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Research
Building caregivers’ emotional, parental and social support skills to prevent violence against adolescent girls: findings from a cluster randomised controlled trial in Democratic Republic of Congo
  1. Lindsay Stark1,2,
  2. Ilana Seff2,
  3. Khudejha Asghar2,
  4. Danielle Roth3,
  5. Theresita Bakamore3,
  6. Mairi MacRae3,
  7. Cecile Fanton D’Andon4,
  8. Kathryn L Falb3
  1. 1 George Warren Brown School of Social Work, Washington University in Saint Louis, St. Louis, Missouri, USA
  2. 2 Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
  3. 3 International Rescue Committee, New York City, New York, USA
  4. 4 Independent Consultant, Paris, France
  1. Correspondence to Dr Lindsay Stark; ls2302{at}cumc.columbia.edu

Abstract

Introduction Parenting programmes are increasingly popular for reducing children’s exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls’ exposure to violence (sexual and others) and caregivers’ gender attitudes and parenting behaviours.

Methods In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10–14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls’ self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted.

Results At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes.

Conclusion While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls’ violence exposure in humanitarian settings.

Trial registration number NCT02384642.

  • child health
  • public health
  • prevention strategies
  • cluster randomised trial

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bmjgh-2018-000824

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors LS is the principal investigator and led the manuscript development. IS led the data analysis and supported the manuscript development. KA supported the data analysis, interpretation and manuscript development. KLF, MM and CFD supported the conceptual development and study implementation. DR and TB managed the tool adaptation and oversight of data collection. All authors reviewed and approved the final manuscript prior to submission. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

    • Funding The study was funded by the UK Department for International Development (grant number 40080602).

    • Disclaimer The funders played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The Columbia University Medical Center Institutional Review Board (protocol number AAAP6855); Ministry of Gender in South Kivu, DRC.

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

    • Data sharing statement Due to legal restrictions, data cannot be made publicly available. Data are owned by the International Rescue Committee (IRC). For more information about IRC data, please visit the following URL: http://www.whatworks.co.za/about/about-what-works. For data related inquiries please contact Kathryn Falb (Kathryn.Falb{at}rescue.org).

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