Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objective

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.

Design

Pragmatic cluster randomised controlled trial.

Setting

40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.

Participants

552 families reporting conflict with their adolescents (aged 10–18).

Intervention

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.

Main outcome measures

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.

Results

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.

Conclusions

This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.

Trial registration number

Pan-African Clinical Trials Registry PACTR201507001119966.

Related collections

Most cited references 27

Record: found
Abstract: found
Article: not found

The MOS social support survey.

C Sherbourne, A Stewart (1991)

This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.

0 comments Cited 451 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

S. Dube, R F Anda, V. Felitti … (2001)

Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.

0 comments Cited 284 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Health of the world's adolescents: a synthesis of internationally comparable data.

George C Patton, Carolyn Coffey, Claudia Cappa … (2012)

Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people. We derive indicators from the conceptual framework for the Series on adolescent health and assess the available data to describe them. We selected indicators for their public health importance and their coverage of major health outcomes in young people, health risk behaviours and states, risk and protective factors, social role transitions relevant to health, and health service inputs. We then specify definitions that maximise international comparability. Even with this optimisation of data usage, only seven of the 25 indicators, covered at least 50% of the world's adolescents. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes. Risks for non-communicable diseases are spreading rapidly, with the highest rates of tobacco use and overweight, and lowest rates of physical activity, predominantly in adolescents living in low-income and middle-income countries. Even for present global health agendas, such as HIV infection and maternal mortality, data sources are incomplete for adolescents. We propose a series of steps that include better coordination and use of data collected across countries, greater harmonisation of school-based surveys, further development of strategies for socially marginalised youth, targeted research into the validity and use of these health indicators, advocating for adolescent-health information within new global health initiatives, and a recommendation that every country produce a regular report on the health of its adolescents. Copyright © 2012 Elsevier Ltd. All rights reserved.

0 comments Cited 161 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BMJ Glob Health

Journal ID (iso-abbrev): BMJ Glob Health

Journal ID (hwp): bmjgh

Journal ID (publisher-id): bmjgh

Title: BMJ Global Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2059-7908

Publication date Collection: 2018

Publication date (Electronic): 31 January 2018

Volume: 3

Issue: 1

Electronic Location Identifier: e000539

Affiliations

[1 ] departmentCentre for Evidence-Based Interventions, Department of Social Policy and Intervention , University of Oxford , Oxford, UK

[2 ] departmentDepartment of Psychiatry and Mental Health , University of Cape Town , Cape Town, South Africa

[3 ] departmentOPTENTIA Research Focus Group , School of Behavioural Sciences, North-West University , Vanderbijlpark, South Africa

[4 ] departmentInstitute of Criminology , University of Cambridge , Cambridge, UK

[5 ] UNICEF Innocenti Office of Research , Florence, Italy

[6 ] departmentBiostatistics Unit , South African Medical Research Council , Cape Town, South Africa

[7 ] departmentSchool of Public Health and Family Medicine , University of Cape Town , Cape Town, South Africa

[8 ] departmentDepartment of Psychology and Safety and Violence Initiative , University of Cape Town , Cape Town, South Africa

[9 ] Clowns Without Borders South Africa , Durban, South Africa

[10 ] departmentDepartment of Sociology & Anthropology , University of Fort Hare , Alice, South Africa

[11 ] Ali-Douglas Research Network , Bulawayo, Zimbabwe

[12 ] departmentDepartment of International Development , London School of Economics and Political Science , London, UK

[13 ] Warwick Medical School , Warwick, UK

[14 ] departmentFaculty of Health Sciences , School of Psychology and Speech Pathology, Curtin University , Perth, Western Australia, Australia

[15 ] London School of Hygiene and Tropical Medicine , London, UK

Author notes

[Correspondence to ] Lucie D Cluver; lucie.cluver@ 123456spi.ox.ac.uk

Article

Publisher ID: bmjgh-2017-000539

DOI: 10.1136/bmjgh-2017-000539

PMC ID: 5859808

PubMed ID: 29564157

SO-VID: d412ca87-fecb-4e5c-baa8-0e245c573401

License:

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

History

Date received : 25 August 2017

Date revision received : 24 November 2017

Date accepted : 07 December 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004789, John Fell Fund, University of Oxford;

Funded by: European Research Council;

Funded by: UNICEF South Africa;

Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;

Funded by: Cambridge Trust;

Funded by: National Department of Social Development South Africa;

Funded by: FundRef http://dx.doi.org/10.13039/501100000275, Leverhulme Trust;

Funded by: UNICEF Innocenti Office of Research;

Custom metadata

special-feature unlocked

Keywords: child abuse,parenting,adolescents,low-income and middle-income countries,rct

Data availability:

Keywords: child abuse, parenting, adolescents, low-income and middle-income countries, rct

Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa

Read this article at

Abstract

Objective

Design

Setting

Participants

Intervention

Main outcome measures

Results

Conclusions

Trial registration number

Related collections

Annual Reviews Child Development

Most cited references 27

The MOS social support survey.

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

Health of the world's adolescents: a synthesis of internationally comparable data.

Author and article information

Journal

Affiliations

Author notes

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 61

Cited by 59

Most referenced authors 990