Project Overview
Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape – parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation — interventions designed as universal or selective have primarily been delivered as such.
This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Smart Parents - Safe and Healthy Kids (SPSHK), informed by social cognitive theory, uses role-play scenarios to emphasize skills related to healthy child sexual development, parent-child communication about sex and sexual abuse, and child safety strategies to protect them from victimization (i.e., vetting babysitters, monitoring activities inside and outside of the home, as well as online).
SPSHK comprises three segments: (1) healthy child sexual development; (2) parent-child communication; and (3) child safety. Each segment is described in a handbook and is divided into age groups, so parents can easily access the most relevant information for their child’s age and developmental range (i.e., 0-2, 2-5, 6-9, 9-12, 13+). In the “Healthy Sexual Development” segment, parents review typical sexual developmental milestones, behaviors that are atypical and may indicate something abusive or harmful has occurred, and the importance of teaching children anatomical labels for body parts (e.g., vagina, penis, breasts). In the “Parent-Child Communication” segment, parents learn why, when, and where to promote open, accurate, and consistent communication about sexual topics. In the “Child Safety” segment, the parent learns the importance of and how to monitor their child’s activities inside and outside of the home, as well as online. Parents create a safety plan so that their child knows what to do if they are feeling unsafe or if something has happened to them. This segment also reviews the behavioral, emotional, and physical signs of CSA. Parents learn how to react to a disclosure or if they suspect abuse has occurred.
SPSHK was uniquely designed to be added to existing parent education (PE) programs (e.g., Parents at Teachers, SafeCare, or Incredible Years) as parents who are enrolled in PE, potentially as a result of involvement in the child protective service system, are at increased risk for subsequent child maltreatment, including CSA. In the adaptation process, it was imperative that we retained qualities of SPSHK that set it apart from other programs: delivery in a single session, use of role play to practice taught skills following principles of social cognitive theory, and provision of materials to the parent that spanned child developmental periods through age 13.
The purpose of the current study was to identify any necessary modifications to the content of the curriculum and to ascertain whether parents from the general community (rather than referred through a PE program) would have enough foundational knowledge to be successful in the Smarter Parents. Safer Kids. program.
We piloted modifications to the curriculum to foster group rapport and the online delivery system, including online data collection. Using a pre-/post-test design, we examined the preliminary efficacy of Smarter Parents. Safer Kids. delivered in increasing parents’ CSA-related awareness and intention to use protective behaviors. Following an educational workshop, we conducted brief interviews with parents to learn about the acceptability and feasibility of the curriculum delivered in a group setting and online. If acceptable and feasible, the eventual addition of an evidence-based universal parent-focused CSA prevention program to child- and community-based CSA prevention efforts holds promise for affecting rates of CSA prevalence.
Overall participants’ mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.
Data and Data Collection Overview
Parents with children under 13 were recruited over a four-week period between June and July 2023 using online social media platforms managed by the study team and community-based partners. Recruitment posts included a link and QR code to a form through which potential participants could express their interest. Parents (N=31) completed pre- and post-workshop surveys, followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion).
This mixed-methods pilot study used a pre-/post-test design and a brief post-workshop interview. Participants completed online surveys pre- (Survey 1) and post-workshop (Survey 2). Participants provided demographic information at Survey 1. The primary outcome of interest was parental awareness and behavioral responses towards child sexual abuse, which was examined by the 15-item Assessment of Smarter Parents Knowledge.
After completing Survey 1, participants selected a scheduled workshop date that best suited their availability. Five workshop options were offered to accommodate varying parent schedules and maximize attendance. Approximately 24 hours prior to the workshop all registered participants received via email an electronic PDF version of the Smarter Parents Parent Handbook. The Smarter Parents workshops were 120 minutes in duration, conducted via Zoom, and ranged in size from 4 to 9 participants. Each workshop was delivered by two certified facilitators on the research team and was observed by at least three additional members of the research team. Participants were encouraged, but not required, to keep their cameras on to increase engagement and group cohesion. After the Smarter Parents workshop, observers from the research team recorded participation in the workshop which prompted the automatic distribution of Survey 2 (same measures as Survey 1) to workshop participants. At this time, observers also classified participants into three levels of engagement: low, moderate, or high. To be considered highly engaged in the workshop, participants had to have actively participated in practice activities and kept their cameras on throughout the workshop. Participants who were moderately engaged either actively participated in activities or had their camera on, but did neither consistently. Low engagement was defined as not having a camera on or participating in activities.
Following completion of Survey 2, participants scheduled a 30-minute semi-structured interview led by a member of the research team. Interviews took place over Zoom and were recorded and transcribed, then reviewed by a team member for de-identification and accuracy. Participation was incentivized by the sequential distribution of Amazon gift cards sent via email.
Interviews were analyzed using qualitative content analysis methods. Themes and corresponding codes emphasized the purpose of the study: to identify necessary modifications to the universal curriculum (content or presentation) and to assess acceptability and feasibility. Three themes, and subsequent subcodes, were identified: (1) parent as agent of prevention, (subcodes: prior action, prior knowledge, new knowledge, confidence, action); (2) curriculum (subcodes: content, design, changes); and (3) engagement (subcodes: marketing/promotion, parent motivation, future use). To ensure the reliability of the analysis, six independent coders initially coded three transcripts independently and then met to evaluate inter-coder reliability. Adequate reliability was defined as greater than or equal to 80% agreement in extracts pulled from each code. To achieve reliability coders met to resolve any disagreements and updated the codebook accordingly. The remaining transcripts were then divided among coders, such that each transcript was coded by two members of the research team. Codes and reliability were reviewed by the lead author throughout.
In terms of organization, the study team used excel to record their coding. Each coder (lab member) created their own tab on a shared excel and filled out a shared template. The template was broken down into main categories with their respective subcategories. Each of these categories was assigned a different color for easy distinction and organization. For example, the code “Engagement” had three subcodes, (marketing / promotion, parent motivation and future use), which were all highlighted in blue across the tabs. This method allowed for easy comparison between the various lab member’s codes and quick category distinction.
Selection and Organization of Shared Data
The data deposit consists of aggregate data files. Focus group transcripts and individual results are not being shared directly due to consent language limitations. Quantitative data are presented as summary demographic results and summary survey scores; qualitative data are presented as abstracted coded portions of the focus groups’ conversations.
The qualitative coding document represents each coder’s individual responses presented on a separate tab, while the fidelity coding document represents the coders’ comparing their same codes for consistency. In other words, the fidelity document is just a side-by-side comparison of codes to make it clear and easy to read.
Documentation files include the consent form, the demographic questionnaire, recruitment script, the interview questionnaire, the post-workshop satisfaction questionnaire, and the survey questionnaire (used in both the pre- and post-workshop surveys), a Data Narrative and an administrative README file. |
