Putting the horse before the cart? Negotiating tensions between the need for evidence and the demand for dissemination of parenting programs to reduce violence against children in low- and middle-income countries

Objectives: Parenting programs have shown promise in preventing violence against children, as well as improving child and parental outcomes. Accordingly, there is an increased demand for the dissemination of evidence-based... [ view full abstract ]

Objectives: Parenting programs have shown promise in preventing violence against children, as well as improving child and parental outcomes. Accordingly, there is an increased demand for the dissemination of evidence-based parenting programs by international agencies such as the World Health Organization, as well as a need for governments to rapidly scale up effective interventions through existing and emerging child protection services. However, few parenting programs are both evidence-based and affordable for low- and middle-income countries, and can therefore meet this demand for dissemination and scale-up.

Methods: This paper examines the tension between the establishing rigorous evidence of effectiveness with the urgent need for the dissemination of parenting programs to reduce violence against children in low-and middle-income countries. It uses interviews with implementing partners and policy makers, and draws on Parenting for Lifelong Health’s experience of developing evidence-based parenting programs in multiple countries and contexts.

Results: This paper presents four challenges facing researchers, policy makers, and practitioners: First, establishing evidence requires substantial time and resources to meet international standards of effectiveness such as the Blueprints criteria. Second, international and local implementing agencies often require lower thresholds for evidence before taking programs to scale. Third, implementation across contexts may require considerable adaptation to fit local cultures and delivery systems, as well as additional research to establish evidence in new contexts. Fourth, maintaining program fidelity requires the development of systems to support training and accreditation for service providers, and monitor implementation at scale.

Conclusion: Parenting for Lifelong Health advocates a pragmatic approach to balance the need for high-quality evidence and implementation with the current global demand for parenting interventions to reduce child abuse. Policy makers and researchers would benefit from adopting a middle-way that uses wide-scale implementation as an opportunity to build evidence of effectiveness while concurrently dissemination occurs in multiple countries.