Effects of the Mother-Child Education Program on Parenting Stress and Disciplinary Practices Among Refugee and Other Marginalized Communities in Lebanon: A Pilot Randomized Controlled Trial

Abstract

Objective: Few randomized controlled trials (RCTs) have explored the implementation and impact of early childhood parenting education programs in very fragile contexts and humanitarian settings. We tested the effects of a group-based intervention, the MotherÀChild Education Program (MOCEP), on parenting stress and practices among two refugee communities and one other marginalized community in Beirut, Lebanon. Method: A pilot wait-list RCT was conducted to assess the program's impact on maternal, child (average age: 4 years), and dyadic outcomes. A total of 106 motherÀchild dyads were randomly assigned to either the intervention group (n ¼ 53) or the wait-list control group (n ¼ 53). Analysis was conducted by modified intention-to-treat and supplemental analyses through multiple imputation of missing post-intervention data. Results: Forty families (38%) withdrew early from the study. After completing the program, mothers in the intervention group showed a reduction in their harsh parenting practices, as indexed by the Disciplinary Style Questionnaire (Cohen's d ¼ À0.76, 95% CI ¼ À1.24, À0.27) and in their level of parenting stress, as indexed by the Parenting Stress IndexÀShort Form (PSI-SF; Cohen's d ¼ À0.90, 95% CI ¼ À1.39, À0.40). Exploratory but underpowered analyses of dyadic interactions revealed reductions in the PSI were associated with a reduction in harsh parenting after the intervention. However, we did not detect any positive impact on behavioral or emotional outcomes among the children. Conclusion: Our analyses suggest that MOCEP had a positive impact on disciplinary practices and parenting stress in a context of high fragility, but that broader effects on maternal and child outcomes may be dependent on program attendance and the availability of other services. We discuss implications of this pilot study for practice and research of a largely unexplored area of program evaluation. Clinical trial registration information: Mother and Child Education Program in Palestinian Refugee Camps; https://clinicaltrials.gov; NCT02402556.

Implementation Evaluation of the Mother‐Child Education Program Among Refugee and Other Vulnerable Communities in Lebanon

“…Mothers also consistently noted a positive relationship with the trainers, across all sites, and, in many instances, the mothers established groups in social networking and communication apps/programs (e.g., WhatsApp) so that they could continue to connect with one another following the completion of the study. The statistical significance of the changes across these parenting domains and behaviors were quantitatively assessed in the outcomes of the RCT, and, as noted above, the results were much more promising among those mothers who participated in 14 or more of the 25 sessions (Ponguta et al., under review).…”

“…From a fidelity perspective, in the context of Lebanon, there were several challenges to the quality of the program: (1) adherence (length of the program, frequency of sessions, and adherence to delivery of CTP content), (2) structural challenges (need to find reliable and efficient care for children during the sessions, and ensuring proper physical conditions and availability of materials), and (3) process considerations (addressing stressors that affect the daily lives of the mothers and their families). Despite these challenges, our analysis shows that MOCEP has an impact on key domains of parental practices—notably, a decrease in harsh disciplinary practices (Ponguta et al., under review). The RCT was crucial in robustly assessing these impacts.…”

“…Although this may have contributed to retaining some participants, the effect that changes to the weekly delivery had on participation and on the program's impact is yet to be determined. In addition, it is clear that the positive impact of the program was significantly greater for the mothers attending 14 or more of the 25 sessions (Ponguta et al., under review). Therefore, exploring the effect of reducing the number of sessions, as well as the frequency of delivery, is an important area for future research.…”

“…For instance, both the qualitative and quantitative analyses signaled positive changes in the way in which mothers engaged with children in the home to support their learning. They also showed a reduction in harsh disciplinary practices (Ponguta et al., under review). This is in line with research in diverse cultural contexts, noting positive changes to parental practices in response to targeted parenting interventions (De Graaf, Speetjens, Smit, de Wolff, & Tavecchio, ; Wittkowski, Dowling, & Smith, ).…”

“…These findings were most robust for mothers who attended 14 or more of the 25 training sessions. A full presentation of the results is reported elsewhere (Ponguta et al., under review). Here, we report on the processes of implementing MOCEP and applying an RCT to assess its impact on participating children, mothers, and families.…”