Parental engagement in preventive parenting programs for child mental health: A systematic review of predictors and strategies to increase engagement

Background. Child mental health problems are now recognised as a key public health concern. Parenting programs have been developed as one solution to reduce children's risk of developing mental health problems. However, their potential for widespread dissemination is hindered by low parental engagement, which includes intent to enrol, enrolment, and attendance. To increase parental engagement in preventive parenting programs, we need a better understanding of the predictors of engagement, and the strategies that can be used to enhance engagement. Method. Employing a PRISMA method, we conducted a systematic review of the predictors of parent engagement and engagement enhancement strategies in preventive parenting programs. Key inclusion criteria included: (1) the intervention is directed primarily at the parent, (2) parent age > 18 years, the article is (3) written in English and (4) published between 2004-2016. Stouffer's method of combining p-values was used to determine whether associations between variables were reliable. Results. Twenty-three articles reported a variety of predictors of parental engagement and engagement enhancement strategies. Only one of eleven predictors (child mental health symptoms) demonstrated a reliable association with enrolment (Stouffer's p <.01). Discussion. There was a lack of consistent evidence for predictors of parental en- gagement. Nonetheless, preliminary evidence suggests that engagement enhancement strategies modelled on theories, such as the Health Belief Model and Theory of Planned Behaviour, may increase parents' engagement. Systematic review registration. PROSPERO CRD42014013664.