The effectiveness of parenting interventions in reducing violence against children in humanitarian settings in low- and middle-income countries: A systematic review and meta-analysis

Effectiveness of a universal film intervention in reducing violence against children and increasing positive parenting among migrant and displaced caregivers from Myanmar: a community-based cluster randomised trial

Background

Parenting interventions have been shown to reduce violence against children and promote positive parenting, but evidence on interventions to achieve population-level reach and impact is limited in low-resource settings. We assessed the impact of a universal film intervention for migrant and displaced caregivers from Myanmar living in Thailand.

Methods

We implemented a two-arm, cluster randomised trial in Tak province, Thailand, on the border with Myanmar. 44 communities were stratified by district and randomly allocated to intervention or control (1:1) using a computer-generated list of random numbers. Intervention group participants received a screening of a 66-min narrative drama film about parenting, followed by a 30-40-min discussion and a 5-min video and poster summarising key messages. Control group participants received information about local health and social services. Eligible participants were primary caregivers aged 18 years or older with a child aged 4-17 years at enrolment. Participants were surveyed at baseline, endline approximately 4 weeks post-intervention, and follow-up approximately 4 months post-intervention. Primary outcomes were caregiver self-reported use of physical and psychological violence and positive parenting, analysed using both imputed and non-imputed multilevel models estimating differences between study arms at endline and follow-up. Due to the nature of the intervention, participants and assessors were not masked. The trial was prospectively registered with Thai Clinical Trials Registry TCTR20230222005.

Findings

Between February and June 2023, 2249 participants in 44 communities completed baseline assessments and were randomly assigned to intervention (n = 1116) and control (n = 1133). 2023 caregivers (n = 998 in intervention and n = 1025 in control) completed the four-week endline survey and 1909 caregivers (n = 961 in intervention and n = 948 in control) completed the four-month follow-up. Intention to treat analyses showed the intervention reduced physical violence (IRR 0.91, 95% CI 0.85-0.97) and increased positive parenting (β 0.46, 95% CI -0.03 to 0.95). No meaningful differences were observed for psychological violence between intervention and control groups, with imprecisely estimated effects close to zero (β 0.47, 95% CI -0.62 to 1.57). Small effects were observed for the secondary and exploratory outcomes of parenting knowledge, belief in the need for harsh punishment, engagement in early learning, family functioning, and social support. Subgroup analyses suggest that the intervention may be more effective at reducing physical violence among female caregivers and caregivers of female children and younger children. There were no reported adverse effects.

Interpretation

Universal parenting interventions using a film-based entertainment-education approach can effectively reduce physical violence against children and increase positive parenting, with potential for scalability in low-resource settings.

Funding

This study is part of the Global Parenting Initiative, which is funded by The LEGO Foundation, Oak Foundation, the World Childhood Foundation, The Human Safety Net, and the UK Research and Innovation Global Challenges Research Fund ((ES/S008101/1).

Humanitarian-specific recommendations for gender-transformative parenting programming: lessons from the field to address gender-based violence

There has been tremendous progress in building and promoting evidence-based practice around parenting programming in low- and middle-income countries. However, there remains a dearth of evidence specifically examining gender transformative programming designed to address gender-based violence in humanitarian settings. To inform this gap, we examine how existing gender transformative programmatic material addresses the unique circumstances of parenting in humanitarian settings. Incorporating lessons from the field, we inform considerations of how to adapt future content to address gender-based violence in humanitarian settings. We reviewed two gender transformative programs in humanitarian settings: Safe at Home and Sibling Support for Adolescent Girls in Emergencies. Four thematic recommendations emerged for gender-transformative parenting programming in humanitarian settings to address gender-based violence, specifically intimate partner violence and violence against children. These recommendations include: 1) Recognize the diversity of families in humanitarian settings, 2) Prioritize participatory approaches from the start, 3) Set realistic parameters and goals for the specific humanitarian context, and 4) Ensure pathways to scale and sustainability within the initial program design. We advocate for broader application of these principals to support gender-transformative parenting programming that is tailored to address gender-based violence in humanitarian settings and that will continue to build the respective evidence base.

Parenting Interventions to Prevent and Reduce Physical Punishment: A Scoping Review

Physical punishment is the most common form of violence against children worldwide and is associated with an increased risk of long-term adverse outcomes. Interventions targeting parents/caregivers are frequently implemented to prevent and reduce the use of physical punishment. This scoping review aimed to map the existing literature on evidence-informed parenting interventions targeting physical punishment. A scoping review following the World Health Organization (WHO) Review Guide, the Joanna Briggs Institute (JBI) 2020 Guide for scoping reviews, was conducted to address the objective of this review. An academic health sciences librarian systematically searched electronic databases (EBSCO, MEDLINE, EMBASE, SCOPUS) for peer-reviewed journal articles. Two reviewers independently screened titles and abstracts, followed by a full-text review according to inclusion and exclusion criteria following the Participants, Concept, and Context framework. Eighty-one studies were included for full-text eligibility. The results suggest that most interventions examined were conducted in North America, targeted mothers and fathers, and were delivered in person. The results from this scoping review describe the state of evidence-informed parenting interventions to prevent and reduce physical punishment. This review found opportunities for future research to implement effective parenting interventions on a larger societal scale and use mixed methods approaches to evaluate parenting interventions.