Parenting on the border
Parenting on the Border is a research project supporting migrant and displaced families from Myanmar living in Thailand’s Tak province.
In response to decades of instability and a recent surge in cross-border displacement, the project evaluates a locally grounded parenting intervention designed to reduce violence against children.
By working closely with affected communities, this study provides vital evidence on how to protect children and strengthen caregiving in humanitarian settings.
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The Parenting on the Border project addresses the critical needs of migrant and displaced families from Myanmar residing in Thailand. For decades, armed conflict and political and economic instability in Myanmar have led to significant migration into Thailand’s Tak province.
This situation has been further intensified by the coup d’état in Myanmar in February 2021, resulting in a substantial influx of individuals seeking refuge across the border.
While Thailand hosts a large number of people of concern, including refugees from Myanmar living in camps, there is also a significant population of migrants and displaced individuals living outside these formal settlements.
It is estimated that millions of migrants in Thailand originate from Myanmar.
These families often face considerable hardship, including insecurity and limited access to essential services. In such contexts of adversity, children can be at heightened risk of maltreatment due to increased parental distress and disrupted social support networks.
Recognising the challenges and vulnerabilities of this refugee community, the “Parenting on the Border” initiative seeks to evaluate a community-based intervention aimed at reducing violence against children and promoting positive parenting practices among these migrant and displaced caregivers.
This study is particularly significant as it represents the first randomised controlled trial evaluation of a film-based intervention to reduce child maltreatment among migrant and displaced families in a low- and middle-income country (LMIC).
Prior to developing this intervention, formative qualitative research was conducted with parents and adolescents from Myanmar living in Tak province to understand existing parenting practices and risk factors for child maltreatment.
This crucial step ensured that the intervention is contextually relevant and responsive to the specific needs of this population. The project aims to contribute valuable evidence to inform strategies for supporting families and protecting children in humanitarian settings.
1. Intervention development
This phase involved creating the film intervention itself.
- Development took place over a period of 12 months.
- It was informed by formative qualitative research with parents/caregivers and adolescents from Myanmar living in Tak province to understand parenting practices, risk factors for child maltreatment, and acceptability of potential strategies.
- Findings from this research were used to inform script development, which was led by a refugee filmmaker in close collaboration with the research team.
- An advisory committee composed of community-based organizations and parents/caregivers from Myanmar reviewed the script and provided feedback on characters, plot, and messages, which was incorporated into the final version.
- Filming took place on location in Tak province from December 2022 to April 2023.
- All cast and crew members were migrants and displaced individuals from Myanmar, providing ongoing feedback for cultural resonance.
- A final draft of the film was shown to the advisory committee, partner organizations, and community members before being finalized for implementation in May 2023.
- The intervention was named “Being Family“. It is a 66-minute narrative drama depicting parenting challenges and strategies.
2. Trial planning and protocol registration
This phase involved designing the study and getting the necessary approvals.
- The study was designed as a pragmatic, superiority cluster randomized controlled trial with approximately 40 communities randomized in a 1:1 ratio to either the intervention or treatment as usual.
- Objectives were defined, including primary outcomes (reducing physical and emotional abuse, increasing positive parenting behaviour) and secondary/exploratory outcomes.
- Measures for assessing outcomes were selected, translated, and pilot tested.
- A sample size calculation was performed by the trial statistician, determining the need for 40 clusters with approximately 55 caregivers per cluster (total 2,200 caregivers) to detect a minimum effect size.
- The study protocol was prospectively registered with the Thai Clinical Trials Registry on 22 February 2023 (TCTR20230222005).
- Ethics approval was obtained from multiple institutional review boards and a Community Ethics Advisory Board on the Thailand-Myanmar border.
- A safety protocol was developed, including procedures for reporting and referring safety concerns and adverse events.
- A mixed methods process evaluation was embedded in the trial design to assess intervention delivery, acceptability, perceived impacts, and potential mechanisms.
3. Trial implementation and data collection
This phase involved recruiting participants, delivering the intervention, and collecting data at different time points.
- Recruitment of the first study participant began on 23 February 2023.
- Communities (clusters) were purposively selected and meetings were held with community leaders to gain permission.
- Eligible caregivers (primary caregivers of a child aged 4-17, from Myanmar, residing in the study site, conversant in Burmese) were recruited by trained community members.
- Baseline data collection took place from February to June 2023, enrolling 2,249 caregivers in 44 communities. Data was collected electronically in small groups or one-on-one using tablets, with survey items read aloud due to low literacy.
- Following baseline data collection in blocks of 4 communities, randomization occurred, allocating communities to either the intervention or control arm. The control arm received information about existing local services.
- The film intervention was delivered in intervention communities on a rolling basis from May to September 2023. This involved a community screening, a 30-40 minute facilitated audience discussion, a 5-minute summary video, and distribution of a poster depicting key parenting skills.
- Endline assessment occurred approximately 4 weeks post-intervention (June to October 2023).
- Follow-up assessment occurred approximately 4 months post-intervention (October 2023 to January 2024).
- Quantitative data collection involved administering measures on primary, secondary, and exploratory outcomes, as well as other characteristics like trauma exposure and daily stressors.
- Qualitative data (focus group discussions with caregivers, adolescents, stakeholders, and implementation staff) were planned to examine acceptability, perceived impacts, and feasibility.
4. Data analysis
This phase involves processing the collected data to assess the intervention’s impact.
- Data management protocols were followed, including daily uploads to a secure server, cross-checking, and de-identification.
- Outcomes are analysed using three-level models with measurement wave within participant within cluster.
- Primary analyses were conducted using the intention-to-treat principle and involved multiple imputation to account for dropouts.
- Sensitivity analyses using crude and unimputed models were also planned.
- Analyses of potential moderators and mediators were planned.
- A cost effectiveness analysis is planned.
- Qualitative data are transcribed, translated, and analysed using thematic content analysis.
- Data analysis for the published Lancet paper included adjusting for caregiver and child gender and age.
5. Results and findings
This phase involves reporting the outcomes of the statistical and qualitative analyses.
- The study found positive impacts on multiple parenting and family outcomes.
- Specific results include a 9% reduction in physical violence against children.
- Improvements were found in positive parenting and caregiver engagement in early learning activities.
- Increased parenting knowledge, family functioning, and social support were reported.
- The reductions in physical violence had faded by the four-month follow-up, although effects on positive parenting and parenting knowledge were sustained.
- There were no impacts on psychological violence at either time point.
- No effects were found on exploratory outcomes such as educational involvement, coping and stress management, or caregiver/child mental health.
- The effect sizes for the primary outcomes were reported (SMD -0.24 for physical violence reduction, SMD 0.09-0.12 for positive parenting).
6. Dissemination and Knowledge Translation
This phase involves sharing the study findings with relevant audiences.
- Results will be disseminated to research participants, implementing organizations, policymakers, and the academic community.
- An integrated knowledge translation approach is used to engage partners and knowledge users.
- Dissemination includes peer-reviewed journal articles (e.g., in The Lancet Regional Health – Southeast Asia and PLoS ONE), conference presentations, and policy briefs.
- Public screenings of the “Being Family” film and panel discussions have been held as part of advocacy efforts.
- The study findings and publication were featured on a university website.
- De-identified data and analytical code will be made publicly available following guidelines.
7. Potential for Replication and Future Work
This phase considers the broader implications and next steps based on the study findings.
- The results show that a light-touch, universal mass media intervention like the film can be effective and has the potential for population-level impact and scalability due to its low cost and ability to reach large numbers.
- The high uptake (83%) supports the feasibility and scalability of the intervention.
- The film content and the film creation process can be adapted and replicated in other contexts and for other outcomes.
- Ongoing analyses (qualitative, quantitative, cost effectiveness) will further examine implications for replication and scale-up.
- Experience from this project, “Parenting on the Border,” can inform replication efforts.
- The “Being Family” film has already been delivered in three refugee camps on the Thailand-Myanmar border with UNHCR funding.
- The team is currently conducting a subsequent randomized controlled trial evaluating a trauma-informed adaptation of a parenting and mental health intervention for higher-need families. This intervention integrates content from evidence-based programs and the “Being Family” film. Implementation began in August 2024 and delivery was completed in December 2024, with data collection ongoing into 2025.
Parenting on the border: Study protocol for a randomized controlled trial of a trauma-informed, edutainment-enhanced intervention to improve parenting and mental health among migrant and displaced caregivers in Thailand
Sim, Amanda, Eve Puffer, Stephanie Eagling-Peche, Khaing Zar Lwin, G. J. Melendez-Torres, Seema Vyas, Tawanchai Jirapramukpitak, Jamie Lachman, Sumitra Thidar Soe, Th’Blay Moo, Mary Soan, Jem Chalk, Hannah Van Vijfeijken | 2025 | SSM – Mental Health
Amanda Sim, Khaing Zar Lwin, Stephanie Eagling-Peche, G. J. Melendez-Torres, Seema Vyas, Francisco Calderon, Tawanchai Jirapramukpitak, Jamie Lachman, Sureeporn Punpuing, Andrea Gonzalez, Mary Soan, Nway Nway Oo, Ivet Castello Mitjans, Greg Tyrosvoutis and Eve Puffer | 2025 | The Lancet Regional Health – Southeast Asia
Amanda Sim, Tawanchai Jirapramukpitak, Stephanie Eagling-Peche, Khaing Zar Lwin, G. J. Melendez-Torres, Andrea Gonzalez, Nway Nway Oo, Ivet Castello Mitjans, Mary Soan, Sureeporn Punpuing, Catherine Lee, Pattraporn Chuenglertsiri, Th’Blay Moo, and Eve Puffer | 2023 | PLOS ONE
The trial was registered with the Thai Clinical Trials Registry.
Mae Tao Clinic
Sermpanya Foundation
Help Without Frontiers
INED
IPSR, Mahidol University
Duke Global Health Institute
Offord Centre for Child Studies
Mary Heersink School of Global Health and Social Medicine
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