Parenting for Lifelong Health for Young Children: a randomized controlled trial of a parenting program in South Africa to prevent harsh parenting and child conduct problems

Abstract

Background Parenting programs suitable for delivery at scale in low‐resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low‐cost 12‐session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2–9. Methods Two hundred and ninety‐six caregivers, whose children showed clinical levels of conduct problems (Eyberg Child Behavior Inventory Problem Score, >15), were randomly assigned using a 1:1 ratio to intervention or control groups. At t0, and at 4–5 months (t1) and 17 months (t2) after randomization, research assistants blind to group assignment assessed (through caregiver self‐report and structured observation) 11 primary outcomes: positive parenting, harsh parenting, and child behavior; four secondary outcomes: parenting stress, caregiver depression, poor monitoring/supervision, and social support. Trial registration: ClinicalTrials.gov (NCT02165371); Pan African Clinical Trial Registry (PACTR201402000755243); Violence Prevention Trials Register (http://www.preventviolence.info/Trials?ID=24). Results Caregivers attended on average 8.4 sessions. After adjustment for 30 comparisons, strongest results were as follows: at t1, frequency of self‐reported positive parenting strategies (10% higher in the intervention group, p = .003), observed positive parenting (39% higher in the intervention group, p = .003), and observed positive child behavior (11% higher in the intervention group, p = .003); at t2, both observed positive parenting and observed positive child behavior were higher in the intervention group (24%, p = .003; and 17%, p = .003, respectively). Results with p‐values < .05 prior to adjustment were as follows: At t1, the intervention group self‐reported 11% fewer child problem behaviors, 20% fewer problems with implementing positive parenting strategies, and less physical and psychological discipline (28% and 14% less, respectively). There were indications that caregivers reported 20% less depression but 7% more parenting stress at t1. Group differences were nonsignificant for observed negative child behavior, and caregiver‐reported child behavior, poor monitoring or supervision, and caregiver social support. Conclusions PLH for Young Children shows promise for increasing positive parenting and reducing harsh parenting.

Commentary: Do we need new parenting programmes for different cultural groups or should we adapt those that already exist: a commentary on Ward et al. (2019)

“…The exciting thing about this programme by Ward et al () is that the elements included as strategies/processes of change are very similar to those highlighted as effective in existing programmes used in HIC [see Figure (Lachman et al, ) diagram below]. This is encouraging to our understanding of programme effectiveness at the individual level.…”

“…In this issue of the JCPP, Ward et al () explore the problems around design and implementation of behaviour interventions in the context of preventing child maltreatment. This intervention, the Sinovuyo Caring Family Programme, has been developed with the United Nation Sustainable Development Goal (SDG) in mind: to end all violence against children in MLICs.…”

“…Ward et al () appear to have gone through a very thorough process to produce a programme that, from the results, appears to engage parents and maintain their engagement, is feasible to deliver in a complex culture and target a population with high needs. The results are promising.…”

“…This is encouraging to our understanding of programme effectiveness at the individual level. Ward et al () mention that they provided weekly supervision and that video tapes of group delivery were used in that supervision to standardize delivery, address implementation problems and communicate treatment fidelity as intended by the creators of the programme. They also indicated that analysis of the videos to back up checklist self‐reported delivery of the content by therapists would be an important next step.…”

Community‐Based Caregiver and Family Interventions to Support the Mental Health of Orphans and Vulnerable Children: Review and Future Directions

“…We focus on these areas in order to synthesize patterns and identify gaps in existing community-based caregiver-and family-based mental health promotion interventions for OVC. (Bell et al, 2008;Bhana et al, 2014;Eloff et al, 2014;Puffer et al, 2016;Ward et al, 2019), relative to zero identified by reviews a decade ago (King, De Silva, Stein, & Patel, 2009;Schenk, 2009). With Schenk (2009), we acknowledge that due to ethical and practical challenges, randomization is not always possible in low-resource settings and quasiexperimental including a control group (but not randomized) is a recommended option in that case.…”