Putting the Horse before the Cart? Negotiating Tensions Between the Need for Evidence and the Demand for Dissemination of Parenting Programmes to Reduce Violence Against Children in Low- and Middle-Income Countries

Objectives: Parenting programmes have shown promise in preventing violence against children, as well as improving child and parental outcomes. Accordingly, there is an increased demand for the dissemination of evidence-based parenting programmes by international agencies such as the World Health Organization and UNICEF, as well as a need for governments to rapidly scale up effective preventative interventions through child protection services. However, few parenting programmes are both evidence-based and affordable for low- and middle-income countries, and can therefore meet this demand for dissemination and scale-up.

Methods: This paper examines the tension between establishing rigorous evidence of effectiveness that is applicable in multiple contexts with the urgent need for the application of parenting programmes to reduce violence against children in low-and middle-income countries. It uses insights gleaned from implementing partners, programme beneficiaries and policy makers, and draws on Parenting for Lifelong Health’s experience of developing evidence-informed parenting programmes in multiple countries and contexts.

Results: This paper presents four challenges facing researchers, policy makers, and practitioners: First, establishing evidence requires substantial time and resources to meet international standards of effectiveness. Second, international and local implementing agencies often require lower thresholds for evidence before taking programmes to scale. Third, implementation across contexts may require considerable adaptation to fit local cultures and delivery systems, as well as additional research to establish evidence in new contexts. Fourth, maintaining programme fidelity requires the development of systems to support training and accreditation for service providers, and monitoring implementation at scale.

Conclusion: The authors advocate a pragmatic approach to balance the need for high-quality evidence and implementation with the current global demand for parenting interventions to reduce child abuse. Policy makers and researchers would benefit from adopting a middle-way that uses wide-scale implementation as an opportunity to apply an inbuilt process for building evidence of effectiveness while concurrently disseminating in multiple countries.