Parenting Interventions to Prevent Violence Against Children in Low- and Middle-Income Countries in East and Southeast Asia: A Systematic Review and Multi-Level Meta-Analysis

Introduction: Ending violence against children is a global priority, as demonstrated in the Sustainable Development Goals. Currently, the strongest evidence that exists for fulfilling this commitment lies with social learning theory-based parenting interventions. An increasing number of experimental studies on such interventions have been conducted in low- and middle-income countries (LMICs) in East and Southeast Asia. The purpose of this study is to review and synthesize the evidence from experimental studies on the effectiveness of parenting interventions in preventing violence against children in LMICs in East and Southeast Asia. These findings will assist in setting the agenda for parenting research in the region, as well as in other LMICs.

Methods: Information sources included seven databases of published literature, nine regional bibliographic databases, seven databases for unpublished and non-indexed reports, and four Thai university databases. A total of 101 experts were contacted to identify other relevant studies. Primary outcomes of interest included rates of violence perpetrated by parents and primary caregivers against children, with secondary outcomes including: harsh or dysfunctional parenting; parenting skills, behaviour, attitudes or knowledge; and quality of parent-child attachment, sensitivity, and relationships. Studies were appraised using the Cochrane risk of bias tool and effect estimates pooled using random effects multilevel meta-analysis.

Results: A total of 11 studies from three countries with 2,813 parent, primary caregiver, and child participants were included, reporting results that favoured intervention on various parenting measures. The studies were of variable quality. A multi-level meta-analysis of 44 effects was conducted based on five outcome category models, finding a medium effect on abusive, harsh, or negative parenting (d=-0.42, 95% CI [-0.81, -0.02], p<.01, I²=72%); a large, non-significant effect on parental knowledge or attitudes (d=1.40, 95% CI [-0.30, 3.10], I²=95%); a small effect on positive parent-child interactions (d=0.25, 95% CI [0.19, 0.32], p<.001, I²=0); a small, non-significant effect on parental stress (d=-0.13, 95% CI [-0.38, 0.11], I²=0); and a small, non-significant effect on family environment (d=0.21, 95% CI=-0.12 to 0.53, I²=85%).

Conclusions: This review updated and extended other relevant reviews by identifying 10 additional studies. The findings suggest that parenting interventions can reduce rates of particular forms of violence against children perpetrated by parents and primary caregivers, as well as promote positive parent-child interactions.