This systematic review, conducted in line with Cochrane Handbook guidelines, investigated the effectiveness of parenting interventions for reducing harsh/abusive parenting, increasing positive parenting practices, and improving parent-child relationships in low-to-middle income countries (LMICs). The authors highlight that parenting interventions are increasingly being implemented in low- and middle- income countries but there have been few rigorous evaluations. Randomized trials were considered for inclusion, with participants that included parents or primary carers of children aged 0-18 years, in countries defined as low- or middle- income by the World Bank (2010). Interventions were those designed to reduce child abuse or harsh parenting, teach positive child behavior management strategies, or improve parent-child attachment and relationships, through specific parenting components or curricula aimed at changing general parenting knowledge, attitudes or skills.
Twelve studies with 1580 parents in nine countries (Brazil, Chile, China, Ethiopia, Iran, Jamaica, Pakistan, South Africa and Turkey) reported results favoring intervention on a range of parenting measures, including parent-child interaction, parent attitudes and knowledge, and reductions in harsh parenting. Participants were mostly mothers, while four included only pregnant women or new mothers a few days after giving birth. Most intervention packages were delivered to individuals through home visiting; two were delivered to groups of parents, in community settings or workplaces and two combined home visits with group-based delivery. The validity of results for most studies was found to be unclear, however, due to substantial or unclear risks of bias. Findings from the two largest, highest- quality trials though suggest parenting interventions may be feasible and effective in improving parent-child interaction and parental knowledge in relation to child development in LMICs. The authors highlight that while limited conclusions can be drawn from this review as a whole, the studies from South Africa, Pakistan and, to some extent, Brazil provide examples of high quality implementation and research design in low-resource settings, as well as showing beneficial impact on parenting outcomes. They conclude that given the well-established evidence base for parenting interventions in high-income countries, and increasingly good evidence for their applicability across cultures and countries, there is now an urgent need for more rigorously evaluated and reported studies, focusing on youth outcomes as well as parenting, adapted for contexts of considerable resource constraints.
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