Reducing child abuse amongst adolescents in low- and middle-income countries: A pre-post trial in South Africa.
Reducing child abuse amongst adolescents in low- and middle-income countries: A pre-post trial in South Africa.
复制标题
DOI：
10.1186/s12889-016-3262-z
复制
发表时间：
2016-07-13
影响因子：
4.5
通讯作者：
Gardner F
中科院分区：
文献类型：
--
作者：
Cluver L;Meinck F;Yakubovich A;Doubt J;Redfern A;Ward C;Salah N;De Stone S;Petersen T;Mpimpilashe P;Romero RH;Ncobo L;Lachman J;Tsoanyane S;Shenderovich Y;Loening H;Byrne J;Sherr L;Kaplan L;Gardner F
没有任何已知的研究测试了低收入或中等收入国家青少年虐待儿童预防方案的有效性。“为人父母促进终身健康”（http：//tiny.cc/whoPLH）是一个合作项目，旨在制定和严格测试预防虐待为人父母方案，供在资源匮乏的情况下免费使用。这项在南非进行的第一次前后试验的研究目的是：i）确定该方案对虐待儿童和相关结果的指示性影响; ii）调查未来随机试验中测试的方案安全性; iii）确定潜在的适应性。230名参与者（青少年和他们的主要照顾者）从学校，福利服务和社区抽样在农村，高度贫困的南非（无排除标准）。所有人都参加了一个为期12周的育儿方案，由当地非政府组织儿童保育工作者实施，以确保现实世界的外部效度。使用标准化的青少年和照顾者的前后措施，并进行配对t检验的主要结果：虐待（身体，情感虐待和忽视），青少年行为问题和养育（积极和参与养育，监测不良和不一致的纪律），和次要结果：心理健康，社会支持和物质使用。参与者报告了高度的社会经济剥夺，例如，60%的青少年有艾滋病毒阳性的照顾者或因艾滋病而成为孤儿，50%的照顾者经历过亲密伴侣暴力。㈠指示性影响：测试前和测试后评估的主要结果比较显示，青少年和照顾者报告的虐待儿童减少（青少年报告测试前63.0%至测试后29.5%，护理人员报告测试前75.5%至测试后36.5%，均p < 0.001）监测不良/纪律不一致（p <0.001），青少年犯罪/攻击行为（均p <0.001），以及积极/参与养育的改善（p <0.01青少年报告，p <0.001照顾者报告）。次要结果显示社会支持改善（青少年和照顾者报告p <0.001），父母和青少年抑郁减少（均p <0.001），父母压力（照顾者报告p <0.001）和照顾者物质使用（照顾者报告p <0.002）。青少年物质使用没有变化。未发现任何负面影响。㈡方案的可接受性和出席率很高。在一些研究村庄中，方案出现了意料之外的传播，家庭在教堂中发起了父母小组，并通过学校集会和宗教布道传播。所确定的潜在调整包括需要加强关于青少年药物使用的组成部分，并考虑如何支持忠实地自发传播方案。该方案没有显示出任何伤害迹象，初步证据表明虐待儿童的情况有所减少，照顾者和青少年的结果有所改善。它表现出很高的可接受性和意想不到的社区一级的传播。研究结果表明，需要适应，并适合在随机试验中进行更严格的测试，使用集群随机化，以允许扩散效应的下一个研究步骤。
No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ (http://tiny.cc/whoPLH) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations. Two hundred thirty participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional abuse and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use. Participants reported high levels of socio-economic deprivation, e.g. 60 % of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50 % of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0 % pre-test to 29.5 % post-test, caregiver report 75.5 % pre-test to 36.5 % post-test, both p < 0.001) poor monitoring/inconsistent discipline (p < .001), adolescent delinquency/aggressive behaviour (both p < .001), and improvements in positive/involved parenting (p < .01 adolescent report, p < .001 caregiver report). Secondary outcomes showed improved social support (p < .001 adolescent and caregiver reports), reduced parental and adolescent depression (both p < .001), parenting stress (p < .001 caregiver report) and caregiver substance use (p < .002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity. The programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs for adaptations, and suitability for the next research step of more rigorous testing in randomised trials, using cluster randomization to allow for diffusion effects.