Hecker Tobias, Mkinga Getrude, Kirika Anette, Nkuba Mabula, Preston Justin, Hermenau Katharin
Department of Psychology, Bielefeld University, 33501 Bielefeld, Germany.
vivo international, 78340 Konstanz, Germany.
Prev Med Rep. 2021 Oct 9;24:101593. doi: 10.1016/j.pmedr.2021.101593. eCollection 2021 Dec.
An increasing number of orphans in low- and middle-income countries are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. To prevent maltreatment, we tested the effectiveness and feasibility of the intervention . In a two-arm cluster-randomized controlled trial, 203 caregivers (65.5% female, = 36.63 years, = 12.26) and 356 children (46.1% female, = 9.43 years, = 1.93) from 24 orphanages in Dar es salaam (Tanzania) participated from August to October 2018 (Baseline) and March to April 2019 (Follow-Up). Orphanages were assigned to the intervention or waitlist-group. Caregivers in the intervention group received the intervention to prevent maltreatment through focusing on non-violent caregiving strategies. The primary outcome was the change in self-reported maltreatment by caregivers (Conflict Tactics Scale). Trial registration: ClinicalTrials.gov, NCT03594617, 20 July 2018. Participation in the intervention resulted in a significant reduction in reported maltreatment ( = 0.153), a decrease of positive attitudes toward violent discipline ( = 0.248), and an increased level of childcare knowledge ( = 0.220) in the caregiver sample, each indicating a moderate effect. Caregivers' training participation did not predict reduced maltreatment reported by children. Aspects of feasibility, including motivation to participate, acceptability, and integration of the new strategies were evaluated positively. The study promises initial effectiveness and feasibility of efforts to improve the situation of children in institutional care settings in resource-poor countries by offering training to care providers.
在低收入和中等收入国家，越来越多的孤儿生活在机构照料设施中，在那里他们接受的照料质量很差，并且不断遭受虐待。为了预防虐待，我们测试了该干预措施的有效性和可行性。在一项双臂整群随机对照试验中，来自坦桑尼亚达累斯萨拉姆24所孤儿院的203名照料者（女性占65.5%，平均年龄36.63岁，标准差12.26）和356名儿童（女性占46.1%，平均年龄9.43岁，标准差1.93）于2018年8月至10月（基线）以及2019年3月至4月（随访）参与了研究。孤儿院被分配到干预组或等待名单组。干预组的照料者接受了通过关注非暴力照料策略来预防虐待的干预措施。主要结局是照料者自我报告的虐待行为的变化（冲突策略量表）。试验注册：ClinicalTrials.gov，NCT03594617，2018年7月20日。参与干预导致照料者样本中报告的虐待行为显著减少（效应量=0.153），对暴力管教的积极态度有所下降（效应量=0.248），以及育儿知识水平有所提高（效应量=0.220），每项均表明有中等程度的效果。照料者参与培训并不能预测儿童报告的虐待行为减少。包括参与动机、可接受性和新策略整合等可行性方面得到了积极评价。该研究表明，通过为照料提供者提供培训来改善资源匮乏国家机构照料环境中儿童状况的努力具有初步的有效性和可行性。
