Learning from Parents How to Co-Design Family Research

There are many different constructs of Early Relational Health (ERH), including bonding, attachment, and maternal sensitivity. But so far, every measurable construct we have was developed by scientists. That begs the question: what aren’t we seeing? What might we learn about early relationships by listening deeply to families? 

That’s why we co-design ERH research with parents: to develop untapped ways of understanding early relationships, make our data as actionable as possible, and see what new ERH constructs we might discover. Our latest findings come from a study we co-designed with Parent Leaders from Reach Out and Read and the Family Network Collaborative, aimed at deeply understanding parents’ firsthand experiences of their relationships with their children. In other words: what does “Early Relational Health” mean to families in the real world? 

Three of those Parent Leaders, Tiffany Solonom, Deepa Srinivasavaradan, and Steven Thibert, (all of whom co-authored the study) sat down with the study’s lead scientist, Andréane Lavallée, PhD, for a webinar diving into their co-design process. Moderated by David Willis, MD, FAAP, founder and director of ERH field catalyst Nurture Connection, the conversation delved into their collaborative success: how they made it work together, what they’ve learned so far, and what’s next for this exciting science — plus, a first look at our emerging findings on how parents view Early Relational Health.

Learning how to co-design highly accurate research together

 

Study Timeline: 2024 – 2026

This is how the study was designed  

 

“We spent months on this high-level analysis,” says lead scientist Andréane Lavallée, PhD, Principal Investigator of the Center’s Interpersonal Synchrony and Connection (InSynC) lab. “My team was really proud of the work we’d done, and we were so excited to show the Parent Leaders our results.” But after presenting their findings, the team was met with a surprising response: you got it wrong. 

There are two pervasive challenges in qualitative research that our team and the Parent Leaders successfully overcame together. The first is that study participants often feel a need to over-report what they think researchers will see as “good” behaviors and under-report what they fear will be seen as “bad.” This social desirability bias can skew results, leading to data that doesn’t quite get to the heart of participants’ experiences. 

That’s why we designed this particular study to gather real-world data in an unusually relational way: first, we co-designed a survey with Parent Leaders from across the U.S. to make sure we were asking questions that are really relevant to today’s families, and using language that families use in their own homes (what the Parent Leaders call “living room language”). 

Typically, a study like this would have the scientists interviewing the families directly. But to reduce social desirability bias, the Parent Leaders used the co-designed surveys to interview members of their own communities — rather than families being interviewed by scientists they didn’t know. To ensure complete accuracy, the Parent Leaders then transcribed the interviews themselves, and finally, after removing all identifying information, sent the transcripts to Center for Early Relational Health scientists for analysis. 

“When the analysis was originally presented… the essence didn’t quite feel right,” recalled Steven Thibert, a Parent Leader from Washington state who came to the study through Nurture Connection’s unique Family Network Collaborative, a group of 66 Parent Leaders in regions across the country. “It was more focused on the current relationship of that parent and child, and [one] thing that really came out was: the parents felt strongly that the history of our relationships with our own parents was deeply influential on the current relationship… it was really the healing of the past that allowed for growth to happen, for most of the parents that were interviewed.”

Because qualitative analysis is time-intensive, it’s important to focus analysis resources on relevant portions of data; and since the study’s focus was on connection within the parent-child relationship, the scientists had initially analyzed the sections of the transcripts where the parent was describing their current relationship with their child. But the Parent Leaders’ push-back showed the scientists that they needed to include more context from the transcripts: from the parent’s own childhood experiences, to stressors on their connection with their children now.

This process of showing results to parents to confirm accuracy is called “member checking,” and it introduces the second key challenge in qualitative research:

Making sure everyone has a seat at the table

Normally, member checking happens directly between the scientists and the interviewees; but as Andréane says, “when researchers member-check with study participants, there is an inherent dynamic that can cause us to sort of miss the point. We want honest feedback, but the structure of research doesn’t necessarily create an environment where people feel comfortable pushing back.” 

Creating that environment is admittedly hard to do under normal circumstances, because to get accurate results, research participants have to be somewhat blinded to a study’s goals and methods. But in this case, we had the unique opportunity to member-check with the Parent Leaders, who had in-depth perspective on what all of these many families had said and felt during those interviews. 

Because the Parent Leaders were truly partners in co-designing this research from the start, they became full authors on the paper for this study. Shifting the dynamic such that everyone was on the same playing field allowed us to gather highly accurate data, not only because the Parent Leaders represent a wide range of families but because, as co-designers and co-authors, they felt they could give us honest feedback. 

“We knew [the research team] did hard work!” said Tiffany Solomon, a mom of three from North Carolina who got into research when her Reach Out and Read pediatrician said she’d make a great Parent Leader. “When [they] received [our] reflection[s] and went back to re-analyze… that was super, super impactful for me, as far as knowing that my work mattered in this process.”

This is a crucial part of making co-design really work, and will ultimately allow us to better meet families’ needs. Very few studies truly embed parent voice from the start, let alone include parents across the country. Many Parent Leaders noted differences in what “connection” meant across caregivers, how it varied between families and communities. Accurately consolidating that broad spectrum of experience into concrete scientific data is a challenging task, but an important one to get right — because families are the ones who will actually use this information. The ultimate goal for this science is developing tools that parents can use, together with their baby’s doctor, to help build strong parent-child relationships from the start. So we can’t just build these tools with parents in mind — it’s essential that we actively involve them in all stages of research, to make sure the tools we develop are based on science that really accurately speaks to their experiences and perspectives.

Study Timeline 2

This is how the study changed, based on Parent Leader input

 

“I’m so thankful that we were able to create this collaborative environment where everyone felt comfortable sharing,” Andréane said. “I remember looking at my team and saying, ‘Yep, we gotta do it all over again. We got it wrong.’ That was an incredible learning experience, both from a research perspective, but also a human-to-human perspective: how we can share our expertise and collaborate to really come up with something that’s representative of all the voices.”

When the scientists presented the second round of analysis, the Parent Leaders were thrilled with the accuracy. It really encapsulated the words and experiences of all families they’d interviewed, and turned out to be fertile ground for exciting scientific findings. 

So what did the study actually find about Early Relational Health in today’s families?

Thanks to the Parent Leaders’ feedback and involvement, this exciting study led the team to accomplish a long-held goal: identifying a new ERH construct anchored in parent voice. 

Together, we coined this construct relational legacy. But how did we find this exciting new construct? 

This particular qualitative study aimed to identify a core set of principles that families across the U.S. feel define early parent-child connection. We looked for unifying themes in their descriptions, and then worked together with the Parent Leaders to refine the language, framing, and emphasis of each principle, to really reflect the families’ expressions of their experiences. 

Here are the 6 principles of connection we found, shaped by the parents’ own words:

  1. Parent-child connection begins with an instinctual sense of responsibility
  2. From this foundation, connection builds as a dynamic process that ebbs and flows
  3. Family circumstances directly shape this connection
  4. Parents’ own upbringing and past relationships indirectly shape how they connect with their child
  5. For connection to grow, parents must show up physically and emotionally, even when other demands compete for their attention
  6. Over time, parents grow from parenting, and that growth feeds back into their connection

The sixth of these principles is what led us to uncover relational legacy: the idea that parents grow from parenting (in part by choosing what they carry from their own upbringing into the relationship they’re currently building with their child), and that growth feeds back into their connection.

Relational legacy creates a cycle that helps parents both grow as individuals and become better parents, which in turn feeds back into the relationship with their child. “This was actually my favorite finding,” Andréane shared, “because it’s the perfect illustration of why the co-design process was so important, and why we need to continue moving it forward. Without the humility to collaborate and join expertise, we would have missed that finding entirely. And this novel construct actually opens the door to many more important questions about how we talk about relationships and relational health, and how we measure relational health in different ways. That, to me, is really the essence of collaborative research: a huge achievement we could only arrive at together.”

“From co-designing the questions, to creating the interview protocols, to identifying parents to participate in the interview, and then to be able to ask those same questions that we co-created — it was really a very meaningful process,” said Deepa Srinivasavaradan, a Parent Leader from New Jersey who also came to this work through our partners at Reach Out and Read. “It really helped me get a deeper understanding of how [parents’] childhood experiences and relationships can impact the relationship that they have with their children [now]. We have all, as parents, probably experienced some of this. But to hear it from other parents in their own words, and in all the different ways that those relationships and experiences have shaped how they parent, I think was really the highlight for me.”

What does it mean to discover a new construct of Early Relational Health?

The implications of this new construct are crucial, as we look at connection across the lifespan. The Center for Early Relational Health is building the scientific evidence base for the field of ERH, with a core focus on how each ERH construct shapes lifelong development and health outcomes. We’re starting to see some important impacts of existing constructs: 

Bonding, for example, correlates with fewer symptoms of postpartum depression in moms, and more optimal child development at 6 months, 18 months, and 2-3 years of age. Now, we have an opportunity to develop ways to study a construct born directly out of families’ own experiences. What impacts might relational legacy have on a parent’s mental well-being or cardiac health, for example? How might it shape a child’s school readiness or future brain function? 

These exciting questions can only be answered with scientific evidence. And this kind of rigorous research is exactly what gets us to the kind of evidence the field needs to develop strengths-based interventions that can be embedded into universal pediatric care.

“When I reflect on this process, it’s kind of scary to me how we, as a field, could have missed all these nuances in the past research that’s been done without this co-design and bringing in parent voices,” Andréane shared. “As an academic scientist, I’ve always been aware of the importance of co-designing research with what we call ‘end users’ (in our case, parents). We learn it at school, theoretically, but this was my first opportunity to experience it. It was a learning experience from a science perspective and really made me a bit more humble. It changed my lens and how I view the potential for collaboration and co-design, from building the research all the way to the results.”

“There are many [things] that make this work challenging,” replied moderator David Willis, “yet we at Nurture Connection believe deeply in making it visible across research communities.” This is why we partner with networks like Nurture Connection and Reach Out and Read — to help ensure our multidisciplinary research really listens to both scientists and parents, to ultimately reach the families and doctors who need it most.

What’s next for this innovative collaboration?

“I’ve always advocated for parents to be part of the small and big decision-making tables,” said Deepa. “So not only do I, as a Parent Leader, want to continue to move forward with the next phase of this project, or other future projects, to see where this research goes. But I also want to support other parents [to] participate meaningfully in research projects — not just as participants, but as co-designers.”

“The six of us were personally valued in this research process,” Tiffany reflected. “I feel like I’m becoming a parent expert of these conversations, and that really gives me this space to kind of go and recruit and find these other parents and say, ‘Your voice matters, here’s why. I can show it to you. I can prove it to you.’”

“It’s really exciting, the prospect of where this type of research can go,” added Steven.” It just struck me as such a unique way to conduct research, and I think we got some amazing results.”

The future of ERH science that makes an impact is partnership between researchers and the communities they aim to serve. By embedding parent voices into the way we study early relationships, we can get to findings that speak directly to families’ experiences. And with evidence, we can begin to co-develop interventions that truly meet these families’ needs. This is how we turn research into action. Uncovering these new ways of looking at early relationships propels the field forward, bringing us one vital step closer to transforming pediatric care for every family across the country.

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