Developing an optimized parenting program for southeastern Europe– a factorial design

• In Event: Towards preventing child maltreatment at scale

Abstract

Introduction: The overall RISE project (Prevention of child mental health problems in south-eastern Europe) aims at disseminating a parenting program (Parenting for Lifelong Health, PLH) for families in three low and middle-income countries, North Macedonia, Republic of Moldova and Romania. The study is informed by the Multiphase Optimization Strategy (MOST) and the RE-AIM framework and is accomplished in three phases. During Phase 1 (Preparation) from April-September 2018, the feasibility of the program was tested and established using a small pilot study (n = 140). We recently completed Phase 2 (Optimization) in which 3 different factors (program length, engagement boosters, fidelity) were tested in a factorial design (2x2x2) to identify the most effective, cost-effective, and scalable program for the local context.
Hypotheses: 1) We expected that higher levels of engagement booster (in addition to basic package food prizes, raffles, award for attendance) would lead to increased participation compared to the basic engagement condition (transport voucher, child care, snack during PLH sessions). Increased participation would in turn lead to higher effects on primary (child aggressive behavior) and secondary outcomes (dysfunctional parenting, positive parenting and effective discipline); 2) With regard to program length we expected no differences on outcomes between conditions: we hypothesized that the 5-session version would have higher participation rates; 3) We assumed that regular supervision would lead to higher program fidelity compared to the supervision on-demand condition. Higher program fidelity would in turn lead to larger effects on primary and secondary outcomes.
Study population: Parents reporting elevated behavioral problems with children ages 2 to 9 were eligible to participate. The sample for the factorial experiement included 289 parents from Macedonia, 284 from Moldova, and 262 from Romania (total n = 835). The mean child age of participating families was M = 5.7 (SD = 2.0) and mean parent age was M = 36.3 (SD = 6.5).
Methods: The three different intervention components of the PLH (session length: 5 vs. 10, engagement boosters: high vs. low, and supervision on-demand vs. regular) were implemented in each of the three countries. Sixteen sites (e.g., kindergardens, schools, community health centers) were randomized within each country to one of 8 conditions (2 sites per condition). Across countries, baseline assessments were conducted with N = 835 parents, N = 735 parents enrolled in the program; N = 661 were assessed at post-assessment, and N = 582 at 6 month follow-up.
Results: Although there were signficant improvements in parenting and decreases in child aggressive behavior from pre to post and follow-up assessments, there were few differences across component levels. According to the pre-specified optimization criterion, we blindly selected the optimized intervention based on main, interaction, and mediation effects on the three primary outcomes as well as cost-effectiveness. Next, the optimized intervention (5 sessions, low engagement boosters, and supervision on-demand) will be tested in a randomized-controlled trial in the three countries starting in January 2021.

Group Authors

RISE consortium members (https://rise-plh.eu/)

Authors

• Melinda Morrill, University of Klagenfurt
  Presenting Author

• Inga Frantz, University of Bremen
  Non-Presenting Author

• Heather Foran, Alpen-Adria University Klagenfurt
  Non-Presenting Author

• Xiang Zhao, University of Klagenfurt
  Non-Presenting Author

• Jamie Lachman, Universities of Oxford and Glasgow
  Non-Presenting Author

• Hugh Murphy, University of Klagenfurt
  Non-Presenting Author

• NIna Heinrichs, University of Bremen
  Non-Presenting Author

• Catherine Ward, University of Cape Town
  Non-Presenting Author

• Judy Hutchings, Bangor University
  Non-Presenting Author

• Frances Gardner, Wolfson College, Oxford
  Non-Presenting Author

• Marija Raleva, Cyril and Methodius University
  Non-Presenting Author

• Slavica Gajdadzis-Knezhevikj, Institute for Marriage, Family and Systemic Practice - Alternativa
  Non-Presenting Author

• Adriana Baban, Babes-Bolyai University
  Non-Presenting Author

• Diana Taut, Babes-Bolyai University
  Non-Presenting Author

• Galina Lesco, Health for Youth Association
  Non-Presenting Author

• Viorel Babii, Health for Youth Association
  Non-Presenting Author