Department of Social Policy and Intervention, University of Oxford, Oxford, UK
MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
BMJ Glob Health. 2024 Nov 24;9(11):e015472. doi: 10.1136/bmjgh-2024-015472.
Parenting programmes, including those delivered in the Global South, are effective strategies to reduce violence against children (VAC). However, there is limited evidence of their impact when implemented at scale within routine delivery systems. This study aimed to address this gap by evaluating the real-world delivery of Parenting for Lifelong Health for Teens in Tanzania.
Participating parents/caregivers and their adolescent girls were recruited by local implementing partners in 2020-2021 as part of a community-based HIV prevention initiative focused on addressing drivers of female adolescent HIV-vulnerability such as VAC, caregiver-adolescent relationships and sexual reproductive health communication. The 14-session, group-based parenting programme was delivered by trained teachers and community facilitators. Quantitative surveys administered by providers measured a variety of outcomes including child maltreatment (primary outcome) and multiple secondary outcomes linked to increased risk of VAC. Multilevel models examined pre-post effects as well as variation by attendance and baseline demographic variables.
Pre-post data from 27 319 parent/caregiver-child dyads were analysed, of which 34.4% of parents/caregivers were male. Analyses showed large reductions in child maltreatment (parents/caregivers: IRR=0.55, (95% CI 0.54, 0.56); adolescents: IRR=0.57, (95% CI 0.56, 0.58)), reduced intimate partner violence experience, reduced school-based violence, increased communication about sexual health, reduced poor supervision, reduced financial insecurity, reduced parenting stress, reduced parent and adolescent depression, and reduced adolescent conduct problems. In contrast to these positive outcomes, parents/caregivers and adolescents also reported reduced parental positive involvement and support of education, with those experiencing greater adversity reporting less change than those with less adversity.
This study is the first to examine the large-scale implementation of an evidence-based parenting programme in the Global South. Although additional research is necessary to examine potential negative effects on positive parenting and parent support of education, findings suggest that Furaha Teens can sustain its impact on key outcomes associated with VAC when delivered at scale.
育儿计划，包括在全球南方实施的育儿计划，是减少针对儿童的暴力（VAC）的有效策略。然而，当在常规提供系统中大规模实施时，其影响的证据有限。本研究旨在通过评估在坦桑尼亚的“终身健康育儿”在现实世界中的实施情况来解决这一差距。
当地实施伙伴于 2020-2021 年招募参与的父母/照顾者及其青少年女儿，作为社区为基础的艾滋病毒预防举措的一部分，该举措侧重于解决导致女性青少年艾滋病毒易感性的驱动因素，如 VAC、照顾者-青少年关系和性生殖健康沟通。由受过培训的教师和社区促进者提供的 14 节小组式育儿计划。由提供者进行的定量调查衡量了多种结果，包括儿童虐待（主要结果）和与增加 VAC 风险相关的多个次要结果。多层次模型检查了前后效果以及出席和基线人口统计学变量的变化。
分析了来自 27319 对父母/照顾者-儿童的预-后数据，其中 34.4%的父母/照顾者为男性。分析表明，儿童虐待（父母/照顾者：IRR=0.55，（95%CI 0.54，0.56）；青少年：IRR=0.57，（95%CI 0.56，0.58））、减少亲密伴侣暴力经历、减少基于学校的暴力、增加性健康沟通、减少监督不力、减少经济不安全、减少育儿压力、减少父母和青少年抑郁、减少青少年行为问题等方面都有较大减少。与这些积极结果相反，父母/照顾者和青少年也报告说减少了对父母的积极参与和对教育的支持，那些经历更多逆境的人报告说变化比那些逆境较少的人少。
这项研究是首次在全球南方检验循证育儿计划的大规模实施。尽管需要进一步研究来检验对积极育儿和父母支持教育的潜在负面影响，但研究结果表明，当大规模提供时，“Furaha Teens”可以维持其对与 VAC 相关的关键结果的影响。
