Feasibility pilot and RCT of an evidence-based parenting intervention delivered by health workers to low-income families with young children in Thailand

• In Event: Towards preventing child maltreatment at scale

Abstract

Objective: This study focused on the cultural and contextual adaptation and subsequent evaluation of the Parenting for Lifelong Health (PLH) for Young Children programme for low-income families with children aged 2-9 years living in Udon Thani, Thailand. The objectives of the mixed methods feasibility pilot and RCT were to test feasibility and effectiveness of the adapted programme by: 1) exploring the relevance and acceptability of key programme themes; 2) examining mechanisms of change as perceived by parent participants and programme facilitators; and 3) assessing RCT effects at post-intervention and 3-month follow-up on the primary outcomes of child maltreatment and 11 related secondary outcomes.

Methods: This study comprised a qualitative formative evaluation, mixed methods process evaluation, and RCT. The formative evaluation included qualitative data from interviews and focus group discussions with policymakers, frontline workers, government officials, academics, and international development sector officials (N = 26). The mixed methods process evaluation was embedded within a pragmatic single group feasibility pilot of the adapted programme, including qualitative data from in-depth parent interviews (N = 11) and a focus group discussion with facilitators (N = 8). Quantitative data included routine delivery logs. The RCT was an observer-blinded, single-site trial with two parallel groups (N = 120), with interviews and observational assessments conducted at baseline, post-test, and one month follow-up using standardized instruments. The study was registered with ClinicalTrials.gov: NCT03539341.

Results: Findings from the formative evaluation indicated that many of the original programme themes were perceived as relevant, although tensions between perceived social norms, practices, and needs were identified. Process evaluation findings from the feasibility pilot showed that enrolled parents attended 92.5% of all sessions, with no programme dropouts. Thematic analyses of perceived key mechanisms of change identified six programme themes as well as four key changes in parent-child relationships and interactions that arose due to programme participation. During the RCT, parents in the intervention group reported reduced overall child maltreatment in comparison to controls at both immediate (IRR=0.39, 95% CI [0.32, 0.47]) and 3-months follow-up (IRR=0.42, 95% CI [0.34,0.52]). Observational assessments also found reduced abusive and harsh parenting at 3-months follow up (IRR=0.56, 95% CI [0.33,0.96]). Results also indicated increased positive parenting, monitoring, and parental efficacy, as well as reduced parental mental health problems and child behavior problems. No differences were reported for child neglect or intimate partner violence.

Conclusions: The adapted PLH programme in Thailand can be effectively implemented in a local public health system setting, with high levels of cultural and contextual relevance. The conduct of a phased approach to programme adaptation and testing was critical to developing local partnerships and increasing prospects for sustainability and scale-up.

Authors

• Amalee McCoy, University of Oxford
  Presenting Author

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

• Sombat Tapanya, Private Practice
  Non-Presenting Author

• GJ Melendez-Torres, University of Exeter
  Non-Presenting Author

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

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