Sustaining Engagement in Longitudinal Research With Vulnerable Families: A Mixed-Methods Study of Attrition

Coming out of isolation: impacts of COVID-19 on physical activity, diet, mental well-being, and sleep over time

Introduction

The COVID-19 pandemic lockdown significantly disrupted daily routines and impacted physical activity, diet, mental well-being, and sleep. This mixed-methods study investigates these changes over three periods-pre-pandemic, pandemic onset, and one-year post-onset-to understand their causes and inform public health policy for improved resilience during future crises.

Methods

A mixed-methods study was conducted with 34 US participants who completed open-ended qualitative questions and quantitative assessments in May 2020 and May 2021. Participants were recruited via social media from 10 states with high COVID-19 cases. Quantitative data categorized health changes (positive, negative, or no change), while qualitative data were analyzed thematically to explore reasons for these changes and uncover interrelationships among health behaviors.

Results

Quantitative results showed that, during the pandemic onset, most participants experienced negative changes in diet, mental well-being, and sleep, while physical activity varied. By one-year post-onset, improvements were noted across all health pillars, with mental well-being and sleep showing the most significant positive changes. Thematic analysis of qualitative data revealed stress, anxiety, and personal motivations as key drivers of health behaviors. Participants' narratives provided a deeper understanding of these shifts that a Likert-style survey alone could not capture, highlighting the interconnectedness of health pillars.

Discussion

The findings demonstrate the importance of addressing mental well-being to improve overall health resilience. Public health interventions should prioritize mental health and consider the interrelated nature of health behaviors. The mixed-methods approach combined quantitative trends with qualitative insights, offering a comprehensive understanding of why health changes occurred, providing actionable guidance for future public health policy.

Recruitment and Retention Strategies for Parents Experiencing Vulnerability: Lessons from an Online Parenting Program

BACKGROUND

Supportive parenting programs can promote parent-child interactions and children's development. However, families experiencing vulnerability (e.g., low socioeconomic status) report barriers (e.g., transportation, distrust of researchers) to research participation, and attrition rates of 40% and higher have been reported in parenting research. In response, we conducted a longitudinal evaluation of a digital parenting program in a major metropolitan centre in western Canada and retained 99% of our sample.

AIM

Review recruitment and retention strategies employed in the First Pathways study and evaluate associations between sociodemographic (e.g., income) and psychosocial (e.g., parental depression) factors with recruitment and retention strategies.

METHODS AND FINDINGS

In collaboration with community agencies, we commenced recruitment of 100 families experiencing vulnerability (e.g., low-income) in June 2021. We utilized strategies to engage staff (e.g., presentations, gift cards, updates) and employed snowball sampling. Families recruited through community agencies were significantly more likely to experience vulnerability (e.g., low income and education, high adverse experiences) compared to families in the snowball sample. We incorporated strategies to minimize participant burden (e.g., choice of online or in-person meetings), promoted rapport (e.g., holiday texts, nonjudgmental environment), incorporated trauma-informed practices (e.g., sensitive inquiry), and demonstrated appreciation for participants' contributions (i.e., honorarium). Family experiences of vulnerability (i.e., low income, depressive symptoms, adversity) were correlated with higher participant rescheduling.

CONCLUSION

Nurses need knowledge of strategies to promote equitable access to research for families experiencing vulnerability. Digital programs with protocols designed to establish rapport, include trauma-informed practices, and minimize participant burden will likely optimize participation and retention.

Influence of the COVID-19 pandemic on executive skills in Canadians experiencing social vulnerability: A descriptive study

The objective of this study was to describe executive skills in clients experiencing social vulnerability in the context of COVID-19 from the perspective of social service agency staff. COVID-19 has required transformational changes to livelihood and day-to-day living. Socially vulnerable individuals are likely to be disproportionally impacted because many have experienced serious early childhood adversity, which may compromise their executive skills in adulthood. Using a cross-sectional survey, we collected data between 05 May 2020 and 03 July 2020, for this mixed methods study of 53 staff in two agencies in western Canada serving clients experiencing social vulnerability. The first case of COVID-19 in this jurisdiction was identified 05 March 2020. Using investigator-designed survey items, we captured executive skills in five areas: (a) planning tasks of daily living, (b) managing time, (c) keeping track of information and appointments, (d) managing emotions, and (e) managing self-control. Staff reported their clients struggled with executive skills and these struggles increased during COVID-19, particularly in the areas of managing daily tasks and emotional regulation. COVID-19 restrictions overwhelmed clients with the decisions required to maintain health, employment, and childcare. With the loss of structure and routine, clients lost track of time and delayed completion of tasks, which further increased stress. Disrupted goals and uncertainty about the future contributed to hopelessness for clients who were trying to regain control over their lives, which made it difficult to manage emotions. Some clients acted more impulsively because of the added stressors, lack of routine and access to friends and extended family. A better understanding of the impact of COVID-19 on socially vulnerable clients will inform social service agencies about areas to focus programming to support their socially vulnerable clients.

Early Impacts of Room to Grow: A Multifaceted Intervention Supporting Parents and Children Age Zero to Three

Children experiencing poverty or low incomes fare worse than their more advantaged peers on a host of developmental and educational outcomes. Interventions have focused on strengthening parenting in families with young children, when supports appear to be most critical. But most parenting programs for low-income families fail to address parents' economic needs, which almost always take precedence relative to broader educational or developmental goals. In this article, we describe the early results of a multifaceted intervention aimed at supporting parents, infants, and toddlers in the first three years of life. The Room to Grow program provides parents, primarily mothers, with support from a clinical social worker, connections to community referrals, and up to $10,000 in material support for the baby in the form of in-kind assistance such as clothes, books, toys, strollers, and other necessities. The current study examines proximal outcomes of the intervention after one year using a randomized controlled trial evaluation design. The study finds that early impacts on proximal outcomes are uniformly positive, especially with regards to the presence of books and developmental goods in the home, developmentally-oriented parenting outcomes, and reduced stress and aggravation in the domain of parenting.