Background
Methods
Inclusion criteria and quality assessment
Characteristics of included studies
Study ID, reference, study location | Data collection and analysis methods | Participant characteristics | Focus/topic | Results | Reliability and validity of data collection methods | Reliability and validity of data analysis methods | Robustness |
---|---|---|---|---|---|---|---|
I Law et al. [52] UK | 6 focus groups run separately for parents and professionals Content analysis | 17 parents using parenting services 24 professionals representing education, health and social work services | Barriers to service access Parenting interventions targeting infant mental health, emotional and behavioural difficulties and ADHD |
Barriers identified by parents: Situational barriers (location) Needs not recognised by professionals Therapist qualities and background
Barriers identified by professionals
Programme content Inter-agency collaboration
Barriers identified by both parents & professionals
Delay accessing information/support Information not accessible for parents with additional needs |
Reliability: Interviews recorded and transcribed, field notes taken.
Validity: Not stated |
Reliability: Use of transcribed data
Validity: Not stated | Robust |
II Boydell et al. [53] Canada | Individual interviews Not stated | 30 parents of children (aged 3–17 yrs) formally diagnosed with emotional or behavioural disorders. | Barriers/facilitators to service access Hard to reach groups (rural) Access issues associated with mental health care for children and youth in rural communities | Personal barriers (stigma, lack of information, financial difficulties) Personal facilitators (word of mouth & advocacy) Systemic barriers (human resources, policy & funding issues, waiting time, invisibility) Systemic facilitators (personalised services, offering services within local communities) Environmental barriers (distance) Environmental facilitators (small size community) |
Reliability: Interview schedule Interviews recorded and transcribed
Validity: Interview schedule reviewed by advisory committee consisting of academics, service providers and health policy makers |
Reliability: Use of transcribed data
Validity: Several researchers examined transcripts. Coding structure was developed through team discussions. | Robust |
III Bayley [54] UK | 2 focus groups with fathers 9 individual interviews with professionals Thematic analysis | 14 fathers engaged in services 9 professionals & academic experts in parenting programmes or working with fathers | Barriers/facilitators to service access Hard to reach groups (fathers) |
Barriers to service access
Lack of information Situational barriers Mother-orientated environment Additional needs
Facilitators to service access
Advertising, flexible & alternative forms of provision, relationship with therapist, father-focused organisational approaches, programme content, support for additional needs |
Reliability
Not stated
Validity
Not stated |
Reliability
Not stated
Validity
Not stated | Less robust |
IV Attride-Stirling et al. [55] UK | Individual interviews Thematic analysis | 11 parents who completed treatment 7 parents who dropped out from treatment | Barriers to continued engagement Parental accounts of why they completed or discontinued treatment within CAMHS |
Reasons for dropping out identified by non-completers: Multiple, personal, parenting and child problems No support network Little understanding of treatment Programme added to stress |
Reliability: Interview schedule Interviews recorded and transcribed
Validity
Not stated |
Reliability: Use of transcribed data
Validity: 3 researchers independently coded. Interrater reliability check on 6 interviews (89 % agreement) | Robust |
V Sarno Owens et al. [56] USA | Focus groups Not directly stated (applying the Focus Group Toolkit by Morgan and Kruger [63]) | 15 parents from a rural, Appalachian area who completed a parenting programme | Barriers to service access Hard to reach groups (rural) Parent’s views of behavioural parent training programme in a rural community |
Barriers: Programme content & set-up Psychological barriers
Facilitators: Group support system Therapist qualities & background Programme content & set-up Advertising (testimonials, word of mouth) |
Reliability
Interview schedule developed using the Focus Group Toolkit (Morgan and Kruger [63]) Focus groups recorded and transcribed
Validity: Moderator fully trained but unaware of the research hypothesis, mock focus group with students conducted before data collection. |
Reliability
Use of transcribed data
Validity: 1/3 of interviews double-coded, interrater reliability check performed, inconsistencies checked independently. | Robust |
VI Cortis et al. [57] Australia | Individual interviews Thematic analysis | 120 professionals across 10 sites within child and family services in Australia | Barriers to service access Hard to reach groups Issues of accessibility to children and family services |
Barriers
Psychological barriers (stigma) Situational barriers (transport & location) Difficulties with inter-agency working
Facilitators: Programme content & set up Good recruitment strategies Provision of resources (food & transport) Positive relationship with therapist |
Reliability
Interview schedule
Validity
Not stated |
Reliability
Not stated
Validity
Not stated | Robust |
VII Barrett [58] UK | Semi-structured interviews Thematic Content Analysis | 10 frontline managers 10 strategic managers in the Voluntary and Community Sector in rural and urban setting | Overcoming barriers to service access Hard to reach groups (rural) Looks at challenge of delivering services to ‘hard to reach’ families. |
Facilitators: Multiple access points More information, advice and training in the use of parenting programmes Good organisational structures and staffing Flexible and diverse staff Interagency collaboration |
Reliability
Interview schedule Interviews recorded and transcribed
Validity
Interview questions developed from literature review and based on previous study with hard to reach groups |
Reliability
Use of transcribed data
Validity
Not stated | Robust |
VIII Pullmann et al. [60] USA | Individual interviews Grounded Theory | 8 caregivers (4 involved with services, 4 not involved or dropped out early) 9 professionals (3 family support providers, 3 community liaisons, 1 programme evaluator, 1 programme marketer, 1 support staff) | Barriers/facilitators to service access Hard to reach groups (rural areas) Barriers to services within a rural system of care site |
Barriers: Stigma/close knit community Lack of resources (e.g. transportation, money) Lack of knowledge of mental health issues Isolation
Facilitators: Social support Provision of resources Family/child emotional support Outreach |
Reliability
Interview schedule Interviews recorded and transcribed
Validity
Interview schedule design with various stakeholders |
Reliability
Use of transcribed data
Validity
Coding by two researchers, triangulation, frequent discussions of coding in team | Robust |
IX Berlyn et al. [61] Australia | Individual interviews Focus groups Thematic analysis | 17 professionals (service managers, project facilitators and workers) 34 fathers | Barriers/facilitators to service access Hard to reach groups (fathers) Strategies to enhance involvement |
Barriers
Mother oriented service culture Lack of knowledge of services Competing work demands Transportation barriers
Facilitators
1. Good recruitment strategies Word of mouth Effective marketing and promotion strategies
2. Good practice in programme delivery Rapport building through sharing experiences Focus on strengths Anti-expert approach Accommodating male learning/communication styles Male friendly spaces, male specific programmes Relaxed and welcoming atmosphere Flexible hours Additional incentives |
Reliability
Interviews recorded and transcribed
Validity
Not stated |
Reliability
Use of transcribed data
Validity
Two researchers coded the data | Robust |
X Friars and Mellor [62] Australia | Individual interviews not stated | 9 parents of children diagnosed with OCD, CD or ADHD (4–11 years) who dropped out of parent training programmes | Barriers to continued engagement Reasons for dropping out of parenting programmes |
Reasons for dropping out
Child more/less difficult than others in group Programme added to stress levels of parents, practical issues Having several children with problems “Not a group person” Difficulties with strategies Issues with therapist |
Reliability: Interviews recorded and transcribed by an independent person
Validity: Not stated |
Reliability: Use of transcribed data
Validity: Not stated | Less robust |
XI Patterson et al. [29] UK | Individual interviews Grounded Theory | 26 parents of children (2–8 years) scoring above the mean on Eyberg, after completion (or dropping out) of IY programme, exclusion if learning difficulties | Barriers to continued engagement Explores reasons for dropping out |
Reasons for dropping out
Aspects of programme delivery Needs not met by programme |
Reliability
Interviewers had access to each other’s recordings to ensure consistency in style and content. Interviews recorded and transcribed
Validity: Independent interviewers (not involved in IY) |
Reliability: Use of transcribed data
Validity: Triangulation | Robust |
XII Barrett [59] UK | Individual interviews Analytic approach not stated | 24 professionals experienced in delivering parenting | Overcoming barriers to service access Barriers to continued engagement Hard to reach groups |
Recommendations: Matching parents to programmes Preparing parents Creating a safe space Providing additional support Adopting a collaborative approach Tailoring the programme Interagency work Ensuring facilitators are highly skilled |
Reliability
Interviews recorded and transcribed
Validity
Not stated |
Reliability
Use of transcribed data
Validity
Not stated | Less robust |
Data extraction and synthesis
Results
Barriers | Facilitators | |
---|---|---|
Service access | 1. Situational barriers • Practical issues (e.g. transport, childcare, inconvenient timing/venue) • Time constraints due to other commitments (e.g. work, having several children) 2. Psychological barriers • Fears/Worries (e.g. confidence, fear of being judged) • Stigma (e.g. shame about needing help, being labelled) • Distrust (e.g. concerns about confidentiality/anonymity) 3. Lack of information/misconception about services (e.g. unawareness of service) 4. Availability of services (e.g. long waiting lists) 5. Poor interagency collaboration (e.g. unorganised referral routes) | 1. Effective Advertisement/service promotion • Multi-channel promotion (e.g. leaflets, posters, internet, newsletters) • Effective advertisement content (e.g. clear, easy to understand) • Targeting of hard to reach groups (e.g. wording, images) • Offer of multiple, ‘soft’ entry points (e.g. open events) 2. Direct recruitment • Personalised recruitment (e.g. through good relationship with parent) • Effective, direct channels (e.g. word of mouth between parents) 3. Good interagency collaboration (e.g. multiple referral routes) |
Continued engagement | 1. Dislike of group activities (e.g. feeling an outsider, shyness) 2. Perception that programme is unhelpful (e.g. programme adding to stress levels) 3. Difficulties following the programme (e.g. lack of support) 4. Change in circumstances (e.g. illness of family member) | 1. Programme factors • Programme meets families’ actual needs (e.g. flexible, individually tailored) • Positive group experience (e.g. homogenous groups) • Additional contact (e.g. phone support) 2. Therapist factors • Positive personal qualities of therapist (e.g. non-judgemental, warm) • Therapist skills/background (e.g. continued training) |