stafford, Seaman,

Ross, & Daniel, 2007). Hill et al. conducted a review of resilience literature and

parenting to consider discrepancies between theory and practice. They acknowledge

that parenting programmes can support parents to be warm, responsive and supportive

towards their children which facilitates positive wellbeing and the ability to cope in

the face of adversity. However, they discussed the significance of distinguishing

between theory and practice within this process. They highlighted that work around

parenting and resilience often comes from ‘expert’ opinion rather than from

discussing parental need with the parents themselves. Discussions with parents in

more detail may help individuals manage adversities more effectively. This potential

discrepancy between ‘expert’ theory and parent experience may go some way to

explain why parenting programmes have variable levels of success in supporting

parents with their own and their child’s wellbeing (Hill et al. 2007).

In addition, poor engagement of these parental programmes has been linked to a

variety of barriers to parents attending the courses in the first place (e.g. Whittaker &

Cowley, 2012). In a systematic review, Whittkaer and Cowley highlighted a number

of factors impacting on parental engagement in the programmes. They showed poor

maternal mental health and low income, poor timing of the programmes, poor

commitment to the programme due to other life commitments, negative parental

beliefs about the programme (such as it being intrusive or too demanding), and

cultural factors all played a part in poor engagement from the parent in attending

and/or completing a programme. Whittaker and Cowley also highlighted that the

programme itself impacted on engagement. For example, their systematic review

indicated that poor clarity over course content and poor understanding of the theories


underpinning the programme may result in inappropriate use of the programme

resulting in lower retention rates. The facilitator of the programme is also a

significant contributor to parental engagement, with characteristics such as non-

judgmental and supportive being key to successful and long-term engagement from

parents in a programme (Miller & Sambell, 2003; Whittkaer & Cowley, 2012).

Additionally, the design of the programme was highlighted as a potential barrier to

attendance where less flexible or adaptable models resulted in poorer attendance. Use

of telephone, individual and group support increased attendance of a programme.

Kane, Wood and Barlow (2007) also found that parents wanted to learn about their

child’s behaviour, to gain more control, to experience and supportive envinroment

from the other parents in the group and to learn ways to cope.

Previous studies suggest if parent’s needs are not addressed or identified,

programmes are less effective. These studies will be discussed in more detail below.

As such, this study aimed to identify what parents think are the most important

aspects contained within the programmes. This was to help establish a more parent-

led approach to the programme’s content in the future to improve their own and

their child’s wellbeing. Evidence suggests that this parent-led approach will

effectively overcome some of the barriers to inclusion frequently seen e.g.

engagement (Miller & Sambell, 2003; Hill et al., 2007). It would increase the

quality of the interaction by improving the ‘fit’ between the needs and

expectations of parents and the provision of services.

Overview of literature

The following study aimed to consider parental opinion on five aspects of parenting

programmes. The programmes were chosen based on high levels of efficacy as

described on the UK government website

(http://www.education.gov.uk/commissioningtoolkit/Programme/ParentsSearch) and

through a previous systematic review undertaken by the author located at the

beginning of this thesis. The programmes were chosen if they scored 4 stars or more

http://www.education.gov.uk/commissioningtoolkit/Programme/ParentsSearch


on the UK government website (indicating an effective intervention) or if they arose

from a systematic review (parenting*programmes*parent*wellbeing) and had

effective outcomes (medium/large effect size).

The programmes used from the government website and explored in the literature

review were the Triple p-parenting programme (TP; Sanders, 2008); the Incredible

Years Parent Training programme (IYPT; Webster-Stratton, 1984); and the Parent

Management Training Oregon model (PMTO; Forgatch, Bullock & Patterson, 2004). These

programmes all utilise Patterson’s coercion model of parenting (1982) as there basis for

teaching skills to change behaviour in the child. Alongside teaching behavioural change

skills, research has also shown that supporting parent’s in their own experience of stress and

parental attitudes to parenting result in positive change for parents and their child/ren

(Chronis et al, 2006). The interventions that aimed to support parents in their own

experience of stress were The Coping With Depression Course’ (CWDC; Lewinsohn et

al., 1984); and guided self-help Cognitive Behavioural Therapy (CBT; Palmer et al.,

2012). These programmes/interventions that are more in line with Deater-Deckard’s model

(1998) of parenting where the parent’s appraisal of the situation affects change. More

comprehensive descriptions and efficacy information of the programmes can be found in

the appendix (Appendix A).

To aid with consistency across the document each programme was considered against five

key criteria. These were outlined by the U K government website when describing

courses to parents, professionals and stakeholders

(http://www.education.gov.uk/commissioningtoolkit/Programme/ParentsSearch), and

were identified in a large systematic review of parenting programmes by Koerting et al

(2007). They included: (1) facilitator training/characteristics; (2) type of programme (e.g.

universal/timescale; (3) practical aspects (e.g. childcare and transport); (4) specific needs

addressed (e.g. mental health); and (5) content/models used.


The results of these programmes/interventions and five aspects are discussed and

highlight similarities and differences. These discrepancies were significant in

developing the research question of whether what is currently offered to parents, is in line

with what parents want.

Introduction to the issues

Previous literature has considered the role of parental wellbeing, child wellbeing,

parenting practices and the development of parenting programmes using theoretical

models and evidence-based research (Hill et al., 2007). Theoretical models

hypothesise that parenting can be a stressful experience which impacts on the wellbeing

of both the child and parent (for a review see Bornstein, 2002). These models have

been used to help develop parenting programmes (identified by a previous systematic

review completed by the author) as they provided a framework on which to ‘hang’ the

skills, techniques and methods taught to combat parenting stress and improve

wellbeing (e.g. Deater-Deckard, 1998).

In order to contextualise the study, a definition of parental stress and parenting

programmes, an outline of key theories/parenting models utilised in the development of

parenting programmes and relevant reports are initially discussed.

Definition of parental stress

It is first important to consider the definition of parental stress to understand the

concept and its influence on the development of parenting programmes. Parental stress (for

a review see Bornstein, 2002) has been conceptualised in terms of individual

differences; where the individual’s appraisal of parenting impacts on the level of stress

experienced (Lazarus & Folkman, 1984). The stressors experienced can be understood as

the irritating, frustrating, annoying, distressing demands that to some degree characterize

everyday transactions of parenting (Kanner, Coyne, Schaefer & Lazarus, 1981).

Patterson’s coercion model of parenting (1982)

Patterson’s coercion model (Patterson, 1982) has been utilised as a framework for


developing a number of programmes (e.g. Parent Management Training). Patterson’s

model specifically relates to difficult behaviour and proposes that parents using

coercion to control their child’s behaviour results in problems. Using coercion

techniques inadvertently reinforces the child’s difficult behaviours resulting in a

negative parental response. Parenting programmes aim to break this parent-child

coercive cycle using positive parenting techniques (e.g. positive or negative

reinforcement). Typically, the interventions using this approach show that children’s

behaviour improves post intervention; alongside improvements in child wellbeing,

improvements in the child’s [enhanced] academic performance, and an increased use

and confidence in using these positive parenting practices (e.g. Kratochwill,

McDonald, Levin, Young Bear-Tibbetss, & Demaray, 2004; Hagen, Ogden &

Bjørnebekk. 2010).

Deater-Deckard parenting model

Deater-Deckard (1998) postulated a parenting model that defined parenting stress as

“the aversive psychological reaction to the demands of being a parent” (p. 315),

experienced as “negative feelings toward self and toward the child or

children………directly attributable to the demands of parenthood” (p. 315). Within

this model, the authors postulated that becoming a parent is the trigger for stress. The

parent’s response to their own internal experience of this stress determines their

parenting practice. This has an indirect effect on their own and their child’s wellbeing

(positive and/or negative). When parents do not utilise effective coping in response to

stress it can cause disruptions in parenting. Their poor parental wellbeing can impair

parenting ability (e.g. Lee & Gramotnev, 2007). Therefore, it can be postulated that

effective coping may attenuate levels of parenting stress and psychological wellbeing

(Wheaton, 1985).

Parenting programmes

A useful definition of parenting programmes to help contextualise this study is


provided by the parentinguk website (http://www.parentinguk.org/your-

work/programmes/). They state that 'There are many different types and styles of

parenting programme available. These program`s are designed to improve parental

effectiveness by providing a clear parenting philosophy and a set of positive parenting

skills and strategies. Different programmes are designed for addressing certain issues or

working with certain communities. It is important that practitioners, who know the needs

of the parents they work with, should select programmes suited to them.’

Government policy for parenting programmes

Public and political concern about parenting and the need for parenting programmes led

to two commissioned reports. The two reports highlighted the services on offer to

children and families. They promoted the role of resilience, prevention and early

intervention. In their respective reports they drew attention that care for children and

families was falling below standard and not meeting the needs of parents (Future in

mind: Promoting, protecting and improving our children and young people’s mental

health and wellbeing, Department of Health, 2015; Report on Children, young people and

families, Youngminds, 2014).

They responded to these concerns and limitations in an effort to improve child and

family wellbeing and care. They gathered opinions from experts and parent/carers

and highlighted two short comings in current services: (1) content of the

programmes; and

(2) accessibility to them. In relation to the content emphasised was a need to improve

the parent-child relationship, build resilience and improve child behaviour.

Additionally a need to identify what parents, families and children want and need

from a programme was highlighted. With regards to accessibility, they highlighted

the need for further research into evidence-based programmes to understand what

was hindering parental engagement. Doing this would help overcome/resolve these

issues to increase engagement and potentially effectiveness (Hill et al., 2007).


Critique of the literature

The following analysis identified the common/similarities and discrete differences in

the programmes using the five criteria. This provided a background to the current

study exploring what parents say they want in a parenting programme.

Overview of programmes/interventions

Critique of the five criteria against the programmes

The following section discusses the programmes using the five key criteria identified

at the outset of this document. Similarities and differences in efficacy and parental

views are explored. This critical analysis provides the basis for exploring whether

parental views on parenting programmes/interventions are in line with what is

currently offered.

Facilitator characteristic

Facilitator characteristics have been shown to be significant to parents’ experience of

a programme (e.g. Koerting et al., 2013). In relation to the programmes in this study,

research has shown parents report the therapeutic relationship with the facilitator aids

positive change in child behaviour, parental behaviour and overall wellbeing

(Holtrop, Parra-Cardona & Forgatch, 2014; Akin & Gomi, 2017). Specific facilitator

characteristics valued by parents are being warm, approachable, friendly, non-

judgemental, affirming and making information accessible (TP programme; Wilson et

al. 2012; IYPT programme; Furlong et al., 2010). Parents reported these positive

characteristics facilitated their ability to learn ways to manage their child’s behaviour

(Wilson et al’s, 2012).

Practical aspects


Research has also shown the practical aspects associated with attending parenting

programmes to be significant in its success (Koerting et al., 2013; Law, Plunket,

Taylor& Gunning, 2009; Wilson et al, 2012). Research highlights that parents report

increased engagement when there is a choice of different times for sessions, proximal

closeness to their homes, provision of childcare and being able to physically attend

(TP programme, Sanders 2008; Wilson et al, 2012; CBT; Palmer et al. 2012). Parents

have also reported homework and workbooks helps consolidate learning (PMTO,

Forgatch et al., 2004; Holtrop et al. 2014). Aligned to this consolidation of learning is

the professional perspective outlined in the CWDC manual (Lewinsohn et al, 1984)

which highlighted the importance of homework assignments.

Research has also highlighted parental reports of practical barriers to engagement.

These included poor presentation of information (TP programme, Wilson et al, 2012),

long duration of the programme (TP programme; Wilson et al. 2012; PMTO, Akin &

Gomi, 2017) and external situations impeding engagement such as starting a new job

or being unwell (IYPT; Furlong et al., 2010).

There was variation in parental reports about some practical aspects. For example,

some parents reported a group format as intrusive whereas others reported it as a

valuable learning experience (TP programme; Wilson et al. 2012). In common with

the positive parental reports of a group, the CWDC manual encouraged a group

format to explore alternative views and aid group cohesion (Lewinsohn et al 1984).

Methods of learning were also experienced differently. Some parents reported

enjoying aspects such as role play to consolidate and practice the skills whereas

others found it awkward (PMTO; Holtrop et al. 2014).

Here, the difference in opinion between parents, and between professionals and

parents supports Hill et al’s (2007) observation: what parents want is not always

aligned with what other parents want or with what professionals believe is required.

Type of programme


The ‘type of programme’ refers to whether the programme/intervention is universal

or targeted. Typically research into the TP (Sanders, 2008), IYPT (Webster-Stratton,

1984) and PMTO (Forgatch et al., 2004) have shown a targeted approach to be more

effective than a universal one (see Table 1: TP: Nowak & Heinrich, 2008; IYPT:

Menting, De Castro & Matthys, 2013; Chamberlain et al., 2008; PMTO; Akin &

Gomi, 2017). The research indicates that the parents in a programme that targets a

variety of needs do less well than those with a common concern (see Table 1 with

effect sizes). The reason for this variation is yet to be established but one explanation

is that parents and children in the intensive programmes report higher levels of

distress at the start. They are therefore more likely to make clinically significant gains

in comparison to those who report less distress.

However, it is difficult to disentangle the cause of these differences as being due to

the delivery format of the intervention (targeted or universal) or the level of parental

distress at the outset (high or low).


Table 1. A table showing the effect sizes from three meta-analyses into the TP and IYPT programmes.Study Se

verity of dist

Severity of

Targeted Child

Universal chi

Targeted parent

Universal Par

Nowak& Heinrich, 2008

level 1-3d =

level 1-3

d =.43

d =.20

d =.16

d =.15

Menting, De Castr

n/a n/a

d = .27

n/a n/a n/a

Chamberlain et al., (2008

n/a Highdistress:

n/a n/a d = .50

n/a

Akin&

Gomi (2017)

OR= 1.005, p=.11

n/a

n/a n/a n/a n/a

The Palmer et al’s (2012) study did not report effect sizes but some reports from parents

suggested the universal approach may not have met their needs. For example, parents with

dyslexia (in particular) reported delivery format being a problem. It is possible that parents

with additional needs (e.g. being deaf or visually impaired) require a more targeted and

specialised method of delivery, such as only face-to-face.


Specific needs addressed (e.g. mental health, ADHD, ASD)

Whether a programme focuses on a specific need in a family is also a key criteria in

considering parenting programmes. Results have been mixed, with some positive and

some negative parental reports (TP programme, Sanders, 2008; Wilson et al. 2012;

PMTO; Holtrop et al., 2014). For example, parents in Wilson’s large scale evaluation

(2012) of the TP programme (Sanders, 2008) reported it was aimed at the wrong age

group or at children with discrete difficulties and did not meet their needs (e.g.

Attention Deficit Hyperactivity Disorder; ADHD). However, some parents reported

the variety of children’s ages within the programme was positive as they had the

opportunity to learn about child development. It also raised awareness of future

difficulties and ways to effectively manage them.

Research has also highlighted effective use of the PMTO (Forgatch et al., 2004) for

specific groups of parents (e.g. Holtrop et al. 2014). However, a number of

difficulties have been encountered. For example, Akin and Gomi (2017) found

parental internal and external pressures (e.g. substance abuse) resulted in poor

outcomes due to non-completion of the programme. Programmes focusing on

parental wellbeing may be useful for these parents over and above those focussing

on child behaviour (e.g. Deater-Deckard, 1982).

For example, results of Chronis et al’s (2006) intervention showed that maternal

functioning (depression, anxiety, perceived stress, self-esteem and cognitions about

their child’s behaviour) improved from pre-treatment to post-treatment for the

treatment group relative to the waiting list control (in all cases, p<.05, d<.29). There

were also significant improvements in child behaviour pre to post treatment. The

authors explained these results by improvements in the mother’s depression. Mothers

had more positive perceptions of their child’s behaviour as opposed to their child’s


behaviour actually improving (indicated by no change in teacher ratings of child

behaviour). It supports Deater-Deckards (1998) model of parenting where altering an

internal experience of depression and stress reduces negative appraisals of disruptive

behaviour.

Content/models used

Research has typically highlighted parents felt better able to manage their child’s

behaviour using positive parenting techniques derived from Patterson’s model

(Webster-Stratton, 1984; Hutchings et al., 2007; Scott et al., 2001; Bodenmann, Cina,

Lederman & Sanders, 2008; Sanders, Bor & Morwaska, 2007; Sanders, Markie-

Dadds, Tully & Bor, 2000). Results have indicated that use of less coercive and

punishment based strategies resulted in better behaviour from children and better

wellbeing for children and their parents. (TP programme: Sanders, Kirby, Tellegen &

Day, 2014; IYPT: Furlong et al., 2010; PMTO; Holtrop, Parra-Cardona & Forgatch,

2014).

For example, Sanders et al. (2014) conducted a large scale meta-analysis and

systematic review on 116 eligible studies over a 33-year period, with 101 studies

comprising 16,099 families. They found significant short-term effects for: children's

social, emotional and behavioural outcomes (d = 0.473); positive parenting practices

(d = 0.578); parenting satisfaction and efficacy (d = 0.519); parental adjustment (d =

0.340); improved parental relationships (d = 0.225) and child observational data (d =

0.501). In addition, significant long-term effects were found for all outcomes

including parent observational data (d = 0.249).

Although there is evidence to support the benefits of Patterson’s coercion model of

parenting (1982), some parents have reported the content or teaching of positive

parenting practices as not relevant to them (TP programme; Wilson et al, 2012) or

that


information on how to manage negative behaviours was lacking (IYPT; Furlong et

al., 2010). This raises a question about whether parents feel the model

provides an appropriate explanatory framework for how to parent effectively.

Outlining the theory and rationale behind positive parenting practices at the outset

of a programme may help resolve this.

Both Chronis et al (2006) and Palmer et al’s (2012) study utilised CBT. Parents learnt

ways to manage their thoughts, feelings and behaviours more effectively with the aim

of improving wellbeing and their relationship with their child. Results from the

studies indicated mothers reported improved self-esteem, better coping strategies,

and increased positive thinking about themselves and their parenting skills (e.g.

Chronis et al’s, 2006; mean effect size d= .31). Again, this provides support for a

programme focussing on those with specific needs and that improving parent’s

wellbeing improves the parenting experience (Deater-Deckards, 1982).

Summary

As can be seen from the research explored above, there are varying results in

programme effectiveness and parental reports of what they find helpful and unhelpful.

For example, some parents reported positive experience of a group format (e.g.

Wilson et al. 2012) whereas others report finding this overwhelming and

intrusive (e.g. Holtrop et al., 2014). Some results indicate that the TP programme

has high efficacy (e.g. Nowak & Heinrich, 2008) whereas others question this and

its generalised use as a primary intervention for parents (Wilson et al. 2012).

Research also highlights that some parents value a behavioural approach (e.g.

Sanders et al., 2007) whereas a CBT approach is also helpful for those with specific

needs (e.g. Chronis et al., 2006). This variation in both efficacy and parental views

is in line with the observations outlined by Hill et al (2007). They suggested that

further research on parental views of


parenting programmes is required to ensure their needs are being met. As such, this

study aims to further understand what parents want from parental programmes.

Research question.

This study aimed to understand what parents want from a parenting programme.

Using a Q Methodology, it proposed to clarify what parents felt would be the most

important elements in a parenting programme. It aimed to consider what parents

believe would have a positive effect on them in a parenting programme. This was

explored using the five aspects covered in the programmes/interventions

discussed above. By understanding this, future services can target programmes with

appropriate content for parent’s needs.

Method

General Overview of Q Methodology

Q methodology provides a comprehensive overview of shared viewpoints and

perspectives from the participants regarding the research question (Stephenson,

1953). Research has highlighted that it is an effective exploratory technique

enabling investigation of participant’s beliefs and values (Baker, 2006). As

highlighted by Watts and Stenner (2012) it combines both qualitative and

quantitative research methods to discern participant’s subjective views on a topic.

For a description of Q Methodology see appendix E.

Q Set Design and Content

The Q set is the set of statements or ideas which are prepared by the researcher and

given to the participant to sort. In this study, the Q set was generated from two

different sources. The parental programmes were chosen based on high levels of

efficacy as described on the government website

(http://www.education.gov.uk/commissioning


toolkit/Programme/ParentsSearch) and through a previous literature review

undertaken by the author. The programmes were chosen if they scored 4 stars or more

on the government website (indicating an effective intervention) or if they arose from

a systematic review (parenting*programmes*parent*wellbeing) and had effective

outcomes (medium/large effect size). This process was completed to ensure coverage

and balance within the q-set (Watts & Stenner, 2012).

Each programme was deconstructed according to the five key aspects (type of

programme, facilitator characteristics, content/model, practical aspects, specific

need). Themes from these various sources were then re-framed into ideas for

statements relating to parenting programmes through discussions with child

psychologists, researchers and through a pilot study (discussed below). A

comprehensive list of statements was formulated in line with these five aspects.

This yielded a set of 152 statements. The statements then underwent a process of

development and re-design as some statements had overlapping themes. Again, this

was done in discussions with research supervisors and child psychologists. A

consensus was reached when the overlap was reduced resulting in a final set

containing 60 items (see Appendix A).

Study Pilot

The study was piloted on two participants (parents and colleagues of the researcher)

who were asked for feedback regarding the statement list, the study instructions and

the process of sorting. Participants completed an online version of the q-sort. Both

agreed that the instructions were clear and easy to follow and the Q set covered

relevant aspects. Both participants were able to complete the Q sort and were

satisfied with the result, stating that the final arrangement of statements provided an

accurate description of their view-point.


Participants

Participants were recruited via personal contacts using email and a snowballing

recruitment strategy. As such, demographics were not pre-determined. It was hoped

that using a snowballing strategy would capture a range of parental view-points on

parenting programmes (Sadler, Lee, Lim, & Fullerton, 2010). Personal contacts of

the researcher were approached if they were known parents with children aged

between 0-11 years old. Snowballing was achieved when these personal contacts

provided contacts of parents they knew. The researcher then approached these

parents via email. Participant demographics (age, income, marital status, number

of children, and mental health) was collected (See Table 1).

Administering the Q Sort

Participation was voluntary, confidential and participants were informed that they

could withdraw at any point without consequence. Once recruited to the study,

participants were emailed a link to an online version of the study to complete. All

participants completed the Q sorts in their own time away from the researcher.

The online system included detailed instructions on how to complete the Q sort (see

Appendix B for screen shots of the online q-sort). Participants read a screen outlining

‘Participant Information’ about the study and consent was requested at the bottom of

the page. If participants clicked onto the next page, consent had been agreed.

Participants still had the right to withdraw or stop the study at any point without

consequence.

Participants were asked to read the instructions and short vignette stating “To

complete the task, consider the following: You are thinking about attending a

parenting group. What would you hope to experience? What would be the critical

components for you?”


This ensured participants were able to contextualise the statements as participant

inclusion criteria were both attendance and non-attendance at a parenting programme.

Participants then saw 60 statements about parenting programmes on the screen,

which appeared one at a time. They were asked to sort these into agree, disagree or

neutral ‘piles’ on the screen. Following this, they then sorted the statements into

an online sorting grid depending on how much they agreed, disagreed or felt

neutrally about them. Although participants may have had unequal agree, disagree

and neutral piles initially, the Q sort process forced them to sort the statements in

a particular shape. This meant that statements were sorted by agreement or

disagreement of items relative to each other rather than by absolute agreement. A

13-point scale was used for the forced distribution, with rankings from -6 (strongly

disagree) to +6 (strongly agree). See Figure 1 for a diagram of the sorting grid.

-6 -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5 +6

Least Important Most important

Figure 1. Q Sort grid


Participants were encouraged to keep moving the statements around until they felt

satisfied with where they were placed. Participants were then asked to submit their

final sort which was stored onto the system under anonymous identification numbers.

Data Statistical Analysis

In this study, all factors were extracted using Horst's 5.5 Centroid Factor Analysis

with iterative solutions for communalities (Horst, 1965). This was used because it is

a more refined approach and does not show some irregularities which can sometimes

be found when using Brown's (1980) customary method of Centroid Factor

Analysis (Schmolck, 2014a). Once extracted, factors were rotated manually

using the PQ Method program (for further information see Schmolck, 2014b)

positioning the factors such that they accounted for the maximum amount of the

study variance, according to statistical criteria (Watts & Stenner, 2012).

Factor extraction and rotation

To be included in the solution, factors needed to satisfy the Kaiser-Guttman criteria

(Guttman, 1954) by having rotated eigenvalues greater than 1.00. In addition, they

needed to satisfy Humphrey’s rule, where the two highest factor loadings multiplied

together should not exceed the standard error. Factors also required two or more

significantly loading Q sorts (Watts & Stenner, 2012). As is customary in Q

methodology (Brown, 1980), significantly loading Q sorts at the 0.01 level were

calculated using the equation 2.58 x (1÷√no. items in Q set) = 0.38. Solutions were

selected where a ‘healthy’ amount of the study variance was accounted for by the

extracted factors (at least 35-40% of the study variance, Kline (1994), where

correlations between the factors were as low as possible and where as many Q sorts

as possible loaded onto the factors.


Ethics

Ethical approval was obtained from The University of Surrey’s Faculty of Arts and

Human Sciences ethics committee (see appendix D for signed ethics approval letter).

Results

Demographic data (see Table 2) indicated that the majority of participants were

female (80%). Most were aged between 35 and 44years old (45%). Most parents

were married (66%), had between 1 and 2 children (95%), earned more than

£50,000 (56%) and most reported having a mental health difficulty (66%). This

sample may be relatively limited in its demographic spread and will be explored in

the context of the results in the discussion section of the document.


Table 2.Demographic Characteristics (N=64).

DepressionAgeLess than 25 (%) 6 (9)25-34 (%) 24 (38)35-44 (%) 29 (45)45-54 (%) 5 (8)GenderMale (%) 13 (20)Female (%) 51 (80)No. Children1 (%) 25 (55)2 (%) 25 (40)3 (%) 2 (3)4 (%) 1 (1)More than 4 1 (1)Marital StatusMarried (%) 42 (66)Single (%) 5 (8)Cohabiting (%) 17 (27)Other (%) 0 (0)Any Reported Mental Health difficultyNone (%) 28 (44)Depression (%) 16 (25)Anxiety (%) 13 (20)OCD (%) 5 (8)Suicide attempts (%) 2 (3)

Other (%) 0 (0)Income (£1000 per year)Less than 10,000 (%) 2 (3)11-15 (%) 4 (6)16-25 (%) 8 (13)26-30 (%) 3 (5)31-40 (%) 5 (8)41-50 (%) 6 (9)50+ (%) 36 (56)


Following the analysis, three factors were manually extracted and rotated. These

three factors (parenting toolkit; fix me first; nurture the nurturer) together explained

39% of the study variance. Thirty-eight of the 64 Q sorts loaded significantly onto

one of these three factors (with factor loadings of +-.38 or above indicating

significance at the p <

.01 level). There were 14 non-significant Q sorts, meaning that they did not load

significantly onto any of the three factors. There were ten confounding factors,

meaning that they loaded significantly onto more than one of the factors. These ten

confounded sorts and 16 non-significant sorts were removed from analysis and not

included in factor interpretation.

Factor interpretation is discussed in the same way for each factor. Each factor has a

title and a brief summary followed by the demographics of participants loading onto

the factor. Presentation of demographic information is common practice in Q

methodology and is mainly used to describe the type of people who load onto each

factor, rather than to compare demographics across factors. Table 3 shows factor

loadings for each participant along with corresponding demographic data. Where

necessary in the text, the ranking of the statement is denoted by the number of the

statement followed by the ranking of that statement (e.g. 10: -3 indicating that

statement 10 was sorted at the -3 point on the grid). Figures representing loadings of

sorts across each array are also included within the text for ease of reference. It

should be noted that the correlations between factors were not significant, indicating

that the factors represent clear distinct ideas (all r’s +/-<.27).


Table 3. Factor loadings for each participant

Ppt Gender Income (£1000)

No. children

Mental health Marital status

Loading on factor 1

Loading on factor 2

Loading on factor 3

1 F 50+ 2 None Married .2091 -.3338 .03622 F 50+ 2 Depression Co-habiting -.1355 -.1009 -.20853 F 31-40 2 None Married .6567 .0418 .28444 F 50+ 1 None Married .4044 -.1500 .54105 F 31-40 8 OCD Single .6829 -.0445 -.06306 F 16-25 1 None Co-habiting .1081 -.1305 -.30527 F 50+ 1 None Married -.0754 .0093 .19018 F 11-15 1 Suicide

attemptsCo-habiting .5280 .5280 -.2187

9 F 50+ 1 Anxiety Married .7304 .0166 .254510 F 50+ 1 None Married .5976 -.1312 .360911 F 16-25 1 Depression Co-habiting .5081 .0342 .176812 F 11-15 1 Anxiety Married .4719 .0053 .043213 M 50+ 2 None Married .4959 -.1370 .585514 M 50+ 2 None Co-habiting .7106 .0408 .243615 F 31-40 1 None Co-habiting .3345 .0049 .125016 F 50+ 2 None Co-habiting .6057 -.0686 .214217 F Less than 10 1 None Co-habiting .4652 .3090 -.170718 F 50+ 2 None Married .6788 -0.450 .033119 F 26-30 3 None Single .2866 -.1279 .266820 F 50+ 2 None Married .7306 .1221 .037221 F 41-50 1 Anxiety Co-habiting .6012 .0551 -.046122 F 41-50 2 None Married .4303 -.3504 .042723 F 50+ 1 None Married .6307 -.0549 .312824 F 50+ 1 Depression Married .4689 .1061 .322825 F 50+ 1 None Married .7246 -.1289 -.059326 F 50+ 2 Depression Married .6958 .0094 .0607


27 F 50+ 3 None Married .4922 .0468 .172328 M 11-15 2 Anxiety Married .5459 .3101 -.041329 F 50+ 2 None Married .6789 .3562 .073230 M 26-30 1 Depression Co-habiting .3434 .4928 -.2642

31 F 16-25 1 Depression Single .3476 .1123 .114932 F 50+ 2 None Married .6192 .0038 .155833 M 31-40 2 Suicide

attemptsCo-habiting .4374 .3217 .0652

34 F 50+ 1 Anxiety Married .3437 .0161 .124335 F 16-25 2 Depression Co-habiting .6094 .2544 -.2664

36 F 11-15 1 None Single .1239 -.2086 .514237 F 50+ 1 Anxiety Co-habiting .6426 .4725 -.1359

38 F 50+ 2 None Married .4555 .1969 .275439 M 26-30 2 Depression Married .6557 -.1664 .282340 F 26-30 2 None Married .3461 -.2963 .333841 M 50+ 1 Anxiety Co-habiting .3665 .5253 -.0966

42 F 50+ 2 None Married .2731 -.3225 .462843 F 41-50 1 None Married .6474 .1682 .288744 F 16-25 1 Depression Co-habiting .6183 .2032 .1573

45 F 50+ 2 None Co-habiting .6688 .2682 -.0997

46 F 16-25 1 Depression Single .2033 -.0256 .3015


47 F 50+ 1 Anxiety Married .6435 .0614 .000748 M 41-50 2 Depression Married .4805 .1405 -.441649 F 31-40 1 Anxiety Married .2535 -.3951 -.410550 F 16-25 1 None Married .2172 .1019 -.078751 M 50+ 4 Depression Married .3158 -.2038 -.419852 F Less than 10 1 None Married .4137 -.0746 -.4788

53 F 16-25 2 OCD Married .4590 -.0199 -.342454 F 50+ 1 OCD Married .3021 -.1263 -.592655 F 50+ 2 Anxiety Married .2234 .0492 -.424756 F 41-50 1 Anxiety Married .2100 -.1165 -.204057 F 41-50 1 OCD Married .5058 -.0668 -.291658 M 50+ 2 Depression Married .3624 -.1436 -.228859 M 50+ 1 Depression Co-habiting -.0073 -.2494 -.1774

60 F 50+ 1 Anxiety Married .3953 .0501 -.548861 M 50+ 1 Depression Married .1272 -.0640 -.134662 F 50+ 1 Anxiety Married .1435 -.3636 -.392863 F 50+ 2 OCD Married .4652 .0092 -.036964 M 50+ 1 Depression Married .3891 -.0087 -.5457

n.b. Numbers in bold represent significant loadings above .38. Data in italics represents confounding sorts, and data in normal font represent

non-significant sorts.


Factor one: parenting toolkit (see figure 2 for factor array; # =factor number from Table 3, + or- signifies where they placed the item onto the q-sort).

Participants on factor one agreed that parenting workshops focussing on their child’s

wellbeing and learning of skills to change their child’s behaviour was most important

over and above the basic practicalities of attending and their own wellbeing. The

individuals in this group wanted to learn specific parenting skills that would enable

them to parent their children more effectively. They wanted to have a ‘toolkit’ of

techniques they could utilise with their children in a practical way. They were less

interested in emotional support.

Factor one had a rotated eigenvalue of 15.27 and explained 24% of the study

variance. Thirty-one participants loaded significantly onto this factor. Participants on

this factor were largely female (84%) with only one of the males in the study

loading onto this factor, with over half being 35 years old or over (58%). The

majority of them had more than one child (58%) and a large proportion of them were

married (68%). Over half of them earned more than £50,000 per year. And it was a

fairly even split between those who did and did not experience mental health

difficulties (52% versus 48%, respectively).

The most defining q-sorts on this factor were around increasing their child’s

wellbeing (child focussed factors) and an externalisation of how this change would

occur (parent focussed factors). In relation to the child focussed factors, the items

focussed on ways in which the child could change or learn new skills to both

behave better and have increased wellbeing that would, in turn improve wellbeing

for the parent. For example, items highlighted as important were to learn how to

build confidence in their children (#8, +6) and to feel more competent as a parent

(#20, +6). Specific skills to help their children manage their own behaviours were

also ranked as significant and included learning how to encourage their child to

problem solve (#23: +4), learning skills to


communicate as a family (#22, +4), and learning how to reduce their child’s stress

(#16, +4).

In relation to the external or parent-focussed factors, individuals in this group also felt

that learning how to deal with conflict effectively (#9, +5), learning how to build their

own confidence as a parent (#7, +5), and learning to nurture their child’s

development (#19, +5) were all significant ‘active ingredients’ they would want to

see in a parenting group. Increasing knowledge of their child’s development (#18,

+3), learning how to problem solve difficult situations (#10, +3) and learning how to

set limits for my child (#21, +3) were all also rated highly.

While participants agreed strongly that the child’s wellbeing were central to the

success of a parenting programme, they were less concerned with the basic

practicalities surrounding the course. Participants strongly felt that the provision of

food and transportation were unnecessary to the ‘active ingredients’ in a parenting

programme where both items (#39 and #40) scored -6. They also agreed that learning

about healthy eating was not a pertinent items in a parenting group (#43, -5). Having

classes during the day were also ranked low (#29, -4) and participants in this group

felt that meeting the team running the group beforehand, doing homework activities

and having reminders about the sessions were not important (#48, -5; #25, -4; #26, -4,

respectively). Additionally, parents in this group did not value decreasing their own

awareness on the negatives in their lives as key to a successful parenting group (#46,

-5).

There were also a number of items that were ranked as less relevant in this factor. It

can be suggested that participants were indifferent towards them or felt them

irrelevant to the overall aims of the parenting group. In this group of

participants, the items typically fell around the theme of gaining support from

other group members, both


inside and outside of the parenting workshops. Having buddy networks encouraged in

the group, to meet people like me in the group and seeking support when stressed

were all rated around the middle of the grid indicating a neutral response (#60, -1;

#27, -1:

#11, 0, respectively). In addition, participants ranked issues around the learning of

information or learning of skills related to their own wellbeing as less significant. For

example, learning mindfulness skills, learning about the parent-child bond, learning

to be aware of my feelings, and learning to control emotions were all rated as less

relevant to those on this factor (e.g. #6, 0; #12, +1; #58, -1; #2, +1, respectively).


Figure 2. Factor array for factor one.


Factor two: fix me first (see figure 3 for factor array; # =factor number from Table 3, + or- signifies where they placed the item onto the q-sort).

This factor array was understood through considering two defining sorts (see Table

1). Factor two had a rotated eigenvalue of 3.51 and explained 5% of the study

variance. Two participants were considered as the defining sorts on this factor.

Participants on this factor were male. Both had one child and both were co-

habiting. One of them earned more than £50,000 per year and both reported mental

health difficulties.

In contrast to factor one, participants on factor two agreed that parenting workshops

focussing on their own wellbeing and learning of skills to change their own behaviour

was most important. This factor and the statements associated with it were about the

parent feeling better able to parent if their own emotional needs were met first. Put

simply, they wanted to get support for managing their own feelings which would

enable them to parent their child/ren more effectively: the parent learning how to

improve their own emotions would improve their child’s wellbeing. They also felt

less reliant on the facilitator or other group members for this change indicated by

negative scores on the items around further communication outside of sessions.

The most highly polarizing q-sorts on this factor were around increasing their own

wellbeing. Specifically, the items of learning how to self soothe and being more

aware of their own body signals and sensations were important (#3, +6; #1, +6,

respectively). Learning how to control their own emotions and learning relaxation

skills were also rated as important (#2, +5; #5, +5, respectively). Additionally,

participants in this group also valued doing homework activities in order to

consolidate the skills (#25,

+5). Parents encapsulating this factor further rated learning mindfulness skills and

decreasing their awareness on the negatives in their lives as important (#6, +4; #46,

+4). In contrast to factor one, individuals in this group also felt that having

transportation provided was important (#40, +5).


While participants agreed strongly that their own wellbeing was paramount to a

parenting programme, they did not agree that communication and support from the

facilitator/s and other parents was important. This suggests they were keen to learn

how to manage their own wellbeing without the support of others and keep the group

separate from their day-to-day lives. For example, participants felt that having

reminders about sessions (e.g. via text messages) were not vital aspects for a

parenting group (#26: -5). In addition, buddy networks being encouraged between

parents was not considered helpful (#60, -6) and having group discussion to learn

new skills was not valued (#35, -5). Furthermore, individuals in this group did not

consider collaborative working between facilitator/s and parents (#52, -5), protection

concerns being addressed (#57, -4), and promotion of a safe and supportive

environment (#42,

-4) as important in a parenting group.

Neutral items for these sorts indicated less value being placed on items relating to the

learning of new skills by their child/ren and wider family to help manage their

wellbeing. For example, learning how to encourage their children to problem solve

(#23, -1), learning about the parent-child bond (#12, 0), learning how to establish

family rules (#24, +1) and increasing their knowledge about their child’s

development (#18, +1) were all ranked neutrally in the array. Facilitator

characteristics were also considered less relevant with facilitators being non-

judgemental (#32, -1), facilitators listening (#33, -1) and facilitators being

approachable (#31, -2) ranked towards the neutral area.

Figure 3. Factor array for factor two



Factor three: nurture the nurturer (see figure 4 for factor array; # =factor number from Table 3, + or- signifies where they placed the item onto the q-sort).

For the purposes of this factor, one participant has been used as a defining sort. There

were five sorts that loaded significantly onto this factor, four of which were polarised.

It was felt that discussing the sort loading positively onto the factor would provide an

interesting exploration of the array. As such, the following results are discussed

according to this one defining sort. Factor three had a rotated eigenvalue of 5.61 and

explained 9% of the study variance. The defining sort in this factor was a female,

who was single, no reported mental health difficulties and with a low income

(<£10K).

When considering the statements in this factor and the defining sort associated with

the array, the theme of the parent wanting to be nurtured was apparent. A sense of

them feeling isolated and lonely was highlighted by both the statements (discussed in

more detail below) and the demographics of the participants defining the sort. For

example, a single mother on a low income may struggle to meet with others and gain

support from other networks. Supporting this idea, the most defining statements on

this factor were the promotion of a safe and supportive environment (#42, +6), the

facilitators being approachable (#31, +5), non-judgmental (#32, +5), listening (#33,

+4) and the facilitator having previous experience of working with parents (#53, +4).

Further practical issues were also ranked as important such as having day classes

(#29, +5) and the group being universal and open to all (#49, +4). In contrast to

factor one, parents in this group also rated learning about healthy eating (#43, +6)

and learning about healthy living (#44, +3). These statements all point towards

someone who values being ‘looked after’ in some way and having their emotional,

physical and health needs met by someone else: they want to be nurtured. It may be

that they are looking for a mentor to help them navigate raising a child or someone

who could potentially look after their child (e.g. providing the child with healthy


eating and healthy living) as they feel enhancing their own wellbeing is less relevant

to them.

While the sort agreed strongly that being nurtured through the learning environment

and facilitator was important, they did not feel that learning skills for their own

wellbeing was as important. This is in contrast to factor one. For example, they

highlighted that learning to self soothe (#3, -6), learning how to reduce their own

stress (#15, -5), to learn skills to communicate as a family (#22, -5), to feel more

competent as a parent (#20, -4) and learning to deal with conflict effectively (#9, -6)

were not significant ingredients for them in a parenting group. Nor was it important

for the facilitator to be approachable (#31, -3). However, they did want them to be

knowledgeable (#34, 1). This makes sense in the context of what they feel is most

important as they want someone else to care for these needs. They do not want to

have to learn how to manage their own wellbeing they want a ‘mother’ figure to do

this for them.

Aspects in this factor that participants rated as neutral were typically issues around

learning specific skills to help manage their own and child/ren’s wellbeing. For

example, learning mindfulness skills (#6, -1), learning how to reduce their child’s

stress (#16, +1), learning relaxation skills (#5, +1) and learning communication

techniques (#47, +1) were all considered less relevant.



Figure 4. Factor array for factor three


Discussion

The current study aimed explore, from a sample of parents, what their opinion was on

five specific aspects (facilitator characteristics, type of programme, model/content,

practical aspects and specific need) within five significant parenting

programmes/interventions TP programme (Sanders, 2008); the IYPT (Webster-

Stratton, 1984); and the PMTO (Forgatch et al., 2004). The interventions taken from

the literature review are the CWDC (Chronis et al. 2006); and guided self-help

cognitive behavioural therapy (CBT; Palmer et al., 2012) which were established

from a previous literature review and from a key government website on parenting

programmes/interventions (http://www.education.gov.uk/commissioning

toolkit/Programme/ParentsSearch).

Previous research highlighted above indicated some variability in parental views and

efficacy across these programmes and in relation to the five key aspects. In an attempt

to address these discrepancies, this study set out to discover what parents want from a

parenting programme in order for them to be best supported depending on their needs

and level of engagement. Following parental engagement with the task of sorting

items form the concourse, the results indicated three distinct factors. Factor one

highlighted value in learning a toolkit of skills to aid parenting. The second Factor

spoke to the idea of ‘fixing the parent first’, where the goal of attending was to stop

‘feeling’ bad as a parent. Factor three indicated the idea of ‘nurturing the

nurturer’, where the emphasis was on the parent wanting someone to care for

and comfort them [the parent], and provide guidance during the group.

Discussions of findings in the context of previous literature

Previous research has highlighted that parenting can be stressful (Deater-Deckard,

1998; Pottie & Ingram, 2008) and this stress can have a negative impact on children


and young people’s wellbeing. Despite consensus over the impact of parenting stress,

there is some disagreement over how best to support individuals with the demands of

parenthood (Hill et al., 2007).

These findings are interesting in the context of previous literature which has

highlighted successful implementation of a number of parental programmes (e.g.

Sanders et al. 2014). These programmes have typically aimed to increase child

wellbeing with parental wellbeing as a secondary outcome (e.g. Kratochwill et al.,

2004; Hagen et al. 2010). They have largely focussed on providing a universal

approach to all parents and aim to teach them a set of skills to learn new parenting

techniques (e.g. Webster-Stratton, 1984; Hutchings et al., 2007; Scott et al., 2001).

Despite the success of these programmes, there is recent evidence indicating that the

programmes are still missing what parents really want and need from a group (e.g.

Hill et al., 2007). The results from the current study go some way to supporting

Hill and colleagues as it begins to highlight some variation in the needs of parents in

supporting them in a parenting programme. The vast majority of the participants

loaded on one factor. This array suggests, for this sample of parents, the current

parenting programmes would sufficiently meet their needs. However the other

factors suggest that there may be unmet needs for fathers and older single

parents. The following discussion sets out to explore these factors in more detail

with comparisons made to previous research. Each factor will be discussed

separately.

Factor one: toolkit for skills for parenting

In keeping with the intention of programmes to provide parenting skills training,

factor one suggests there is a clear demand for this skills training in how to

manage their child’s wellbeing and development. This is in line with existing

research and service


provision supporting a universal approach (see Sanders et al., 2014). The sorts that

created factor one also loaded most strongly onto statements associated with learning

parental skills to become a better parent and feel less stressed, with less emphasis on

the nurturing element of the group. This factor focussed on learning new parenting

skills and was consistent with a universal approach to recruitment of parents currently

promoted in a large number of parenting groups. The factor also highlighted some

parents felt their own emotional needs were also important. As such, this section

discusses these in turn, behavioural skills, parental wellbeing and the universal

approach.

Behavioural/parental skills

In terms of parenting skills, this factor supports a number of programmes already on

offer. For example, the standard TP programme incorporates the opportunity to learn

parenting skills (Sanders et al. 2000). This programme teaches parents 17 core skills,

ten of which are designed to promote the child/ren’s development and competence

and the other seven aim to decrease negative or unhelpful child behaviours. Factor

array one shows a number of sorts that relate to these core skills. For example, the

q-sorts that relate to children’s development and competence were: ‘to learn ways to

nurture my child’s development’, ‘learning how to build confidence in my children’,

‘to reduce my child’s stress’ and ‘to encourage my child to problem solve’. The

seven items in the TP programme that focus on reducing unwanted behaviours in

children are also supported in this factor with statements such as ‘learning how to

deal with conflict effectively’, learning how to change my child’s difficult

behaviour’ and ‘to learn skills to communicate as a family’.

Previous research has further indicated support for the behavioural skills approach

used by the TP programme (and other programmes discussed later in the study)

where


Sanders and colleagues (2014) conducted a large scale meta-analysis and systematic

review. They found significant short and long-term effects for parents and their

children who had completed the TP programme for both children's social, emotional

and behavioural outcomes (d = 0.473), and parenting practices (d = 0.578).

Parental wellbeing skills

Although what parents have identified as important in factor one in the current study

are supported by current programmes on offer, there were some interesting statements

that suggest other motivating factors for attendance and completion. For example, a

number of statements ranked as important indicate the motivation for parents

attending may also be about learning how to be a better parent through changing

their own behaviour instead of their child’s. For example, the factor in this study

was made up of a high loadings on the statements ‘to learn how to build my

confidence as a parent’ and ‘to feel more competent as a parent’. As previously

mentioned, most parenting programmes focus on change in child outcomes

(emotional, behavioural, social etc.) as the main objective with parental change as

a secondary outcome. However, the statements highlighted above suggest some

parents may attend to learn skills to change their own behaviour first. This may be

important when promoting the groups to parents who want to focus on their own

behaviour (e.g. Akin & Gomi, 2017; Chronis et al., 2006).

Universal programme

This factor also provides a strong endorsement for the design of the Universal

parenting programme and clearly captures what many parents want. It could be

suggested from the number and varied demographics of participants who loaded onto

this factor that a universal approach is popular. The large majority of programmes

currently on offer fit this universal approach and want to prioritise behavioural skills


to enhance parenting rather than engaging the adult in managing their own emotional

well-being.

Factor two: fix me first

Factor two highlighted a need for the group to be more adult orientated and wanting

the parent to feel better about themselves. The two defining sorts for this factor were

both men, first time parents, co-habiting and with self-reported mental health

difficulties. Key themes for discussion were threefold: (1) being first time parents; (2)

the role of mental health difficulties; and (3) mental health and parenting.

First time parent

In relation to being a first time parent it could be suggested they lacked confidence in

their parenting ability as they had no previous experience of being a parent (Kuo et

al., 2012). This may influence what they want from a group.

Mental health

Personal vulnerabilities may have a role to play in understanding the factor array. The

two sorts had self-reported mental health difficulties (depression and anxiety). These

fathers may have felt support with their emotional wellbeing (e.g. ‘learning to be

aware of my emotions’, ‘learning to control my emotions’ and ‘learning to self

soothe when experiencing difficult thoughts’) in a parenting programme was most

important. Previous research has shown that parents with specific needs value

programmes focusing on their wellbeing (e.g. Chronis et al., 2006). Research has

shown that a barrier to fathers attending programmes is concerns over content (e.g.

Bayley, Wallace

& Choudhry, 2014). It could be suggested that the current results show that the

fathers in this study wanted a programme focussing on how they could feel better as

a parent as opposed to learning behavioural skills.

Parenting and mental health


Previous research has highlighted the significant association between parental

wellbeing and child mental health (e.g. Naerde et al, 2000). Programmes that

currently offer support for parents with mental health difficulties that specifically

focus on their emotional needs as a main objective are limited.

One such programme that is available is the Family Links Nurturing Programme

(Family Link research team, 2011). This programme aims to firstly help parents

understand their own emotional needs and secondly learn about positive parenting

practices. This programme postulates that parents with higher levels of self-esteem

and self-awareness are in a better position to respond to their child’s needs in a

positive and helpful way. This ultimately results in increased child and parental

wellbeing. Despite having promising ideas which support factor two in the

current study, the evidence base for this programme is poor.

Factor three: nurture the nurturer

Factor three was defined by gaining support from the group to parent more

effectively. They were not concerned with learning new skills (unlike factor one) or

about helping them to feel better in order to parent more effectively (unlike factor

two). The parent who loaded onto this factor wanted someone to mentor them and

have company from a group. Interestingly, the mother on this factor was an older,

single, first time mother, with low income. She reported no mental health problems.

These demographic characteristics that may be significant in understanding this

factor array and typically point towards the need for additional support. They have

been used to structure this section (single, age, and income).

Single

This mother may have limited support networks given that she is a single mother with

a low income. This may impact on her ability to seek support and reassurance.


A single parent’s needs and concerns are likely to be different from that of a two

parent family. The former having the constant pressure and stress of the job of

raising children and no one to share day-to-day responsibilities or decision-making

with (e.g. McCubbin, 1989). Increased demand is likely to lead to increased stress

(e.g. Deater- Deckard, 1998; Pottie & Ingram, 2008) and with a large proportion of

parents parenting alone in the United Kingdom (UK; Office Of National

Statistics, 2015), having a parenting group dedicated to those ‘going it alone’ would

potentially improve parental and child wellbeing. Although, it is worth noting that

factor one had some single parents loading onto to it so further research into this

area is warranted to make a clear decision about this. There are online courses

for single parents (e.g. the confident parenting online course;

singleparents.org.uk) but there is currently no evidence-base to support their

effectiveness, despite sharing similar content to the face-to-face courses discussed

in this paper. Of course, single parents can attend any of the groups if they meet the

criteria but there are no groups that specifically recruit for just single parents.

Age

There may be an increasing stigma for older mothers who need support with

parenting in that they should be able to care for their child and themselves. At the

time of writing this document the author could not identify any research into

older parents and parenting programmes which may indicate a gap in the research.

However, it could be suggested that older parents may feel less able to attend

programmes due to this stigma. One statement to support this is ‘meeting people

like me in the group’. Perhaps a normalising experience is something older

parent’s value. Previous research has shown sharing and normalising of the parent

experience is helpful to parental and child wellbeing (Wilson et al., 2012).


Income

Income may also play a part in the lack of support. It may be difficult to fund

activities to meet other parents. We also know that low economic status is linked to

decreased wellbeing in single mothers and increased behavioural problems in

their children (Jackson, Brooks-Gunn, Huang & Glassman, 2000). Increasing

support networks and utilising parenting programmes as a way of doing this may

help alleviate some of these difficulties for those on low incomes. Providing free

childcare has been shown to increase attendance and effectiveness of the

programmes and having venues close to individual’s homes to reduce financial

transport pressure may help (Wilson et al. 2012). Having childcare and evening

classes were both reported as relevant to this parent.

Confounding and non-significant q-sorts

Not only is it important to consider the q-sorts that were significant but it is also

noteworthy to address those that were confounding and non-significant. Although

they are not used in the final interpretation of the data, they potentially provide

additional information about parental views and opinions on parenting programmes. It

is beyond the scope of this study to consider the potential meaning behind the

confounding and non-significant q-sorts in the current data set. However, further

research considering these q-sorts in more detail may provide rich information about

these parents views on parenting programmes. For example, completing qualitative

interviews with the individuals would gather more information about their potentially

differing views about what they want from a parenting programme in comparison to

the current studies data set.

Summary from discussion

This study shows that parents believe the important aspects for programmes are the

kind of elements already provided by particular programmes (factor one: e.g. IYPT,

PMTO, and TP programme). These programmes have been proven to be effective in

terms of outcomes (e.g. Chronis et al., 2006; Wilson et al., 2012; Sanders, 2008).


However, this study highlights that there may be minorities of parents who would

wish for different types of programmes than those that are currently available

(factor two and three).

Limitations

This study provides an interesting account of parental opinion on parenting groups.

However, additional demographic information could have allowed for more extensive

analysis (e.g. ethnicity, level of education). This data may help to consider additional

groups of parents who may require a particular focus or emphasis within a

programme. Utilising a different recruitment approach could increase this

demographic information as the personal contacts and snowballing method in the

current study potentially restricted gathering a range of demographic data.

To address more specific questions it would have been interesting to have gathered

specific data on attendance at parenting programmes. The inclusion criteria for this

study was that participants did not require or preclude parent’s attendance at a

programme to participate. Given the participants demographics in this study, it is

unlikely the participants had attended a programme (high income, married, low

mental health difficulties). This may have impacted on the findings. For example,

those who had already experienced a programme may have responded dependent

on the nature of their experience (good or bad). As such, the results may have been

informed by their previous experience and/or knowledge of how a programme

worked.

Future research and implications

It may be useful to complete a similar q-methodology study asking the children of

parents who have or might attend a programme what they would like their parents to

learn about and or change. As although research highlights that parental needs are not

being met (e.g. Hill et al., 2007) and that parental wellbeing is a secondary outcome

to child wellbeing (e.g. Sanders, 2008), what is unclear from this work is how the


children perceive the benefits of their parents attending the programmes and what

they think their parents need assistance with. Understanding what children feel is

relevant would help address specific needs in more detail. This seems particularly

significant given that the programmes main aims are to increase child wellbeing.

Future research may also investigate opinion from other care givers to provide a

holistic approach to caring for children. This study focussed on parents but

information regarding step-parents, grandparents, foster carers, adoptive parents,

carers, guardians etc. would be interesting when addressing specific need and

demographics. This is


particularly pertinent given the large number of Looked after children. Children in

need of adoption or fostering require a positive attachment experience (e.g.

Department of Health, 2015; Youngminds, 2014). Parenting programmes for these

individuals may provide a vital source of support and ensure the wellbeing of both the

child and parent are healthy.

It may also be beneficial to consider asking parents what they want from a parenting

programme at the outset of taking part in order to potentially adapt and individualise

current programmes on offer. This may increase engagement as parents may feel their

needs are being met and heard at the beginning.

Conclusion

The results of this research support the governments wish that services users have

access to a choice of evidence based interventions that will meet their needs by

exploring what and how much parents value what is currently offered by parenting

programmes (e.g. Department of Health, 2015; Youngminds, 2014). The creation of

evidence based interventions requires consultation and collaboration with Service

users. The results highlight the possible need to further develop some targeted

specific parenting programmes for fathers and single mothers as they appear to

report very different needs to those parents benefiting from the more ‘universal’

programmes. Future research is needed to further examine the needs of these

specific programmes and consideration of the views of fathers, those with mental

health difficulties, older and single mothers to develop understanding of parental

need in parenting programmes.


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List of Appendices

Appendix A – Overview of programmes/interventions Appendix B – Clinical Psychology Review: Guidelines for AuthorsAppendix C – Q-sort statementsAppendix D – Screen shots of the online Q-sort study Appendix E – Favourable ethical approval Appendix F – Description of Q Methodology.


Appendix A: Overview of programmes/interventions

Parenting programmes that target behaviour change:

The programmes described below all utilise Patterson’s coercion model of parenting

(1982) as there basis for teaching skills to change behaviour in the child.

Triple P Programme (Sanders, 2008):

The TP is a programme aims to provide parents with new techniques to manage their

child’s behaviour. Outcomes have shown it increases parent’s use of positive

parenting strategies, improves child behaviour, improves child wellbeing and

improves parental wellbeing (Sanders, 2008). However, there is evidence suggesting

its widespread use is unfounded as the improvements are not always reliable

(Wilson et al., 2012; discussed in more detail below). This programme can be

offered as an effective universal (open to all) or targeted (specific needs)

programme with varying durations (Wilson et al. 2012).

Incredible Years Parenting Training (Webster-Stratton, 1984).

The IYPT programme aims to teach parents to use positive parenting techniques (e.g.

positive reinforcement, praise, active encouragement) with outcomes showing

improved child and parental wellbeing, improved child behaviour and increased use

of positive parenting practices (Menting, De Castro & Matthys, 2013; mean effect

size of d = .27). The programme has shown positive results at a universal and

targeted level (Webster-Stratton, 1984).

Parent management training: Oregon Model (Forgatch, Bullock & Patterson, 2004).

The PMTO covers five areas of learning including skill encouragement, setting

limits, monitoring, problem solving and positive involvement. This programme can

be offered at four levels of intensity ranging from low to high need (oppositional

behaviour). It can be delivered in a group (14 weekly sessions) or individual format

(19-30 sessions for one hour). Effect sizes for the efficacy of the programme


(discussed below) indicate variability, with both positive and little or no effect

(DeGarmo & Forgatch, 1999).

Parenting programmes targeting parent wellbeing:

Below, the CWDC and a guided self-help CBT course are outlined. These

programmes/interventions are more in line with Deater-Deckard’s model (1998) of

parenting where the parent’s appraisal of the situation affects change.

Coping with depression course

The CWDC is a psychoeducational intervention for individuals struggling with

unipolar depression showing positive effects (Lewinsohn, Antonuccio, Breckenridge

& Teri, 1984). The programme is 12 sessions teaching CBT coping techniques for

individuals including cognitive restructuring, behavioural activation and relaxation

techniques. Given the established links between parenting and mental health

(Bornstein, 2002), Chronis et al (2006) studied its effects for parents with depression.

Guided self-help cognitive behavioural therapy (CBT)

CBT guided self-help has been shown to improve wellbeing in those experiencing

anxiety and/or depression (Seekles et al., 2011). As such, Palmer et al (2012)

explored its use for mothers with depression using online support (‘living life to

the full’) or workbooks (overcoming anxiety/depression). Each group had support

from a psychological wellbeing practitioner (PWP) at the initial appointment, at

four weeks


and at the end. At the end, nine participants completed in-depth interviews. The authors concluded that

guided self-help CBT for depressed mothers had a positive impact on the mother’s children and family’s

wellbeing (effect sizes not quoted).


Appendix B.

Author guidelines for Children and Society taken from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1099-0860/homepage/ForAuthors.html

CHILDREN & SOCIETY AUTHOR GUIDELINES

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Appendix C: Q-sort statements.

1. Learning to be aware of my body sensations/signals

2. Learning to control my emotions

3. To learn to self soothe when experiencing difficult thoughts and

feelings

4. To understand the link between thoughts and feelings

5. Learning relaxation skills to help manage feelings and situations

effectively

6. Learning mindfulness skills

7. Learning how to build my confidence as a parent

8. Learning how to build confidence in my child/ren

9. Learning how to deal with conflict effectively

10. Learning how to problem solve difficult situations

11. Learning how to seek support from others when I’m stressed.

12. Learning about the parent-child bond

13. Improving my self-esteem

14. Learning how to change my child’s difficult behaviour

15. To learn how to reduce my stress

16. To learn how to reduce my child’s stress

17. Learning about discipline methods

18. To increase my knowledge of my child’s development

19. To learn ways to nurture my child’s development

20. To feel more competent as a parent

21. To learn how to set limits for my child


22. To learn skills to communicate as a family

23. To learn how to encourage my child to problem solve

24. To learn how to establish family rules

25. Doing homework activities to help me learn the skills from the group

26. Having reminders about sessions

27. To meet people like me in the group

28. Having evening classes

29. Having day classes

30. Having a childcare service when parents attend the group

31. Facilitators being approachable

32. Facilitators being non-judgemental

33. Facilitators listening

34. Facilitators being knowledgeable

35. Having group discussions to learn new skills

36. Practicing new techniques in the sessions

37. Communication outside of sessions for support/coaching (e.g. home

visits/texts, telephone)

38. Sessions are face-to-face

39. Food provided

40. Transportation provided

41. Parents have a workbook to use in and out of sessions

42. Promotion of a safe and supportive learning environment

43. Learning about healthy eating

44. Learning about healthy living (e.g. exercising)


45. To understand how emotions such as stress and worry can negatively

affect physical and psychological health

46. Decreasing my awareness on the negatives in my life

47. Learning about different communication styles and how to

communicate effectively

48. Meeting the team running the group beforehand

49. The group being universal and open to all

50. The group being a targeted programme and open to specific groups of

parents

51. Having an overview of the programme before it starts

52. Collaborative working between the facilitator/s and parents

53. Facilitator having previous experience of working with parents and

children

54. Completion of measures before and after attending the group to assess

change

55. For parent goals to be considered whilst completing the group

56. For child goals to be considered whilst completing the group

57. Protection concerns are addressed (eg. child and parent)

58. Learning to be aware of my feelings

59. Learning how to increase my child’s performance at school

60. Buddy networks encouraged between parents


Appendix D: Screen shots of the online Q-sort study.


Appendix E: Favourable ethical approval.


Appendix F: description of Q Methodology.

Q methodology is based on two main features: (1) the sorting of a collection of

statements or ideas prepared by the researcher along a subjective dimension, such as

'agree/disagree' or 'like/dislike' (Watts & Stenner, 2012) known as a ‘Q sorts’. This

method provides the researcher with an indication of what the participants view on

the topic being investigated are in a form that allows it to be fully compared

with the viewpoints of other participants. Owing to the Q-sorts inter-correlation, a

by-person factor analysis is used to compare patterns of responses between

participants. This provides data indicating what the shared understanding of the

concept being explored is. Using this method allowed for an exploratory

investigation into what parents consider the most helpful aspects in parenting

programmes are.

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