Randomized Controlled Trial of a Parenting Intervention Transported into a Low-Resource Setting with Minimal Cultural Adaptations: The Case of Triple P in Panama

Introduction: Research suggests that evidence-based parenting interventions are effective for preventing child behavioral difficulties.  However, most trials of parenting interventions have been carried out in English-speaking high-income countries and two recent systematic reviews identified a gap in research on the efficacy and cultural fit of these interventions in low- and middle-income countries (LMIC). The aim of this study was to test the efficacy of one brief intervention from the Triple P Positive Parenting Program in Panama, a LMIC in Latin America.  Triple P is an evidence-based Australian intervention, and in this particular study, the intervention was transported into Panama with minimal cultural adaptations after parents’ feedback suggested the original protocol and materials would fit their existing parenting needs.

Methods: A parallel group randomized controlled trial was carried out.  Parents (n=108) of children 3 to 12 years old with moderate levels of child behavioral difficulties, as indicated by the Eyberg Child Behavior Inventory (ECBI), were randomly assigned to receiving a Triple P one-session discussion group intervention on dealing with disobedience (n=54), or to a no intervention control (n=54).  Blind assessments took place at baseline, two weeks after the intervention, 3 months and 6 months after. The main outcome measure was the ECBI to assess behavioral difficulties. Other outcome measures were parental stress (Depression Anxiety Stress Scale 21) and parenting practices (Parenting Scale).

Results: Linear two-level mixed models suggested that child behavioral difficulties changed over time and decreased more steeply in the intervention than in the control group [F (1, 146) = 38.5, p < 0.001].  The effects of the intervention on child behavioral difficulties were d=0.52, 95% CI [-6.5, 7.6] at post intervention, d=0.42, 95% CI [-7.9, 8.8] at three months follow-up, and d=1.09, 95% CI [-6.9, 9.1] at six months follow-up.  Similar results were found for parental stress and parenting practices and were maintained in an intention-to-treat analysis. 

Discussion:  Results from this RCT suggested that this brief intervention delivered in its original form and with minimal cultural adaptations (i.e. translation and delivery by a local facilitator) was effective in reducing child behavioral difficulties, parental stress and ineffective parenting practices.  There is a pressing need for the implementation of preventive family interventions globally, and this is one of the few existing RCTs of an evidence-based parenting intervention in a LMIC.