Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice

Abstract

Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.

Me and My New World

“…Thus, the dual emphasis on academic achievement and better capacities to improve relationships and avoid health risks seems to be a viable way to approach parents in future interventions. This finding is also in line with recent evidence in Panama and other low and middle income countries that showed high acceptability by parents of programs reducing health risk behaviors of their children (Baumann et al, 2019;Mejia et al, 2015).…”

Reframing implementation science to address inequities in healthcare delivery

“…Given the reality that vulnerable populations tend to be absent from clinical trials, implementation scientists need to examine where the populations from our implementation trials are, where they are served, and who is providing services to them. For example, conducting studies in non-traditional settings, such as faith communities, family resource agencies, barbershops, and community centers, can increase reach because vulnerable populations may not go to traditional healthcare settings due to stigma, mistrust and discrimination [30,[34][35][36][37]. Implementation and health inequity researchers should aspire to conduct studies that mirror the context of vulnerable populations.…”

“…Community-based participatory research (CBPR) is one approach that focuses on fostering partnerships between stakeholders by capitalizing on their shared and local knowledge, wisdom, and expertise [44]. CBPR helps to: (a) contextualize interventions to the realities and conditions of specific communities and settings; (b) integrate social and cultural values, perspectives, and norms into the development and implementation of interventions to enhance their relevance, acceptability, and effectiveness; and (c) build capacities of stakeholders to produce community-engaged research and practices critical for reducing inequities in healthcare [37,45,46]. Hopefully these methodologies will help develop interventions that are meaningful and more effective for vulnerable populations.…”

A Multi-Sectoral Approach Improves Early Child Development in a Disadvantaged Community in Peru: Role of Community Gardens, Nutrition Workshops and Enhanced Caregiver-Child Interaction: Project “Wawa Illari”

“…The fundamentals of participatory research were critical to the implementation of this multi-sectorial study. The bidirectional communication between high-and low/medium-income countries through our project ensured that our research was grounded in social justice (41). Consistent with participatory research, our project focused on the mutual learning relationship between the international and local project team, the nurses, and the CHPs.…”