Parenting on the border: Study protocol for a randomized controlled trial of a trauma-informed, edutainment-enhanced intervention to improve parenting and mental health among migrant and displaced caregivers in Thailand

There is currently a lack of evidence-based interventions with a dual focus on improving parenting and caregiver mental health in conflict and humanitarian settings. To address this gap, we co-designed a trauma-informed, edutainment-enhanced intervention to improve both parenting and mental health outcomes among migrant and displaced caregivers on the Thailand-Myanmar border. This paper outlines the study protocol for a pragmatic, community-based type I hybrid effectiveness-implementation superiority randomized controlled trial with 480 caregivers individually randomized to the intervention or treatment as usual arms in a 1:1 ratio. Caregivers assigned to the intervention arm will be invited to a 6-session group intervention delivered by non-specialist facilitators. Primary outcomes for the trial are (1) positive parenting behaviour; (2) physical and psychological violence against children; and (3) caregiver psychological distress. Secondary outcomes include parenting knowledge, beliefs, and efficacy, caregiver engagement in young children's early learning, family functioning, social support, post-traumatic stress symptoms, emotion regulation, psychological flexibility, well-being, and children's internalizing and externalizing symptoms. Outcomes will be assessed at 3 time points: baseline, 1-month post-intervention, and 6-month follow up. A mixed methods process evaluation and cost effectiveness analysis are embedded within the trial to assess intervention delivery, acceptability, potential mechanisms of change, and cost effectiveness. The study was prospectively registered with the Thai Clinical Trials Registry on July 25, 2024 (TCTR20240725001).