Process Evaluation of a Parenting Program for Low-Income Families in South Africa

Lachman, Jamie M.; Kelly, Jane; Cluver, Lucie; Ward, Catherine L.; Hutchings, Judy; Gardner, Frances

doi:10.1177/1049731516645665

Cited by 38 publications

(42 citation statements)

References 55 publications

(60 reference statements)

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“…There is some evidence suggesting that monitoring implementation can boost its quality. Hence, implementation quality may be lower, if it is not monitored (Lachman et al 2016). For instance, a review of 59 mentoring studies found that programs that monitored implementation had three times higher average effect sizes than programs without monitoring (DuBois et al 2002).…”

Section: Discussionmentioning

confidence: 99%

Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes

et al. 2019

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Objectives Previous studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low-and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings. Methods This study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomesparenting and maltreatment reported by caregivers and adolescents aged 10-18 (N = 270 pairs), 14 outcome constructs. Results Fidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01). Conclusions Our study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.

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Section: Discussionmentioning

confidence: 99%

Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes

et al. 2019

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“…The program was tested in a pilot RCT, which suggested that although the program had promise, revisions might strengthen its impact and feasibility (Lachman, Cluver, et al., ; Lachman et al., ). Content on positive reinforcement and discipline was subsequently refined, and additional training was provided to facilitators to strengthen competency in the collaborative process and in understanding social learning theory.…”

Section: Introductionmentioning

confidence: 99%

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

Ward

Wessels

Lachman

et al. 2019

Child Psychology Psychiatry

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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.

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“…Table 1 shows the content and structure of each program. PLH for Young Children and PLH for Adolescents provide some of the most promising evidence of parenting program effectiveness in LMICs (Cluver et al, 2018;Cluver et al, 2016;Lachman et al, 2017;Lachman et al, 2018a;Ward et al, 2020). One of the first countries implementing these programs as part of routine service delivery is South Sudan.…”

Section: The Parenting For Lifelong Health Programsmentioning

confidence: 99%

Transferability of Evidence-Based Parenting Programs to Routine Implementation in Postconflict South Sudan

Janowski

Wessels

Bojo

et al. 2020

Research on Social Work Practice

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Purpose: This study investigated process and outcomes of the Parenting for Lifelong Health (PLH) for Young Children and for Adolescents programs implemented as part of routine service delivery in postconflict settings. Methods: These group-based programs were delivered by trained facilitators to 97 caregivers (PLH for Young Children) and 108 caregiver–adolescent dyads (PLH for Adolescents) over 12 or 14 (respectively) weekly sessions. Routine monitoring data were collected by the implementing partners using standardized self-report measures. Reducing harsh discipline was specified as the primary outcome, with secondary outcomes including improvements in positive parenting and reductions in poor parental supervision and parental inefficacy. Results: Analyses were intention to treat. Both PLH programs retained effectiveness in routine conditions in a postwar setting, with moderate to large effect sizes. The programs also had high enrollment and attendance rates, indicating high acceptability. Conclusions: Findings suggest promising viability for the implementation of evidence-based parenting programs in challenging postconflict contexts.

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Process Evaluation of a Parenting Program for Low-Income Families in South Africa

Cited by 38 publications

References 55 publications

Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes

Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes

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

Transferability of Evidence-Based Parenting Programs to Routine Implementation in Postconflict South Sudan

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