Transferring Parenting Programmes from HICs to LICs
The cost-effectiveness of intervening in the early years to address a wide range of health and social problems in high income countries (HICs) is widely recognised. Many interventions target parents to reduce child maltreatment, given evidence of long-term associations with behavioural problems, violence and health-related risk behaviours.
Western interventions are increasingly being adapted for low income countries (LICs), on the assumption that associations between parent-child interactions and beneficial child outcomes identified in HICs apply throughout the world, irrespective of social class and culture. However, it is unclear how transferable programmes are since there is little supporting evidence, especially from Africa where there have been few large-scale studies of how parent-child relationships affect children. In the UK and USA there is some evidence that parenting practices have different effects on children in different cultures or ethnic groups.
This project is investigating the transferability of parenting programmes to reduce child maltreatment from HICs to LICs in two stages. First, we reviewed whether associations between parenting practices and child outcomes are similar in both settings, on which the transfer of interventions from high to low income countries is premised. In a search for studies from sub-Saharan Africa (SSA) reporting quantitative associations between parenting practices and child health or psychosocial outcomes, 44 studies from 13 countries met our inclusion criteria. Associations between parenting practices or styles and child outcomes in SSA were broadly similar to those previously found in HICs. These findings suggest that the impacts of parenting practices on child outcomes are similar across contrasting global regions and, therefore, parenting interventions from HICs might be successfully transferred to SSA, subject to appropriate adaptation (Devlin et al. 2018).
Second, we are reviewing the effectiveness of parenting interventions to prevent child maltreatment in MLICs, and how this varies by origin of programme and extent of adaptation, context, programme mechanisms, or population. A highly sensitive and comprehensive search of more than 30 electronic databases, grey literature sources and trial registries was conducted, and international experts queried to identify relevant trials. No language restrictions were imposed, and we searched in English, Spanish, Chinese, Farsi, Thai and Russian. Trials were included if: they involved parents/carers of children aged 2―17; were RCTs or strong quasi-experimental designs; and interventions aimed to reduce child maltreatment. Ninety-one trials fitted our criteria, and 61 were suitable for meta-analysis, representing a seven-fold increase in rigorous parenting trials in LMICs since 2009. We found a relatively equal regional distribution of relevant trials from North Africa/Middle East, sub-Saharan Africa, East Asia and South/Central America with the fewest in Central and Eastern Europe and Central Asia. Most interventions originated in the trial country, with only around 33% ‘transported’ from another (most often a HIC).
We are about to start meta-analysis, with additional analyses comparing effectiveness according to study design, intervention origin and characteristics, type of delivery, and implementation and contextual factors. This will provide the most comprehensive evidence of the effectiveness of parenting programmes to reduce maltreatment, and of which can be transferred to work with which populations, and in which contexts.