Primary prevention of parent-child conflict and abuse in Iranian mothers: A randomized-controlled trial☆
Introduction
Child abuse and neglect (CAN) are worldwide problems. An estimated 872,000 children were victims of child abuse or neglect in 2004 (US Department of Health and Human Services, 2006). It is widely accepted, and there is much empirical evidence, that children's exposure to physical abuse is related to a host of negative outcomes. The impact of child abuse and neglect is often discussed in terms of physical, psychological, behavioral, and societal consequences. In reality, however, it is impossible to separate them completely (Child Welfare Information Gateway, 2006). Some of the problems associated with abuse include post-traumatic stress disorder, depression, and alcoholism (Carlin et al., 1994, Kolko, 1992), aggressive and violent behavior (Dodge, Bates, & Pettit, 1990), and academic and interpersonal difficulties (Kolko, 1992).
Attempts to apply behavioral theory and technology such as parent training to family problems including CAN began in the late 1960s and the field has grown steadily since then (Falloon, 1988). In young children (toddler and preschool-aged children), there is strong evidence that social-learning-based parenting programs are effective with a wide range of family problems from quite diverse socio-economic and ethnic backgrounds (Biglan, 1995). Quality of parenting is a modifiable risk factor contributing to early-onset conduct problems in children, and parenting practices have a major influence on many different domains of children's development (Biglan, 1995). In one of the most celebrated examples, families who participated in an early intervention program focusing on parental skills and support had a 50% lower abuse rate than a comparison group (Olds, 1992).
The targeting of prevention programs at different groups with varying degrees of risk for child maltreatment is referred to as a “composite approach” to prevention. In the public health model of child maltreatment prevention, preventative interventions are described as either: primary, secondary, or tertiary interventions (Holzer, Higgins, Bromfield, & Higgins, 2006). Secondary or early intervention programs target individuals at risk of developing a disorder or showing early or mild signs of the problem. Yet primary or “universal programs” in the purest sense do not require that an individual be either at risk or showing any signs of disorder. An advantage of universal programs is that no selection procedures are needed and thus stigmatization is unlikely to result (Dadds, 2002). Universal interventions are strategies that target whole communities in order to build public resources and attend to the factors that contribute to child maltreatment (Holzer et al., 2006). Thus, a key assumption of a public health or a population-based approach is that parenting interventions strategies should be widely accessible to the community (Sanders & Morawska, 2006). The Australian Childhood Foundation's “Every Child is Important” campaign is an example of a primary intervention (Australian Childhood Foundation, 2004). The other example of universal intervention is the Triple P-Positive Parenting Program (Australia). Clinical Outcome with participating families in the Triple P by measure of Parenting Scale was 4.3 with 1.1 (SD) in the pre-test and 2.6 with 1.2 (SD) in the post-test (Sanders, 2007). Although many parenting programs exist to prevent child abuse, few are supported by research evidence (Cowen, 2001).
In Iran, one way of accessing parents is at health centers where parents routinely bring their children for monitoring of growth or vaccinating against some disease at least once a year. In Iran, health services are free for all parents. Most of the personnel who work in these centers hold science degrees in the field of family health. Mothers are routinely educated at the health centers about nutrition problems, failure to thrive (FTT), upper respiratory tract infection, diarrhea diseases; however, nothing is taught about parenting skills.
The aim of this study was to assess whether primary health care settings can be used to engage and provide a preventive intervention to mothers of young children. It was hypothesized that parents would agree to participate in a parenting education program, and those participating would report reduction in negative parenting practices. In addition, this study explored whether parents who completed the SOS (helps for parents) Program (Clark, 2003) improved their parenting skills.
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Participants
The study was conducted in Qazvin, Iran, a city near Tehran with a population of about 500,000 at the time of study. We invited consecutive eligible mothers who had come to health centers to vaccinate their children between June 15 and 20, 2007. Participants in this study were 224 mothers with a child aged between 2 and 6 years (M age = 29.8 years, SD = 4.49 years) who attended any 1 of 5 centers of health service. Mothers were all biological parents of the child; all participants provided written
Sample equivalence
We first compared to demographic characteristics and pre-scores on two domains (PS, CTSPCm) of the two groups. Using χ2 and t-tests, there was no significant difference between them (see Table 2, Table 3) on any of the demographic variables and all pre-scores.
Intervention effects
First we conducted ANCOVA using the Last Observation Carried Forward (LOCF) procedure (Lane, 2007) to manage missing data. There were main effects for treatment (see Table 4). The results were similar to those with missing data, so we
Discussion
The aim of this study was to assess whether primary health care settings can be used to engage and provide preventive interventions to mothers of young children. Mothers with a child aged between 2 and 6 years who had come to the health centers in Iran to vaccinate their children were randomly assigned to either CG or IG. Mothers in IG received a parent-training program. The program gave skills for managing misbehavior and preventing child behavior problems. It was hypothesized that parents
Acknowledgement
The authors thank the participants involved in this study.
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This project was endorsed by the Health Service Executive of Qazvin.