Family Experiences of the Strong Families Program in Thailand: Prospective Mixed Methods Cohort Study.

Abstract

Background: The Strong Families (SF) Program, developed by the United Nations Office on Drugs and Crime, is an evidence-informed family skills intervention designed to support caregivers and children in low-resourced, high-stress circumstances. Following a pilot phase, we revised the program materials according to the expert trainers' suggestions to best reflect the needs of the target population.

Objective: This study aimed to evaluate the feasibility, effectiveness, and cultural adaptability of the second phase of the SF Program expansion in northern Thailand.

Methods: This prospective mixed methods pretest-posttest feasibility cohort study involved 68 families (caregivers and children as 1:1) from Chiang Mai, Lamphun, and Chiang Rai-3 provinces in northern Thailand. The applied intervention consisted of a 3-week program with both separate and joint sessions for caregivers and children. Quantitative data were collected using the Parent and Family Adjustment Scales, Strengths and Difficulties Questionnaire, and Child and Youth Resilience Measure-Revised-Person Most Knowledgeable About the Child. Data were analyzed using linear mixed-effects regression. Qualitative data were gathered through semistructured interviews with 19 families and analyzed using content analysis to identify key themes.

Results: Quantitative analysis using linear mixed-effects regression revealed significant improvements in coercive parenting (β=-0.10; P=.003), child conduct problems (β=-0.04; P=.002), and peer relationship problems (β=-0.04; P=.048) for parents and in emotional (β=-0.05; P=.01) and conduct (β=-0.04; P=.02) behavior for children. However, scores for positive encouragement (β=0.05; P=.009) and parent-child relationship (β=0.28; P<.001) significantly declined, a discrepancy that may be due to response shift bias, in which participants adopt stricter self-evaluation standards after the intervention. Qualitative findings showed 5 themes that highlighted improved family atmosphere, better emotional regulation, and successful translation of knowledge into practice to better develop protective factors for young people. Participants viewed the program as feasible and culturally appropriate but recommended extending the duration and increasing paternal involvement for more significant, sustainable outcomes.

Conclusions: The SF Program is a culturally adaptable and effective intervention for improving family dynamics in low-resource settings.