Abstract
Background: Violence against adolescents is a universal reality, with severe individual and societal costs. There is a critical need for scalable and effective violence prevention strategies such as parenting programmes, particularly in low- and middle-income countries where rates of maltreatment are highest. Digital interventions may be a scalable and cost-effective alternative to in-person delivery, yet maximising caregiver engagement is a substantial challenge. This trial employs a cluster randomised factorial experiment and a novel mixed-methods analytic approach to assess the effectiveness, cost-effectiveness, and feasibility of intervention components designed to optimise engagement in an open-source parenting app, ParentApp for Teens. The app is based on the evidence-based Parenting for Lifelong Health for Teens programme, developed collaboratively by academic institutions in the Global South and North, the WHO, and UNICEF. Methods/design: Sixteen neighbourhoods, i.e., clusters, will be randomised to one of eight experimental conditions which consist of any combination of three components (Support: self-guided/moderated WhatsApp groups; App Design: sequential workshops/non-sequential modules; Digital Literacy Training: on/off). The study will be conducted in low-income communities in Tanzania, targeting socioeconomically vulnerable caregivers of adolescents aged 10 to 17 years (16 clusters, 8 conditions, 640 caregivers, 80 per condition). The primary objective of this trial is to estimate the main effects of the three components on engagement. Secondary objectives are to explore the interactions between components, the effects of the components on caregiver behavioural outcomes, moderators and mediators of programme engagement and impact, and the cost-effectiveness of components. The study will also assess enablers and barriers to engagement qualitatively via interviews with a subset of low, medium, and high engaging participants. We will combine quantitative and qualitative data to develop an optimised ParentApp for Teens delivery package. Discussion: This is the first known cluster randomised factorial trial for the optimisation of engagement in a digital parenting intervention in a low- and middle-income country. Findings will be used to inform the evaluation of the optimised app in a subsequent randomised controlled trial. Trial registration: Pan African Clinical Trial Registry, PACTR202210657553944. Registered 11 October 2022, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 .
| Original language | English |
|---|---|
| Article number | 1224 |
| Journal | BMC Public Health |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| State | Published - 23 Jun 2023 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2023, The Author(s).
Funding
This work was supported by the UKRI Economic and Social Research Council (ES/P000649/1); the UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (ES/S008101/1); the LEGO Foundation (R75755/GA001); the Oak Foundation (OFIL-21-212); the Wellspring Philanthropic Fund (16204); the European Research Council (ERC) under the Proof of Concept 2022-1 Call (proposal no. 101067451); and a private family trust which wishes to remain anonymous. ParentApp was developed and implemented by members of the research team. RJs doctoral work is based on this trial. JML is the CEO and LDC is a trustee of Parenting for Lifelong Health (PLH), a charity based in the United Kingdom. JML also receives occasional fees for providing training and supervision for PLH programmes. YS is supported by the Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer) and the Wolfson Centre for Young People’s Mental Health. DECIPHer is funded by Welsh Government through Health and Care Research Wales. The Wolfson Centre for Young People’s Mental Health has been established with support from the Wolfson Foundation. LDC, FG, JML, GJMT, YS have worked and/or currently work on other studies of PLH, as investigators, and the University of Oxford and Exeter, and Cardiff University receive research grants to support this work. OS receives consultancy fees for designing the app graphics and illustrations. The intellectual property of the intervention is owned by the developers of the original intervention as part of PLH. The app’s code is on Github under a GPL 3 license and the content of the programme is under a Creative Commons Attribution license (CC BY). No profit or financial gain will be made from the implementation and dissemination of the intervention. The sponsor and funders had no influence over the study design and will not be involved in its execution, analyses, interpretation of data, and dissemination of results. We would like that thank all staff at IDEMS International and INNODEMS Kenya, in addition to those who are authors, for designing and programming the app, providing technical and research support, building the online data collection and monitoring system, and assisting user testing. We would also like to thank Clowns Without Borders South Africa, who played a key role in conducting programme adaptation and contextualisation, curriculum development for facilitators, and training and coaching of facilitators. We also thank colleagues at the Tanzanian National Institute of Medical Research (NIMR) and Investing in Children and Strengthening their Societies (ICS) who contributed to the conceptualisation, planning and implementation of the study. We also gratefully acknowledge the contributions of the World Health Organizations’ (WHO) Behavioural Insights team for their critical feedback on the study design.
| Funders | Funder number |
|---|---|
| Clowns Without Borders South Africa | |
| UKRI GCRF | ES/S008101/1 |
| Wellspring Philanthropic Fund | 16204 |
| Oak Foundation | OFIL-21-212 |
| World Health Organization | |
| Health and Care Research Wales | |
| Llywodraeth Cymru | |
| LEGO Foundation | R75755/GA001 |
| Economic and Social Research Council | ES/P000649/1 |
| European Commission | 101067451 |
| Wolfson Foundation | |
| Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement | |
| National Institute for Medical Research |
Keywords
- Digital intervention
- Engagement
- Factorial experiment
- Low- and middle-income countries
- Multiphase optimisation strategy (MOST)
- Optimisation
- Parenting
