Open-access parenting programme shows promise

University of Cape Town (UCT) researchers have co-developed and trialled a programme to help caregivers in low- and middle-income countries parent in positive ways. They designed the programme to be successful in resource-poor settings specifically: places that – up to now – only had the option of similar programmes developed for high-income countries.

However, low- and middle-income countries have different challenges: fewer resources, a higher prevalence of violent parenting, and conditions that make parenting more difficult, such as poverty. This means they need tailored programmes that can be scaled up cost-effectively.

“Violence against children is a key global problem, and eliminating it is one of the targets set for the world in the United Nations Sustainable Development Goals (SDG),” says Professor Cathy Ward from the UCT Department of Psychology. “But parents feel disempowered by messages that tell them to stop using corporal punishment: we aimed to give parents evidence-based strategies that are much more effective than harsh approaches to parenting.”

Ward joined with Dr Inge Wessels, also from the psychology department, other UCT researchers and international collaborators on the study published today: UCT’s Dr Reshma Kassanjee, Associate Professor Francesca Little and Raymond Nhapi; researchers from the universities of Bangor and Oxford; and the non-governmental organisation Clowns Without Borders South Africa. Oxford University’s Professor Lucie Cluver, also an honorary professor at UCT’s Department of Psychiatry and Mental Health, was one of the researchers involved.

“Violence against children is a key global problem, and eliminating it is one of the targets set for the world in the United Nations Sustainable Development Goals.”

The study’s results are timely given the South African Constitutional Court’s ruling, yesterday, on the constitutionality of corporal punishment in the home. The Court found that the right to be free from all forms of violence should include freedom from corporal punishment. It also found that this punishment isn’t necessary or justifiable considering the non-violent ways to discipline children, such as through positive parenting.

Parents are asking for alternatives to corporal punishment: Parenting for Lifelong Health for Young Children is one of several programmes that offer these alternatives.

The global view

Parenting and violence during childhood have a major lifetime impact on children, and surveys of low- and middle-income countries show that around three-quarters of children between two- and 14-years old experience harsh parenting.

In contrast, the benefits of positive parenting can span generations.

Children who receive positive reinforcement, warmth, affection and consistent, non-violent discipline are more likely to achieve their developmental potential and make a meaningful contribution to society. They are also more likely to transfer these benefits to their own children.

The SDGs recognise the importance of ending “all forms of violence against children” (target 16.2). And parenting programmes – interventions in which parents learn specific parenting skills – have been established as an effective way to prevent violence against children.

Yet evidence comes chiefly from high-income countries, and many evidence-based parenting programmes are costly and culturally Western.

Positive parenting

The Parenting for Lifelong Health programme for young children – the one investigated in this study – is the first open-access parenting programme for parents of two- to nine-year-olds developed with low-cost delivery in mind.

“This programme drew on evidence from programmes in high-income countries. But with input from African caregivers, we developed content that also included stress management, illustrated stories of parenting scenarios, songs and storytelling,” says Wessels. “To make the programme more accessible, community members – not professionals – deliver it and there is no need for electronic equipment or costly materials.”

“We aimed to give parents evidence-based strategies that are much more effective than harsh approaches to parenting.”

It takes the form of 12 facilitated, group-based sessions delivered with interactive activities and a good dose of fun.

To assess the impact of the programme, the researchers worked with 296 parents from two low-income communities in Cape Town, half of whom they randomly chose to participate in the parenting programme. They asked the parents a set of questions and observed them during a structured play task with their child three times: once before and once immediately after completing the programme, and during a follow-up one year later.

Parents who participated in the programme said that they used positive parenting more often and used less physical and emotional punishment than those who hadn’t. They also had more positive interactions with their children, who behaved better, during the structured play task. One year later, the participating parents still reported using more non-violent discipline strategies.

For other factors, there was no difference, though, such as the behaviour of children as reported by their caregivers, the level of poor monitoring or supervision, and caregiver social support.

To make the programme more accessible, community members – not professionals – deliver it and there is no need for electronic equipment or costly materials.”

Through the trial, the research team also identified ways to enhance the programme and its impact. 

While attendance was about as good as in high-income countries, in lower income countries there are specific barriers to parents attending. These include seeking employment, a lack of money for transport and issues related to substance abuse. Research into this is ongoing, with colleagues in Southeast Asia and Eastern Europe exploring how to encourage parent attendance while streamlining the programme and possibly even improving its effectiveness.

Extremely low cost

Another boon of the trial: successfully demonstrating the extent to which the programme can be delivered at low cost.

While some costs are unavoidable for any parenting programme (e.g., paying facilitators and venue hire), the researchers estimated that the costs of delivering this course may be as low as USD17 per family – although this will vary depending on the context.

Parenting for Lifelong Health

This study was a stringent test of Parenting for Lifelong Health for Young Children: one of a suite of four culturally adaptable, not-for-profit and well-tested parenting programmes for reducing violence against children and promoting child wellbeing. Developed by researchers from UCT, Stellenbosch and institutions in the United Kingdom with the World Health Organization, UNICEF and community-based organisations, the programmes are designed to be offered on a large scale in low-resource settings.

The programmes have reached more than 300 000 families in 22 countries across sub-Saharan Africa, Southeast Asia, Eastern Europe and the Caribbean.

For more information and to access the Parenting for Lifelong Health programme manuals at no cost, visit the Parenting for Lifelong Health website.

• Ward CL et al. (2019) Parenting for Lifelong Health for young children: a randomized controlled trial of a parenting program in South Africa to prevent harsh parenting and child conduct problems. The Journal of Child Psychology and Psychiatry. doi.org/10.1111/jcpp.13129