Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa

Abstract

ObjectiveTo assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices.DesignPragmatic cluster randomised controlled trial.Setting40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.Participants552 families reporting conflict with their adolescents (aged 10–18).InterventionIntervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.Main outcome measuresPrimary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible.ResultsAt 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.ConclusionsThis parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.Trial registration numberPan-African Clinical Trials Registry PACTR201507001119966.

A Systematic Review of the Evidence for Family and Parenting Interventions in Low- and Middle-Income Countries: Child and Youth Mental Health Outcomes

“…11 studies reported on conducting the intervention in the community's mother tongue. No between-group difference, but significant improvement for treatment group over time i Secondary analysis showed increased attention was significant to improvement for treatment group j Treatment group decline expressions, and examples (Annan et al 2016;Bhana et al 2014;Cluver et al 2016;Cluver et al 2018;Eloff et al 2014;Li et al 2014;Maalouf and Campello 2014;O'Callaghan et al 2014;O'Donnell et al 2014;Rochat et al 2015;Smith Fawzi et al 2012).…”

“…Of the total of 32 studies in the review, 28 intervention protocols were coded from studies which showed a positive effect for child or youth mental health and wellbeing outcomes in LMICs (Chorpita et al 2005). In three cases, identical intervention manuals were used in multiple studies, and were only included once Cluver et al 2016;Cluver et al 2018;Li et al 2017;Li et al 2014). One study only showed intervention effects in HICs (though LMICs were included in the study (Davis et al 2005;Puura et al 2012) and therefore this intervention manual was not included in the coding process).…”

Exposure to violence, teacher support, and school delay amongst adolescents in South Africa

“…The current investigation was part of the Sinovuyo Teen study: a randomized control trial (RCT) evaluating the effectiveness of a parenting programme in reducing child abuse and harsh parenting in severely disadvantaged communities in the Eastern Cape, South Africa (Cluver et al ., ). Study participants were adolescents aged 10 to 18 who were recruited alongside their main caregivers to take part in a parenting programme trial.…”

Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model

“…Free access to education, school feeding and books at primary and secondary school level may be an important part of an HIV prevention package for adolescent girls in South Africa. Previous research has focused on single provisions such as grants to alleviate poverty, access to education to reduce risk behaviour, or parenting to reduce abuse and improve adolescent mental health . In recent years, research focus has shifted to combination interventions of “cash and care”, in the form of grants combined with parenting.…”