Is Parenting Enough? Combining Economic Strengthening and Skillful Parenting to Reduce Violence Against Children in Impoverished Communities in Rural Tanzania: A Pilot Cluster Randomized Controlled Trial

Introduction: Parenting programs have been shown to reduce the risk of violence against children and improve child wellbeing in high-income countries. There is also emerging evidence regarding their effectiveness in low- and middle-income countries. However, in highly deprived communities, parenting programs may require additional economic support to address the negative impact of poverty on parenting and risk of abuse. This study fits within the theme of "Enhancing Physical, Social and Economic Environments to Improve Health Equity.” It uses a pilot cluster randomized controlled trial design to examine the differential effects of parenting and economic strengthening programs in order to reduce the risk of violence against children and improve child wellbeing in impoverished farming communities in rural Tanzania.

Methods: Participating rural villages in northern Tanzania were randomly assigned to one of four conditions: 1) a 12-session group-based parenting program; 2) an agricultural training program; 3) a combination of parenting and agricultural training programs; 4) or a 1-year wait-list control (N = 8 villages, 240 families, 2:2:2:2 arm ratios). Within each village, we randomly selected two agricultural farmer groups to participate in the study. Assessments at baseline were conducted with one adult per household who was a member of the selected farmer group and a primary caregiver of at least one child aged 3 to 17 years. If present in the household, assessments were also conducted with one child aged 10 to 17 years per household as well as early childhood assessments with the adult and a child aged 0 to 3 years. Primary outcomes include adult-report, teen-report, and observational assessments of harsh and positive parenting. Adult secondary outcomes include parenting stress, depression, child behavior, food consumption, and household poverty. Child secondary outcomes include child behavior, depression, sexual behavior, and child labor. Early childhood secondary outcomes include family environment, child development, and child nutrition and growth.

Results: Post-test data collection will occur in March 2016 with initial results available by early May. Multi-level modeling analyses will assess differences between study conditions as well as between each intervention arm and the control group at immediate post-test. The analysis will be intention-to-treat using multiple imputation for missing data. We will also use the Bonferroni adjustment in order to deal with potential multiplicity due to Type 1 errors. Due to the pilot nature of the study, we will examine tests for significance (set at the p < 0.05 level) as well as the direction and magnitude of effect sizes to assess program efficacy and clinical relevance.

Conclusions: This is the first study to test the impact of combining parenting and economic strengthening programs to reduce violence against children in a low- and middle-income country. Findings will provide important insights on how economic strengthening might improve the uptake and engagement of parenting for highly impoverished families. Results will also inform subsequent testing in a larger cluster randomized controlled trial.