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Evaluating the impact of the 5 pillars of parenting programme: A novel parenting intervention for Muslim families

Universal parenting intervention courses often fail to recruit and retain Muslim families. Kathryn Thomson, Hanan Hussein, Kathleen Roche-Nagi and Ruth Butterworth evaluated the impact of the faith-based Five Pillars of Parenting programme.

Authors:
Kathryn Thomson, BSc. Trainee psychological wellbeing practitioner at Oxford Health NHS Foundation Trust.
Dr Hanan Hussein, BSc, ClinPsyD. Principal clinical psychologist at Black Country Partnership NHS Foundation Trust.
Kathleen Roche-Nagi, RGN, SCM, QTLS. Managing director of Approachable Parenting.
Dr Ruth Butterworth, BSc, ClinPsyD. Clinical psychologist at Coventry and Warwickshire Partnership NHS Trust and the University of Birmingham.

Correspondence to: Hanan.hussein@nhs.net

 

Abstract

Objective: To evaluate the impact of the 5 Pillars of Parenting Programme, an eight-week parenting intervention group, which incorporates Islamic values and concepts. The evaluation sought to look at outcomes for families attending the programme. 

Design: 160 parents completed questionnaires to assess the parent and child outcomes using a pre-post within-participants quantitative design. 

Results: Statistical analysis demonstrated a significant reduction in difficult child behaviours (p≤.05), ineffectual parental discipline practices (p≤.000), parental depression (p≤.05), anxiety, (p≤.05) and stress (p≤.05). Attrition was also comparatively low. 

Conclusions: The 5 Pillars of Parenting 4-11 years course appears to be a promising programme for supporting Muslim parents. Research comparing the outcomes to those of other parenting groups would now be of benefit. 


Introduction

The primary aim of parenting programmes is to motivate change within the parent's behaviour, perception, communication and understanding, so that desirable changes occur within the child's behaviour (Lundahl et al, 2006). Previous literature demonstrates the range of benefits that participating in group parenting programmes can achieve. This includes: helping relieve parental stress and anxiety (Barlow et al, 2002), being an effective tool in targeting early child conduct problems (Borden et al, 2010) and improving family relations (Sanders, 2008).

Previous research has highlighted the importance of parenting programmes being tailored to suit specific cultures. Kumpfer et al (2002) noted that most universal prevention programmes are strongly influenced by white, middle class values due to being developed for Western cultures. Therefore, there is a need for for culturally-specific family programmes that draw on the deep structural cultural values and practices, to make such programmes acceptable to different cultural groups (Resnicow et al, 2000). 

Evidence-based parenting programmes that are not culturally adapted can often struggle to recruit and retain parents from marginalised groups (Davis et al, 2012). Furthermore, Barlow (1999) found poor engagement with black and minority ethnic (BME) communities as well as high attrition to be risk factors when cultural factors are not considered in the programme. Becher and Hussain (2003) stated that the needs of parents from ethnic minorities should be built into an original programme, rather than added once developed. Prior research has concluded that people from minority backgrounds are under-served due to parenting programmes being unaccessible and not culturally relevant (Dumas et al, 2011). 

The literature on adapting evidence-based parenting programmes for religious groups is limited. Furthermore, the degree to which evidence-based interventions are adapted for specific populations varies. Surface level adaptations are described as those which establish feasibility, such as changing the langauge of the programme, whereas deep structural adaptations determine the impact of the intervention by ensuring it fits a specific culture (Resnicow et al, 2000). The Strengthening Families Programme, a US family-skills training programme designed for preventing drug use, has been culturally adapted for people from a range of different cultures including African Americans, multicultural, Hispanic, Asian, Pacific Islander and Indian American familes living in the US with successful outcomes (Kumpfer et al, 2008). In addition, that same programme has been culturally adapted for use in 17 different countries using a thorough adaptation model (Kumpfer et al, 2008). 

A meta-analysis conducted by Griner and Smith (2006) found mental health interventions targeted at particular cultural populations were four times more effective than generalised interventions. But, despite previous literature highlighting the importance of culturally adapting interventions, there has been concern with adapted programmes' fidelity. Davis et al (2012) stated that parenting programmes can become less effective when core elements of the programme are removed or inappropriately altered. However, this may be overcome by identifying core components of the programme before adapting it (Kumpfer et al, 2008). An alternative to culturally adapting an existing evidence-based parenting programme, is to create a new one specifically for that population, potentially offering a solution to the fidelity and fit problem that culturally adapted programmes may experience. If this option is taken, it is important to assess a target population to understand the population and its needs before starting the adaptation process (Wainberg et al, 2007; Wingood and DiClemente, 2008). By involving the target population in the design of a new parenting programme, this may result in more ownership amongst the community, therefore yielding stronger results. 

The 5 Pillars of Parenting 4-11 years Programme was designed by Approachable Parenting, a social enterprise that provides parenting courses and parent-coaching to Muslim families. It came about after it was observed that Muslim parents were not attending or completing universal parenting programmes. Focus groups and questionnaires highlighted that these parents wanted a programme that was identifiable and consistent with their beliefs. Islam is a growing religion in the UK, making up 5% of the population in England (Office for National Statistics, 2012). It was therefore considered necessary to devise a parenting programme to suit this large specific group. 

The 5 Pillars of Parenting programme is a parenting course encompassing both psychological principles and Islamic references. The programme has been evaluated by the National Academy of Parenting Research (NAPR), Kings College London, and is part of the commissioning toolkit (Department for Education, 2013). In addition, the programme received the UK CANparent Quality Mark in 2014 for achieving desired standard in the quality of development, delivery and provision of parenting classes.

To overcome potential barriers of engagement, the courses are held with crèche facilities, refreshments and, where applicable, an interpreter (Axford et al, 2012). Trained interpreters met with the facilitators prior to the programme to cover the programme's content and research forms to enable them to deliver alongside the facilitators at each session. By consciously removing these barriers in the design and implementation of the programme, the programme content can be one of the main deciding factors for whether a parent attends. Facilitator background is also considered, with each facilitator having a recognised teaching qualification and being Muslim - that is, they self-identify with the Muslim faith, are able to understand core concepts of the programme and are able to seek support when parents ask for clarification on Islamic concepts - so that the Islamic concepts are understood and values shared (Castro et al, 2004). Cultural references are viewed as an effective tool in increasing engagement and retention with a targeted group (Patrick et al, 2008) so it was anticipated that the programme would be successful in retaining and recruiting parents of Islamic faith. 

The aim of the current research was to evaluate the impact a novel group parenting intervention for Muslim families had on child and parent outcomes. It was hypothesised that the 5 Pillars of Parenting 4-11 years course would positively impact on parents' mental health, improve parents' approach to behaviour management and improve the child's behaviour.


Method 

Design

A pre-post, within-participants, quantitative design was used to evaluate the effectiveness of the 5 Pillars of Parenting 4-11 years programme. This allowed changes in outcome measures to be evaluated for participants and then analysed for statistical significance to ensure that changes were due to the programme rather than chance. 

 

Ethical approval

The University of Birmingham Ethical Review Board provided full ethical approval for the analysis of data collected by the 5 Pillars of Parenting project team, which included both information and consent sheets being provided to participants regarding the nature of the research, data analysis and use.

 

Participants

The participants were 160 parents who had attended a 5 Pillars of Parenting course in the West Midlands between 2009 and 2014. Participants were a community sample who had either self-referred, or attended a school or children's centre at which the course was held. Only parents who had attended at least five of the eight sessions were included in the data analysis to ensure that their data accurately represented the full impact of the programme.

 

Materials

Three commonly used measures were used to evaluate the impact of the course: The Strengths and Difficulties Questionnaire (SDQ) (Goodman and Scott, 1999) is a 25-item measure of a child's emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behaviour. The questionnaire also has an impact supplement to assess if the parent believes that their child has a problem in each area and, if so, the impact of this on the child and family. The SDQ has been found to be valid and reliable in measuring each factor in children and adolescents and in assessing psychological change (Goodman, 2001). Furthermore, the Hindi, Punjabi, Bengali, Arabic and Urdu translated SDQs which were completed by the participants whose first language was not English, are all validated measures (Youthinmind, 2009). 

The Parenting Scale (Arnold et al, 1993) is a 30-item questionnaire measuring parental discipline practices in parents with young children. The authors of the scale identified three stable factors of ineffectual parental discipline practices: overreactivity, laxness and verbosity (see table 1). The scale has been found to be reliable and valid in measuring these factors as well as total parental discipline style.

The 21-Item Depression Anxiety Stress Scale (DASS-21) (Lovibond and Lovibond, 1995) is used to measure the levels of depression, anxiety and stress that the parent is experiencing. This scale has been found to be both valid and reliable in measuring all these factors (Lovibond and Lovibond, 1995). The DASS-21 questionnaire was introduced as it was felt an additional measure to explore the wellbeing of parents would be of use. It was not completed by all parents who attended initial programmes.

 

Procedure

The 5 Pillars of Parenting 4-11 years course is an eight-week parenting course with each session lasting two hours. The course is facilitated by two trainers who, to become a licensed trainer, have attended a four-day training programme, completed a portfolio of assessments and co-facilitated a full course with an experienced Approachable Parenting trainer.

At the start of the first session, when the pre-intervention measures are introduced, consent is sought by the facilitator for the parents' data to be used in research.

Over the eight sessions, the parents explore a range of different psychological topics within an Islamic framework (see table 2). This includes taught skills, which have been found to be effective, such as teaching positive parent-child interaction and communication; specific ways to deal with difficult behaviour and the ability to practise these during the group via role play and home tasks (Kaminski et al, 2008).

The Islamic references used in the programme include evidence from the Quran, examples from the Prophets and core Islamic concepts, such as thankfulness to Allah in rewarding children and taking consultation (Shura) when setting family rules, to illustrate positive parenting principles. The five pillars of parenting in the course name are: character, knowledge, action, steadfast and positive relationships (table 3). Sessions are structured to include didactic teaching, role-play, observation and facilitated group discussion. In addition, parents are given homework tasks in each session to consolidate and practise the techniques and concepts taught in the previous session.

Outcome measures are completed by parents at the start of the first session and at the end of the final session. Once the course has finished, parents whose scores remained within the clinical range may be referred onto a clinical service.


Results

Demographic data

Table 4 provides an overview of the demographic characteristics of the sample. The majority of attendees were mothers (91.3%) and were more commonly attending in relation to a son (68.1%). The age bracket of the parents' children stretched beyond the remit of the group (0-15 years) although the majority fell in the prescribed 4-11 year bracket. Parents were asked to provide a free response for their ethnicity, with the majority describing themselves as Asian or Asian British (including Pakistani, Indian, Bangladeshi or Kashmiri). Most spoke English either as a first or strong second or other language, while those speaking other languages were provided with an interpreter. The educational background of parents was broad, with a large number having completed higher education.

 

Attrition

Of those parents joining the groups at the first session, 13.8% left during the course. Only participants who had attended at least five of the eight sessions were included in the participant pool for the subsequent analysis.

 

Statistical analyses

Overall Change. A combination of parametric and non-parametric tests were used (as determined by the data) to evaluate whether there was a significant change in participants' scores having completed the group. Table 5 summarises the results of these analyses, which showed significant improvement on all subscales.

Wilcoxon sign-ranked tests indicated that there was a significant improvement in SDQ total score, z=-7.301, p≤.001, DASS Depression score, z=-4.853, p≤.001, DASS Anxiety score z=-3.079, p≤.002 and DASS Stress score, z=-4.600, p≤.001. A t-test demonstrated that the Parenting Scale total score had also significantly improved, t(123)=10.323, p≤0.001.

Reliable And Clinically Significant Change. As there was no control group available for the evaluation, there is a risk that the results fail to account for change that might have occurred irrespective of the intervention. Reliable Change Indices (RCIs) and Clinically Significant Change Indices (CSCs) were calculated to measure statistically significant change across each factor, based on the reliability of each measure and normative values (Jacobson and Truax, 1991). Reliable change indices are used to explore whether the changes in participants scores from the pre-post data are statistically significant and not due to measurement error (Zahra et al, 2016) whereas the clinical significance change indices are used to analyse the percentage of scores that have shifted from a clinical to a non-clinical range. This analysis demonstrated that the greatest impact was demonstrated on over-reactivity, poor parental discipline practices as a whole, and parental stress. 

Regression Analyses. The RCI scores for each measure were then used as the dependent variable in an entry method multiple regression analysis to establish the parents for whom the programme was most effective. All of the demographics featured in table 4 were entered, along with the pre-intervention score for the associated measure. 

For each variable, the first item to be entered into the equation was the pre-intervention score. Visual inspection of the data clarified that more severe pre-intervention ratings were more likely to be associated with significant change.

The only demographic variable that contributed to explaining the variance in RCI was parent education - with parents with higher levels of education demonstrating greater change in verbosity.


Discussion

This study found the 5 Pillars of Parenting 4-11 years course to be an effective parenting programme. The SDQ showed improved child behaviour within every domain measured. The Parenting Scale showed a reduction in poor parental discipline practices across all factors. Finally, the DASS-21 showed a decrease in parental depression, anxiety and stress. Scores indicate - statistically and clinically - significant positive change for a large proportion of participants, and very few participants deteriorated over the course of the programme. These findings support those in other studies, demonstrating the success of evidence-based parenting programmes for both parent and child (Lundahl et al, 2006). 

The 5 Pillars of Parenting 4-11 years Programme was designed to be accessible to a broad range of parents from the Muslim community. The regression analysis found that the only demographic variable that explained a significant amount of the variance in RCI was parents' education level being associated with reduction in verbosity (i.e. less reliance of overly long reprimands and on talking among was stronger for more educated parents).This suggests that parents from a range of demographics can access and potentially benefit from the programme.

Of particular interest was the large proportion of participants who showed significant change clinically, as well as statistically. These results suggest that attending a 5 Pillars of Parenting course offers an effective model of intervention for Muslim families, where parenting and child difficulties exist, with particular emphasis on changes in parenting practices and stress. This adds support to the benefits of religious adaptation alongside cultural considerations in parenting programmes (Scourfield and Nasiruddin, 2015). 

 

Strengths, Limitations and Suggestions for Future Research

Muslim parents have traditionally been hard to reach and retain in universal parenting programmes (Scourfield and Nasiruddin, 2015). The average attrition rate in parenting programmes is 30% of attendees. Some programmes have an attrition rate as high as 50% (Department of Education and Early Childhood Development, 2011).  So the low attrition rate (13.8%) found in the current study supports previous literature highlighting the importance of parenting courses respecting the values of people from BME communities (Barlow, 1999). Further research is required to clarify the extent to which parents engaging in the programme see the tailored nature of the group as fudamental to its success. 

This study also demonstrated a significant immediate impact on both the parent and their child after attending the 5 Pillars of Parenting 4-11 year programme, and follow-up to determine longer-term impacts is ongoing. 

The main limitation of this study is that there was no control or comparison group. As the 5 Pillars of Parenting Programme was developed by a social enterprise, it would have been impractical and costly in both time and resources for the organisation to have had a control group. Delivering a universal parenting course alongside a 5 Pillars of Parenting Programme as a comparison group is problematic as programmes which do not take into account parents' cultural needs risk high attrition (Barlow, 1999) and having a control group with no intervention is potentially unethical given the benefits of parenting programmes to both parent and child. 


Conclusions and implications for practice

As most universal parenting programmes have been developed for parents of Western cultures (Kumpfer et al, 2002), developing an original programme specifically for a targeted population is uncommon. It more usual to culturally adapt existing programmes. Part of the success of this programme is believed to be the balance of psychological theories with Islamic references, resulting in a programme that was meaningful and identifiable to the attendees, and would suit those from different cultural backgrounds who identified with the Muslim faith. 

This study has shown that a faith-based and culturally sensitive, theory-driven intervention can both be clinically effective and overcome issues with programme fidelity and suitability that potentially occur when programmes are culturally-adapted (Davis et al, 2012). 

The results suggest the importance of considering faith in the development, implementation and funding of parenting programmes, as well as considering the impact of faith in working with Muslim families. Further research into the longitundial outcomes for this parent group is warrented. 


Acknowledgements

The authors would like to thank all the volunteers and parent trainers who supported the development of the programme, with special acknowledgement to the parents who attended the programme and committed to the positive changes in their families, without whom this research would not have been possible.   


References

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Tables

 

Table 1: Parenting Scale sample items

Parental Discipline Practice Example from Scale
Laxness When I say my child can't do something, I let my child do it anyway
Overreactivity I spank, grab, slap, or hit my child most of the time
Verbosity I give my child a long lecture

 

 

Table 2: Session Content

Session Number Content Overview
Session One Welcome, philosophy, setting goals
Session Two Qualities of parents, rights and responsibilities, attending to your child
Session Three Praising your child, behaviour charts, self-reflection
Session Four Importance of play, parenting styles, rules and boundaries
Session Five     Responding to difficult behaviour
Session Six Child development, dealing with society and community pressures, consistent parenting
Session Seven Life coaching, managing stress positively
Session Eight Programme review and evaluation, goal reflection, celebration

 

 

Table 3: 5 Pillars of Parenting which are qualities that the course aims for the parents to achieve from participating in the course

Parenting Pillar Overview
Character Identify the importance of having good character, morals, personality and behaviour
Knowledge Learning new skills and strategies and acting on this knowledge
Action Putting the new learnt parenting techniques into practice to achieve results
Steadfast Dedication to overcome difficulties as parents may doubt themselves as they experience resistance to the new techniques
Positive Relationships Stronger family bonding, improved parenting and families initiate meaningful and permanent positive relationships

 

 

Table 4: Demographic characteristics of the sample given in frequencies and percentages

Table 4: Demographic characteristics of the sample given in frequencies and percentages
Key for Table 4
English SOL = English spoken as a strong second or other language 

 

Table 5: Statistical analysis of overall change

Table 5 - Statistical analysis of overall change

 

Table 6: Reliable Changes Indices

Scale % significant positive change % no significant change % significant deterioration
Strengths and Difficulties Questionnaire (SDQ) Total 17.4 82.6 0
SDQ Impact 25.2 68.7 6.1
Parenting Scale Total   50.0 48.4 1.6
Laxness     35.2 62.3 2.5
Verbosity 27.0 71.3 1.6
Overreactivity 48.8 48.8 2.4
Depression 23.2 76.8 0
Anxiety 19.6 78.6 1.8
Stress 38.9 55.6 5.6

 

 

Table 7: Clinically Significant Change Indices

Scale % significant positive change % no significant change % significant  deterioration
SDQ Total 31.6 63.2 5.3
SDQ Impact 28 64.4 7.6
Parenting Scale Total 42.6 54.1 3.3
Laxness 32.8 61.5 5.7
Verbosity 18.9 78.7 2.5
Overreactivity 39.8 56.1 4.1
Depression 28.6 67.9 3.6
Anxiety 14.3 80.4 5.4
Stress 33.3 59.3 7.4

 

 

Table 8: Regression Analyses

RCI for Scale Variable 1 (Beta/Significance) Variable 2 (Beta/Significance)
SDQ Total Pre- SDQ Total (-.5/.001)  
SDQ Impact Pre SDQ Impact (-.667/.001)  
Parenting Scale Total Pre Total Parenting Scale (-.55/.001)  
Laxness Pre Laxness (-.495/.001)  
Verbosity Pre Verbosity (-.603/.001) Parent Education (-.173/.02)
Overreactivity Pre Overreactivity (-.746/.001)  
Depression Pre Depression (-.614/.001)  
Anxiety Pre Anxiety (-.75 / .001)  
Stress Pre Stress (-.689 / .001)  

 

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