Nine broad themes emerged during the interviews: A) Reasons for joining the study; B) Understanding of the randomization process; C) Feelings about the first session; D) Reasons why participants kept attending; E) Factors that made it difficult to attend the course; F) Parent’s views of the Teamplay course and how it could be improved; G) Perceptions of the course leaders; H) Course content and delivery and I) Course structure. A summary of the key themes and sub-themes that emerged from the interviews are presented below. Themes related to recruitment are presented for the intervention and control group participants combined because they were asked they same questions and there was little variation in responses. Moreover, participants were recruited before they knew their arm allocation and as such their experiences if recruitment would not be influenced group arm allocation. All other themes are presented separately.
A). Reasons for joining the project (intervention and control group interviews)
Parents gave a variety of reasons for joining the Teamplay project. Some parents had been thinking about ways to improve their parenting skills, getting ideas about how to change PA and SV behavior, or had been actively looking for a parenting course but with little success in enrolling on one. For these parents, the course came at the right time:
“It’s good because, you know, we did Peep Squeak [course for younger children] when they were little but I think things change as they get a little bit older and I was kind of like thinking you know, I was thinking what can we you know do to improve? It came at the right time really, all the little ideas have really helped.” (Mother, Intervention, mid SES)
“I mean because prior to doing that I spoke to the health visitor and tried to get on a few parenting courses, one wasn’t running any more, the other one wasn’t in my area and it was difficult you know. I actively went looking for it and I couldn’t get it.” (Mother, Intervention, Evening - mid SES)
Project communication
Many of the reasons parents gave for signing up to the Teamplay project related to how effectively the project was communicated to parents initially. The initial promotional materials were distributed via community venues and schools, including in person distribution at school gates. The indicative course topics resonated with some parent’s experiences and represented a possible solution to the parenting challenges they faced:
“We’ve actually signed up for it because it said, ‘does your child have too much energy?” (Mother, Intervention, Evening – mid SES)
“… there are several courses that we get advertised in the newsletters and stuff like that at school, this is the first one that I’ve applied to because it did sound like it might be really suitable for the child that I was doing it with.” (Mother, Control, low SES)
Childcare provision
The free daytime creche was viewed positively and the parents believed that this service would encourage parents to attend the course.
“It took her a week or two you know to get settled but the crèche facilities were brilliant.” (Mother, Intervention, Mid SES)
“The daytime ones could have a crèche and that might take the kids away and so the mums are more likely to turn up if they’d got childcare.” (Mother, Intervention, Evening - mid SES)
Friend encouragement
Other reasons for joining included being encouraged by a friend who had already signed up to the project, being interested in helping with a research project, and being motivated by the opportunity for peer learning from other parents.
“My friends, she told me… Yeah she told me you enjoy it, starting next week called Teamplay and I say yes I start.” (Mother, Intervention, mid SES)
“I thought actually this is all part of this bigger project that we can contribute so let’s go for it.” (Mother, Control, Evening - mid SES)
“I know when I first talked to you about it I was quite excited about going to a workshop, I think that adds more to it especially as you get to meet other parents and talk to them as well.” (Mother, Control, Evening - low SES)
Initial reticence
Teamplay did not appeal initially to all parents who eventually enrolled. The example below shows how one parent’s first impression changed after an informal face-to-face meeting with one of the research team during the recruitment phase:
“Well my initial thing was something came through and I thought oh no I can’t be bothered with that, that’s not me and then a very nice person spoke to me in the playground and gave me a leaflet and I thought oh actually you know this would be quite interesting.” (Mother, Control, Evening - mid SES)
Despite efforts to make descriptions of the course inclusive, this was not always successful. One parent had discussed the course with other parents, and found they had assumed that course would be for parents with problems.
“Some of them seemed to think it maybe was for people with problem children… or, or obese children.” (Mother, Intervention, Evening - mid SES)
B). Parents’ understanding of the randomization process
The majority of parents understood the randomization process and felt that it was explained clearly.
“Yeah, I mean it (leaflet) explained everything, I didn’t need to ask any questions.” (Mother, Control, Evening - low SES)
No, it was all perfect, perfectly easy to understand and enough information.” (Mother, Control, low SES)
However, some parents felt it wasn’t clear from the first contact that the course was part of a research project and that they would be randomly assigned to one of two groups.
“Not necessarily no, no that wasn’t that clear.” (Mother, Control, Evening).
“Yeah when I first signed up I knew but when I first went along to the … maybe it was the very first flyer I picked up where I thought that would be good I’d like to go to that course, it wasn’t until I found out, whether there was another leaflet, I’m not sure, or when it was signing up, that it was actually a study and you might get on it, or you might not if that makes sense, it wasn’t till a bit further down the line that there were two groups.” (Mother, Control, Evening - mid SES)
Intervention group
C). Feelings about the first session
Although some parents reported having no concerns about attending the first sessions, the majority of parents recognized that factors related to attending a course for the first time, such as meeting new people, and knowing the type of people who will constitute the group could be daunting.
“You just want to get that first half hour over with so you know who else is joining” (Mother, Intervention, low SES)
“I think maybe like the first couple of sessions it was like all a bit daunting, you feel a bit sort of conscious but I think once you got to know everybody and got into it, it was quite fun really.” (Mother, Intervention, mid SES)
The role of course leader in making participants feel comfortable
The course leaders played an important role in helping parents to feel comfortable during the first session, engaging anxious parents and their friendly approach put parents at ease.
“I thought it was a lot of effort into putting everyone at ease” (Mother, Intervention, Evening - mid SES)
“There was one lady in the course that once you know suffered from a bit of anxiety and one of the girls did get her to go in… Yeah, [leader’s name] she went to the crèche and just sort of said come along and I think just seeing her familiar face and that … if she hadn’t have done she probably wouldn’t have come back”. (Mother, Intervention, low SES)
Meeting the course leaders before the first session was an important factor in helping parents feel more comfortable about joining a new group.
“We also knew the faces of the girls that were running the course because they were the ones that went and talk about the course and used to doing it. So it was good to see a familiar face.” (Mother, Intervention, low SES)
Parents also valued a group activity around setting group rules which helped them to feel comfortable in the group.
“The fact that we were at the beginning discussing all the things helped to make people think about oh this is a nice group and I am going to get along with these people” (Mother, Intervention, low SES)
D). Why did parents keep attending?
The most commonly reported reason for parents returning to the course was because they wanted to learn new information. There was a sense that parents did not want to miss out on the upcoming topics which were advertised by the course leaders.
“I had the plan of what was to come in the future and keen not to miss out on certain parts of it.” (Mother, Intervention, Evening - mid SES)
“…they gave us a rundown of what the course was and some of the things sort of later on in the course I thought ‘well that will come in handy” (Mother, Intervention, mid SES)
Enjoyment
Some parents reported looking forward to attending because they were enjoying the course with other parents:
“Yes I enjoyed it. If I’m not enjoying it I’m not coming! … Yeah, If I enjoy I give my time yeah.” (Mother, Intervention, mid SES)
“…it was a nice time, you know we all looked forward to going actually so it was quite good” (Mother, Intervention, Evening - mid SES)
Others parents referred to their commitment to attending a course and because they felt a responsibility to attend once they had committed:
“If I miss I feel so bad.” (Mother, Intervention, mid SES)
“I think people went to a lot of effort to put that on… I’m like that, I’m quite a reliable person … it’s just my natural personality that just I wouldn’t like to let people down like that.” (Mother, Intervention, Evening - mid SES)
Project support
Several parents talked about additional factors which supported their attendance, such as support provided to parents who missed a session, reminder text messages, the convenience of the location or their child’s enjoyment of the crèche.
“Well I spoke to them before and I explained that I couldn’t attend the sessions, and they were very useful because they gave me the material… they sent the material to me so when I went to the next session they discussed with me the session… I feel sorry I didn’t, but at the same time I didn’t need anything because they were very good to feed me back with whatever they did on the sessions” (Mother, Intervention, low SES)
“If you’re trying to do so much organization for the kids and what you have to do that little reminders [are] quite good actually”(Mother, Intervention, low SES)
Refreshments
Parents also appreciated the provision of snacks and facilities to make a drink.
“It was nice having that little kitchen area where you could make a cup of tea.” (Mother, Intervention, Mid SES)
“No I think they made you feel very welcome you know there was like nibbles provided every night because they realized people were coming straight from work” (Mother, Intervention, Evening - mid SES)
E). What made it difficult to attend?
Parents talked about factors that hindered their attendance. The main reason for not attending was due to the competing priorities of family life, such as illness or other commitments.
“I don’t think I had any intention of missing any, it was only through a clash with something else that was already arranged so in terms of keep on coming back that was all fine.” (Mother, Intervention, Evening - mid SES)
“the only reason I wouldn’t have gone is if any of us were ill you know or if we had a you know a sort of an appointment already booked.” (Mother, Intervention, mid SES)
Balancing the course with working life was also a factor that affected attendance of some parents:
“It’s a very tricky time of the day trying to get home from work and … get the kids”. (Mother, Intervention, Evening - mid SES)
Parents recognized the impact of the half term school holiday on the following week’s attendance.
“I think that was after the school holiday… We sort of a couple of weeks off, and then I totally forgot about it,.” (Mother, Intervention, low SES)
“I think it was good to have a break in between although I think a few people didn’t turn up after the break, so I don’t know if that, you know if that was a benefit to everybody but it was fine for us” (Mother, Intervention, mid SES)
F). Parent’s views of the Teamplay course
The facilitating group environment - “You weren’t on your own”
The number of parents attending sessions varied between courses [24], but there seemed to be a general sense that between 8 and 10 parents per session was desirable. The Mid SES morning course had the highest and most stable attendance (between 7 and 10 parents per session). All parents interviewed from this course were happy with the group size and thought that it facilitated discussion with other parents. Some parents cautioned against having larger groups as this may discourage individual contributions to discussions. Parents also referred to the relationship between the group size and developing personal bonds with a “core” of regular attendees.
“there were a couple you know that started off and then didn’t complete the course for one reason or another but there was like a core of us that sort of came every, you know, came every week. And yeah it was … you know a small enough group to be sort of quite personal, yeah I think it was just about the right size.” (Mother, Intervention, mid SES)
Irregular attendance
The low SES morning course had very inconsistent attendance. In comparison to the idea of the “core” group of frequent attendees, parents identified that irregular attendance was somewhat disruptive to the flow of the sessions. It was suggested that more parents should be recruited initially to allow for attrition and fluctuation in attendance.
“I think maybe 15 [parents on a course], because with every course that starts you’re going to have drop out anyway, so that will allow for a few to drop out and then you’ve still got your 10.” (Mother, Intervention, low SES)
“I thought it was a good number, I think at the beginning, I can’t remember how many there were but maybe ten or twelve. The problem was that sessions were not consistent in the number of people attending.” (Mother, Intervention, low SES)
The evening course had low, but consistent attendance. Only 4 participants were enrolled on this course, plus one participant’s husband who also attended but was not involved in the measurement component of the study. The majority of parents from this course believed that the group was too small and that it would have benefitted from being larger with specific reference to having a greater number of parent’s experiences to share and learn from.
“Yes, I think it would have been better to have more [parents]. I mean we all, a couple were two of the five so it meant there weren’t that many families to talk about different situations and sharing different experiences. So I think more would definitely have been beneficial.” (Mother, Intervention, Evening - mid SES)
Relationship with other attendees
The majority of parents reported that they formed good relationships with the other parents in the group. Many reported that sharing experiences with parents of a similar background helped them to bond as a group.
“most of the parents’ (children) went to the same school as my kids so they sort of would, you know, be from a similar area, background so that was … they were very easy to talk to, and the other mothers were very easy to talk to and quite similar to me as well, so probably not what I was expecting seeing as I kind of thought maybe it was for problem families. “ (Mother, Intervention, mid SES)
“And in that course, I enjoyed it because a lot of the mums were the same, you know… So you weren’t on your own if you like, an example used, a lot of the mums say oh yes that would happen with us so you didn’t feel oh god you are just a failure on yourself, you know.” (Mother, Intervention, Evening – mid SES)
G). Perceptions of the course leaders - “They were so full of enthusiasm”
The majority of parent’s responses regarding the leaders were positive and the course leaders appeared to have made an important impact on parents’ attendance and enjoyment of the course.
“The tutors are the ones that make the course interesting… they make fun out of… you don’t even feel like it’s a lesson you’re learning. (Mother, Intervention, mid SES)
Parents felt that the two course leaders worked well together and were organized. Their friendly and relaxed approach helped to put people at ease and feel part of the group. Parents also valued the leaders’ interaction with parents and the fact that they joined in with activities.
“They both would be part of the discussion and part of the games or activities so I thought that was quite good … the way they involved people to be part of the course and feedback their own experiences was very useful.” (Mother, Intervention, low SES)
An empathetic interaction style appeared to impact positively on course attendance as the leaders accommodated parent’s busy lives and competing demands:
“I have the feeling that because they were so nice, even if I am going late, I still go because they are not going to look at me like why are you here, you know I feel they would really respectful and they were considering people who were attending and understood that people get stressed having a family life” (Mother, Intervention, low SES)
Leader enthusiasm and commitment was also important, often it helped parents to engage and made the course interesting.
“…they were so full of enthusiasm it was quite contagious” (Mother, Intervention, Evening - mid SES)
“It was always like you know this is really important, it felt almost as important to them as it did to you, and it's your family life do you know what I mean so .… that was really good.” (Mother, Intervention, Evening - mid SES)
Based on their perception of the leader’s parenting experience, some parents attending the evening course described their initial reservations about the leaders. Two parents said their initial reservation changed once they got to know the leaders. This finding suggests that initially the parents wanted experiential expertise (i.e., from a mother) but were surprised that the professional expertise from non-mothers was still useful, thereby indicting that professional expertise is helpful, provided the session leader has the skills needed to run these groups.
“Oh, I think they were lovely, they did a great job. At the start I was kind of thinking, you know, they don’t look like they have [children]… they, they don’t really look like they know much about… the sharp end of parenting”. (Mother, Intervention, Evening mid SES)
“At first I was a bit dubious because oh god they are so young and haven’t even got children you know but that stopped, you know you stopped feeling that way once you got to know them because obviously they had done all their training and they knew.” (Mother, Intervention, Evening - mid SES)
One parent felt that parental experiences would have been more beneficial.
“It’s a bit tough to say you’ve got to be a parent to run the course but I think there are valuable experiences which are helpful.. I think if you are including parenting techniques in it, yes that would be my only kind of query.” (Mother, Intervention, Evening - mid SES)
Course content and delivery - “It covered everything you needed to know”
Parents reported that they were happy with the overall concept of Teamplay, they felt that the three components of parenting, PA and SV were clearly connected and that the course progressed logically.
“Yeah I think, I think the course ran really well and it was like a natural flow really.” (Mother, Intervention, mid SES)
“No I think I was happy with it all actually and like I said it all seemed to balance out really well and make the big picture.” (Mother, Intervention, Evening - mid SES)
Topic number and coverage
Most parents felt that the course covered all the content that they required.
“It covered everything I think you needed to know… it gave you all the tools to be able to handle most situations that occurred.” (Mother, Intervention, Evening - mid SES)
Some parents felt the number of topics covered was too much and often content was rushed in order to fit everything in. Some parents would have liked to have spent more time on particular topics.
“I understand that because of the amount of things you are covering you try to do the maximum amount in the time but sometimes I thought on some topics deserved a bit more time.”(Mother, Intervention, low SES)
Parents valued the peer interaction and discussions with other parents through pair and group activities. This facilitated peer learning and parents enjoyed the social aspect of talking with parents.
“I enjoyed interaction between the different members of the group and also between the two persons that were facilitating the sessions.” (Mother, Intervention, low SES)
“Everybody talking, ideas, more ideas…” (Mother, Intervention, mid SES)
“when they were chatting and you know sort of taking stuff in you don’t have chance to sort of think ‘oh god this is boring’ you know. It was just the right you know sort of mix to keep your attention span as well. “(Mother, Intervention, mid SES)
Content length
Whilst parents valued this style of delivery, some parents attending the low SES course felt that discussions were too lengthy, which disengaged parents or meant that subsequent topics were hurried or neglected.
“Yeah, I think it could have done with a little bit longer, especially in our group because people seemed to like to talk….” (Mother, Intervention, low SES)
“… during many sessions the talk, the discussions were carried on… Because sometimes no, you could feel a bit bored as well, you know, when it goes on and on.” (Mother, Intervention, low SES)
Whilst some parents felt the ‘Put into Practice’ component (trying things out at home) was an important part of the course, others said that being busy at home prevented them from engaging fully with the take home materials.
“even if we haven’t done it yet it’s not like we’ve given up or anything, it’s not a very good excuse is it but busy lives.” (Mother, Intervention, Evening – mid SES)
“Yeah, yeah, I know it is good because otherwise you could be just going there, taking the handouts, coming back not thinking about it at all until next.” (Mother, Intervention, low SES)
I). Course structure
Overall, parents in both the morning courses and the evening course felt that the timing of the weekly session and the length of the course was suitable and convenient. However, many parents also reported that they would have liked the session or the course length to have been longer, because they were enjoying the course, or to allow more time for discussion.
“I think it’s okay but for me it was two hours and a half maybe, because when you spend two hours and a half and then you have a good discussion or someone is telling you about her experience or his experience it’s like you need to have more time to listen to what she wanted to say.” (Mother, Intervention, mid SES)
“Yes, yes so I suppose … perhaps an extra week or two might have given a bit of chance to think about all the different techniques a bit more.” (Mother, Intervention, Evening - mid SES)
However, another parent mentioned that having a longer session would be problematic due to competing priorities. A number of parents on the evening course said that initially they felt that 8 weeks was a long time, which suggests that having a longer course may be off-putting to parents at the stage of recruitment.
“No, two hours is good. Yeah no more. I’m mum … I need cooking, cleaning.” (Mother, Intervention, mid SES)
“Well at the beginning it sounded a lot and there was a two week break for Easter …which again it made it seem, it seemed like it went on for a long time. But because I was quite into it I didn’t mind at all. Had it, had I not been getting anything from it I think it would’ve been quite long.” (Mother, Intervention, Evening - mid SES)
Perceived usefulness
The mean perceived usefulness of sessions 1–7 is presented by intervention delivery location in Figure 1. The figure indicates that on a scale that ranged from 1–5 the mean perceived usefulness was on the average above 4.5 for all sessions.