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Promoting Positive Relationship between Parents and Grandparents: A
Randomized Controlled Trial of Group Triple P Plus Compassion in Vietnam
Nam-Phuong T. Hoang, James N. Kirby, Divna Haslam, Matthew Sanders
PII: S0005-7894(22)00075-2
DOI: https://doi.org/10.1016/j.beth.2022.06.002
Reference: BETH 1186
To appear in: Behavior Therapy
Received Date: 9 June 2021
Accepted Date: 1 June 2022
Please cite this article as: N.T. Hoang, J.N. Kirby, D. Haslam, M. Sanders, Promoting Positive Relationship
between Parents and Grandparents: A Randomized Controlled Trial of Group Triple P Plus Compassion in
Vietnam, Behavior Therapy (2022), doi: https://doi.org/10.1016/j.beth.2022.06.002
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© 2022 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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Promoting Positive Relationship between Parents and Grandparents:
A Randomized Controlled Trial of Group Triple P Plus Compassion in Vietnam
Nam-Phuong T. Hoang1,2, James N. Kirby1, , Divna Haslam3 ,Matthew Sanders1
1Parenting and Family Support Centre, School of Psychology, The University of Queensland.
2 Compassionate Mind Research Group, School of Psychology, The University of
Queensland
3 Queensland University of Technology
Correspondence concerning this article should be addressed to Nam Phuong T. Hoang,
Parenting and Family Support Centre, School of Psychology, The University of Queensland,
St Lucia, Brisbane, 4072. E-mail: a.phuong@uq.edu.au
Declaration of Interest
The Parenting and Family Support Centre is partly funded by royalties stemming from
published resources of the Triple P – Positive Parenting Program, which is developed and
owned by The University of Queensland (UQ). Royalties are also distributed to the Faculty of
Health and Behavioural Sciences at UQ and contributory authors of published Triple P
resources. Triple P International (TPI) Pty Ltd is a private company licensed by Uniquest Pty
Ltd on behalf of UQ, to publish and disseminate Triple P worldwide. The authors of this
report have no share or ownership of TPI. Drs Sanders. Kirby and Haslam and Ms Hoang
receive or may in future receive royalties and/or consultancy fees from TPI. TPI had no
involvement in the study design, collection, analysis or interpretation of data, or writing of
this report. Dr. Sanders & Dr Kirby are an employee at UQ, Dr. Haslam hold an an honourary
appointment and Ms Hoang is a Postdoctoral Research Fellow at Parenting and Family
Support Centre.
Funding: This research did not receive any specific grant from funding agencies in the
public, commercial, or not-for-profit sectors.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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Abstract
In Vietnamese culture, grandparents are significantly involved in the upbringing of
grandchildren. This involvement of grandparents entails lots of ambiguities and challenges.
Boundaries between parents and grandparents are often unclear, and communication can be
restricted due to power differentials, leading to inconsistent discipline. This study seeks to
evaluate the efficacy of the Group Triple P - Positive Parenting Program plus Building
Coparenting Alliance - a compassion-focused module to promote the parent-grandparents
relationship. One hundred Vietnamese parents whose parents or parent in-laws provided care
for their children were randomly assigned to either an Intervention condition (n = 50) or a
Waitlist control condition (n = 50). Both groups were assessed at three time-points (pre-
intervention, post-intervention, and six-month follow-up). The short-term intervention effects
were found across domains, including co-parenting conflict, parents' self-compassion,
dysfunctional parenting, parenting self-efficacy, parental adjustment, child behavioral
problems and child prosocial behaviors. Intervention effects on co-parenting conflict,
parenting behaviors, and the child's prosocial behaviors were maintained at a six-month
follow-up. This study demonstrates the efficacy of Triple P plus compassion in promoting co-
parenting relationships between parents and grandparents, enhancing parenting practice and
child outcomes in Vietnamese families.
Keywords: Parent, grandparent, Triple P, compassion, Vietnam, Asian
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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Introduction
In Vietnamese culture, grandparents play an important role in the parenting process.
Grandparent involvement does not occur within the sphere of skipped-generation households
(e.g. where parents are absent due to work, family tragedies, being incarcerated) but rather in
a multigenerational context, where all adults play equally active caregiving roles (Guilmoto,
2012). This is the result of patrilineal custom that requires newly wedded couples to co-live
with the groom's parents. Within this multigenerational context, grandparents become the
primary source of childcare support. They are expected to impart traditions, cultural norms
and the social rituals that make up the core of their family values (Selin, 2014). In the last
decade, multigenerational households have declined slightly, and the number of nuclear
households is increasing in Vietnam (Thang, 2010). Nevertheless, the active role of
Vietnamese grandparents in childcare remains unchanged. Grandparents may not live in the
same household but continue to stay in close proximity to the parents or regularly visit to
provide care for their grandchildren (Knodel et al., 2000; Mehta & Thang, 2011). Shanas
(2017) coined this “new” family living arrangement that is prominent across Asian countries
as the “intimacy at distance” phenomenon.
The arrangement in which parents and grandparents share childcare responsibility has
many benefits yet is fraught with ambiguity due to the overlapping nature of the roles and
responsibilities (Abel, 1989; Oberlander et al., 2007; Thomas, 1990). The arrangement is
even more complex in many Asian cultures. A recent meta-ethnographic synthesis by Hoang
and Kirby (2019) showed that Asian parents face various challenges in raising their children
due to grandparents' interference. Grandparents are highly respected in these cultures as
family authority figures, thus having the right to intervene and make decisions regarding their
grandchildren's upbringing (Goh, 2006). Grandparents are also allowed to reject or refuse the
parents’ opinion (Hoang & Kirby, 2019).
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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On the other hand, bound by the rule of filial piety, parents cannot freely question the
opinion of the grandparent, thus leaving them feeling distressed and unheard (Leung & Fung,
2014). The conflict between parents and grandparents further contributes to the difficulties
parents experience in managing children's behaviors. In an environment where there are high
levels of inconsistency between adults, children often experience difficulties when it comes
to learning what are acceptable and appropriate behaviors. Disagreement and conflict can
also lead to many "loopholes" that children can use to their advantage (Conn et al., 2013;
Goh, 2013).
Despite accumulating evidence that demonstrates the complexity of parent-grandparent
co-parenting relationships, there are few parenting programs designed to support this
childcare arrangement, particularly in Asian cultures. To date, there has been only one
evidence-based parenting program developed specifically to promote parent-grandparent
relationships within the informal care context - Grandparent Triple P (Kirby & Sanders,
2014). The Grandparent Triple P (GTP) program is a variant of the Triple P-Positive
Parenting Program, one of the most extensively studied parenting programs in the world
(Sanders, Kirby, Tellegen, & Day, 2014). The program included modules on positive
parenting strategies, and an additional module was developed specifically to focus on the
parent-grandparent relationship, which was based on behavioral couple therapy (Kirby &
Sanders, 2014). A randomized controlled trial study that examined GTP in an Australian
context indicated improvement in the relationship between parent and grandparent (Kirby &
Sanders, 2014). However, in Hong Kong, no improvements were observed in terms of the
amount of support felt, tension, or conflict between parents and grandparents (Leung et al.,
2014).
After reviewing the GTP, it became evident that the GTP was developed based on
studies of Australian grandparents who have minimal influence over their grandchildren's
discipline (Kirby & Sanders, 2012). Research on Asian grandparenting, however, suggests
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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the opposite. In many Asian cultures, Hong Kong included, grandparents hold substantial
power in the family context and are typically allowed to interfere with or criticize parents'
parenting. Even though such involvement comes with good intentions, it can be challenging
for parents to develop their own autonomy and discipline their children effectively (Goh &
Kuczynski, 2010; Leung & Fung, 2014). Parents often find themselves caught between the
respecting grandparents' opinions and wanting to exercise their own parenting authority.
Occasionally, this can be settled by open communication with the grandparents (Conn
et al., 2013). In most cases, however, open discussion instigated by parents can be seen as
disrespectful and further result in more conflict (Goh & Kuczynski, 2010; Hoang & Kirby,
2019). Parents thus end up suppressing their emotions or avoiding discipline in front of the
grandparents to sustain family harmony (Hoang & Kirby, 2019). In light of such
complexities, an intervention to improve parent-grandparent co-parenting in the Asian
context should not ignore the obstacles parents face, as it could miss the key elements that
maintain the relationship’s ambiguity.
The World Health Organization (2010) recommended that Evidence-Based Parenting
Programs (EBPPs) should be tailored to meet the specific needs, aspirations, traditions, and
cultural values of local ethnic groups when delivered in a context different from their original
setting. The cultural tailoring of EBPPs is necessary not so better outcomes can be achieved
but to enhance program engagement and minimize any adverse effects on families (Resnicow
et al., 2000).
To address the limitations of GTP, we developed a module called Building the Co-
Parenting Alliance (BCA). BCA was built to provide a culturally appropriate approach to
addressing the co-care relationship between parents and grandparents in the Asian
context. Acknowledging the challenges that Asian parents face parenting their children
alongside grandparents (Hoang & Kirby, 2019; Hoang et al., 2019), the focus of BCA
intervention was shifted to be with parents rather than grandparents.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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This BCA module is designed as an additional module that can be added to the existing
Group Triple P program, designed for families in which grandparents are highly involved in
the care of grandchildren. Through BCA, parents are empowered to negotiate co-parenting
experiences without violating filial duties or dismissing grandparents' roles and
responsibilities, creating a supportive, nurturing family environment to benefit young
children. The BCA module was informed by a series of empirical studies which identified
challenges faced by Asian and Vietnamese parents raising their children with grandparents
(Hoang & Kirby, 2019; Hoang et al., 2019).
The strategies within the BCA module were informed by compassion-focused
therapeutic approaches. Compassion Focused Therapy was designed to target rank and status
as core mechanisms behind the manifestation of psychopathology symptoms (Gilbert, 2014),
making it highly relevant to our target population. A growing body of evidence suggests that
compassion and mindfulness can significantly benefit individuals' mental health, well-being,
and relationships (Crocker et al., 2009; Kirby, 2016; Kirby et al., 2017). Compassion,
specifically self-compassion, is associated with reduced levels of personal distress (Bluth et
al., 2017), better emotion-regulation skills (Diedrich et al., 2014), lower levels of self-
criticism (Kim, Cunnington, et al., 2020), and more adaptive coping strategies (Allen &
Leary, 2010). Compassion towards oneself also impacts conflict resolution choices. A person
with high levels of self-compassion is more likely to behave flexibly, ensuring that neither
their needs nor those of others are neglected (Klimecki, 2019; Yarnell & Neff, 2013).
Based on previous empirical work and models of compassion (Gilbert, 2014), it is
postulated that through the cultivation of compassion, parents can be more sensitive to their
own needs and feelings (which have been neglected due to filial piety and a focus on family
harmony) (Hoang & Kirby, 2019). Such change may then motivate them to develop conflict
resolution styles that do not abandon their own needs or those of the grandparents. By
learning that many human experiences are constructed socially, parents might become less
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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critical and blaming toward the grandparents and more willing to change the relationship.
Therefore, part One of the BCA module focuses on helping parents take care of their needs
and emotions. The specific exercises chosen for the BCA module were drawn from
Compassionate Mind Training (CMT) (Gilbert, 2010), which randomized controlled trial
studies have found to be effective in brief two-hour formats (Matos et al., 2017).
During the second part of the module, parents learn skills and strategies to facilitate
open, non-judgmental communications with grandparents in the context of conflict. Past
study in Vietnamese families suggested that open communication contributes to better
cooperation between parents and grandparents (Hoang et al., 2019). However, establishing
positive and open communication with senior family members can be difficult in Asian
culture. Filial piety dictates that children should obey without question. As such, demanding
change that contradicts grandparents' beliefs could be considered disrespectful (Leung &
Fung, 2014). Communication strategies between parents and grandparents thus need to be
carefully planned. An effective intervention needs to help parents become assertive in
communicating their struggles and difficulties while still respecting the wishes and welfare of
grandparents. Part Two of the BCA module provides communication strategies based on the
Non-Violent Communication model by Rosenberg and Chopra (2015). Non-Violent
Communication is the most popular compassionate communication model, showing
significant effects in various contexts, including those with high conflict (Marlow et al.,
2012; Nosek et al., 2014). Non-Violent Communication emphasizes the act of expressing
one's request without forcing the other person to agree. It also promotes an open attitude to
receiving rejections from others (Rosenberg & Chopra, 2015). Communication strategies
based on the Non-Violent Communication model hopefully can foster an authentic exchange
of information between Asian parents and grandparents, free from judgement and defensive
responses.
The current study
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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This study aims to evaluate the efficacy of Group Triple P + BCA as a program to
promote positive co-parenting relationships between parents and grandparents in the
Vietnamese context. Using a two-arm randomized controlled trial (RCT), our primary
hypotheses were that relative to the control condition, Vietnamese parents participating in the
Group Triple P + BCA program reported at post-intervention: (H1) decrease in co-parenting
conflict, (H2) increase in co-parenting cooperation, (H3) increase in confidence to
communicate with the grandparents, and (H4) increase in self-compassion compared to their
pre-intervention experiences. Based on previous research of Triple P, there were secondary
hypotheses that: relative to the control group, Vietnamese parents of the intervention group
would report (H5) decrease in dysfunctional parenting strategies, (H6) increase in parenting
self-efficacy, (H7) decrease in stress, depression and anxiety symptoms, (H8) decrease in
child's behavior problems, and (H9) increase in child's prosocial behavior. The post-
intervention effects were hypothesized to maintain at six-months follow-up (H10), and
parents would report high satisfaction with the program content and delivery (H11).
Method
Registration
This trial was registered on the Australian New Zealand Clinical Trials Registry
(ANZCTR). Ethical clearance was obtained from the author's affiliation Ethics Committee.
Participants
To be eligible for the study, parents needed to express both a) concern regarding their
relationship with the grandparents (“Do you find the co-parenting relationship with
grandparents difficult to manage?”) and b) concern with their child’s current functioning
(“Are you concerned about behavioural problems with your children?”). For both of these
questions, parents needed to respond on a five-point Likert scale, from 1= not at all, to 5= a
great deal. Those who responded with a 4 or above in both questions are considered eligible
for the study. In addition, previous research using Triple P with grandparents in Australia
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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(Kirby & Sanders, 2014) and Hong Kong China (Leung et al., 2014) have used the 12 hours
or more care per week as a criterion of eligibility. To be consistent with this past research, we
also applied this criterion and included only participants who indicated that the grandparents
provide 12 hours or more of care for their children per week.
An advertisement was posted on the Facebook page of Hoa Sen University - the local
host of this study - calling for parents who meet those criteria to sign up. In total, 224 parents
expressed their interest and completed the online assessment of those 100 parents met the
criteria and were invited to participate. Details of participants were presented in Table 1. The
flow of participants through each stage of the study was detailed in Fig. 1.
Power analysis
Power analysis (calculated using G*Power) indicated that to detect a medium effect
size of d = .05 with 80% power at p < .05, a minimum of 43 participants are required for
each group. The sample of 100 parents should provide sufficient power for the analysis
required.
Design
The study was a two-arm randomized controlled trial designed with two groups:
Intervention vs. Waitlist control.
Procedure
One hundred parents met the study's eligibility criteria and were randomly assigned to
either the Intervention (n = 50) or Waitlist control condition (n = 50). Parents received an
email with information about the study and their right to withdraw. The email also contained
a link to the online consent form and pre-intervention assessment. Once all participants had
completed and returned the consent and pre-intervention assessment, workshop training was
held for the Intervention group. After the Intervention group completed the training, the post-
intervention assessment was collected for both groups. A follow-up survey was conducted six
months later. The Waitlist control group received treatment once data collection was
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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completed. Workshops were held in Hanoi and HoChiMinh cities since most participants
lived in these two centers or nearby. In total, fifty-three (53) parents attended workshops in
Hanoi (Intervention group: n= 26; Waitlist control: n=27) and 47 parents attended workshops
in HoChiMinh city (Intervention group n= 24; Waitlist control n=23). There were no
significant differences between the Intervention and the Waitlist control groups with regard
to the workshop location (2=.841; p>.05).
Condition Allocation
A random list, generated on the website https://www.random.org/ was used to
determine whether participants were in the Intervention (Group Triple P + BCA) or Waitlist
control groups. Simple randomization was chosen since the participant list was confirmed
prior to randomization and the recruitment process was conducted online. Allocation was
handled by a researcher who was not involved in this project at the time. This allocation
process was concealed from the investigators of this study.
Intervention condition
The intervention program consisted of six modules delivered over two full days one
week apart. Each module lasted 120 minutes. Four of the six modules covered content related
to Group Triple P; the two remaining modules (Modules 4-5) were BCA modules. After
completing the modules, each parent also received four 20-minute weekly telephone
consultations to assist in putting the skills learned into practice. The intervention was
delivered in Vietnamese by a Vietnamese Australian Triple P accredited practitioner, trained
in Level 4 Triple P. Please refer to Appendix A for more detail of the program’s modules
and content.
Measures
Parent-Grandparent Co-parenting Quality
The Co-parenting Quality Checklist (CQC) was used to assess the co-parenting
relationship between parent and grandparent. The CQC incorporates elements of the
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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Parenting Problem Checklist (Dadds & Powell, 1991) and the Co-parenting Relationship
Scale (Feinberg et al., 2012). The CQC consists of 25 items in two subscales: 17 items relate
to conflict, and 8 items relate to cooperation. An example of a Conflict subscale item is "My
parents and I have different ideas about how to raise the child (e.g., smacking children)" and
an example of a Cooperation subscale item was “My parents ask my opinion on issues related
to parenting”. A high score on the Cooperative subscale suggests a supportive co-parenting
relationship. High Conflict scores signaled more conflict between parents and grandparents
when co-caring for their grandchildren. Past work of Hoang et al. (2019) found that the mean
of CQC score between parents and grandparents for a typical Vietnamese sample is M=47.85
(SD=20.56) for Conflict and M=37.13 (SD=11.48) for Cooperation. In this current study, the
mean score of Conflict at pre-intervention is M=71.36 (SD=20.89), which is higher than that
of Hoang et al. (2019). Meanwhile, Cooperation score in this study at pre-intervention is
M=28.95 (SD=10.78), which is lower than that of Hoang et al. (2019). Cronbach alpha (α) of
the total scale was .89, while the individual (α) of the Conflict subscale was 0.93 and the
Cooperation subscale was 0.91 in this study.
Communication Efficacy
An 8-item scale was designed specifically for this study to assess parents' confidence in
communicating with grandparents. The items included: "How confident are you to discuss
disagreements about child discipline with the grandparents?" or "How confident are you to
discuss boundaries and roles with the grandparents?". Parents rated their levels of
confidence on a scale of 1 to 10. The total scores ranged from 8 to 80, with a higher score
indicating a greater confidence in communicating with grandparents. Exploratory factor
analysis supported a one-factor model, which explains 64.98% of the variance. Confirmatory
factor analysis was also conducted and confirmed that the one-factor model fitted the data
well (
2= 57.34, df=19; p<.05; CFI=.94, RSMEA=.06). Cronbach's alpha tested for the scale
in this study was α = .96.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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Parents' Self-Compassion
Self-compassion was measured using the Self-Compassion Scale - Short Form (SCS-
SF) (Raes et al., 2011). There are twelve items on the scale which describe how one generally
acts toward themselves in times, such as: "When I fail at something important to me, I feel
insufficient." or "When I'm having a hard time, I provide myself with the care and tenderness
I need." Participants rate how applicable the items are to their own behaviors on a scale from
1 to 5. Six items have reversed scores. Scores range from 12 to 60, with higher scores
indicating greater self-compassion. The SCS-SF has good reliability with Cronbach's alphas
(α) ranging from .79 to .85 (Garcia et al., 2014; Khanjani et al., 2016; Raes et al.,
2011). Cronbach's alpha (α) of the 12-item version was acceptable at .71, with low item-to-
item correlation values for items 2, 5, and 10. With these items removed, (α) increased to .81.
A total of 9 items were used in the analysis.
Dysfunctional Parenting
Parents' dysfunctional parenting behaviors were assessed using the Parenting Scale
(Arnold et al., 1993). The parenting scale consists of 30 self-report items that measure the
likelihood of parents/caregivers using specific discipline strategies in response to their child's
misbehavior. Parents rated each statement's applicability to how they deal with their children
on a continuum of 1 to 7, with higher scores indicating more problematic parenting
behaviors. The scale yields three different parenting styles: Laxness (permissive, inconsistent
parenting), Overreactivity (authoritarian, meanness, and irritability), and Verbosity (use of
verbal or physical force). The scale has a good internal consistency with Cronbach alphas (α)
as follows for mothers and fathers: Laxness (α = .85 and α = .82), Overreactivity (α = .80
and α = .80) and Verbosity (α = .78 and α = .83).
Parenting efficacy
Parents' parental self-efficacy was measured by the Self-efficacy subscale of the Child
Adjustment and Parental Self-efficacy Scale (CAPES) (Morawska et al., 2014). This self-
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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efficacy subscale has 20 items measuring parents’ level of self-efficacy in managing their
children's emotional and behavioral problems. Parents rate each item on a 10-point scale,
ranging from “Certain I can’t do it” (1) to “Certain I can do it” (10). Total scores range from
20–200, with higher scores indicating a greater self-efficacy. The Cronbach’s alpha for
CAPES Self-efficacy for an Australian sample was α = .96 (Morawska et al., 2014). This is
the first study to use this scale in Vietnam, and the reliability test showed an excellent result
with α = .95
Parents' adjustment
Parents’ adjustment was measured by the Depression Anxiety Stress Scale-21(DASS-
21) (Lovibond & Lovibond, 1995). DASS-21 is a well-known questionnaire used to assess
symptoms of depression, anxiety, and stress in adults. DASS-21 has been translated and
validated among Vietnamese women with young children. Validation of DASS-21
Vietnamese showed the scale is comprehensible and sufficiently sensitive to detect common
mental health symptoms in Vietnamese women (Tran et al., 2013). Cronbach alpha (α) range
from .70 to .77 across subscales and .88 for the total scale (Tran et al., 2013). Convergent
validity of the scale was also confirmed for Vietnamese adolescents with moderate
correlation coefficients between DASS scores and other mental health-related measures or
domains. In this study, DASS-21demonstrated excellent reliability with Cronbach alpha α =
.94 for the whole scale. Cronbach alphas of subscales were as follows: Stress α = .84,
Depression α = .88, Anxiety α = .84.
Child emotional and behavioral difficulties
CAPES (Morawska et al., 2014). CAPES consist of 27 items and assesses child
behavioral and emotional difficulties , like " Gets upset or angry when they don’t get their
way". Parents were asked to rate how truthfully the statements described their child on a 4-
point scale, (0) not true at all to (3) very much true to my child. Total scores ranged from 0-
72 (behavioral maladaptive) and 0-12 (emotional maladaptive), where higher scores indicate
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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more problems. The Cronbach alpha of CAPES total scale on this study was α = .88, and
Cronbach alpha on each subscale was Emotional Adjustment α = .76; Behavioral problems α
= .87.
Child prosocial behaviors
Child prosocial behaviors were assessed by the Strength and Difficulties Questionnaire
- Prosocial behaviors subscale (SDQ- Prosocial behaviors) (Goodman, 1997). SDQ-
Prosocial behaviors consisted of 5 items measuring the child's prosocial action toward others
(E.g., “Kind to younger children”), of which parents rated their children on a 3-point scale.
The item summary yields a total score ranging from 0-10, with a higher score indicating a
higher level of prosocial behaviors. A previous study to validating the SDQ- Prosocial
behaviors in Vietnam indicated that the scale has adequate reliability and validity to assess
mental health development of children and adolescents in Vietnam (Dang et al., 2017). The
Cronbach alpha for SDQ- prosocial subscale in this study was acceptable at α = .77.
Client satisfaction
Client Satisfaction Questionnaire (CSQ) is a 13-item survey that measures consumer
satisfaction with the quality of service. Participants rated their satisfaction with different
aspects of the program on a scale from 1 (Quite dissatisfied/No needs have been met) to 7
(Very satisfied/ Almost all needs have been met). CSQ tested as reliable for the current
sample α = .93.
Measures translation
All measures were translated, back-translated, and cross-checked by a group of
Vietnamese-Australian researchers and were sent to 15 Vietnamese parents for validity and
legibility checks. Feedback on the final drafts indicated consensus and cultural suitability to
capture the phenomenon under research. As the research of parenting and family relationship
in Vietnam is still in its infancy, there was limited evidence regarding the validity of the
current measures (except for the DASS-21 and SDQ- Prosocial) with Vietnamese population.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
15
To examine the concurrent validity of the measures, correlations between all measures
(except for CSQ) and the DASS-21 and SDQ-Prosocial at baseline were explored.
Correlation outcomes were significant and in the expected direction, indicating adequate
concurrent validities of the measures used. (See Appendix B).
*Insert Figure 1*
*Insert Table 1*
Statistical Analyses
A series of repeated measures ANOVAs and MANOVAs were used to evaluate
intervention efficacy. Univariate ANOVAs were conducted following significant multivariate
results (time by condition interactions) with Holm-Bonferroni correction of the alpha (Aickin
& Gensler, 1996). Consistent with latest consort guidelines, baseline differences were not
tested .
Results
Missing data
Analysis of missing data indicated an overall of 18.03% of missing values, including
97% of participants who had missing data on one or more variables. Little’s test showed data
missing completely at random (MCAR) with p-value greater than .05 (χ2 (41157) = 8247.53,
p>.05). Missing values were then estimated using the Expectation-maximization (EM)
method.
Attrition
Nine out of 100 (9 %) parents did not complete the post-intervention assessment. Six
were in the intervention group, of which four did not attend any training modules. Out of the
original 100 parents, 28 (28 %) did not complete the six-month follow-up assessment.
Thirteen were from the Waitlist control group, and fifteen were from the Intervention group,
of which 12 did not attend any training module. An Independent t-test revealed no significant
difference in attrition rate between the two groups post-intervention, χ2(1,100) = 1.93, p>.05.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
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At six-month follow-up, the rate of attrition was still non-significant with χ2(1,100) = <.001,
p >.05
Short-term effect
Parents-Grandparents Co-parenting Quality
A MANOVA test was conducted for the Co-parenting Quality Checklist indicating
significant time by group interaction effect, F(3,96) = 4.22, p<.05. A follow-up one-way
ANOVA test on the Co-parenting Conflict subscale revealed a significant reduction of
Conflict within the Intervention group, F(1,49)= 25.88, p<.001 and no significant change for
the Waitlist control group, F(1,49)= 1.55, p>.05. No univariate effect was found for Co-
parenting Cooperation subscale, F(1,98) = .12, p>.05.
Communication Efficacy
Repeated measures ANOVA revealed no significant differences between the
Intervention group and Waitlist control post-intervention, F(1,98)= 1.611, p>.05
Self-compassion
Repeated measures ANOVA revealed significant time by group interaction effect for
Self-Compassion Scale, F(1,98)= 4.789, p<.05. Follow-up one-way ANOVA indicated no
significant improvement of self-compassion within the Waitlist control but significant
improvement within the Intervention Group at post-intervention F(1,49) = 15.50, p<.001.
Parental adjustment
The MANOVA for the DASS-21 revealed a significant time by group interaction
effect, F(3,96) = 2.781; p<.05. Follow-up tests revealed significant univariate effects for the
Stress subscale, F(1,98)= 6.50, p< .05; and the Anxiety subscale, F(1,98)= 5.89, p<.05; but
not for the Depression subscale, F(1,98)= 1.785, p>.05.
Parenting behaviors
A MANOVA revealed significant multivariate time by group interaction for the
Parenting Scale, F(4,95)= 9.376, p<.001. Follow-up univariate tests showed a significant
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
17
result for the Laxness, F(1,98)= 5.40, p<0.5, Verbosity, F(1,98)= 9.96, p< .05, and
Overreactivity, F(1,98)= 34.62, p<.001 subscales. Follow-up one-way ANOVAs showed a
significant decrease in scores for the intervention group (Laxness, F(1,49)= 13.40, p<0.5;
Overreactivity, F(1,49)= 27.16, p<.001); Verbosity, F(1,49)= 19.44, p<.001), but no change
from pre-intervention to post-intervention for the Waitlist control group on the Laxness,
F(1,49)= 1.22, p >.05 and Verbosity subscale, F(1,49)= .003, p>.05 and a significant increase
of the Overreactivity subscale F(1,49)= 7.63, p<.01.
Parenting efficacy
Repeated ANOVA revealed a significant time by group interaction effect of the
CAPES- Parenting efficacy, F(1,98)= 4.34, p<.001. Follow-up tests showed a significant
change in parenting confidence among the Intervention group, F(1,49)= 24.89, p <.001 at
post-intervention, and no significant change in the Waitlist control group, F(1,49)= 3.23,
p>0.5.
Child's behaviors and emotional adjustment
A MANOVA revealed a significant multivariate time by group interaction effect for
CAPES, F(2,97)= 3.86, p< .05. Follow-up tests revealed a univariate effect for the
Behavioral Problem subscale, F(1,98)= 7.71, p <.01, but not for Emotional Problem subscale
F(1,98)= 2.23, p>.05. This finding indicated a significant decrease of child behavioral
problem but not emotional difficulties within the Intervention.
Child's prosocial behaviors
Repeated measures ANOVA tests showed a significant time by group interaction effect
for the Child's Prosocial Behaviors, F(1,98)= 9.43, p< .01. Follow-up tests revealed a
significant change of child's prosocial behaviors in the Intervention group, F(1,49)= 7.85, p<
.01 but not the Waitlist control group, F(1,49)= 2.120, p >.05.
Client's satisfaction
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
18
Mean scores on all questions were above 5.0 on a 7- point scale with an overall mean
score of M= 5.70, SD=.84. This high score indicated that parents were satisfied with the
program. The two questions specifically designed to ask parents to rate the two components
of the BCA module were also above 5.0 (Taking care of your emotions, M= 5.60, SD= .81;
Building the Co-parenting Alliance, M= 5.47, SD= 1.08) suggesting parents were satisfied
with the usefulness of the program.
*Insert Table 2*
*Insert Table 3*
Long- term effects
Parents- Grandparents Co-parenting Quality
Repeated MANOVA indicated no significant intervention effect between Time 2 and
Time 3 for conflict and cooperation scores (F(2,97)=.286, p>.05). Repeated MANOVA
between Time 1 and Time 3 showed a significant effect of time, F(2,97)= 10.94, p <.001 and
time by group interaction effect, F(2,97)= 5.81, p<.001. Follow up univariate test revealed a
significant difference between the Intervention group and Waitlist control group in term of
Co-parenting Conflict subscale at six months post-intervention, F(1,98)= 7.60, p< .01. No
long-term effect was found for Co-parenting Cooperation subscale, F(1,98)= .076, p>.05.
Communication efficacy
ANOVA repeated measure test indicated no significant change of intervention effect
between Time 2 and Time 3 (F(1,98)= .359, p>.05). When comparing the communication
efficacy score between Time 3 and Time 1 (not between Time 1 and Time 3?), there was a
significant main effect of time, F(1,98)= 58.32, p< .001 but a non-significant time by group
effect, F(1,98)= .493, p>.05, indicating no significant intervention effect of the program on
parents’ communication efficacy at 6-month follow-up.
Self-compassion
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
19
From Time 2 to Time 3, the self-compassion score for the Intervention group declined
slightly from M= 43.50 (SD= 4.82) to M= 42.99 (SD= 4.60) while that of the Waitlist control
group increased from M= 40.72 (SD= 6.90) to M= 42.71 (SD=5.79). The differences between
the two groups across Time 2 and Time 3 were significant F(1,98)=5.48, p<.05. When
comparing Time 3 self-compassion score of two groups to their baseline (Time 1), no
significant time by group interaction effect for Self-Compassion Scale was found, F(1,98) =
4.789, p<.05 indicated there was no intervention effect on self-compassion at six-month
follow-up.
Parental adjustment
Repeated MANOVA tests for DASS-21 subscales revealed no significant time by
group effect between Time 2 to Time 3, (F(3,96)=1.79, p>.05). and no significant time by
group interaction effect between Time 1 Time 3 F(3,96) = 3.99; p>.05. No long-term effect
of the intervention on parental adjustment was evident.
Dysfunctional parenting behaviors
Repeated MANOVA tests for the Parenting Scale found no significant time by group
effect between Time 2 and Time 3, F(3,96)=1.47,p< .05, indicated no significant change in
parenting behaviors between Time 2 and Time 3. Repeated measures MANOVA between
Time 3 and Time 1 revealed significant time by group interaction effect F(3,96)= 5.758,
p<.01. Follow-up analysis found an interaction effect evident in measures of parental
Laxness F(1,49)= 14.09, p< .001; and Overreactivity, F(1,49)= 26.33, p< .001.
Parenting efficacy
No significant time by group effect was found between Time 2 and Time 3, (F(1,98)=
4.276, p> .05). Comparing parenting score between Time 1 and Time 3 also found no time by
group effect (F(1,98)= .75, p> .05), indicated no long term intervention effect for parenting
efficacy.
Child's behaviors and emotional adjustment
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
20
No significant interaction effect was found on child behavior or emotion (F(2,97)= .65,
p>.05) between Time 2 to Time 3. Comparing children' behavior and emotion scores for
Time 3 to Time 1 also revealed no significant time by group interaction effect, F(2,97)=
2.036, p>.05
Child's prosocial behaviors
No significant time by group effect was found between Time 2 and Time 3
(F(1,98)=2.05), p>.05). Meanwhile, a significant time by group interaction effect, F(1,98)=
13.02, p<.001 was revealed on SDQ- Prosocial subscale between Time 3 and Time 1.
Intervention group F(1,49)= 23.85, p<.001 but not the Waitlist control group F(1,49)= .22,
p>.05 indicated a significant improvement in child’ prosocial behaviors at six month follow-
up.
Discussion
This project evaluated the efficacy of a parenting program on establishing a supportive
co-parenting relationship between parents and grandparents in Vietnam. The intervention
results confirmed the primary hypothesis (H1), with significant reductions in parent -
grandparent conflict. This effect continued after six months. This is a novel finding since the
previous GTP study conducted in a similar cultural context did not find improvements in the
parent-grandparent relationship. In this study, we turned the focus of intervention away from
grandparents to the parents as an agent of change. This is because research showed that in the
Asian context, it is not grandparents but parents who usually experience emotional
difficulties in negotiating the co-parenting relationship (Goh, 2006; Li et al., 2020). As a
result, apart from providing parents with strategies to manage their children's behaviors, the
Triple P+ BCA also focus on enhancing parents’ ability to take care of their emotions and
reconsider the relationship from different perspectives, which might have helped them to
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
21
become more appreciative and accepting of grandparents’ involvement, enabling them to deal
with conflict more flexibly.
Contrary to hypothesis (H2) however, we did not find an intervention effect for co-
parenting cooperation. This may be due to the limited timeframe over which the BCA module
is delivered. During the four hours of the module, we focused primarily on increasing parents'
acceptance, which we hoped might lead to parents becoming less critical of grandparents'
behavior, reducing the likelihood of disagreements escalating into conflicts. It is clear,
however, that a reduction in the conflict did not necessarily lead to an improvement in
cooperation. Cooperation may take longer to improve because skills such as non-judgmental
communication may take longer to learn (Kim, Parker, et al., 2020). In addition, we found no
improvement in parent communication efficacy (H3). This may be due to the lack of
sensitivity in the newly developed Communication Efficacy Scale. The Communication
Efficacy Scale was developed for this study to assess parents' communication with
grandparents. While the scale is reliable, it may not be sufficiently sensitive to capture the
early changes in the co-parenting relationship, especially given the relative de-emphasis of
direct or explicit communication in Asian family contexts.
Another objective of our study was to cultivate self-compassion to help parents manage
their emotions better when they interact with grandparents. In line with our prediction (H4),
we observed a significant increase in self-compassion among parents in the intervention
group compared to the control group post-intervention. This result is encouraging as this is
the first time CMT was integrated within an existing evidence-based parenting program. The
significant finding suggests that the integration of CMT may be beneficial in evidence-based
parenting programs seeking to reduce parents’ emotional distress.
As for the secondary hypotheses (H4, H5, H6, H7, H8, and H9), we observed short-
term intervention effects on parenting behaviors (laxness and overreactivity), parental
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
22
adjustment (stress and anxiety symptoms), and child outcomes (behavioral and prosocial).
The short-term effects found in this current study are consistent with previous research in
East and Southeast Asia, which indicates that Triple P can help decrease dysfunctional
parenting practices, improve parental adjustment, and reduce children's behavioral
problems. There was no improvement observed for children emotional difficulties. This
outcome is not surprising considering that Triple P was originally developed as an
intervention program for children with behavioral issues. Its effects are thus more
pronounced for children prone to behavioral problems. A study by Fujiwara et al. (2011) in
Japan found a similar null outcome for children with emotional difficulties. However, it is
worth noting that the children in our sample did not exhibit elevated emotional problems,
with pre-intervention scores being in the normal range, suggesting little improvement was
needed.
For long-term outcomes, the results partly support our hypothesis (H10). At six months,
the intervention continued to have effects on co-parenting conflict, parenting behavior and
the child's prosocial outcome, but not others. This is the first study of the Triple P program to
collect long-term randomized effect data in Asia. An earlier study by Guo et al. (2016)
reported that behavioral problems in young children continued to improve six months after
intervention. In the Guo et al. (2016) study, however, there was no control condition
comparison. Our post-hoc analysis of data showed that the Intervention group improved
across all domains during follow-up. Interestingly, the Waitlist control group also achieved
improvements in a number of other domains (self-compassion, parenting efficacy, parental
stress, and child behavior problems). Consequently, no significant differences were found
between the Intervention and Waitlist control in those domains at six-month follow-up. We
are not entirely certain why the Waitlist control group improved significantly during this six-
month waiting period. It is possible that the parents in the waitlist control group were
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
23
motivated to change and thus may have sought out different methods to help improve their
situation.
Despite those increases in the Waitlist control group, the effects of the intervention
were maintained at six-month follow-up for three critical variables: coparenting conflict,
parenting behaviors, and child's prosocial behavior for the invention group. In particular, the
effect size of prosocial behavior at six-month follow-up was greater than that immediately
following the intervention. This finding is significant as previous research examining Triple P
has not found the same intervention effects for children's prosocial outcomes. In Triple P +
BCA, we aimed to concurrently reduce problematic behaviors and promote positive
behaviors such as empathy, caring, and flexibility within family relationships. Even though
the program was designed to support parents and grandparents' relationships, it may have
created a prosocial modelling effect on their children. One possible explanation for the
increasing of prosocial behaviors in children is that as parents learn to relate to grandparents
positively and healthily, they might have incidentally demonstrated to their children a
constructive way to build relationships and be attentive to others’ needs and emotions.
Another alternative explanation is that as parents went through the program, they learned new
skills to encourage children’s positive behaviors, thus increasing their children’s desirable
pro-sociality. These two explanations are not mutually exclusive.
Parents who took part in the program also reported high levels of program satisfaction,
which is in line with our final hypothesis (H11). When we started the program, 12
participants were unable to start (7 were too busy to attend and 5 were unable to be
contacted). However, all 38 who started session 1 remained in the program throughout,
indicating high levels of program’s engagement.
This study's strengths and findings need to be interpreted within the context of its
limitations. Most of our sample was middle-class, highly educated parents without significant
emotional difficulties. Families in these circumstances might be more responsive to the
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
24
intervention. Families of lower-income, less-educated parents with more adjustment
difficulties may not demonstrate the same level of improvement. Our study targeted parents
as agents of change as they tend to be the most vulnerable in intergenerational co-parenting
relationships. As such, we relied primarily on parents' reports of the parent-grandparent
relationship. Future research may benefit from involving grandparents, since they can provide
insight into whether both sides have experienced improvements. Future interventions could
also examine the potential of having grandparents and parents attend workshops
together. The major problem with such an approach is that criticism, blaming, and controlling
behaviors might be challenging to address with both parties present in the same room.
Alternatively, researchers can consider providing separate relationship-building modules for
parents and grandparents or providing parents with tip sheets that they could share with the
grandparents, a strategy used in the Australian Grandparent Triple P evaluation (Kirby &
Sanders, 2014).
Although we believe that the integration of compassion benefitted the family
relationships, no precise linkage was confirmed in this study. A component analysis or three-
arm trial (Triple P versus Triple P + BCA versus Waitlist control) would be beneficial in
future studies to determine the unique effects of compassion and clarify the mechanisms of
change. Furthermore, in the context of Asia, where the relationship between parents and
grandparents is highly defined by filial piety, the importance of this cultural value could
impact the program’s outcomes. While it was beyond the scope of this study, we recommend
that future work examine the role of filial piety as a possible cultural factor that could
moderate intervention effects.
Future iterations of the program could expand the BCA modules to include other
strategies that aim to promote greater cooperation or mutually beneficial problem-solving.
Research using other Compassion Focused Therapy strategies such as "developing the
compassionate-self” has been tested in different dyads in order to resolve past arguments and
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
25
achieve mutually beneficial outcomes. This exercise involves deliberately contrasting the
thinking about a life difficulty from a natural position to a compassionate-self position. The
compassionate-self position is achieved through a guided 10-minute compassionate mind
training imagery exercise. Results from a previous study (Gilbert & Basran, 2018) have
found it increased participants' ability to be empathic to their difficulties, generate more
insight into their difficulties, feel better able to cope, and feel encouraged about the future.
Although this method has not been tested in the parent-grandparent context, including such
an exercise would be of interest, to see if it could promote cooperation between parents and
grandparents.
In summary, this body of work shows great promise for Vietnamese families and
families in Asian countries in general. Yet we must recognize that as societies change, so do
family relationships. Filial piety might shift over time, and not all Vietnamese/Asian families
will hold the value of filial piety to the same extent. Consequently, practitioners/clinicians
should not make assumptions about family relationships but rather work with families to
determine difficulties and how to best address them. It is imperative that future research
continues to examine the benefits of Triple P plus BCA in other cultural groups where
grandparents also play a vital role in family life, such as in other Asian countries, African or
Mediterranean cultures (Arpino et al., 2014; Barnett, 2008). Furthermore, a pandemic like
COVID-19 may also impose significant changes in family relationships. Because of their age
and high-risk vulnerability factors, and travel restrictions, many grandparents have to
distance themselves from their families, which may result in a decline in grandparental care.
Such physical distance and the uncertainty that comes with the current pandemic may change
both parents' and grandparents' perceptions, allowing them to have a closer relationship.
However, the pandemic can also have a detrimental effect on family relationships. For
example, with children staying home more often during restitution periods (e.g., schooling
from home), parents and grandparents who are co-parenting might be required to reorganize
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
26
their different childcare responsibilities. Consequently, family tension and conflict may be
more likely to occur. This situation illustrates the need for researchers to always be aware of
the changing circumstances families will encounter and keep interventions flexible to best
support families.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
27
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Assessed for eligibility (n= 224)
Excluded (n= 124)
Not meeting inclusion criteria (n=109)
Refuse to participate (n= 15)
Other reasons (n= 0)
Analyzed (Intention to treat n= 50)
Excluded from analysis (n= 0)
Intervention (n= 50)
5)
Waitlist (n= 50)
Analyzed (Intention to treat n= 50)
Excluded from analysis (n= 0)
Post
Pre
Completed PRE assessment (n=50)
Completed PRE assessment (n=50)
Completed POST assessment (n= 44)
Drop-out (n=6: Busy n=2, Unable to contact n=1,
Discontinued intervention n=3)
Completed POST assessment (n= 47)
Drop-out (n=3: Busy n=3)
Completed FOLLOW-UP assessment (n= 35)
Drop-out (n=15: Busy n=3; Discontinued
intervention n=12)
Completed Follow-Up assessment (n=37)
Drop-out (n=13: Discontinued intervention
n= 10, Busy n = 3,)
Follow-up
Analysis
Intervention
Received intervention (n=38)
Did not receive Intervention (n=12: Busy
n=7, unable to contact n=5)
No intervention received (n=50)
Assignment (n=100)
Enrollment
Figure 1. CONSORT diagram showing participants' flow through each stage of the
randomized controlled trial and reasons for drop out.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
33
Table 1
Demographics
Intervention
Waitlist control
Continuous variables
M
SD
M
SD
Parentage
33.56
0.5
33.04
0.6
Child age
4.54
2.32
4.61
2.52
Hours of care by grandparents
39.16
39.38
40.47
40.89
Categorical variables
n
%
n
%
Child gender
Male
30
60
27
54
Female
20
40
23
46
Parent gender
Male
6
12
3
6
Female
44
88
47
94
Parent's education
High school or lower
1
2
1
2
Trade/technical college
0
0
0
0
University degree
32
64
29
58
Postgraduate degree
17
34
20
40
Parent marital status
Married/Defacto
45
90
46
92
Divorce/Separated
4
8
2
4
Widow/er
0
0
0
0
Single
1
2
2
4
Living area
Urban
45
90
44
88
Rural
5
10
6
12
Grandparent relationship
Biological parents
19
38
23
46
In-law
21
42
19
38
Living arrangement
Co-reside
34
68
24
48
Not co-reside
16
32
26
52
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
34
Able to meet expenses
Yes
32
64
37
74
No
18
36
13
26
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
35
Table 2
Short-term effect
Intervention (n = 50)
Waitlist (n = 50)
Time 1
Time 2
Time 1
Time 2
Time 1-Time 2
Variables
M (SD)
M (SD)
M (SD)
M (SD)
F
df
p
d [95% CI]
Co-parenting conflict
71.36 (20.89)
56.51 (19.91)
67.02 (22.04)
63.49 (23.88)
8.672
1, 97
.008*
0.56[0.17, 0.96]
Co-parenting cooperation
28.95 (10.78)
31.56 (9.08)
27.94 (11.70)
29.88 (10.75)
.124
1, 97
.726
0.06[-0.33, 0.45]
Communication efficacy
31.64 (10.13)
43.90 (18.38)
31.52 (16.25)
40.13 (17.85)
1.611
1, 98
.207
0.27[-0.12, 0.66]
Parents' self-compassion
39.83 (7.31)
43.50 (4.81)
39.96 (6.73)
40.72 (6.89)
4.789
1, 98
.031*
0.41[0.02,0.80]
Parental stress
9.34 (5.17)
6.38 (3.57)
8.73 (4.04)
7.96 (4.25)
6.503
1, 96
.015**
0.47[0.08,0.86]
Parental anxiety
5.59 (5.20)
3.47 (3.29)
4.43 (3.40)
4.12 (3.70)
5.890
1, 96
.034*
0.41[0.02,0.80]
Parental depression
5.69 (5.06)
3.68 (3.28)
5.59 (4.04)
4.75 (3.98)
1.785
1, 96
.185
0.25[-0.14,0.64]
Parenting-Laxness
3.35 (0.82)
2.91 (0.71)
3.21(0.68)
3.12 (0.64)
5.404
1.96
.022*
0.46[0.07,0.86]
Parenting-Verbosity
4.19 (0.65)
3.71 (0.61)
4.19(0.69)
4.18 (0.55)
9.959
1, 96
.004**
0.70[0.30,1.09]
Parenting-Overreactivity
3.64 (0.88)
2.96 (0.85)
3.29(0.95)
3.51 (0.97)
34.616
1, 96
.000***
0.37[-0.02,0.76]
Parenting efficacy
114.47(30.24)
128.44(20.64)
118.63 (27.58)
120.04(30.22)
4.340
1, 98
.042*
0.43 [0.44,0.82]
Child Pro-social Behaviors
5.42(2.36)
6.15 (1.99)
5.92 (1.86)
5.59 (2.13)
9.433
1, 98
.003**
0.50[0.10,0.89]
Child Emotional Problems
2.51 (2.30)
1.65 (1.70)
2.39 (2.02)
2.16 (1.84)
2.229
1,97
.139
0.29[-0.10,0.68]
Child Behavior problems
32.25 (9.88)
25.56 (8.82)
30.09 (10.53)
28.74 (11.23)
7.771
1,97
.012**
0.52[0.12,0.91]
Note: Significant level *p<.05, **p<.01, ***p<.001
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
36
Table 3
Long term efficacy
Intervention (n = 50)
Waitlist (n = 50)
Time 1
Time 3
Time 1
Time 3
Variables
M (SD)
M (SD)
M (SD)
M (SD)
F
df
p
d [95% CI]
Co-parenting conflict
71.36(20.89)
57.23(16.25)
67.02(22.04)
62.96(18.69)
7.600
1, 97
.014*
0.51[0.11,0.90]
Co-parenting cooperation
28.95(10.78)
32.5(10.13)
27.94(11.70)
32.12(10.01)
.076
1, 97
.784
-0.06[-0.44,0.33]
Communication efficacy
31.64(10.13)
44.14 (14.84)
31.52(16.25)
41.92(15.28)
.493
1, 98
.484
0.15[-0.24,0.54]
Parents' self-compassion
39.83(7.31)
43.00 (4.60)
39.96(6.73)
42.71(5.79)
0.113
1, 98
.738
0.06[-0.33,0.45]
Parental stress
9.34(5.17)
6.99 (3.45)
8.73(4.04)
7.08(3.52)
0.788
1,96
.377
0.15[-0.24,0.54]
Parental anxiety
5.59(5.20)
3.97 (3.19)
4.43(3.40)
3.45(2.72)
0.668
1, 96
.416
0.14 [-0.24,0.53]
Parental depression
5.69(5.06)
3.79 (3.63)
5.59(4.04)
4.04(2.81)
0.160
1, 96
.690
0.08 [-0.31,0.47]
Parenting-Laxness
3.3(0.82)
2.93 (0.62)
3.21(0.68)
3.11(0.62)
4.535
1, 96
.072
0.42 [0.03,0.81]
Parenting-Verbosity
4.19 (0.65)
3.86 (0.56)
4.19(0.69)
4.10(0.52)
2.609
1, 96
.109
0.36 [-0.04,0.75]
Parenting-Overreactivity
3.64(0.88)
3.04 (0.69)
3.29 (0.95)
3.33(0.80)
15.245
1, 96
.000***
0.69 [0.29,1.09]
Parenting efficacy
114.47(30.24)
135.42(16.42)
118.63(27.58)
134.4(21.02)
0.746
1, 96
.390
0.18[-0.21,0.57]
Child Pro-social Behaviors
5.42(2.36)
7.18(1.77)
5.92(1.86)
6.04(1.88)
13.032
1, 98
.000***
0.77[0.36,1.17]
Child Emotional Problems
2.51(2.30)
1.89(1.37)
2.39(2.02)
1.95(1.44)
0.222
1,97
.638
0.08[-0.31,0.47]
Child Behavior problems
32.25(9.88)
24.30(7.44)
30.09(10.53)
26.13(8.86)
4.008
1,97
.096
0.39[-0.01,0.78]
Note: Significant level *p<.05, **p<.01, ***p<.001
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
37
Appendix A
Description of Group Triple P plus BCA Intervention
Module
Module content
Module 1
Positive Parenting
Parents are introduced to the principles of positive parenting,
methods to keep track of children behaviors and set goals for
change.
Module 2
Helping Children Develop
Parents are introduced to strategies to build positive relationships,
encourage desirable behavior, and teach new skills and behaviors to
children.
Module 3
Managing Misbehavior
Parents are introduced to strategies to manage misbehaviors
Module 4
(BCA Module
Part 1)
Taking care of your emotion
Parents are psycho-educated of humanity's shared experience, de-
shaming and de-personalizing their experience, driving them away
from shaming and blaming.
Parents are introduced to strategies to regulate their emotions and
develop their compassion-self such as Three-circles, Soothing
Breathing Rhythm, Compassionate self- imaginary: Compassionate
letter-writing. These exercises help parents take a wider view
reflecting on their thoughts and feelings and using their
compassionate capacity to balance their unhelpful emotions.
Module 5
(BCA Module
Part 2)
Building Co-parenting Alliance
Parents were asked to reflect on their relationship, identify co-
parenting traps, fears, blocks, and resistances they might
experience; parents also learn to observe the event from the
grandparents' perspective, and then practice formulating a
conversation without judging or demanding, planning for rejection
and compromise.
Module 6
Planning ahead
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
38
Parents are taught to assess for high-risk situations and develop
routines to manage them.
Parents are encouraged to develop a plan to apply the learned skills
in their family environment.
Module 7-10
Telephone Consultation and Program Close
Parents set agenda and discuss the situations they are having. The
practitioner provides support utilizing self-regulatory framework.
Parents are introduced to how to maintain change and identify
future obstacles; the co-parenting relationships are also discussed.
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
39
Appendix B
Correlations between variables
CQC -
Confli
ct
CQ
C -
Coo
pera
tion
CAP
ES -
Emot
ion
CAP
ES-
Beha
vior
SD
Q -
Pros
ocia
l
DAS
S-
Stres
s
DA
SS-
Anx
iety
DAS
S-
Depr
essio
n
PS-
Lax
PS-
Over
reacti
on
PS-
Verbo
sity
CE
CA
PES
-PE
CQC -
Cooperation
-
.748**
CAPES -
Emotion
.201*
-
0.09
4
CAPES-
Behaviour
.339**
-
0.19
2
.387*
*
SDQ -
Prosocial
-.233*
.279
**
-
0.05
8
-
.440*
*
DASS-Stress
.311**
-
0.10
1
.216*
.374*
*
-
0.04
6
DASS- Anxiety
0.195
-
0.03
1
.266*
*
.311*
*
-
0.08
2
.764*
*
DASS-
Depression
.414**
-
.275
**
.202*
.385*
*
-
0.19
3
.816*
*
.725
**
PS- Lax
.276**
-
0.07
7
0.12
3
0.15
5
-
.220
*
.317*
*
.287
**
.248*
PS-
Overreaction
.211*
-
0.12
2
0.16
5
.267*
*
-
0.18
7
.441*
*
.439
**
.483*
*
.244
*
PS- Verbosity
0.088
-
0.04
1
0.12
4
-
0.12
3
0.16
8
0.04
3
0.11
0
0.08
5
.294
**
.269*
*
CE
-
.616**
.608
**
-
0.14
3
-
.220*
0.14
0
-
.245*
-
0.15
8
-
.295*
*
-
0.12
9
-
.206*
0.080
CAPES - PE
-0.162
0.02
8
-
.197*
-
.305*
*
0.05
3
-
.266*
*
-
0.18
5
-
.276*
*
-
.329
**
-
.222*
0.035
.21
8*
PROMOTING PARENTS-GRANDPARENTS RELATIONSHIPS
40
SCS - SF
-
.318**
.224
*
-
.285*
*
-
.364*
*
0.16
4
-
.582*
*
-
.508
**
-
.677*
*
-
0.19
3
-
.513*
*
0.012
.33
5**
.321
**
*. Correlation is significant at the 0.05 level (2-tailed); **. Correlation is significant at the 0.01 level (2-tailed). CQC: Coparenting Quality
Checklist, CAPES; Child Adjustment and Parental Self-efficacy Scale; SDQ: Strength and Difficulties Questionnaires; DASS: Depression
Anxiety Stress Scale-21; PS: Parenting Scale; CE: Communication Efficacy; PE: Parenting Efficacy
Highlights
Triple P + compassion was effective in reducing parent-grandparent conflict.
Parental self-compassion increased post intervention.
Dysfunctional parenting and child behavioral problems decreased post intervention.
Child prosocial behaviors increased steadily post intervention and at follow-up.
Parents reported high levels of program satisfaction.
