Cluver Lucie D, Meinck Franziska, Steinert Janina I, Shenderovich Yulia, Doubt Jenny, Herrero Romero Rocio, Lombard Carl J, Redfern Alice, Ward Catherine L, Tsoanyane Sibongile, Nzima Divane, Sibanda Nkosiyapha, Wittesaele Camille, De Stone Sachin, Boyes Mark E, Catanho Ricardo, Lachman Jamie McLaren, Salah Nasteha, Nocuza Mzuvukile, Gardner Frances
Centre for Evidence-Based Interventions, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
BMJ Glob Health. 2018 Jan 31;3(1):e000539. doi: 10.1136/bmjgh-2017-000539. eCollection 2018.
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.
Pragmatic cluster randomised controlled trial.
40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.
552 families reporting conflict with their adolescents (aged 10-18).
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.
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.
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.
This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.
Pan-African Clinical Trials Registry PACTR201507001119966.
评估“终身健康育儿：西诺武约青少年”（一项针对低收入和中等收入国家青少年的育儿项目）对虐待行为和育儿方式的影响。
实用整群随机对照试验。
南非东开普省的40个村庄/城市地区（群组）。
552个报告与青少年（10 - 18岁）存在冲突的家庭。
干预群组（n = 20）接受由经过培训的社区成员提供的为期14节的家长和青少年课程。对照群组（n = 20）接受卫生和洗手促进项目。
主要结局：干预后1个月及5 - 9个月时的虐待行为和育儿方式。次要结局：干预后5 - 9个月时照顾者和青少年的心理健康及物质使用情况、青少年行为问题、社会支持、社区暴力暴露情况和家庭经济状况。无法实施盲法。
干预后5 - 9个月，干预措施与较低的虐待行为（照顾者报告的发病率比（IRR）为0.55（95%可信区间0.40至0.75，P < 0.001））、体罚（照顾者报告的IRR = 0.55（95%可信区间0.37至0.83，P = 0.004））、改善的积极育儿方式（照顾者报告的d = 0.25（95%可信区间0.03至0.47，P = 0.024））、参与式育儿（照顾者报告的d = 0.86（95%可信区间0.64至1.08，P < 0.001）；青少年报告的d = 0.28（95%可信区间0.08至0.48，P = 0.006））以及较少的监管不力（照顾者报告的d = -0.50（95%可信区间 -0.70至 -0.29，P < 0.001）；青少年报告的d = -0.34（95%可信区间 -0.55至 -0.12，P = 0.002））相关，但与忽视行为减少无关（照顾者报告的IRR为0.31（95%可信区间0.09至1.08，P = 0.066）；青少年报告的IRR为1.46（95%可信区间0.75至2.85，P = 0.264）），与不一致的管教方式无关（照顾者报告的d = -0.14（95%可信区间 -0.36至0.09，P = 0.229）；青少年报告的d = 0.03（95%可信区间 -0.20至0.26，P = 0.804）），也与青少年报告的虐待行为IRR = 0.90（95%可信区间0.66至1.24，P = 0.508）和体罚行为IRR = 1.05（95%可信区间0.70至1.57，P = 0.819）无关。次要结局显示照顾者对体罚的认可、心理健康问题、育儿压力、物质使用情况有所减少，社会支持增加（均为照顾者报告）。干预组青少年在心理健康、行为或社区暴力方面报告无差异，但物质使用情况较低（均为青少年报告）。干预家庭的经济福利、财务管理得到改善，更多家庭制定了暴力规避计划（照顾者和青少年报告）。未检测到不良影响。
该育儿项目有望在资源匮乏地区减少暴力、改善育儿方式和家庭功能。
泛非临床试验注册中心PACTR201507001119966 。
