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Research
Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa
  1. Lucie D Cluver1,2,
  2. Franziska Meinck1,3,
  3. Janina I Steinert1,
  4. Yulia Shenderovich1,4,
  5. Jenny Doubt1,5,
  6. Rocio Herrero Romero1,
  7. Carl J Lombard6,7,
  8. Alice Redfern1,
  9. Catherine L Ward8,
  10. Sibongile Tsoanyane9,
  11. Divane Nzima10,11,
  12. Nkosiyapha Sibanda12,
  13. Camille Wittesaele1,
  14. Sachin De Stone13,
  15. Mark E Boyes14,
  16. Ricardo Catanho1,
  17. Jamie McLaren Lachman1,9,
  18. Nasteha Salah15,
  19. Mzuvukile Nocuza1,
  20. Frances Gardner1
  1. 1 Centre for Evidence-Based Interventions, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
  2. 2 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  3. 3 OPTENTIA Research Focus Group, School of Behavioural Sciences, North-West University, Vanderbijlpark, South Africa
  4. 4 Institute of Criminology, University of Cambridge, Cambridge, UK
  5. 5 UNICEF Innocenti Office of Research, Florence, Italy
  6. 6 Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  7. 7 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  8. 8 Department of Psychology and Safety and Violence Initiative, University of Cape Town, Cape Town, South Africa
  9. 9 Clowns Without Borders South Africa, Durban, South Africa
  10. 10 Department of Sociology & Anthropology, University of Fort Hare, Alice, South Africa
  11. 11 Ali-Douglas Research Network, Bulawayo, Zimbabwe
  12. 12 Department of International Development, London School of Economics and Political Science, London, UK
  13. 13 Warwick Medical School, Warwick, UK
  14. 14 Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
  15. 15 London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Lucie D Cluver; lucie.cluver{at}spi.ox.ac.uk

Abstract

Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices.

Design Pragmatic cluster randomised controlled trial.

Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.

Participants 552 families reporting conflict with their adolescents (aged 10–18).

Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.

Main outcome measures Primary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible.

Results At 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.

Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.

Trial registration number Pan-African Clinical Trials Registry PACTR201507001119966.

  • child abuse
  • parenting
  • adolescents
  • low-income and middle-income countries
  • RCT

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2017-000539

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors LDC, FM, CLW, MEB and FG contributed towards conceptualising and designing the experiment. LDC, JD, ST and JML designed the programme and oversaw implementation. LDC, FM, JD, AR, SDS, MN, NS, DN, JIS, YS, RHR, RC and CW contributed significantly towards data acquisition. JIS, YS, CJL and RHR conducted data cleaning and analysis. All authors provided comments towards drafts of the article and approved the final version for publication.

    • Funding The study and intervention are supported by the European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007-2013) with ERC grant agreement 313421, Unicef Innocenti Office of Research, Unicef South Africa, the John Fell Fund, the Leverhulme Trust (PLP-2014-095), the Cambridge Trust, and the University of Oxford’s ESRC Impact Acceleration Account (1311-KEA-004 and 1602-KEA-189). The South African National Department of Social Development provided in-kind support through posting social workers to be trained as programme facilitators. FM was supported by the ESRC under a Future Research Leader Award (ES/N017447/1). RHR was supported by Fundación Obra Social ‘La Caixa’ and the Economic and Social Research Council (UK) (SSD/2/2/16). JIS was funded by an ESRC doctoral studentship (ES/J500112/1). YS was supported by the Cambridge Commonwealth, European and International Trust, Additional Insights 2016–2017 Fellowship, Smuts Memorial Fund, managed by the University of Cambridge in memory of Jan Christiaan Smuts, and St John’s College, Cambridge. Funders of this study had no role in study design, data collection, data analysis or writing of the report. LDC, CJL, YS, JIS, FM and RHR had full access to all the data in the study. LDC had final responsibility for the decision to submit for publication.

    • Competing interests JD, JML, ST, LDC, CLW and JIS were involved in developing the Sinovuyo Caring Families Programme for Parents and Teens, which is licensed under a Creative Commons 4.0 Non-commercial No Derivatives license. JD, JML and ST work for Clowns Without Borders South Africa, the non-profit institution responsible for the delivery of the intervention that was evaluated in this study. All other authors declare no competing interests.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Ethical approval was obtained from the Institutional Review Boards of the University of Oxford (SSD/CUREC2/11-40) and University of Cape Town (PSY2013-46) and by the Provincial Government Departments of Social Development and Education.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The full data set, technical appendix and statistical code are available from the corresponding author.