The reflective component of the Mellow Bumps parenting intervention: Implementation, engagement and mechanisms of change

Understanding why parenting programmes work or do not work, and for whom, is crucial for development of more effective parenting interventions. In this paper we focus on a specific component of Mellow Bumps: reflection on one’s own childhood/past/life. We explore how this component was implemented, how participants engaged with it, the facilitating and constraining factors shaping this, whether and how it appeared to work, or not, and for whom. The paper analyses data from the Process Evaluation of the Trial of Healthy Relationships Initiatives for the Very Early years, which is evaluating two antenatal interventions delivered to vulnerable women, one of which is Mellow Bumps. Data were collected from January 2014 to June 2018 for 28 groups, 108 participants and 24 facilitators in a comprehensive and rigorous Process Evaluation designed to complement the Outcome Evaluation. Data were gathered at various time points using multiple methods, and were synthesised to triangulate findings. The reflective component was implemented with fidelity and participants engaged with it to varying degrees, dependent largely on the coherence of the group. Patchy attendance compromised the coherence of some groups, with the development of rapport, which is key to delivering reflective exercises, more difficult when group composition varied from week to week. Where there was a coherent group, powerful mechanisms of change, leading to stress reduction, included: relief through unburdening, empowerment through support given and received, reduced isolation through sharing anxieties, and control through self-care advice. A minority of highly vulnerable mothers seemed not to benefit from the reflective exercises and were marginalised within their groups. In order to minimise potential harmful effects of such exercises, allocation of participants to groups should strive to maximise group homogeneity. More research is needed to explore how very vulnerable parents can be supported in attending parenting interventions from start to finish

A realist process evaluation of Enhanced Triple P for Baby and Mellow Bumps, within a Trial of Healthy Relationship Initiatives for the Very Early years (THRIVE): study protocol for a randomized controlled trial

Background: THRIVE is a three-arm randomised controlled trial (RCT) that aims to evaluate whether antenatal and early postnatal interventions, Enhanced Triple B for Baby (ETPB) plus care as usual (CAU) or Mellow Bumps (MB) plus CAU (versus CAU alone), can: 1) improve the mental health and well-being of pregnant women with complex health and social care needs; 2) improve mother-infant bonding and interaction; 3) reduce child maltreatment; and 4) improve child language acquisition. This paper focuses on THRIVE’s realist process evaluation, which is carefully monitoring what is happening in the RCT. Methods: Realistic evaluation provides the theoretical rationale for the process evaluation. We question: 1) how faithfully are MB and ETPB implemented? 2) What are the mechanisms by which they work, if they do, and who do they work for and how? 3) What contextual factors are necessary for the programmes to function, or might prevent them functioning? The mixed-methods design includes quantitative measures, which are pre- and post-training/intervention questionnaires for facilitators and mothers-to-be, and post-session evaluation forms. Qualitative data collection methods include participant observation of facilitator training and the delivery of a series of antenatal sessions in selected intervention groups (n = 3 for ETPB and n = 3 for MB), semi-structured interviews with facilitators, pregnant women, partners, and referring facilitators, and telephone interviews examining the content of the postnatal components of ETPB and MB. Discussion: The findings of this process evaluation will help researchers and decision makers interpret the outcomes of THRIVE. It will provide a greater understanding of: how the interventions work (if they do); the extent and quality of their implementation; contextual factors facilitating and constraining intervention functioning; variations in response within and between subgroups of vulnerable parents; and benefits or unintended consequences of either intervention. Few studies to date have published detailed research protocols illustrating how realist process evaluation is designed and conducted as an integral part of a randomised controlled trial

Race and subtype differences in the replication of previously identified breast cancer susceptibility loci: A Bayesian approach

Over the last twenty-five years, researchers have identified several dozen genetic polymorphisms associated with breast cancer susceptibility. While many of these loci are now considered well-established risk factors for the disease, previous attempts to replicate variant-disease associations in African Americans or to identify subtype-specific risk variants have been imprecise and inconsistent. I examined the association between breast cancer subtypes and previously established candidate gene and genome-wide association study hits among white and African American women in the Carolina Breast Cancer Study. Maximum likelihood and Bayesian methods were used to estimate race and subtype-specific odds ratios (ORs) for each of 83 candidate single nucleotide polymorphisms (SNPs). Selected SNPs included several previous GWAS hits (n=22), near-GWAS hits (n=19), otherwise well-established risk loci (n=5), or SNPs in the same gene as another selected variant (n=37). Subtypes were defined using 5 immunohistochemical markers: estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptors 1 and 2 (HER1/2) and cytokeratin (CK) 5/6. Eighteen GWAS-identified SNPs successfully replicated in whites and ten GWAS-identified SNPs successfully replicated in African Americans. SNPs in FGFR2 and TNRC9/TOX3 were strongly associated with breast cancer in both races. Additionally, SNPs in MRPS30, MAP3K1, CDKN2A/B, ZM1Z1, LSP1, H19, and TP53 were associated with breast cancer in whites and SNPs in TLR1, ESR1, and H19 were associated with breast cancer in African Americans. Several SNPs in TNRC9/TOX3 were associated with luminal A (ER/PR+, HER2-) or basal-like disease (ER-, PR-, HER2-, HER1 or CK 5/6+), and one SNP (rs3104746) was associated with both. SNPs in FGFR2 were associated with luminal A, luminal B (ER/PR+, HER2+), and HER2+/ER-, but not basal-like disease. There were also subtype differences in the effects of SNPs in 2q35, 4p, TLR1, MAP3K1, ESR1, CDKN2A/B, ANKRD16, and ZM1Z1. These analyses provide precise, well-informed race and subtype-stratified ORs for several key breast cancer-related SNPs. These results also demonstrate the utility of Bayesian methods in genetic epidemiology and provide evidence of subtype-specific etiologies. This work may help to identify specific causal variants, locate targets for research on directed therapies, and identify high-risk individuals.Doctor of Philosoph

Pandemic impacts on Family Lives and Parental Wellbeing: Families in Tower Hamlets survey and panel findings

Families in Tower Hamlets was a study of 992 parents and parents to be during the Covid-19 pandemic. This briefing is one of five papers, summarizing findings in relation to families lives and wellbeing

Work, income and food insecurity: Families in Tower Hamlets community survey and panel findings

Summarizes findings from a survey and panel of families in Tower Hamlets in relation to work and insecurit

Young children's lives during the pandemic: Families in Tower Hamlets survey and panel findings

Young children were not in focus during the Covid-19 pandemic. This briefing summarises results from a study of the impacts of Covid-19 on families with young children in one east London borough. Young children's lives were dramatically curtailed. Analyses by ethnic group and household income show that some children were more disadvantaged than others

Access to community services and support through family and friends during the pandemic: Families in Tower Hamlets survey and panel findings

Summarises findings of a survey and panel of ESRC funded Families in Tower Hamlets, services and communitie

Exploring the classroom practices that may enable a compassionate approach to financial literacy education

From an early age, children are faced with financial dilemmas and are expected to make effective financial decisions about money. In this paper, we explore the classroom practices that may enable a compassionate approach to financial literacy education. We observed an inquiry-based mathematics lesson in a Year 4 primary school classroom. The financial maths task asked students to decide on the best fundraising option for the school. We used the theory of practice architectures to analyse the interactions in the classroom in order to understand what may have enabled and constrained classroom practices. We found that classroom practices such as engaging with peers through positive and collaborative learning opportunities, making ethical, social and mathematical connections of the task, and considering the impact of financial decisions on others may enable a compassionate approach to financial literacy education