Parents make the difference: a randomized-controlled trial of a parenting intervention in Liberia

Abstract

Background: The objective of this study was to evaluate the impact of a brief parenting intervention, 'Parents Make the Difference'(PMD), on parenting behaviors, quality of parent-child interactions, children's cognitive, emotional, and behavioral wellbeing, and malaria prevention behaviors in rural, post-conflict Liberia.

Methods: A sample of 270 caregivers of children ages 3-7 were randomized into an immediate treatment group that received a 10-session parent training intervention or a wait-list control condition (1:1 allocation). Interviewers administered baseline and 1-month post-intervention surveys and conducted child-caregiver observations. Intent-to-treat estimates of the average treatment effects were calculated using ordinary least squares regression. This study was pre-registered at ClinicalTrials.gov (NCT01829815).

Results: The program led to a 55.5% reduction in caregiver-reported use of harsh punishment practices (p < 0.001). The program also increased the use of positive behavior management strategies and improved caregiver-child interactions. The average caregiver in the treatment group reported a 4.4% increase in positive interactions (p < 0.05), while the average child of a caregiver assigned to the treatment group reported a 17.5% increase (p < 0.01). The program did not have a measurable impact on child wellbeing, cognitive skills, or household adoption of malaria prevention behaviors.

Conclusions: PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings.

Keywords: Abuse prevention; Africa; Liberia; family-based intervention; global mental health; parenting.

Fig. 1.

Participant flow diagram.

Fig. 2.

This plot displays standardized results of intention-to-treat (ITT) ordinary least squares (OLS) regressions of each primary and secondary outcome on an indicator of assignment to treatment, stratum fixed effects, and baseline covariates. The point estimates were standardized by dividing the coefficient on assignment by the control group standard deviation (Glass's Δ). Black dots represent point estimates in the hypothesized direction (grey if not in the hypothesized direction). Dotted lines represent 95% confidence intervals (CI).