Parent Attendance in a Family-Based Preventive Intervention Delivered in Latin America and the United States

Abstract

In Latin America, there is an increasing interest in the implementation and dissemination of evidence-based, family-centered interventions to prevent youth behavioral problems. While families’ participation in interventions is integral to achieving the interventions’ desired impact, little is known about what predicts Latin American families’ attendance. The current study provides a unique opportunity to explore the participation of families living in the United States, Ecuador, and Chile in an evidence-based intervention, Familias Unidas. We tested for differences in attendance rates, family functioning variables, and adolescent behavioral problem variables, then applied a hierarchical multiple regression to (a) identify which variables significantly predicted program attendance and (b) assess whether the country in which the intervention was implemented in moderated the relationship between predictors and program attendance. On average, Chilean and Ecuadorian parents were more engaged and attended more sessions than parents living in the United States. Across samples, there was significant differences in family functioning and adolescent behavioral problem variables. However, effective parent–adolescent communication was the only significant predictor of lower program attendance. A significant interaction effect revealed that even though Chilean parents had high parent–adolescent communication, they were more likely to attend sessions, compared to parents living in the United States. We highlight the promise of engaging and retaining families, across U.S. and Latin American samples, into a culturally syntonic, family-based intervention, and discuss potential explanations for success in Chile and Ecuador. Researchers interested in implementing interventions in Latin America could utilize these findings to better target participants and intervention efforts.

Keywords

program planning and evaluation international/cross-cultural health Latino minority health

Family-based interventions have demonstrated strong prevention effects on youth behavioral health outcomes (Sandler et al., 2015). With their well-documented success, there has been an increased interest for the implementation and dissemination of family-centered, evidence-based interventions (EBIs) across the world (Sundell et al., 2014). Unfortunately, a common challenge to family-based interventions is the lack of participant engagement (i.e., initial attendance) and retention (i.e., continued attendance) in these interventions (Griffin & Botvin, 2010), with approximately 50% of recruited families participating in half or less than half of the planned intervention sessions (Heinrichs et al., 2005). High participant attendance is significantly associated with increased intervention impact on parent and youth outcomes, including family conflict, substance use, and antisocial behaviors (Van Ryzin et al., 2012). Hence, to maximize the benefits for family-based intervention participants, it is essential to understand what predicts participant attendance (Hooven et al., 2011).

Family-based intervention researchers in the United States have studied predictors of engagement and retention including demographics (e.g., socioeconomic status), family-level variables (e.g., baseline levels of family conflict), or child-level variables (e.g., baseline levels of child behavioral health). As an example at the family level, one study found that parents who reported high levels of parental monitoring, positive parenting, and parental involvement in their adolescent’s lives were less likely to attend intervention sessions, compared with those who displayed ineffective parenting skills (Perrino et al., 2018). At the child level, while researchers have concluded that high levels of child externalizing symptoms (e.g., aggression) were significantly associated with decreased attendance in intervention activities (Coatsworth et al., 2006), others have stated that the more parents perceive their child is having problems, the more likely they are to participate in an intervention (Winslow et al., 2009). Further, others have concluded that high baseline levels of child problem behaviors were not significantly associated with family’s program attendance (Fleming et al., 2015). The mixed findings could imply that predictors of attendance are specific to the participants being recruited or the intervention being studied. Regardless, if a study could answer who is most likely to attend a family-based intervention, it may translate into increased public health impact on parents and their youths.

While researchers examined predictors of participant attendance in family-based interventions based in the United States, little to nothing is known on this subject in Latin America. Effective child and adolescent behavioral preventive interventions, including family-based interventions (Fernald et al., 2017; Suárez et al., 2018), are being implemented in Latin America to combat public health issues, such as HIV (Huedo-Medina et al., 2010) and youth violence (Atienzo et al., 2017). Yet, to our knowledge, no family-based intervention studies in Latin America have studied predictors of participant attendance. The current study provides a unique opportunity to explore attendance in study participants living in Ecuador, Chile, and the United States into a family-based preventive intervention, Familias Unidas. Familias Unidas, described in detail elsewhere (Prado & Pantin, 2011), and, briefly in the “Method” section, is a Hispanic-specific, family-centered EBI which aims to prevent adolescent problem behaviors.

The objectives of this study are threefold: (1) describe the baseline characteristics and the intervention attendance rates of the Latin American and U.S. study participants; (2) test for differences in attendance rates, family functioning, and adolescent behavior, among the three samples; and (3) explore which characteristics predict participant engagement and retention. Ultimately, findings from this study could not only inform future family preventive intervention delivery in Ecuador and Chile but also encourage other researchers and practitioners in Latin America to study predictors of attendance in their own trials.

Method

This study is a secondary data analysis of three Familias Unidas randomized controlled trials: an effectiveness trial conducted in Miami, Florida between 2010 and 2014 (n = 746 families; Estrada et al., 2017), an efficacy trial conducted in Ecuador with Universidad Católica de Santiago de Guayaquil between 2015 and 2018 (n = 239 families; Molleda et al., 2017), and an ongoing efficacy trial with Fundación San Carlos de Maipo in Chile, which started in 2017 (n = 241 families). All studies were approved by the University of Miami Institutional Review Board, as well as the Comité de Ética del Hospital General Luis Vernaza y el Ministerio de Salud Pública de Ecuador, and Ética Científica del Comité de Ciencias Sociales, Artes y Humanidades de la Pontificia Universidad Católica de Chile.

Participants and Procedures

For the U.S. trial, all Hispanic-immigrant origin eighth graders (ages 12-14 years) and their parents attending any of the 18 participating middle schools were invited (Estrada et al., 2017). Participants were excluded if they planned on moving out of the South Florida area during the duration of the study. For the Ecuador trial, all 12- to 14-year-olds and their parents from two participating middle schools were invited. Families were excluded if they had a history of prior psychiatric hospitalization (Jacobs et al., 2016; Molleda et al., 2017). For the Chile trial, all 11- to 16-year-olds, recruited through school referrals and study team member phone calls, and their parents from four participating schools, were invited. Families were excluded if they had a history of prior psychiatric hospitalization or were already attending a psychological intervention weekly. Across all three trials, the schools were in predominantly low-income areas serving low-income families. Table 1 displays demographic characteristics by study and pooled data set.

Table 1

Demographic Characteristics by Trial and Pooled Data Set

Characteristic	Chile	Ecuador	United States	Pooled Data
Sample size, n of trial (% of pooled data)	120 (19.2)	129 (20.7)	376 (60.1)	625 (100)
Parent age, years, M (SD)	40.62 (6.66)	37.03 (6.43)	42.40 (6.91)	40.95 (7.08)
Mother of adolescent, %	91.7	93	79.1	84.4
Married, %	52.5	32.6	57.9	51.6
Adolescent age, years, M (SD)	12.79 (0.80)	12.88 (0.73)	13.39 (0.68)	13.17 (0.76)
Adolescent gender, % female	49.6	53.9	47.7	49.4

NOTE: Participants were considered parents if they were mothers, fathers, or legal guardians. The marital status variable included married, single, civil union, widowed, divorced, or separated.

In all trials, trained study personnel consented the parents and assented the adolescents. While both parents (i.e., mothers, fathers, and/or legal guardians) were welcome to attend sessions, only one parent and one adolescent completed assessment measures. Once families enrolled, they completed the baseline survey. Families were compensated for their time in completing the survey and randomly allocated to intervention (Familias Unidas) or control (no intervention provided by study staff). In this study, only baseline surveys and attendance data for those participants randomized to the Familias Unidas condition were analyzed (N = 625; 376, 129, and 120 from the United States, Ecuador, and Chile trials, respectively). Further, because engagement strategies were directed toward the parent, we only utilized parent data.

Familias Unidas

Familias Unidas aims to prevent substance use, HIV, and other problem behaviors in Hispanic adolescents by improving how the family functions. Over two decades ago, Hispanic-immigrant psychologists, epidemiologists, and social workers developed Familias Unidas. Their lived experience and connection to the community helped facilitate the inclusion of cultural values in the intervention. Specifically, they train skilled facilitators who are not only Spanish-speaking but also can relate to the families’ cultures. Facilitators (e.g., social workers, school counselors, clinical psychologists) deliver 12 participatory sessions that are guided by manuals: eight parent-only group sessions¹ and four family sessions. In the group sessions, facilitators lead a group of 10 to 15 parents through a participatory learning process to practice positive parenting, enhance communication skills, and gain insight on how to monitor their adolescents’ lives. The group sessions also build rapport and social support among the parents. In the four family sessions, facilitators meet one-on-one with each family. Here, the parent has the opportunity to practice the skills learned in the parent-only group sessions directly with their adolescent.

Cultural Adaptations

Only surface-level, cultural adaptations were made to the Ecuadorian (Jacobs et al., 2016) and Chilean version of the intervention. Adaptations, including specific language adjustments to the manuals and assessment batteries, were made prior to the trials’ implementation. No significant changes in the core activities of the Familias Unidas intervention were needed, and the training of the facilitators was the same across trials. Unlike in the U.S. trial, study team members from the Ecuador and Chile trials provided child-care services for participants if needed/whenever possible. While the Chilean and Ecuadorian teams were trained by the U.S. team, they still had autonomy to make decisions concerning participant recruitment (e.g., age range of adolescents to be included) and intervention implementation (i.e., which schools or communities they wished to recruit from).

Theory

The intervention is based on Ecodevelopmental theory (Szapocznik & Coatsworth, 1999), which posits that risk and protective factors associated with adolescent behavior are expressed through complex relationships in various interacting systems (Pantin et al., 2004). The macrosystem (e.g., cultural values), exosystem (e.g., parent’s friends), mesosystem (e.g., parental monitoring of peers), and microsystem (e.g., parent–adolescent communication) play an influential role in the development of the adolescent. One key aspect of this theory is the “trickle-down” effects of risk and protective factors. Using this perspective, risk or protection occurring in a specific system (e.g., exosystem; parental work stress) can influence problematic behaviors in following systems (e.g., microsystem; positive parenting practices).

Measures

Participants completed the baseline survey utilizing an audio-enhanced, computer-assisted self-interviewing methodology (Metzger et al., 2000). In the U.S. trial, participants completed the surveys in English or Spanish: 84% of participants chose to complete the surveys in Spanish. In the Ecuador and Chile trials, all the participants completed the surveys in Spanish.

Attendance

Facilitators recorded participant attendance, then shared the information with a study team member who was responsible for keeping an up-to-date excel file with attendance data. Grouped under their respective facilitator, families were recorded as attended or not attended for each of the 12 sessions. Participants were classified as “engaged” if they attended one of the first three sessions. Retention was a continuous variable (with a maximum possible total of 12 sessions). We further categorized retention into the family sessions (a possible total of four sessions) and group sessions (a possible total of eight sessions), respectively.

Family Functioning

The following four indicators of family functioning have been found to be associated with adolescent behavioral problems and are active targets of the Familias Unidas intervention (Pantin et al., 2004).

Parent–adolescent communication

The Parent–Adolescent Communication Scale (20 items; Cronbach’s α = .69, .79, and .82 in Ecuador, Chile, and the United States, respectively) was utilized (Barnes & Olson, 1985). A sample item includes, “It is very easy for me to express all my true feelings to my child.” Response options were on a scale from 1 (strongly disagree) to 5 (strongly agree). Possible mean scores ranged from 20 to 100 with higher scores indicating better parent–adolescent communication.

Parental monitoring of peers

The parent relationship with Peer Group Scale (five items; Cronbach’s α = .77, .75, and .87 in Ecuador, Chile, and the United States, respectively) was utilized (Pantin, 1996). A sample item includes, “How well do you personally know your child’s best friends?” Response options were on a scale from 0 (not at all) to 4 (extremely well). Possible mean scores ranged from 0 to 20 with higher scores indicating stronger parental monitoring.

Positive parenting practices

The Positive Parenting subscale of the Parenting Practices Scale (nine items; Cronbach’s α = .71, .66, and .53 in Ecuador, Chile, and the United States, respectively) was utilized (Gorman-Smith, Tolan, Zelli, & Huesmann, 1996). A sample item included, “When your child does something you like or approve of, how often did you say something nice about, praise or give approval?” Response options were on a scale from 0 (never) to 4 (always). Possible mean scores ranged from 0 to 36 with higher scores indicating more positive parenting.

Parental involvement

Seventeen items from the Parenting Practices Scale (Cronbach’s α = .59, .70, and .71 in Ecuador, Chile, and the United States, respectively) were utilized (Gorman-Smith et al., 1996). A sample item includes, “Does your child like to get involved in family activities?” Response options were on a scale from 0 (never) to 4 (always). Possible mean scores ranged from 0 to 68 with higher scores indicating more involvement.

Adolescent Externalizing Symptoms

The Conduct Disorder subscale of Revised Behavior Problem Checklist (22 items; Cronbach’s α = .94, .51, and .98 in Ecuador, Chile, and the United States, respectively) was utilized (Quay, 1983). Parents rated their adolescent’s behavior on a scale from 0 (no problem) to 2 (severe problem). A sample item includes “(My child is) irritable, hot-tempered, easily angered.” Possible mean scores ranged from 0 to 44 with higher scores indicating more externalizing symptoms.

Adolescent Internalizing Symptoms

The Anxiety-Withdrawal subscale of the Revised Behavior Problem Checklist (11 items; Cronbach’s α = .86, .89, and .94 in Ecuador, Chile, and the United States, respectively) was utilized (Quay, 1983). Parents rated their adolescent’s behavior on a scale from 0 (no problem) to 2 (severe problem). A sample item includes “(my child is) depressed; always sad.” Possible mean scores ranged from 0 to 22 with higher scores indicating higher levels of internalizing symptoms.

Adolescent Substance Use

Substance use was measured by asking the adolescents whether they have used alcohol, cigarettes, or other drugs in their lifetime. Response options were “yes” or “no.”

Analytic Plan

The analytic plan consisted of three phases. First, we calculated the attendance rates for each of the three trials. Second, to compare the trials’ participants on attendance rates, family functioning, and adolescent behavior variables, two different approaches were utilized. For categorical variables (i.e., engagement, substance use), we conducted chi-square tests with Bonferroni correction. For continuous variables (i.e., attendance, family functioning, adolescent internalizing and externalizing symptoms), we conducted one-way analysis of variance test with Dunnett post hoc multiple comparisons. Third, hierarchical multiple regression was used to assess the moderating effects of country’s sample on the relationship between baseline variables and attendance rates (for the total intervention, for family sessions only, and for group sessions only). In the first regression model, demographic, family functioning, and adolescent behavior variables were included. In the second model, the interaction terms were added. Interaction terms were created between the baseline variable (e.g., parent–adolescent communication) and trial’s sample (e.g., Ecuador). Trials’ samples were dummy coded, such that the United States was the reference group. If significant interaction effects were found, we examined interaction plots. All analyses were conducted on SPSS Version 24 (IBM Corp, 2013).

Results

Comparisons

Attendance rates and comparisons are in Table 2. In summary, parents from Chile and Ecuador were significantly more likely to be engaged in and attend the intervention sessions, compared with parents living in the United States.

Table 2

Description and Comparison of Engagement and Attendance Rates by Trial

Characteristic	Chile	Ecuador	United States	Pooled Data Set	Comparison
Engagement, %	97.5	99.2	86.7	91.3	χ² = 26.175, df = 2, p < .0001^a,b
Total attendance, out of 12; M (SD)	9.14 (3.25)	9.54 (2.47)	6.41 (4.17)	7.60 (3.97)	F(2, 619) = 47.34, p < .001^a,b
Total FS, out of 4; M (SD)	3.61 (1.01)	3.74 (0.69)	2.68 (1.59)	3.08 (1.43)	F(2, 618) = 40.75, p < .0001^a,b
Total GS, out of 8; M (SD)	5.53 (2.43)	5.81 (2.07)	3.71 (2.91)	4.50 (2.83)	F(2, 621) = 40.90, p < .0001^a,b

NOTE: FS = family sessions; GS = group sessions. Superscripts “a” and “b” represent the significant post hoc comparisons.

Chile vs. United States, p < .0001. ^b Ecuador vs. United States, p < .0001.

Family functioning and adolescent behavioral health characteristic descriptions and comparisons are in Table 3. Overall, parents living in the United States reported higher family functioning than parents from Chile and Ecuador, and parents from Chile reported higher family functioning than parents from Ecuador. In general, adolescents from Chile experienced more behavioral problems than those from United States and Ecuador. For ease of interpretation, we provide a visual representation of all the comparisons in Table 4.

Table 3

Description and Comparison of Family Functioning and Adolescent Behavioral Health by Trial

Characteristic	Chile	Ecuador	United States	Comparison
Family functioning, M (SD)
Parental monitoring	10.56 (4.40)	9.06 (4.52)	11.75 (4.76)	F(2, 612) = 16.26, p < .0001^a,b,c
Family communication	73.30 (9.65)	71.24 (9.00)	79.00 (10.49)	F(2, 610) = 33.97, p < .0001^a,b
Parental involvement	47.90 (7.73)	39.03 (6.06)	47.21 (5.48)	F(2, 618) = 452.15, p < .0001^b,c
Positive parenting	31.10 (4.64)	19.61 (4.20)	21.07 (2.57)	F(2, 612) = 16.26, p < .0001^a,b,c
Adolescent behavioral health, M (SD) or %
Externalizing symptoms	9.08 (9.27)	8.04 (8.27)	9.83 (12.97)	χ² = 4.69, df = 2, p = .096
Internalizing symptoms	7.26 (5.37)	4.97 (4.01)	6.04 (6.25)	F(2, 616) = 4.911, p = .008^c
Lifetime substance use	35.9	16.8	19.6	χ² = 16.33, df = 2, p = .001^a,c

Chile vs. United States, p < .05. ^b Ecuador vs. United States, p < .05. ^c Ecuador vs. Chile, p < .05.

Table 4

Visual Representation of Comparison Results From Tables 2 and 3

Characteristic	United States vs. Chile		United States vs. Ecuador		Chile vs. Ecuador
Characteristic	United States	Chile	United States	Ecuador	Chile	Ecuador
Engagement and attendance
Engagement		✓		✓	—	—
Total attendance		✓		✓	—	—
Total family sessions		✓		✓	—	—
Total group sessions		✓		✓	—	—
Family functioning
Parental monitoring of peers	✓		✓		✓
Parent–adolescent communication	✓		✓		—	—
Parental involvement	—	—	✓		✓
Positive parenting		✓	✓		✓
Adolescent behavioral health
Externalizing symptoms	—	—	—	—	—	—
Internalizing symptoms	—	—	—	—	✓
Lifetime substance use		✓	—	—	✓

NOTE: “✓” signifies that a country’s sample demonstrated significantly higher levels of the characteristic, compared with another country’s samples. “—” signifies that there was no significant difference between the country’s samples.

Hierarchical Multiple Regression

In the first model, country, demographics, family functioning, and adolescent behavioral problem variables were included. These variables accounted for a significant amount of variance in total attendance: R² = .113, F(13, 560) = 5.47, p < .0001. In the second model, the interaction terms of country with family functioning and adolescent behavioral problems, respectively, were added. The second model accounted for a significant proportion of the variance in total attendance: ΔR² = .089, ΔF(14, 546) = 4.322, p < .0001. The second model revealed that higher communication at baseline was associated with less attendance (b = −.07, p < .0001), controlling for all other demographic, family functioning, and adolescent behavioral problem variables. The interaction between Chile and communication was statistically significant: b = .144, t(546) = 3.079, p = .002. The interaction plot showed, as seen in Figure 1, that effective parent–adolescent communication in the Chile parents meant higher attendance rates, compared with parents living in the United States. The same analyses were conducted with family sessions (possible four sessions) and group sessions (possible eight sessions) attendance as the outcomes, respectively, and the findings were consistent (see Supplemental Material 1).

Discussion

To effectively implement and disseminate EBIs, it is important to understand what predicts participant attendance, as it has been linked to desired intervention impact (Hooven et al., 2011; Van Ryzin et al., 2012). This is particularly true when we are speaking about implementing interventions in Latin America, where little to none is published about participant attendance in EBIs. Consequently, the purpose of our study was to describe and compare the attendance rates, family functioning, and adolescent behavioral health problem baseline rates, then explore family-level and child-level predictors of intervention attendance. In summary, Chilean and Ecuadorian parents attended significantly more sessions than parents living in the United States. Although there were significant differences between trials across all family functioning constructs and adolescent substance use and internalizing symptoms, our hierarchical multiple regression revealed (1) that only parent–adolescent communication predicted attendance and (2) a significant interaction effect between Chilean parents, compared with parents living in the United States and parent–adolescent communication. Below we discuss potential explanations for successful attendance rates in the Latin American trials.

To our knowledge, there is not a comparable study in Latin American countries; as such, we do not know whether the higher attendance rates align with other Latin American parents or whether it is due to the intervention’s material and/or the facilitator’s ability to engage and retain the families. One possible explanation is the facilitators’ comfort with delivering the program: In the U.S. trials, it was the facilitators’ first time delivering the program, while in the Latin American trials, the facilitators were able to practice in pilot trials (Jacobs et al., 2016). Another possible explanation is that Latin American countries may not have as many parenting skills training resources as in the United States. Hence, they are more eager to attend when such a resource is offered. Additionally, parents living in the United States, who are mostly of immigrant origin with children born in the United States, may be struggling with working multiple jobs or differential acculturation (Pantin et al., 2004) that may interfere with their attendance in the intervention (Perrino et al., 2001).

The significant differences found between the countries’ family- and child-level baseline variables may help explain the higher attendance rates in Latin America. For an example at the family level, parents living in the United States consistently reported more effective family functioning than Ecuadorian parents. This aligns with a previous study that found high levels of effective family functioning were associated with less intervention attendance (Perrino et al., 2018). Interestingly, Chilean parents also reported more effective family functioning, compared with Ecuadorian parents, and more positive parenting practices, compared with U.S. parents. This lends some support to our hypothesis that Chilean parents may be more eager to participate, compared with parents living in the United States, due to the lack of available programs in their country. For an example at the child level, the higher than expected substance use rate in Chile may explain why they had higher engagement and retention rates than the United States, regardless of also reportedly high parenting skills. This may suggest that, in Latin American study participants, adolescent behavioral problems may encourage a parent to attend an intervention more than the need for parenting skills.

Despite the significant comparisons, our hierarchical multiple regression did not reveal that all the family functioning indicators or that adolescent behavior problems significantly predicted attendance. Our results suggested that child-level variables are not as significant as family-level variables in regard to attendance (Coatsworth et al., 2006). The strongest and only predictor of less intervention attendance at the family level was high levels of parent–adolescent communication. While it is surprising that the other family functioning constructs did not significantly predict attendance, prior Familias Unidas literature has supported parent–adolescent communication as a key mediator and moderator of the intervention’s effects (Perrino et al., 2014). Therefore, if the parents are starting with effective communication, they may not perceive that the sessions, of which the first few focus on communication, are helpful or interesting. The only significant interaction effect was with Chile and communication, in comparison with the United States, which further supports our hypothesis that regardless of high baseline parent–adolescent communication they are still more likely to attend. Thus, intervention efforts aimed at engaging and retaining Hispanic families in the United States may need to focus on targeting those who have low parent–adolescent communication at baseline to assure intervention attendance, while intervention efforts aimed at Latin American families could target a wider audience.

Limitations

There are several limitations. First, even though Ecuador and Chile had similar attendance rates, our findings may not be generalizable to other Latin American communities. It would be important to rerun these analyses with other Latin American countries in which Familias Unidas, or similar interventions (Orpinas et al., 2014), are implemented in. Second, we did not collect facilitator-level variables in the Latin American studies. A past Familias Unidas trial in the United States found that the facilitator–parent relationship quality was the strongest predictor of engagement (Prado et al., 2005). Thus, it would be interesting to see if this finding translates to the Latin American study participants. Across all samples, we also did not systematically collect other variables, such as income and child-care needs, that have been associated with attendance in prior studies. However, we do know that Ecuadorian and Chilean trials provided child care whenever possible, but the U.S. study did not. Finally, the attendance rates across the Latin American samples were not significantly different, which may have limited our findings of predictors and interaction effects in the hierarchical multiple regression. Despite the lack of variability in attendance, we were able to draw conclusions which may benefit future implementation of family-based EBIs in Latin America.

Implications for Practice and Research

Our study has shown the ability of an evidence-based intervention to engage and retain participants across Latin American countries, superior to efforts in the United States. Our findings imply that parents living in Latin America may be more inclined to participate in an EBI when compared with families living in the United States. As EBIs are developed and/or implemented in Latin America, researchers and practitioners need to train facilitators who can culturally connect with the families and are from the community. Further, facilitators may want to focus on the enhancement of family communication before delving into other prevention topics. Capitalizing on effective communication in the beginning may set the stage for higher retention throughout the intervention.

Moreover, researchers easily could replicate the methodology utilized in this study (i.e., simple comparisons and regression analyses). We encourage other researchers to study the predictors of engagement and attendance to add to the literature and inform future efforts. This information could aid researchers and practitioners in the targeting of families who are likely to attend intervention sessions. Conversely, this information could aid in the careful planning and distribution of resources to try to engage families who would be likely to not attend. More research is needed to understand what specific retention strategies could be deployed to circumvent families from not attending. Ultimately, and most important, promoting attendance in EBIs can promote the health of the families participating.

Supplemental Material

Supplement_1_HPP – Supplemental material for Parent Attendance in a Family-Based Preventive Intervention Delivered in Latin America and the United States

Supplemental material, Supplement_1_HPP for Parent Attendance in a Family-Based Preventive Intervention Delivered in Latin America and the United States by Lourdes M. Rojas, Lucas G. Ochoa, Marcelo Sánchez Ahumada, Ana Quevedo, Viviana Muñoz, Cecilia Condo and Guillermo Prado in Health Promotion Practice

Footnotes

Authors’ Note:

We’d like to thank the families and facilitators. Funding for the data collection was provided by Fundación San Carlos de Maipo, Chile and the Universidad Catolica Santiago de Guayaquil, Ecuador.

ORCID iDs

Lourdes M. Rojas

Lucas G. Ochoa

Supplemental Material

Supplemental material for this article is available at .

Notes

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