Review: Systematic review and meta-analysis – financial incentives increase engagement with parenting programs for disruptive behavior problems

Background: To evaluate the effect of financial incentives on engagement in parenting programs for disruptive behavior disorders, as well as effect on child behavior. As a secondary aim, demographic differences were investigated as effect modifiers. Methods: We searched PubMed, CINAHL, Sociological Abstracts, Cochrane Trials, and PsycINFO for randomized controlled trials and quasi experimental studies offering parents a financial incentive for engagement with parenting programs targeting disruptive behavior in children aged under 18, vs no incentive. Engagement in each group was evaluated at four stages: connection, attendance, participation, and enaction. Per protocol (CRD42022336210) random effects meta-analysis was conducted using Stata-16. Meta-analyses of binary data used a log odds ratio and continuous data was standardized using Hedges' g. Results: We identified 2438 papers and screened 35 at full length. We included eight independent cohorts from seven papers. Parents invited to incentive arms were more likely to complete a threshold of sessions than parents invited to control arms (odds ratio 2.51 95% CI 1.42–4.48). Parents were more likely to agree to participate when they knew they were joining the incentive program (odds ratio 1.40, 95% CI 1.20–1.65) and parents in the incentive group were more likely than parents in the control group to reach a completion threshold of sessions (odds ratio 1.76 95% CI 1.17–2.66). Conclusion: Incentives increase parenting programs engagement among parents who are invited and among parents who have begun attending programs. Incentives are an effective potential tool for increasing engagement but further research is needed to establish acceptability and optimal design.