Effects of two early parenting programmes on child aggression and risk for violence in Brazil: a randomised controlled trial

• In Event: Parent and Family Interventions: Applying pre-existing knowledge and experience in new and global contexts

Abstract

BACKGROUND: Violence is a major public health problem, with the highest rates in low- and middle-income countries (LMICs) in the Americas and southern Africa. Parenting programmes supporting early nurturing care can reduce risk for violence, by reducing child aggression and other risk factors including harsh parenting and poor child cognitive and socio-emotional development. However, low-cost programmes suitable for LMICs require more studies demonstrating their effectiveness in real-world contexts.

METHODS: A three-arm, randomised, single-blind trial evaluated effects of two low-cost parenting programmes (ACT: Raising Safe Kids; DBS: dialogic book-sharing) on child aggression (primary outcome), child development, parenting, maltreatment, and stress. Participants were 369 children in poor households (mean age 37 months, medium-high levels of aggression). Interventions were implemented in city health and education services in southern Brazil. Maternal reports, filmed observations, child tasks, and hair cortisol were assessed at baseline, one-month post intervention, and eight-month follow-up. Intention-to-treat analyses compared each of ACT and DBS with a control group.

RESULTS: 368 (99.7%) participants completed follow-up assessments eight-months after the interventions. There was no effect of ACT (standardised mean difference, SMD 0.11, 95%CI -0.05, 0.27) or DBS (SMD 0.05, 95%CI -0.11, 0.21) on child aggression. ACT reduced harsh parenting behaviour post intervention (SMD -0.23; 95%CI -0.46, -0.01), but not at follow-up. DBS improved book-sharing practices at both time points (e.g., maternal sensitivity at follow-up SMD 0.33; 95%CI: 0.08, 0.57). There were no benefits of either programme for other parenting, child development, or stress outcomes.

CONCLUSION: Two parenting programmes in Brazil did not reduce child aggression or several other important risk factors for violence. Effective and scalable, early interventions to reduce violence in LMICs are highly desirable but are a challenge to achieve.

Group Authors

PIÁ Trial Team (Elisa Altafim,4,† Adriane Xavier Arteche,5,† Peter J. Cooper,6,† Marlos Rodrigues Domingues,7,† Andrea Gonzalez,8,† Adriana Kramer Fiala Machado,2,† Lynne Murray,6,† Isabel Oliveira,2,† Iná Santos,2,† Tâmara Biolo Soares,9,† Luciana Tovo-Rodrigues,1,2,† Merryn Voysey3,†) † In alphabetical order

Authors

• Joseph Murray, Federal University of Pelotas
  Presenting Author

• Rafaela Costa Martins, Universidade Federal de Pelotas

• Melanie Greenland

• Suelen Cruz