PLH-MaPaParenting for Lifelong Health-Philippines: Randomized Controlled Trial of a Culturally-adapted Parenting Program on Reducing the Risk of Violence Against Children in Low-income Filipino Families With Children Aged 2 to 6 Years in Manila

Over the past decade there have been increasing calls for the scale-up of evidence-based interventions in order to reduce the risk of violence against children in low- and middle-income countries (LMICs) \[1\]. In particular, parenting programmes for families with young children have been shown to be effective in reducing the risk of child maltreatment and improving child wellbeing with promising evidence emerging from low- and middle-income countries \[2-4\]. These group-based programmes typically aim to strengthen caregiver-child relationships through positive parenting and to help parents to manage child behaviour problems through effective, age-appropriate, nonviolent discipline strategies. Despite the emerging evidence of the effectiveness of parenting interventions in reducing violence against children, many local governments and service providers in LMICs face multiple challenges implementing evidence-based parenting programs in resource poor contexts \[5\]. Parenting programmes are often too expensive to deliver effectively at scale in low-resource settings due to their complexity, intensity, and length \[3\]. Parenting programmes developed and evaluated in other contexts also may not fit the local service delivery context and may require adaptation to be relevant to the local culture of families. Additional programme content may also be necessary to address stress related to economic deprivation, high community violence, and parental distress. The process of delivery may also need to be simplified to improve participant engagement and the quality of delivery. As a result, it is essential that programmes implemented in LMICs are 1) effective at reducing violence against children, 2) integrated within the existing service delivery system, 3) feasible and culturally acceptable to service providers and families, and 4) scalable in terms of their affordability, replicability, and sustainability while reaching a maximum number of beneficiaries. However, there are currently very few parenting programmes that meet these criteria in LMICs, such as the Philippines, where the need is the greatest \[3\]. The PLH Philippines Evaluation Study aims to fill this gap by examining the efficacy of a locally-adapted, evidence-based parenting programme, the Masayang Pamilya Para Sa Batang Pilipino Parenting Programme (MaPa), for families with children ages two to six years living in Metro Manila who are enrolled in the Philippine Department of Social Welfare and Development (DSWD) conditional cash transfer system. Our overall objective is to use a randomised controlled trial design to test the efficacy of the MaPa programme in reducing the risk of child maltreatment while improving child socio-emotional development, child behaviour, and parental mental health in comparison to treatment as usual controls in Metro Manila. Our primary objective is to examine the impact of the MaPa programme on the primary outcome of child maltreatment in comparison to treatment-as-usual controls at immediate post-intervention and at 1-year follow-up. Our secondary objective is to examine the impact of the MaPa programme on proximal outcomes associated with increased risks of child maltreatment, namely, positive parenting, intrusive parenting, and harsh parenting in comparison to treatment-as-usual controls at immediate post-intervention and at 1-year follow-up. Another secondary objective is to examine the impact of the MaPa programme at immediate post-intervention and at 1-year follow-up on child behaviour problems, child development outcomes (i.e., communication skills and socio-emotional development), parenting efficacy, parental wellbeing, parenting stress, parental depression, marital satisfaction, and intimate partner violence, in comparison to treatment as usual controls. Our tertiary objective is to examine the implementation of the MaPa programme when delivered within the DSWD conditional cash transfer system in terms of programme adherence by parents (i.e., recruitment, enrolment, attendance, engagement, dropout, and completion) and delivery by service providers (i.e., competency and fidelity). Our final objective is to examine predictors of programme adherence and associations between programme adherence and primary and secondary outcomes at immediate post-test and at 1-year follow-up.