Context
A two-armed, pragmatic, facilitator-matched cluster RCT testing ‘Hope Groups’, a psychosocial, mental health, and parenting support group, launched in November 2023 among Ukrainians affected by war. Hope Groups is among the first RCTs to be implemented within an active war setting, which is essential to provide insights on effective approaches for strengthening families amidst active war and displacement.
Methods
Between November 2023 and February 2024, 510 participants were recruited and randomised with a 1:1 allocation ratio (treatment or waitlist control arm). The Hope Groups intervention was delivered to treatment arm clusters, followed by waitlist control clusters immediately after trial endline (1-week post-intervention). Analyses of RCT data were completed in July 2024. In mid-August 2024, six weeks after completion of the endline survey, RCT intervention participants completed a follow-up survey to assess the durability of intervention outcomes. Analyses for this data set were finalised in late August. Following primary analyses, exploratory analyses to assess differences in intervention effects by participant characteristics and delivery format and instrumental variable analysis were concluded in early September 2024.
Findings and discussion
The Hope Groups RCT found statistically significant improvements across all outcomes measured when comparing RCT intervention participants to control participants 1-week post-implementation: caregiver mental health, parenting practices, violence against children, child well-being and behavioural issues, caregiver resilience, and prevention of violence against women.
Key findings include a significant decrease in physical violence against children and emotional violence against children (54% and 53%, respectively), when comparing the intervention arm to the control arm one-week post-Hope Group implementation.
In addition, positive parenting (which includes playful parenting) increased by over one day each week (corresponding to a 32% increase). Child behavioural issues, such as anger outbursts and depression, decreased by more than one day per week (57%). In response to the high-level and urgent need identified by project partners in Ukraine, the team decided to deliver Hope Groups to control groups immediately after endline, rather than delay their participation throughout a follow-up period.
This revealed a need for flexible long-term evaluation methods; therefore, the team explored using a quasi-experimental follow-up approach to simultaneously prioritise long-term evaluation of the intervention and expedited delivery to waiting control clusters, which was piloted within a 6-month evaluation. RCT intervention participants were compared with 600 ‘untreated’ Ukrainians completing baseline surveys as they enrolled into Hope Groups, who were from the same source population as RCT intervention participants. Analysis for this phase was completed in 2025 and will be published in early 2026.
This study enabled the identification of an effective, flexible, scalable intervention which can improve mental health, parenting, and reduce violence against children amidst war and crisis for many future families. Conducting rigorous interim analyses to assess effectiveness in real-time revealed evidence of the intervention’s benefits and enabled early scaling of Hope Groups to affected populations.
Teams in Zimbabwe, Colombia, the Middle East, and India are actively pursuing adaptations of Hope Groups to implement in their crisis settings.
Dissemination
Interim trial findings were presented at a World Without Orphans conference to over 500 faith leaders from 100 countries seeking interventions to strengthen children in crisis settings. Study findings have subsequently been published in the Journal of Migration and Health.