Building a Rondavel of Support: Using a Systematic Approach to Culturally Adapting Evidence-Based Principles in Order to Develop a Parenting Program for Disadvantaged Families in South Africa

Introduction: In high-income countries, parenting programs have been shown to be effective in reducing the risk of child maltreatment. However, there is limited evidence on their effectiveness in low- and middle-income countries (LMICs). Moreover, due to licensing fees, accreditation requirements, and complex delivery mechanisms, many evidence-based parenting programs are prohibitively expensive to implement with fidelity and therefore not feasible to deliver in low-resource contexts. As a result, this study focused on the systematic cultural adaptation and evaluation of a locally developed parenting program derived from evidence-based principles for low-income families with children ages 2 to 9 in South Africa – the Sinovuyo Caring Families Program.

Methods: The Sinovuyo Caring Families Program’s development and evaluation is being implemented over 4 phases in South Africa: 1) Development Phase: community based participatory formative research in 2012 to adapt evidence-based parenting principles to a local cultural context; 2) Pilot Phase: a pilot randomized controlled trial in 2013 to test program feasibility and initial effects (n=68); 3) Efficacy Phase: a larger randomized controlled trial in 2014-2016 to evaluate program efficacy and test potential moderators and mediators of intervention effects (n=290); and 4) Dissemination Phase: further testing in other low- or middle-income countries to establish effectiveness and plan for wide-scale rollout by 2020.

Results: Formative research found a high receptivity to evidence-based parenting principles that have been shown to improve parenting and reduce child behavior problems. Using an intention-to-treat design, the pilot feasibility trial showed improvements in parent self-report of positive parenting for the intervention group in comparison with the control group (F=8.93, p=.004, Cohen's d=0.74). The program was also implemented with an acceptable degree of dosage (64.4% attended 9 or more sessions), participant satisfaction, cultural acceptability, and program fidelity. Post-test results from the larger randomized controlled trial will be available in April 2015.

Discussion: This study is the first in sub-Saharan Africa to use a systematic approach to program development and evaluation of a parenting program to reduce violence against young children. Initial results indicate that the program is feasible, culturally acceptable, and has the potential to reduce the risk of child maltreatment by improving positive parenting behavior. Further testing is necessary and currently underway to determine program efficacy prior to dissemination throughout low- and middle-income countries. 

Funding was provided by the South African National Lottery Trust Distribution Fund, Ilifa Labantwana, the World Health Organisation, the Rand Merchant Bank Fund, the ApexHi Charitable Trust, and the Fell Fund. Trial registry: Pan African Clinical Trial Registry, PACTR201302000455414; ClinicalTrials.gov, NCT01802294.