title: Reducing child abuse amongst adolescents in low- and middle-income countries: A pre-post trial in South Africa.
abstract: No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. 'Parenting for Lifelong Health' ( http://tiny.cc/whoPLH ) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations.
  
  
  
  Two hundred thirty participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional abuse and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use.
  
  
  
  Participants reported high levels of socio-economic deprivation, e.g. 60 % of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50 % of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0 % pre-test to 29.5 % post-test, caregiver report 75.5 % pre-test to 36.5 % post-test, both p < 0.001) poor monitoring/inconsistent discipline (p < .001), adolescent delinquency/aggressive behaviour (both p < .001), and improvements in positive/involved parenting (p < .01 adolescent report, p < .001 caregiver report). Secondary outcomes showed improved social support (p < .001 adolescent and caregiver reports), reduced parental and adolescent depression (both p < .001), parenting stress (p < .001 caregiver report) and caregiver substance use (p < .002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity.
  
  
  
  The programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs for adaptations, and suitability for the next research step of more rigorous testing in randomised trials, using cluster randomization to allow for diffusion effects.
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK. lucie.cluver@spi.ox.ac.uk.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. lucie.cluver@spi.ox.ac.uk.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cluver
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Franziska
authors.initials: F
authors.lastname: Meinck
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Alexa
authors.initials: A
authors.lastname: Yakubovich
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Doubt
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Redfern
authors.affiliation: Department of Psychology, University of Cape Town, Cape Town, South Africa.
authors.forename: Catherine
authors.initials: C
authors.lastname: Ward
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Nasteha
authors.initials: N
authors.lastname: Salah
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Sachin
authors.initials: S
authors.lastname: De Stone
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Tshiamo
authors.initials: T
authors.lastname: Petersen
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Phelisa
authors.initials: P
authors.lastname: Mpimpilashe
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Rocio Herrero
authors.initials: RH
authors.lastname: Romero
authors.affiliation: Clowns Without Borders South Africa, PO Box 18670, Durban, 4014, South Africa.
authors.forename: Lulu
authors.initials: L
authors.lastname: Ncobo
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.|Clowns Without Borders South Africa, PO Box 18670, Durban, 4014, South Africa.
authors.forename: Jamie
authors.initials: J
authors.lastname: Lachman
authors.affiliation: Clowns Without Borders South Africa, PO Box 18670, Durban, 4014, South Africa.
authors.forename: Sibongile
authors.initials: S
authors.lastname: Tsoanyane
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Shenderovich
authors.affiliation: UNICEF, Offices of Research - Innocenti, Florence, Italy.
authors.forename: Heidi
authors.initials: H
authors.lastname: Loening
authors.affiliation: UNICEF, Offices of Research - Innocenti, Florence, Italy.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Royal Free and University College Medical School, University College London, London, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.affiliation: Alcohol Research Group, Public Health Institute, Emeryville, California, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Kaplan
authors.affiliation: Department of Social Policy & Intervention, Centre for Evidence-Based Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Gardner
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000374:Aggression; D017028:Caregivers / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data; D003863:Depression / Q000517:prevention & control; D003906:Developing Countries; D004644:Emotions; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008603:Mental Health; D016487:Parenting; D010290:Parents / Q000523:psychology; D015397:Program Evaluation; D012944:Social Support; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D013179:Spouse Abuse; D019966:Substance-Related Disorders
keywords: Abuse prevention; Child abuse; Parenting; Parenting stress; Prevention; Psycho-social aspects; South Africa