Background: South Africa has high prevalence rates of physical, emotional and sexual child abuse also in adolescents. Systematic reviews show effective abuse reduction for parenting programmes for parents of young children in high-income countries, but limited evidence in low or middle-income countries. There are currently no parenting programmes for caregivers of teenagers. In response, WHO, UNICEF and a South-North academic collaboration are developing and testing low-resource programmes for free availability: ‘Parenting for Lifelong Health’. This reports on the development of the intervention, pilot, pre-post and randomized trial results for the ‘Sinovuyo Teen’ programme.
Methods: 4-stage testing prevalence deep rural and urban communities in the Eastern Cape, South Africa: 1) Development and pre-post pilot (N = 60 participants); 2) Adaptation and pre-post testing (N = 230 participants); 3) Adaptation and pragmatic Cluster RCT (N = 1200 participants, 40 sites). Adolescents and primary caregivers participated in 10-14 evidence-informed sessions (i.e. positive relationship development, conflict reduction, avoiding community violence), implemented by local NGOs.
Results: Acceptance was high with attendance rates above 75% across the studies. 1) 2013 Pre-post pilot showed reduced abuse (t-4.18, p<.001), adolescent risk-taking (t=3.21 p<.003) and aggression (t=3.07, p<.005) and improved positive parenting (t=4.49, p<.001) and social support (t=-3.69, p<.001). Families requested inclusion of economic empowerment. 2) 2014 Pre-post testing showed 75% reductions in child abuse (63%-29%, p<.001), poor monitoring/discipline (p<.001), adolescent risk-taking (p<.001), depression (p<.001), and caregiver (but not adolescent) substance use, and improved positive parenting (p<.01) and social support. In light of high levels of illness, families requested home visits for missed-sessions. There was extensive unanticipated community diffusion of the programme. 3) 2015-16 Cluster RCT is ongoing, with completed results by June 2016.
Conclusions: Pragmatic testing suggests potential for prevention and reduction of child abuse and adolescent risk behaviors. Inclusion of structural-level support may be important.
