Reducing Child Maltreatment in South Africa: Feasibility of a Locally Developed Parenting Programme for at-Risk Low-Income Families

Background: In sub-Saharan Africa, many children are at high risk for maltreatment because they are living in poverty and/or in families affected by intimate partner violence (IPV), substance misuse, or HIV/AIDS. Parenting programs have been shown to be effective in reducing child abuse and neglect for children ages 3 to 8. However, there are no known evidence-based parenting interventions to prevent child abuse in sub-Saharan Africa.

Methods: This feasibility pilot study was part of a small-scale, pilot randomized controlled trial (n = 68 parents of children aged 3 to 8 with behavioral problems) of the Sinovuyo Caring Families Program – a locally developed parenting program in Cape Town, South Africa. Derived from evidence-based social learning principles (Kaminski, 2008), the program used a collaborative approach to engage parents in positive parent-child relationship building and effective, nonviolent discipline strategies. Locally trained paraprofessional facilitators delivered the program through 12 weekly group sessions combined with home visit consultations. Using a grounded theory approach, in-depth interviews from a random sampling of participants (n = 24) and focus groups with paraprofessionals (n = 6) examined cultural acceptability and appropriateness, barriers to implementation and participation, and potential approaches to overcoming these barriers. Attendance registers and participant self-report on home activities examined program exposure, adherence, and engagement. Self-report questionnaires assessed participant satisfaction for each program session as well as overall program satisfaction. Facilitator checklists and randomly selected video recordings of sessions examined implementation fidelity.

Results: Study retention from baseline to four month post-test in the randomized controlled trial was very high (97%). Attendance rate (75%; mean = 9 sessions) was consistent with parenting programs implemented in high-income countries. Qualitative and quantitative data analysis indicates a high program satisfaction and acceptability. Paraprofessional community facilitators were able to deliver the program with an acceptable level of fidelity. Participants reported some challenges in using some evidence-based parenting approaches, including emotional labeling and non-violent discipline strategies such as Time-Out.

Conclusion: Results indicate that a program derived from evidence-based parenting principles is feasible and culturally acceptable for vulnerable isiXhosa families in Cape Town, South Africa. Using a collaborative approach that elicits parents’ views and engages them in experiential problem solving requires skilled and sensitive program facilitators with ongoing training, supervision, and logistical support to maintain program fidelity. Additional sessions may be necessary to deliver parenting principles that are relatively new to participants’ cultural framework or life experience in order to be fully integrated into practice.