The Multiphase Optimisation Strategy (MOST) As an Innovative and Efficient Framework to Optimize Parenting Interventions for Scalability in Low- and Middle-Income Countries

Violence against children is a global health problem with over 1 billion children affected annually, and higher rates in low- and middle-income countries (LMIC). This has serious immediate and long-term health consequences, including increased risks of mental health problems, substance use, peer violence and delinquency, and intergenerational transfer of violence via intimate partner violence and child maltreatment. Parenting interventions have been shown to be effective for violence prevention by directly reducing parental harsh discipline and improving parent-child relationships, and by indirectly reducing associated risks such as youth violence, delinquency, and substance use, as well as parental mental health difficulties. Despite emerging evidence that supports such effects in LMIC, there are many substantial barriers to accessing evidence-based interventions due to limited human and financial resources in such countries. As a result, it is important to utilize innovative research methods optimize parenting interventions by testing active components based on effectiveness, cost efficiency, and scalability.

This 20x20 presentation will discuss how the Multiphase Optimization Strategy (MOST) framework may be applied to address the urgent need for effective, cost-effective, and scalable parenting interventions in the LMICs that prevent violence against children and associated risks. The MOST framework was developed by Professor Linda Collins from the Methodology Centre at Penn State University to optimize and evaluate multicomponent behavioural interventions for improving and maintaining health and mental wellbeing. The framework involves three steps – Preparation, Optimization, and Evaluation – to identify an intervention package that provides the highest expected level of effectiveness obtainable within key constraints imposed by the need for efficiency, economy, and scalability.

The presentation will use an upcoming Horzon2020-funded study in three countries in Southeastern Europe (2018-2021) as an illustrative example of how MOST can be applied to optimize parenting interventions in LMIC. This study focuses on the optimization of the Parenting for Lifelong Health for Young Children program to reduce child behavior problems and associated risks in families with children ages two to nine years in Romania, Macedonia, and Moldova. The paper provides an overview of the study design, with particular emphasis on some of the critical aspects of MOST, including 1) defining the conceptual model and optimisation criteria during the Preparation Phase, 2) conducting a factorial experiment to inform the selection of the most effective and cost-effective components with the highest levels of program implementation during the Optimization Phase (N = 4 components, 16 experimental conditions, 720 families), and 3) testing the optimized intervention package in a multi-country RCT (N = 720). As the first study to use MOST to optimize a parenting program in the world, this paper will also explore potential challenges that should be considered when applying the framework to optimize complex child and youth interventions in low-resource settings.