Assessing the Feasibility of Providing a Parenting Intervention for War-Affected Mothers in Northern Uganda

Introduction: This presentation will include a description of cultural adaptation, early implementation efforts, and feasibility results of a 9-session manualized parenting intervention called Enhancing Family Connection (EFC). This intervention was based on the adaptation of the evidence-based Parent Management Training-Oregon (PMTO) model to fit cultural and post-conflict realities of families in Northern Uganda.

Methods: EFC included six sessions adapted from PMTO core components (positive reinforcement, setting limits, positive involvement), one session on traumatic stress and two on the intergenerational transmission of violence that included psychoeducation on domestic violence and substance abuse. Parent manuals were completely illustrated to account for illiteracy. Two groups (N=14) were conducted summer 2012 with Acholi mothers. Each session consisted of meeting for three hours, two times per week. EFC was conducted by two co-facilitators, two trained interpreters, and a support team. Small incentives for participation included one pound of beans and posho at the end of each session and transportation reimbursement. Multi-method data collected at pre-, post- and 5-month follow-up were gathered for mothers and an identified focal child between the ages of 9-13 to assess for mental health status (standardized measures), parenting practices (standardized and parent-child observational measures), and child outcomes (standardized measures). Phenomenological interviews were also conducted with mothers and focal child separately at the same intervals to explore their experiences of being involved in the intervention and to reflect on changes in family life pre and post. Specifically, study goals were to evaluate (a) acceptability, (b) implementation, and (c) limited efficacy and effectiveness.

Results: Results indicated that EFC was acceptable and can be implemented with Acholi mothers. All mothers attended all EFC sessions. In interviews, mothers reported increased positive involvement (“more love”) in their families, increased use of encouragement, and encouraged the spread of the intervention. Reductions in harsh discipline were reported in interviews and on standardized questionnaires. These results provide early evidence that parenting practices seemed to change for most mothers; however, prolonged intervention with additional support is necessary.

Conclusions: This study was instrumental in advancing our efforts in the preparation and early adaptation phases of transporting an evidence-based intervention to a new cultural and contextual setting. The next phases will involve full implementation and randomized tests of the model parallel to learning about potential for long-term implications for sustainability.