TY - JOUR
T1 - Delivering a parenting program in South Africa
T2 - The impact of implementation on outcomes
AU - Shenderovich, Yulia
AU - Eisner, Manuel
AU - Cluver, Lucie
AU - Doubt, Jenny
AU - Berezin, McKenzie K.
AU - Majokweni, Sybil
AU - Murray, Aja Louise
N1 - Funding Yulia Shenderovich was supported by the Cambridge Commonwealth, European & International Trust, research fellowship awarded by Global TIES for Children at New York University and funded by a grant from the Hewlett Foundation, Smuts Memorial Fund, managed by the University of Cambridge in memory of Jan Christiaan Smuts, and St John’s College, Cambridge. The Sinovuyo Teen Study was funded by the European Research Council under the European Union’s Seventh Framework Program (FP7/2007-2013, grant agreement 313421), UNICEF Innocenti Office of Research, the Leverhulme Trust (grant number PLP-2014-095), the University of Oxford’s ESRC Impact Acceleration Account (K1311-KEA-004 & 1602-KEA-189), and the John Fell Fund (103/757).
Funding Information:
A number of research assistants contributed to the execution of this study, including Babalwa Mkati, Ntombizodwa Tsotso, Lungiswa Mzimeli, Kholiswa Mabizela, Veliswa Tokwe, Babalwa Mkati, Vuyolwethu Banzi, Deneo Sephulo, Mzuvukile Nocuza, Phelisa Mphimphilashe, Busisiwe Tusani, Zikhona Fihlani, Unathi Simandla, Ntombomzi Theodora, Noluvuyo Tsoko, Nonzukiso Bokwe, Nolitha Tshathu, Zikhona Capa, Mzoxolo Cannon, Pumla Myoyo, Simphiwe James Mahl, and Simphiwe Vimbayo. The authors also wish to thank Rocio Herrero Romero, Janina Steinert, Divane Nzima, Franziska Meinck, and the rest of the research and implementation teams for their dedicated work. Special thanks go to all the participants and their families. Y.S., M.E., L.C., J.D. and M.B. contributed towards designing the study. Y.S., L.C., J.D., S.M. and M.B. contributed significantly towards data acquisition. Y.S. conducted data cleaning and analysis, and drafted the manuscript, and A.L.M. provided statistical advice. All authors participated in writing of the manuscript. Yulia Shenderovich was supported by the Cambridge Commonwealth, European & International Trust, research fellowship awarded by Global TIES for Children at New York University and funded by a grant from the Hewlett Foundation, Smuts Memorial Fund, managed by the University of Cambridge in memory of Jan Christiaan Smuts, and St John’s College, Cambridge. The Sinovuyo Teen Study was funded by the European Research Council under the European Union’s Seventh Framework Program (FP7/2007-2013, grant agreement 313421), UNICEF Innocenti Office of Research, the Leverhulme Trust (grant number PLP-2014-095), the University of Oxford’s ESRC Impact Acceleration Account (K1311-KEA-004 & 1602-KEA-189), and the John Fell Fund (103/757).
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Objectives: Previous studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low- and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings. Methods: This study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomes – parenting and maltreatment reported by caregivers and adolescents aged 10–18 (N = 270 pairs), 14 outcome constructs. Results: Fidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01). Conclusions: Our study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.
AB - Objectives: Previous studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low- and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings. Methods: This study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomes – parenting and maltreatment reported by caregivers and adolescents aged 10–18 (N = 270 pairs), 14 outcome constructs. Results: Fidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01). Conclusions: Our study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.
KW - Child abuse
KW - Fidelity
KW - Implementation
KW - Parenting
KW - Process evaluation
U2 - 10.1007/s10826-018-01319-y
DO - 10.1007/s10826-018-01319-y
M3 - Article
AN - SCOPUS:85061649562
SN - 1062-1024
VL - 28
SP - 1005
EP - 1017
JO - Journal of Child and Family Studies
JF - Journal of Child and Family Studies
IS - 4
ER -