title: Exploring and enhancing engagement to the psychosocial intervention 'Preparing for Parenthood'.
abstract: BACKGROUND
  Poor compliance by participants consenting to be randomised to receive both physical and mental health promotion interventions represents a potentially serious threat to external and internal validity of those interventions. Quantitative and qualitative investigation of possible predictors of engagement forms an appropriate basis for efforts to enhance it.
  
  
  METHODS
  Eight 'Preparing for Parenthood' intervention courses of a randomized controlled trial (RCT) underpinned a quantitative study. One 'Preparing for Parenthood' (PFP) intervention course, run upon completion of the RCT, formed a qualitative study. All nine courses followed identical procedures to enable clear comparisons. The three factors quantitatively explored with respect to engagement in health promoting behaviours were: locus of control (LOC), psychosocial support, and life events. The qualitative study utilised grounded theory analysis, the participants reflecting upon their experiences of the intervention and/or their reasons for not attending the course; nine interviews were completed.
  
  
  RESULTS
  Participants in the quantitative and qualitative studies were divided into three sub-groups: compliant, non-compliant, and refusers. None of the three health promoting variables predicted compliance to a statistically significant degree. However, a variable from the trial analysis was found to reach significance; those women who had had less contact with the National Health Service in the 12 months prior to the baseline assessment were more likely to refuse the invitation to PFP. The qualitative study produced nine main themes that had influenced participant engagement at both the initial recruitment stage and during the course itself.
  
  
  CONCLUSIONS
  In combination these findings may contribute to the future design of both effective and acceptable interventions to prevent postnatal depression. One such modified intervention is described and its impact on engagement outlined.
authors: Section of Social and Epidemiological Psychiatry, Leicester General Hospital, Leicester, UK. slw16@le.ac.uk
authors: S L
authors: SL
authors: Wheatley
authors: T S
authors: TS
authors: Brugha
authors: D A
authors: DA
authors: Shapiro
mesh_terms: D019052:Depression, Postpartum / Q000517:prevention & control*; D004739:England; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006302:Health Services Research; D006801:Humans; D007389:Internal-External Control; D008016:Life Change Events; D016487:Parenting / Q000523:psychology*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology; D010353:Patient Education as Topic; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D012944:Social Support; D016312:Treatment Refusal / Q000706:statistics & numerical data