Graduation Year

2025

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Psychology

Major Professor

Kathy Bradley-Klug, Ph.D.

Committee Member

Heather Agazzi, Ph.D.

Committee Member

Shannon Suldo, Ph.D.

Committee Member

John Ferron, Ph.D.

Keywords

Adherence, Behavioral Parent Training, digital reminders, homework, mHealth

Abstract

Disruptive behavior disorders (DBDs) are prevalent in approximately 17% of children ages birth to 5 years (CDC, 2023). DBDs can significantly impact a child’s learning, social-emotional wellbeing, and ability to develop and maintain healthy relationship (CDC, 2023). Behavioral parent training (BPT) has been proven effective in reducing disruptive behavior and improving parent-child relationships. However, many families do not fully engage in treatment, leading to poor outcomes for both the child and the family. Chacko (2016) describes BPT engagement as enrolling in treatment, attending weekly sessions, participating in group discussions or role plays in sessions, practicing skills between sessions, and completing treatment. Prior research demonstrates the efficacy of text-based reminders to increase attendance to doctor visits and other health-related appointments. Because there is limited research on the use of cellphones and text-based reminders in BPT programs, this quantitative study analyzed the impact of text-message reminders on participants’ between-session practice of skills or homework, attendance, satisfaction of the program, stress levels, and child outcomes in the six-week Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS) BPT program. Participants were 147 caregivers who successfully completed the six-week program. Multilevel modeling allowed for the examination of both within-group (individual-level) and between-group (session level) variability. Results indicated that while caregivers who received reminders demonstrated slightly higher rates of homework completion and attendance rates, the effect was not statistically significant. Similarly, homework completion was not a significant predictor of parenting stress, session attendance, childhood behavioral outcomes, or overall caregiver satisfaction with the BPT program. Attendance itself was not significantly related to any outcome, suggesting that presence in sessions does not guarantee active engagement or skill generalization. Additionally, caregiver-specific factors—such as motivation, mental health, and self-efficacy—accounted for more variability in outcomes than group-level factors or reminders. These findings suggest that while text-message reminders may offer some benefit, they are insufficient as a standalone strategy for improving BPT adherence. Practitioners may consider integrating multi-modal engagement strategies —such as app-based tools, real-time feedback, or peer coaching. Additionally, incorporating skills such as organizational strategies, time-management, emotion regulation, and cognitive behavioral-therapy techniques may help address caregiver-specific challenges and improve treatment outcomes.

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