普遍电影干预在缅甸移民和流离失所看护者中减少对儿童的暴力行为和增加积极养育的有效性:一项基于社区的集群随机试验

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES
Amanda Sim , Khaing Zar Lwin , Stephanie Eagling-Peche , G.J. Melendez-Torres , Seema Vyas , Francisco Calderon , Tawanchai Jirapramukpitak , Jamie Lachman , Sureeporn Punpuing , Andrea Gonzalez , Mary Soan , Nway Nway Oo , Ivet Castello Mitjans , Greg Tyrosvoutis , Eve Puffer
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引用次数: 0

摘要

育儿干预措施已被证明可以减少对儿童的暴力行为并促进积极的育儿方式,但在资源匮乏的环境中,关于干预措施在人口层面上的覆盖面和影响的证据有限。我们评估了普遍电影干预对居住在泰国的缅甸移民和流离失所看护者的影响。方法我们在与缅甸接壤的泰国德省实施了一项双组、整群随机试验,44个社区按地区分层,使用计算机生成的随机数列表随机分配到干预组或对照组(1:1)。干预组的参与者先观看了一部66分钟的关于育儿的叙事戏剧电影,然后是30 - 40分钟的讨论和5分钟的视频和海报,总结了关键信息。对照组参与者收到了有关当地保健和社会服务的信息。符合条件的参与者是18岁或以上的主要照顾者,在入组时有一个4-17岁的孩子。参与者在基线、干预后约4周结束时接受调查,并在干预后约4个月随访。主要结局是照顾者自我报告的使用身体和心理暴力以及积极的养育方式,使用归因和非归因多级模型来分析研究组在终点和随访时的差异。由于干预的性质,参与者和评估者没有被掩盖。该试验已在泰国临床试验注册中心TCTR20230222005前瞻性注册。在2023年2月至6月期间,来自44个社区的2249名参与者完成了基线评估,并被随机分配到干预组(n = 1116)和对照组(n = 1133)。2023名护理人员(干预组n = 998,对照组n = 1025)完成了为期四周的终线调查,1909名护理人员(干预组n = 961,对照组n = 948)完成了为期四个月的随访。意向治疗分析显示,干预减少了身体暴力(IRR 0.91, 95% CI 0.85-0.97),增加了积极的养育(β 0.46, 95% CI - 0.03 - 0.95)。干预组和对照组在心理暴力方面没有观察到有意义的差异,不精确估计的影响接近于零(β 0.47, 95% CI - 0.62至1.57)。在育儿知识、对严厉惩罚的需要的信念、早期学习的参与、家庭功能和社会支持的次要和探索性结果中观察到小的影响。亚组分析表明,干预措施可能更有效地减少女性照顾者以及女童和幼童的照顾者的身体暴力。没有不良反应的报道。使用基于电影的娱乐教育方法的普遍育儿干预措施可以有效地减少对儿童的身体暴力,增加积极的育儿方式,在资源匮乏的环境中具有可扩展性的潜力。本研究是全球育儿倡议的一部分,由乐高基金会、橡树基金会、世界儿童基金会、人类安全网和英国研究与创新全球挑战研究基金(ES/S008101/1)资助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of a universal film intervention in reducing violence against children and increasing positive parenting among migrant and displaced caregivers from Myanmar: a community-based cluster randomised trial

Background

Parenting interventions have been shown to reduce violence against children and promote positive parenting, but evidence on interventions to achieve population-level reach and impact is limited in low-resource settings. We assessed the impact of a universal film intervention for migrant and displaced caregivers from Myanmar living in Thailand.

Methods

We implemented a two-arm, cluster randomised trial in Tak province, Thailand, on the border with Myanmar. 44 communities were stratified by district and randomly allocated to intervention or control (1:1) using a computer-generated list of random numbers. Intervention group participants received a screening of a 66-min narrative drama film about parenting, followed by a 30–40-min discussion and a 5-min video and poster summarising key messages. Control group participants received information about local health and social services. Eligible participants were primary caregivers aged 18 years or older with a child aged 4–17 years at enrolment. Participants were surveyed at baseline, endline approximately 4 weeks post-intervention, and follow-up approximately 4 months post-intervention. Primary outcomes were caregiver self-reported use of physical and psychological violence and positive parenting, analysed using both imputed and non-imputed multilevel models estimating differences between study arms at endline and follow-up. Due to the nature of the intervention, participants and assessors were not masked. The trial was prospectively registered with Thai Clinical Trials Registry TCTR20230222005.

Findings

Between February and June 2023, 2249 participants in 44 communities completed baseline assessments and were randomly assigned to intervention (n = 1116) and control (n = 1133). 2023 caregivers (n = 998 in intervention and n = 1025 in control) completed the four-week endline survey and 1909 caregivers (n = 961 in intervention and n = 948 in control) completed the four-month follow-up. Intention to treat analyses showed the intervention reduced physical violence (IRR 0.91, 95% CI 0.85–0.97) and increased positive parenting (β 0.46, 95% CI −0.03 to 0.95). No meaningful differences were observed for psychological violence between intervention and control groups, with imprecisely estimated effects close to zero (β 0.47, 95% CI −0.62 to 1.57). Small effects were observed for the secondary and exploratory outcomes of parenting knowledge, belief in the need for harsh punishment, engagement in early learning, family functioning, and social support. Subgroup analyses suggest that the intervention may be more effective at reducing physical violence among female caregivers and caregivers of female children and younger children. There were no reported adverse effects.

Interpretation

Universal parenting interventions using a film-based entertainment-education approach can effectively reduce physical violence against children and increase positive parenting, with potential for scalability in low-resource settings.

Funding

This study is part of the Global Parenting Initiative, which is funded by The LEGO Foundation, Oak Foundation, the World Childhood Foundation, The Human Safety Net, and the UK Research and Innovation Global Challenges Research Fund ((ES/S008101/1).
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