Supporting Wellness through Integrated Family Training (SWIFT) Study South Africa Updates

Sequential Multiple Assignment Randomised Trial (SMART) to identify the most optimal and cost-effective system of delivery of the Parenting for Lifelong Health (PLH) human-digital parenting package within the health sector. Benefactors will be parents or caregivers above the age of 18 who show an interest in parenting support.

2024

Preparations for phase two of SWIFT study implementation, a Randomised Encouragement Trial (RET), continue to advance well. Following consultation with the provincial Department of Social Development, one of the implementation locations for the RET will be changed from Mitchell’s Plain to Ceres to facilitate access to planned referral pathways. A protocol for a pilot study, to be conducted in Wolseley (Ceres) is also under development, pending the inclusion of data analysis processes and technical components of the chatbot design and delivery. The team aims to finalise the protocol and associated ethics documentation to be submitted to the University of Cape Town by the end of August. The team have also confirmed the following stakeholders for the study’s Trial Steering Committee (TSC): the Director of the Violence Prevention Unit, the Director of Childline Western Cape, and an experienced statistician and TSC member in the field of parenting and violence prevention. 

With regards to innovation progress, All ParentText content has been translated, proofread and finalised by implementation partner Clowns Without Borders South Africa (CWBSA). To enable the programme to be viewed in isiXhosa and Afrikaans, CWBSA has translated video scripts in both languages. The SWIFT team and CWBSA also confirmed actors for isiXhosa videos (to be recorded by LifeBrand from mid August) and developed a guideline document to provide actors with a background to PLH, the ParentText programme, and the goals of each daily lesson. Following training with PLH on 13 August, Cindee Bruyns (Co-Investigator) and Carly Katzef (Research Assistant) will generate the AI Afrikaans videos using Synthesia. 

Over July and August, the SWIFT team participated in several stakeholder engagements. The team met with the South African Parenting Programme Implementers Network (SAPPIN) to discuss the potential inclusion of the digital parenting programme, ParentLine within SWIFT for parents/caregivers under the age of 18 years, or those with children under the age of two years. A meeting was also held in conjunction with SAPPIN to discuss South Africa’s input to the upcoming Global Ministerial Conference in November. In addition, the team met with Childline, a referral partner who works closely with NGOs across South Africa to provide support to children and families. The Director of the Western Cape expressed enthusiasm for the SWIFT study and a willingness to join the study TSC.

GPI Future Leaders Cindee and Carly continue to engage in various capacity building activities. In collaboration with the GPI Programme team (Peter Burr and Lydia Holland), GPI Capacity Building Officer (Nondumiso Mginywa) and Kahabi Isangula (Study Coordinator, ParentApp for Teens), Cindee hosted and Carly co-facilitated a GPI Future Leaders Fieldwork Safety and Wellbeing workshop on 30 July. Cindee also presented a half-day NVivo training workshop for Honours in Social Work students at the University of Cape Town, with Carly assisting in the computer lab with students’ queries and challenges. In addition, Carly plans to complete a Good Clinical Practice certification prior to the submission of Phase two ethics applications. 

Preparations for phase two of SWIFT study implementation are ongoing. The team has begun drafting a protocol for the pilot study and is establishing a Data Safety and Monitoring board. Following discussions with PLH, referral processes have been outlined. Parents will be asked at the end of each day whether they wish to continue with the following day's content, access a playful parenting activity, or seek further support. Within the further support menu, more targeted referrals will also be presented. Regarding existing stakeholder engagements, The team met with the Witzenberg district Department of Social Development (DSD), to discuss ‘SWIMS’, an initiative in which all social workers are provided with cellphones to facilitate their work. Future discussions will consider the feasibility of embedding a programme such as ParentChat into SWIMS delivery. In addition, the team met with key stakeholders in the DSD and the Department of Basic Education and South African Police Services at the Witzenberg Gender Based Violence/Victim Empowerment Programme forum, learning how GBV is being addressed within the district. The team also visited four clinics in the Witzenberg region and the Ceres Hospital, to understand how each facility operates day to day. 

In terms of capacity building activities, Cindee Bruyns (Co-Principal Investigator) and Carly Katzef (Research Assistant) attended a GPI PowerPoint workshop and future leaders training sessions on cost analysis and evaluation, and qualitative methods and data analysis. In addition, they also completed an Early Childhood Development Action Network Systems Thinking Masterclass course, and participated in an Emerging Researchers Programme Stakeholder Engagement workshop and a four session Project Management course.

Plans for the design and implementation of the SWIFT study intervention are advancing well. A flowchart of the study implementation process has been drafted for use as a tracking resource for the team and dissemination purposes. To assist with intervention delivery and sustainability, the team plans to design a user manual prior to the first quarter of 2025, outlining steps for replicating and implementing the intervention in new sites. A meeting was also held in April with colleagues in the GPI core research team to discuss the study research design and methodology. The SWIFT intervention will implement the 5-day ParentText user experience, in parallel to a large-scale randomised controlled trial led by the ParentText team to evaluate the programme’s effectiveness and cost-effectiveness. Implementation partner Clowns Without Borders South Africa (CWBSA) will fully translate the ParentText 5- day content into Afrikaans and isiXhosa and the SWIFT team are reviewing options to film new videos in isiXhosa. In addition, an in-person stakeholder design workshop is planned for 3 May. Co-hosted by SWIFT and CWBSA, the aim of the workshop is to orient stakeholders to the 5-day user experience, discuss possible referral pathways, check cultural appropriateness of translation efforts, and determine the feasibility of offering additional modules in addition to the 5-day programme.

Engagement of existing stakeholders and assessment of new partnerships also continues to progress. The SWIFT team is in the process of establishing a framework for reaching out to NGOs to offer the in-person parenting programme component of the referral system. In addition, the partnership established in 2023 with the provincial Child and Adolescent Mental Health Strengthening (CAMHS) taskforce contact is also ongoing. A WhatsApp group has been set up to facilitate regular communication, and the CAMHS taskforce has indicated a willingness to include SWIFT in any coordinating meetings they have in the pilot sites, as well as broader strategic CAMHS meetings.

With regards to dissemination activities, the SWIFT team have submitted two abstracts for The Sexual Violence Research Initiative (SVRI) Forum (21-25 October, Cape Town). One abstract is focused on the upcoming design workshop with stakeholders, and another will concern the study protocol. Partners in the Violence Prevention Unit and The Provincial Department of Health and Wellness have agreed to present with the team to detail their work to create the policy environment that facilitates projects such as SWIFT. In terms of capacity building, Cindee and Carly attended a virtual two-day PLH facilitator training course led by CWBSA, which focused on the facilitator role and role play activities. In addition, Cindee and Carly are also working alongside colleagues in the GPI core team and Future Leaders to facilitate a workshop on safety in research which will be presented in July to the GPI community.

Engagements conducted in 2023, generated positive responses to the SWIFT study with varying stakeholders, indicating the relevance and alignment to current government priorities. For example, the establishment of Area Based Teams which draw together government (Department of Social Development and the Department of Health and Wellness) and community stakeholders within study implementation areas. Following these engagements, the SWIFT team has outlined an expected timeline for research implementation in 2024, beginning with a stakeholder co-design workshop. To be hosted in collaboration with CWBSA, the workshop aims to check translations are contextually appropriate, determine which referral pathways are feasible to build into the programme, and which additional ParentText modules can be offered to parents following a 5-day user experience. The team will meet with implementation partner IDEMS to review the adaptation of ParentText for the study, which will inform the development of a study protocol once the research design and implementation plans are finalised. Over this period, the team also met with the GPI communications colleagues to review expectations for website updates, and the creation of materials to promote the SWIFT brand

2023

In phase 1 of research implementation, The SWIFT team has continued to make good progress with stakeholder engagements. Following initial discussions with the provincial mental health steering committee, the team received confirmation of the Western Cape mental health task team’s interest in incorporating SWIFT into the Child and Adolescent Mental Health Services (CAMHS) project. During a training workshop on 17 November, Cindee Bruyns (Co-investigator) and Carly Katzef (Research Assistant) also learnt about a red flags tool for assisting frontline staff to make rapid decisions regarding children’s needs, which will be funded alongside the CAMHS project. On 6 December, Cindee and Carly presented the SWIFT study to the Witzenberg mental health steering committee in Ceres. Those in attendance included psychologists, social workers, community health workers and nurses. There was enthusiasm for the project and attendees provided valuable contributions for the team’s planning endeavours. The team is reviewing which departments and units can best support the programme, to ensure as many costs as possible are covered by systems that will be sustainable once SWIFT finishes. 

Following the South African Parenting Programme Implementers Network (SAPPIN) conference (25 - 26 October), the SWIFT team identified the opportunity to establish a responsible research working group to address the relationship between academia and NGOs in research collaborations. A meeting was held with Genevieve Haupt Ronnie (GPI Community of Practice Lead) and the SAPPIN board on 22 November. SAPPIN is reviewing the proposed group with their member NGOs.

The Systems Testing project team continues to make good progress in its formative and design work. The research team is in the process of identifying and interviewing key stakeholders, including the Ministry of Social Development, to gain insights into organisational structure and operations of local health care centres. Development of  a detailed flow-chart to elucidate the interaction of nursing staff with ParentText is also underway. Once finalised, the flow chart will inform the content of future interviews and a study protocol. Refinement of systems for monitoring and documenting the tool's uptake are also ongoing. 

The team is undertaking a retrospective analysis of past trials to garner more information about parents whose practices remained unchanged post-intervention.  Following a meeting with economists, the team will also investigate analysis options for determining the costs of upscaling and supporting evidence for cost effectiveness and financial value derived from study implementation. In terms of permissions and stakeholder engagement, the team are in the early stages of liaising with the City of Cape Town, which is responsible for family planning and health services. In addition, the team is seeking mandates from all relevant local, provincial, and national government stakeholders, ensuring all necessary permissions are in place. 
 

2022