Skip to main content
Log in

A Pilot Randomized Controlled Trial of a Brief Parenting Intervention in Low-Resource Settings in Panama

  • Published:
Prevention Science Aims and scope Submit manuscript

Abstract

The aim of this study was to determine whether an intervention from the Triple P Positive Parenting Program system was effective in reducing parental reports of child behavioral difficulties in urban low-income settings in Panama City. A pilot parallel-group randomized controlled trial was carried out. A total of 108 parents of children 3 to 12 years old with some level of parent-rated behavioral difficulties were randomly assigned to a discussion group on “dealing with disobedience” or to a no intervention control. Blinded assessments were carried out prior to the intervention, 2 weeks, 3 months, and 6 months later. Results indicated that parental reports of child behavioral difficulties changed over time and decreased more steeply in the intervention than in the control group. The effects of the intervention on parental reports of behavioral difficulties were moderate at post-intervention and 3-month follow-up, and large at 6-month follow-up. Parents who participated in the discussion group reported fewer behavioral difficulties in their children after the intervention than those in the control condition. They also reported reduced parental stress and less use of dysfunctional parenting practices. There is a limited amount of evidence on the efficacy of parenting interventions in low-resource settings. This pilot trial was carried out using a small convenience sample living in low-income urban communities in Panama City, and therefore, the findings are of reduced generalizability to other settings. However, the methodology employed in this trial represents an example for future work in other low-resource settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Arnold, D. S., O’Leary, S. G., Wolff, L., & Acker, M. M. (1993). The Parenting Scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137–144.

    Article  Google Scholar 

  • Bernal, G. A., & Domenech-Rodriguez, M. M. (2012). Cultural adaptations: Tools for evidence-based practice with diverse populations. APA Press.

  • Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. N. (2012). The critical role of nurturing environments for promoting human well-being. American Psychologist, 67, 257–271.

    Article  PubMed Central  PubMed  Google Scholar 

  • Borkowski, J. G., Landesman, S., & Bristol-Power, M. (Eds.). (2009). Parenting and the child’s world: Influences on academic, intellectual, and socio-emotional development. New Yersey: Taylos& Francis.

    Google Scholar 

  • Brauner, C. B., & Stephens, C. B. (2006). Estimating the prevalence of early childhood serious emotional/behavioural disorders: Challenges and recommendations. Public Health Reports, 121, 303–310.

    PubMed Central  PubMed  Google Scholar 

  • Center for Substance Abuse Prevention (CSAP). (2001). Finding the balance: Program Fidelity and adaptation in substance abuse. Rockville: SAMHSA, U.S. Department of Health and Human Services.

    Google Scholar 

  • Chaffin, M., Silovsky, J. F., Funderburk, B., Valle, L. A., Brestan, E. V., Balachova, T., et al. (2004). Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500–510.

    Article  PubMed  Google Scholar 

  • Coard, S. I., Foy-Watson, S., Zimmer, C., & Wallace, A. (2007). Considering culturally relevant parenting practices in intervention development and adaptation: A randomized controlled trial of the black parenting strengths and strategies (BPSS) program. The Counselling Psychologist, 35, 797–820.

    Article  Google Scholar 

  • Collins, P. Y., et al. (2011). Grand challenges in global mental health. Nature, 475, 27–30.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Dempster, A. P., Laird, N. M., & Rubin, D. B. (1977). Maximum likelihood from incomplete data via the EM algorithm. Journal Royal Statistical Society – Series B, 39, 1–38.

    Google Scholar 

  • Domenech-Rodriguez, M. M., Baumann, A. A., & Schwartz, A. L. (2011). Cultural adaptation of an evidence based intervention: From theory to practice in a Latino/a community context. American Journal of Community Psychology, 47, 170–186.

    Article  PubMed  Google Scholar 

  • Dumas, J. E., Arriaga, X., Moreland, A., & Longoria, Z. (2010). When will your program be available in Spanish? Adapting an early parenting intervention for Latino families. Cognitive and Behavioral Practice, 17, 176–187.

    Article  PubMed Central  PubMed  Google Scholar 

  • Elliot, D. S., & Mihalic, S. (2004). Issues in disseminating and replicating effective prevention programs. Prevention Science, 5, 47–53.

    Article  Google Scholar 

  • Ensor, T., & Cooper, S. (2004). Overcoming barriers to health service access: Influencing the demand side. Health Policy and Planning, 19, 69–79.

    Article  PubMed  Google Scholar 

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg child behaviour inventory and sutter-eyberg student behaviour inventory-revised: professional manual. Florida: Psychological Assessment Resources.

    Google Scholar 

  • Faircloth, B., & Cummings, M. (2008). Evaluating a parent education program for preventing the negative effects of marital conflict. Journal of Applied Developmental Psychology, 29, 141–156.

    Article  Google Scholar 

  • Fergusson, D. M., Horwood, L. J., & Ridder, E. M. (2005). Show me the child at seven: The consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychology and Psychiatry, 46, 837–849.

    Article  PubMed  Google Scholar 

  • Gray, D. O., Jakes, S. S., Emshoff, J., & Blakely, C. (2003). ESID, dissemination, and community psychology: A case of partial implementation? American Journal of Community Psychology, 32, 359–370.

    Article  PubMed  Google Scholar 

  • Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice & Training, 43, 531–548.

    Article  Google Scholar 

  • Haslam, D. M., Sanders, M. R., & Sofronoff, K. (2013). Reducing work and family conflict in teachers: a randomized controlled trial of Workplace Triple P. School Mental Health, 5, 70–82.

    Article  Google Scholar 

  • Hiscock, H., Bayer, J. K., Price, A., Ukoumunne, O. C., Rogers, S., & Wake, M. (2008). Universal parenting programme to prevent early childhood behavioural problems: Cluster randomized trial. British Medical Journal, 336, 318–321.

    Article  PubMed Central  PubMed  Google Scholar 

  • Jakobsen, I. S., Fergusson, D., & Horwood, D. (2012). Early conduct problems, school achievement and later crime: Findings from a 30-year longitudinal study. New Zealand Journal of Educational Studies, 47, 123–135.

    Google Scholar 

  • Joachim, S., Sanders, M. R., & Turner, K. M. T. (2010). Reducing preschoolers’ disruptive behaviour in public with a brief parent discussion group. Child Psychiatry and Human Development, 41, 47–60.

    Article  PubMed  Google Scholar 

  • Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589.

    Article  PubMed  Google Scholar 

  • Kim, E., Cain, K., & Webster-Stratton, C. (2008). The preliminary effect of a parenting program for Korean American mothers: A randomized controlled experimental study. International Journal of Nursing Studies, 9, 1261–1273.

    Article  Google Scholar 

  • Kinnunen, U., & Mauno, S. (2008). Work-family conflict in individuals’ lives: Prevalence, antecedents, and outcomes. In K. Näswall, J. Hellgren, & M. Sverke (Eds.), The Individual in the Changing Working Life (pp. 126–146). Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Knerr, W., Gardner, F., & Cluver, L. (2013). Improving positive parenting skills and reducing harsh and abusive parenting in low and middle income countries: A systematic review. Prevention Science, 14, 352–363.

    Article  PubMed  Google Scholar 

  • Kumpfer, K. L., Pinyuchon, M., Teixeira, A., & Whiteside, H. O. (2008). Cultural adaptation process for international dissemination of the Stregthening Families Program. Evaluation and the Health Professions, 31, 226–239.

    Article  PubMed  Google Scholar 

  • Leung, C., Sanders, M. R., Ip, F., & Lau, J. (2006). Implementation of Triple P Positive Parenting Program in Hong Kong: Predictors of program completion and clinical outcomes. Journal of Children’s Services, 1, 4–17.

    Article  Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scale (4th ed.). Sydney: NWS Families International Publishing.

    Google Scholar 

  • Lund, C., De Silva, M., Plagerson, S., Cooper, S., Chisholm, D., Das, J., Knapp, M., & Patel, V. (2011). Poverty and mental disorders: Breaking the cycle in low-income and middle-income countries. The Lancet, 378, 1502–1514.

    Article  Google Scholar 

  • Lundahl, B. W., Nimer, J., & Parsons, B. (2006). Preventing child abuse: A meta-analysis of parent training programs. Research on Social Work Practice, 16, 251–262.

    Article  Google Scholar 

  • Martorrel, G. A., & Bugental, D. B. (2006). Maternal variations in stress reactivity: Implications for harsh parenting practices with very young children. Journal of Family Psychology, 20, 641–647.

    Article  Google Scholar 

  • Matsumoto, Y., Sofronoff, K., & Sanders, M. R. (2010). Investigation of the effectiveness and social validity of the Triple P Positive Parenting Program in Japanese society. Journal of Family Psychology, 24, 87–91.

    Article  PubMed  Google Scholar 

  • Mejia, A., Calam, R., & Sanders, M. R. (2012). A review of parenting programs in developing countries: Opportunities and challenges for preventing emotional and behavioural difficulties in children. Clinical Child and Family Psychology Review, 15, 163–175.

    Article  PubMed  Google Scholar 

  • Mejia, A., Calam, R., & Sanders, M. R. (2014a). Examining delivery preferences and cultural relevance of an evidence-based parenting program in a low-resource setting of Central America: Approaching parents as consumers. Journal of Child and Family Psychology. doi:10.1007/s10826-014-9911-x.

    Google Scholar 

  • Mejia, A., Calam, R., & Sanders, M. R. (2014b). Dissemination of evidence-based parenting programs into low resource settings: Examining the views of practitioners. Journal of Child and Family Studies. doi:10.1007/s10826-014-0028-z.

    Google Scholar 

  • Mejia, A., Ulph, F., & Calam, R. (under review). Exploration of child and parental changes after participation in a parenting intervention: A qualitative study in a low resource setting.

  • Morawska, A., Haslam, D., Milne, D., & Sanders, M. R. (2011). Evaluation of a brief parenting discussion group for parents of young children. Journal of Developmental and Behavioral Pediatrics, 32, 136–145.

    Article  PubMed  Google Scholar 

  • Nixon, R. D. (2002). Treatment of behavior problems in preschoolers: A review of parent training programs. Clinical Psychology Review, 22, 525–546.

    Article  PubMed  Google Scholar 

  • O’Connell, M. E., Boat, T., & Warner, K. (2009). Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities. Washington, DC: National Academy Press.

    Google Scholar 

  • Parra-Cardona, J., Holtrop, K., Cordova, D., Escobar-Chew, A., Horsford, S., Tams, L., Villarruel, F. A., et al. (2009). “Queremosaprender”: Latino immigrants’ call to integrate cultural adaptation with best practice knowledge in a parenting intervention. Family Process, 48, 211–231.

    Article  PubMed Central  Google Scholar 

  • Parra-Cardona, J. R., Domenech-Rodriguez, M., Forgatch, M., Sullivan, C., Bybee, D., Holtrop, K., Escobar-Chew, A., et al. (2012). Culturally adapting an evidence-based parenting intervention for Latino immigrants: The need to integrate fidelity and cultural relevance. Family Process, 51, 56–72.

    Article  PubMed  Google Scholar 

  • Patel, V., Kieling, C., Maulik, P. K., & Divan, G. (2013). Improving access to care for children with mental disorders: A global perspective. Archives of Disease in Childhood, 98, 323–327.

    Article  PubMed Central  PubMed  Google Scholar 

  • Peterson, C. (2009). Minimally sufficient research. Perspectives on Psychological Science, 4, 7–9.

    Article  PubMed  Google Scholar 

  • Pierantoni, L., & Cabral, I. E. (2009). Criançasemsituação de violência de um ambulatório do Rio de Janeiro: Conhecendoseuperfil. Escola Anna Nery, 13, 699–707.

    Article  Google Scholar 

  • Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10, 1–12.

    Article  PubMed Central  PubMed  Google Scholar 

  • Sanders, M. (2012). Development, evaluation, and multinational dissemination of the Triple P Positive Parenting Program. Annual Review of Clinical Psychology, 8, 345–379.

    Article  PubMed  Google Scholar 

  • Schell, C. O., Reilly, M., Rosling, H., Peterson, S., & Ekstrom, A. M. (2007). Socioeconomic determinants of infant mortality: A worldwide study of 152 low-, middle-, and high-income countries. Scandinavian Journal of Public Health, 35, 288–297.

    Article  PubMed  Google Scholar 

  • Shapiro, C. (2011). Taking a public health approach to parenting: Lessons on minimal sufficiency. Invited Plenary Address, presented at the Excellence in Child Mental Health Conference, December, Istanbul, Turkey.

  • Shonkoff, J. P., & Phillips, D. A. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.

    Google Scholar 

  • Small, S., & Huser, M. (2012). Family-based prevention programs. Encyclopaedia of Adolescence. Retrieved from: http://whatworks.uwex.edu/attachment/FamilyBasedPreventionProgramschapterdraft6-10-10.pdf

  • Smith, T., Domenech Rodriguez, M. M., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175.

  • Turner, K. M. T., Richards, M., & Sanders, M. (2007). Randomised clinical trial of a group parent education programme for Australian indigenous families. Journal of Paediatrics and Child Health, 43, 429–437.

    Article  PubMed  Google Scholar 

  • United Nations Development Program [UNDP]. (2014). The future is now: Early childhood, youth and the formation of skills for life. National Human Development Report. Panama, UNDP.

  • United Nations Office on Drugs and Crime [UNODC]. (2009). Compilation of evidence-based family-skills training programs. Vienna: UNODC.

    Google Scholar 

  • Vera-Noriega, J. A., Morales, D. K., & Vera-Noriega, C. (2005). Relación del desarrollocognitivo con el clima familiar y el estrés de la crianza. Psico-USF, 10, 161–168.

    Article  Google Scholar 

  • Walker, S. P., Wachs, T. D., Gardner, J., Lozoff, B., Wasserman, G. A., Pollitt, E., & Carter, J. A. (2007). Child development: Risk factors for adverse outcomes in developing countries. The Lancet, 369, 145–157.

    Article  Google Scholar 

  • Webster-Stratton, C., Reid, M. J., & Hammond, M. (2004). Treating children with early-onset conduct problems: Intervention outcomes for parent, child, and teacher training. Journal of Clinical Child and Adolescent Psychology, 33, 105–124.

    Article  PubMed  Google Scholar 

  • World Bank [WB]. (2010). World Development Indicators Database.The World Bank.

  • World Bank [WB]. (2012). Panama Poverty Assessment: Priorities and Strategies for Poverty Reduction. Volume I, Main report. Human Development Department, The World Bank.

  • World Health Organization [WHO]. (2009). Preventing violence through the development of safe, stable and nurturing relationships between children and their parents and caregivers. Series of briefings on violence prevention: The evidence. Geneva: World Health Organization.

    Google Scholar 

  • Yoshikawa, H., Aber, L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional and behavioral health of children and youth. American Psychologist, 67, 272–284.

    Article  PubMed  Google Scholar 

  • Zubrick, S. R., Ward, K. A., & Silburn, S. R. (2005). Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prevention Science, 6, 287–304.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

A Mejia is chair of the LMIC Triple P Research Network. She carried out this RCT as part of her PhD project at the University of Manchester. Triple P provided for free training and materials for the conduction of the study. R Calam has long-standing research collaborations with staff at the Parenting and Family Support Centre (PFSC), School of Psychology, University of Queensland (UQ). She has been a board member of the Triple P Research Network and is currently on the Triple P International Scientific Advisory Committee in a research capacity. The Parenting and Family Research Group at The University of Manchester and its members have no share in, ownership of, or formal relationship with Triple P International Pty Ltd and derive no funding or royalty from it. Triple P is owned by UQ. The University through its main technology transfer company, UniQuest Pty Ltd, has licensed Triple P International Pty Ltd to publish and disseminate the program worldwide. Royalties stemming from published Triple P resources are distributed to the PFSC, School of Psychology, Faculty of Health and Behavioral Sciences, and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. MR Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International.

Registration of trial

ClinicalTrials.gov, NCT0177106

Funding

The National Secretariat of Science and Technology in Panama (SENACYT) funded this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anilena Mejia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mejia, A., Calam, R. & Sanders, M.R. A Pilot Randomized Controlled Trial of a Brief Parenting Intervention in Low-Resource Settings in Panama. Prev Sci 16, 707–717 (2015). https://doi.org/10.1007/s11121-015-0551-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-015-0551-1

Keywords

Navigation