Feasibility Study of the Parenting for Lifelong Health for Young Children Parent Program in Three South-Eastern European Countries

Introduction: Childhood behavior problems are of global concern since they predict poor outcomes both short and long term. Parenting programs are effective in reducing child behavior problems, however there is a lack of research in low- and middle-income countries (LMIC). This feasibility study aimed to evaluate the implementation of a parent program in three LMIC in South-eastern Europe. It forms part of a larger project that aims to adapt, optimize, and test a parenting intervention using rigorous evaluation methods including the Multiphase Optimization Strategy (MOST) and the RE-AIM framework. This feasibility study represents the preparation phase of the MOST framework. The project is funded by a Horizon 2020 grant. The parenting intervention being evaluated was developed as part of the Parenting for Lifelong Health initiative led by the World Health Organization, UNICEF, and partner universities that aims to develop and test low-cost parenting interventions

Methods: A pre-post feasibility study was conducted in FYR Macedonia, Republic of Moldova, and Romania. Parents of children aged 2-9 years reporting elevated levels of child behavior problems were recruited (N = 140) to participate in the PLH for Young Children program, a 12-week, group-based, evidence-informed parenting intervention developed for implementation in LMIC. The sample recruited were reporting a number of disadvantages including elevated levels of maternal depressive symptoms, economic strain with approximately half experiencing hunger in the past month. A portion of the sample also had difficulty reading. Feasibility outcomes around recruitment, engagement, implementation, and barriers were examined as well as pre-post measures for child behavior, parenting, and parental mental health.

Results: Recruitment was ultimately successful with all three countries recruiting above the target sample size of 40 families using a range of different recruitment methods. There were some recruitment challenges reported and even though each country delivered four groups of the PLH program, implementation differed between countries with two delivering the 12-session version and one the six-session version. Program engagement rates varied between countries with higher levels in FYR Macedonia. The program content and aspects of delivery were acceptable in all three countries. Pre-post results will also be reported.

Conclusions: The PLH for Young Children program was successfully implemented in three LMIC in South-eastern Europe. The results of the feasibility study will be used to inform the next phase of the larger project, the Optimization phase, which will aim to test different components of the program to identify the most efficacious, affordable, and scalable combination.