Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa.
Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa.
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DOI：
10.1136/bmjgh-2017-000539
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发表时间：
2018
影响因子：
8.1
通讯作者：
Gardner F
中科院分区：
文献类型：
--
作者：
Cluver LD;Meinck F;Steinert JI;Shenderovich Y;Doubt J;Herrero Romero R;Lombard CJ;Redfern A;Ward CL;Tsoanyane S;Nzima D;Sibanda N;Wittesaele C;De Stone S;Boyes ME;Catanho R;Lachman JM;Salah N;Nocuza M;Gardner F
评估针对低收入和中等收入国家青少年的“为终身健康而养育：中国青少年”养育方案对虐待和养育做法的影响。语用集群随机对照试验。南非东开普省40个村庄/城市（集群），552个家庭报告与其青少年（10-18岁）发生冲突。干预组（n=20）接受了由受过培训的社区成员提供的14期家长和青少年计划。对照组（n=20）接受了卫生和洗手促进计划。主要结果：干预后1个月和5-9个月的虐待和养育行为。次要结果：干预后5-9个月，照顾者和青少年心理健康和药物使用、青少年行为问题、社会支持、遭受社区暴力和家庭经济状况。失明是不可能的。在干预后5-9个月，干预与较低的虐待相关(照顾者报告发生率比（IRR） 0.55 (95% CI 0.40 ~ 0.75， P<0.001)；体罚（照顾者报告IRR=0.55 (95% CI 0.37 ~ 0.83， P=0.004)）；改善积极的养育方式（照料者报告d=0.25 (95% CI 0.03 ~ 0.47， P=0.024)），参与的养育方式(照料者报告d=0.86 (95% CI 0.64 ~ 1.08， P<0.001)；青少年报告d=0.28 (95% CI 0.08 ~ 0.48， P=0.006))和较少的不良监督(护理人员报告d= - 0.50 (95% CI - 0.70 ~ - 0.29， P<0.001)；青少年报告d= - 0.34 (95% CI - 0.55至- 0.12，P=0.002))，但没有减少忽视(照顾者报告IRR 0.31 (95% CI 0.09至1.08，P=0.066)；青少年报告IRR 1.46 (95% CI 0.75至2.85，P=0.264))，不一致的纪律(护理人员报告d= - 0.14 (95% CI - 0.36至0.09，P=0.229)；青少年报告d=0.03 (95% CI - 0.20 ~ 0.26， P=0.804)，或青少年报告虐待IRR=0.90 (95% CI 0.66 ~ 1.24， P=0.508)，体罚IRR=1.05 （95% CI 0.70 ~ 1.57， P=0.819）。次要结果显示，照顾者体罚支持、心理健康问题、养育压力、物质使用和社会支持增加的减少（所有照顾者报告）。参与干预的青少年报告在心理健康、行为或社区暴力方面没有差异，但药物使用较低（所有青少年都报告）。干预家庭改善了经济福利、财务管理和更多的暴力避免计划（在照顾者和青少年报告中）。未发现不良反应。这一养育规划有望在资源匮乏的环境中减少暴力、改善养育和家庭功能。泛非临床试验注册中心PACTR201507001119966。
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. Pragmatic cluster randomised controlled trial. 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa. 552 families reporting conflict with their adolescents (aged 10–18). 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. 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. 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. This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings. Pan-African Clinical Trials Registry PACTR201507001119966.
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DOI：
10.1136/bmj.a1655
发表时间：
2008-09-29
期刊：
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影响因子：
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作者：
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Medical Research Council Guidance