Article type
Year
Abstract
Background: Parenting interventions have been shown to improve parent/child outcomes in high-income countries. Many are potentially applicable across cultures and countries, but little is known about their effectiveness in low-and middle-income countries (LMICs). Prior reviews identify few trials in LMICs and even fewer trials of interventions with prior established efficacy. Global interest in parenting interventions has not been met by empirical guidance on whether/how interventions translate between countries.
Objectives: To investigate effectiveness of parenting interventions for reducing harsh/abusive parenting and increasing positive parenting in LMICs; to explore methods for sysnthesising characteristics of 'transported’ interventions, as a step towards further understanding transportability mechanisms.
Methods: A range of databases were searched; unpublished reports were hand and online-searched, and experts contacted. Included were randomised trials with no-intervention, alternative-intervention, or services-as-usual comparisons. High heterogeneity precluded meta-analysis, but charac-teristics of included studies were discussed narratively according to type of delivery mode, outcome, level of evidence in country of origin, and extent of adaptation for current setting.
Results: Twelve studies (N = 1580) in nine countries reported results favouring intervention on a range of measures, but overall validity is unclear due to significant/unclear risks of bias. Results of the two largest, highest-quality trials suggest interventions may be feasible and effective for improving parent-child interaction and parentalknowledge/ attitudes in LMICs. Results provide initial evidence on feasibility of coding factors related to transportability across countries, although this was sometimes limited by poor reporting, and lack of efficacy evidence from countries of origin.
Conclusions: While limited conclusions can be drawn, there is promising evidence that parenting interventions can be implemented and may be effective in improving positive parenting in LMICs. The results raise key methodological and implementation issues for wider investigation, e.g., how best to synthesise evidence about transportability; relative benefits of 'transported’ versus indigenous interventions; adaptation to new service contexts.
Objectives: To investigate effectiveness of parenting interventions for reducing harsh/abusive parenting and increasing positive parenting in LMICs; to explore methods for sysnthesising characteristics of 'transported’ interventions, as a step towards further understanding transportability mechanisms.
Methods: A range of databases were searched; unpublished reports were hand and online-searched, and experts contacted. Included were randomised trials with no-intervention, alternative-intervention, or services-as-usual comparisons. High heterogeneity precluded meta-analysis, but charac-teristics of included studies were discussed narratively according to type of delivery mode, outcome, level of evidence in country of origin, and extent of adaptation for current setting.
Results: Twelve studies (N = 1580) in nine countries reported results favouring intervention on a range of measures, but overall validity is unclear due to significant/unclear risks of bias. Results of the two largest, highest-quality trials suggest interventions may be feasible and effective for improving parent-child interaction and parentalknowledge/ attitudes in LMICs. Results provide initial evidence on feasibility of coding factors related to transportability across countries, although this was sometimes limited by poor reporting, and lack of efficacy evidence from countries of origin.
Conclusions: While limited conclusions can be drawn, there is promising evidence that parenting interventions can be implemented and may be effective in improving positive parenting in LMICs. The results raise key methodological and implementation issues for wider investigation, e.g., how best to synthesise evidence about transportability; relative benefits of 'transported’ versus indigenous interventions; adaptation to new service contexts.