Scaling a parenting program to reduce child maltreatment in Tanzania: The role of facilitator fidelity in adolescent and parent outcomes

Background

There is limited and mixed evidence on the relationship between facilitator fidelity and the outcomes of parents/caregivers and children participating in parenting programs aiming to reduce violence against children. The evidence is particularly limited from program delivery in low- and middle-countries, at scale, and in community settings.

Participants and setting

The study used data collected by implementing partners during the 2020–2021 scale-up of Parenting for Lifelong Health for Parents and Adolescents (PLH-Teens) to 75,061 parents/caregivers and adolescents in rural and semi-urban Tanzania.

Methods

This study examined the predictive validity of an observational measure used to assess the fidelity of facilitators delivering PLH-Teens. To examine the relationship between facilitator fidelity and outcomes, multi-level Poisson regressions were conducted. A total of 24 facilitator assessments could be linked with pre-post surveys from 3057 families.

Findings

Analyses found mixed results, with fidelity having positive, negative, and insignificant associations with participant outcomes. The observational measure used in PLH-Teens was not found to demonstrate consistent predictive validity across multiple outcomes. As cfidelity was positively associated with some participant outcomes, including the primary outcome (child maltreatment) according to adolescent- but not caregiver-reports, facilitator fidelity appears beneficial for participants to some extent.

Conclusion

There are a variety of potential explanations for the inconsistent results which suggest avenues for future research. Exploration of these avenues would benefit the ongoing dissemination of PLH and other parent programs as these communities strive to maximize the ability of families globally to benefit from evidence-based parenting programs.