Ugandan Parenting for Respectability Implementation Science Cluster Trial

Overview

A cluster randomised controlled trial quantitatively and qualitatively examining the impact of three different delivery modalities on programme implementation within the intervention group. This includes 1) geographical location (rural vs. peri-urban), 2) group composition (existing vs. newly formed groups), and 3) facilitator experience (experience vs. novice).

Context

Evidence that builds our understanding of the prevalence and prevention of violence against children in low- and middle-income countries remains sparse. Evidence of effective, culturally relevant, and locally grounded VAC prevention interventions is even less.

The Parenting for Respectability (PfR) Programme in Uganda represents a home-grown, culturally-relevant parenting intervention that aims to prevent violence against children which has been disseminated widely in Uganda, and both government and NGOs have expressed interest to scale it. However, two key uncertainties remained: the optimal way to scale up the intervention in a ‘real-world setting’,and whether the evidence of effectiveness would be confirmed through a more rigorous, experimental, evaluation.

In 2019, the Ugandan Parenting for Respectability Implementation Science Evaluation (UPRISE) project, was launched to address the first question. The current study aims to address the second.

Study Objectives

Test the effectiveness of the PfR programme, in modifying key outcomes in parent-child relationships and relationships between partners, which contribute to violence against children. The trial will be powered to detect meaningful change in four primary outcomes: parent-reported and child-reported harsh parenting and partner conflict. Secondary outcomes assessed will include positive parenting, parental support for children’s education, child behaviour problems, parent/child mental health problems, material provision for children (all parent- and child-report), and inequitable gendered socialization
Examine the cost effectiveness of PfR using incremental cost-effectiveness analyses (CEA) based both on the primary outcomes of harsh parenting and partner conflict as well as on disability-adjusted life years (DALYs)
Examine how three implementation variables – rural vs peri-urban locality, previously established groups vs new groups, and professional vs non-professional facilitators – affect participation, programme fidelity, and quality of delivery (measured quantitatively)
Examine the impact of implementation variables – participant engagement and quality of delivery by facilitators – on primary outcomes of parent- and child-report of harsh parenting and partner conflict. This project will also examine associations between baseline characteristics and participant engagement to further understand potential barriers to participation and whether there are particularly vulnerable families that have greater challenges in attending the programme

ualitatively investigate five elements of implementation: (i) what training facilitators need (length, follow-up, who delivers training, location, etc.); (ii) what supervision facilitators need (frequency, by whom, nature of feedback, etc.); (iii) targeting of PfR at the most vulnerable families and how this can be done; (iv) disseminating PfR’s messages beyond those participating in group sessions to operate at a community, as well as individual, level; (v) differences between Wakiso and Gulu Districts in facilitative and hindering contextual factors. This project will explore how these affect participation, programme fidelity, quality of delivery, participant response and community-wide impact