Testing the effectiveness of the Responsible, Engaged, and Loving Fathers (REAL Fathers) intervention for improving early childhood development and reducing family violence in Uganda: Study protocol for a cluster-randomized controlled trial.

Abstract

Background: Witnessing and experiencing violence impedes children's healthy development and learning, inhibits positive relationships, provokes low self-esteem and emotional distress, and can lead to self-harm and aggressive behavior across the life course. Evidence-based programs are needed that incorporate violence prevention strategies alongside methods to improve wellbeing and healthy development for children and their families. This trial evaluates the Responsible, Engaged, and Loving Fathers (REAL Fathers) intervention, a Ugandan-led multilevel community-based mentoring program for young fathers (ages 16-25) with children below the age of three years.

Methods: To assess the REAL Fathers intervention, we use a cluster-randomized controlled trial design within 48 sub-counties randomly sampled from 24 districts in six regions of Uganda. Sub-counties were randomly allocated to treatment or control arms at baseline. Study participants are fathers ages 16-25 years and their cohabitating wives whose eldest child is below the age of 3 years (n = 3744 couple dyads). Primary outcomes are the following: (1) reduced intimate partner violence; (2) reduced violent discipline of children; (3) increased father-child engagement and play; (4) improved early childhood development. Secondary outcomes include the following: (1) father's knowledge of and (2) attitudes towards positive parenting and discipline; (3) father's use of positive parenting and discipline; (4) father's use of emotional engagement with child; (5) couple communication and conflict resolution; (6) gender equitable household and caregiving decision-making and behaviors; (7) father engagement in child health-promoting activities; (8) improved knowledge of family planning methods; (9) reduced unmet need for family planning; (10) reduced problem alcohol use; and (11) supportive community norms for father-child engagement and play. Longitudinal survey data will be collected by trained enumerators using KoboCollect in six local languages at three time points: one month before the intervention (baseline); one month after the intervention (endline); and nine months after the intervention (follow-up). Intervention effects on primary and secondary outcomes will be assessed using difference-in-differences (DiD) mixed-effects models that account for the clustered design.

Discussion: This trial will examine the impacts of a multilevel community-based intervention for young fathers and their families in Uganda on positive parenting, childhood development, and violence reduction. Overall, successful completion of this study will contribute to the evidence-based on context-informed multilevel approaches that reduce harm and promote wellbeing in families with very young children.

Trial registration: ClinicalTrials.gov #NCT06100679. Registered on October 24, 2023. https://clinicaltrials.gov/study/NCT06100679 .