Parenting in the Preschool System in Malaysia

Cluster Randomised Trial of a Hybrid Human-digital Playful Parenting Programme in the Malaysian Preschool System

This study aims to evaluate the effectiveness of a hybrid human-digital playful parenting programme, "Naungan Kasih-Hybrid (NK-Hybrid)", in Malaysia. The programme is facilitated by teachers from Malaysian preschools for low-income families, consisting of a) one in-person session to introduce caregivers to the programme, b) teacher-facilitated WhatsApp support groups, and c) an interactive chatbot-led parenting programme featured on WhatsApp, called "Naungan Kasih-Text (NKText)". It tests the effectiveness of this package in a cluster-randomised trial, with 50 preschools as clusters, randomly assigned to either the treatment group or a waitlist control group. Findings from this study will provide evidence for the effectiveness of a low-cost and scalable intervention integrating digital modalities with a "light-touch" in-person component to improve educational outcomes in children attending preschools for low-income families, and thereby address social inequalities in Malaysia.

N = 50 Clusters, 772 Primary Caregivers, 304 Secondary Caregivers, and 754 Children. Enrolment reflects participating primary caregivers.

Study Overview

• Status: Completed
• Conditions: Child Behavior; Child Development; Child Maltreatment; Parenting Stress; Parent Mental Health; Positive Parenting
• Intervention / Treatment: Behavioral: Naungan Kasih Positive Parenting Programme

Detailed Description

The primary aims of the study are to:

Evaluate the effectiveness of NK-Hybrid on positive parenting at three months post-baseline in comparison to wait-list controls Evaluate the effectiveness of NK-Hybrid on child learning and development, as measured by parent and teacher reports of language and communication, literacy, socioemotional, and numeracy skills, and by direct assessments of literacy and numeracy skills, at approximately 12 months post-baseline in comparison to wait-list controls

Secondary aims of the study include:

Evaluate the sustained effectiveness of NK-Hybrid on positive parenting at approximately 12 months post-baseline.

Evaluate the effectiveness of NK-Hybrid on children's learning, namely their literacy and numeracy skills, in comparison to the control group, at three months post-baseline Evaluate the effectiveness of NK-Hybrid on secondary outcomes - parent involvement in playful learning, child maltreatment (physical and emotional abuse), caregiver anxiety and depression, parenting stress, child externalising symptoms, child learning and development, caregiver financial stress, intimate partner violence, marital health, co-parenting support, father involvement, and gender equitable behaviours - at approximately three months post-baseline and 12 months post-baseline.

Evaluate the intervention costs and cost-effectiveness of NK-Hybrid on primary outcomes of positive parenting and child literacy and numeracy skills.

Evaluate the association between engagement in the NK-Hybrid intervention and primary and secondary outcomes.

Explore potential mediators of positive parenting, child literacy and numeracy skills, child maltreatment, child externalising symptoms, and caregiver depression and anxiety at 12 months post-baseline.

Explore potential moderators of positive parenting, child literacy and numeracy skills, child maltreatment, child externalising symptoms, and caregiver depression and anxiety based on socio-demographics and psychosocial assessments at baseline

In line with the study's primary and secondary objectives, the following hypotheses have been defined a priori and will be evaluated using the methods outlined in this statistical analysis plan.

Hypothesis 1a: Caregivers in the treatment group will show higher levels of positive parenting, in comparison to the control group, at 3 months post-baseline.

Hypothesis 1b: Children in the treatment group will show greater improvements in early learning and development, namely their literacy and numeracy skills, in comparison to the control group, at 12 months post-baseline.

Hypothesis 2a: Caregivers in the treatment group will show higher levels of positive parenting, in comparison to the control group, at 12 months post-baseline.

Hypothesis 2b: Children in the treatment group will show greater improvements in learning, namely their literacy and numeracy skills, in comparison to the control group, at three months post-baseline.

Hypothesis 2c: Caregivers in the treatment group will show lower levels of child maltreatment (physical and emotional abuse), anxiety and depression, parenting stress, child externalising symptoms, financial stress, and intimate partner violence, in comparison to the control group, at 3 months and 12 months post-baseline.

Hypothesis 2d: Caregivers in the treatment group will show higher levels of parent involvement in playful learning, marital health, co-parenting support, father involvement, and gender equitable behaviours in comparison to the control group, at 3 months and 12 months post-baseline.

Hypothesis 3a: The intervention will be more cost-effective than the control condition for the primary outcomes, yielding a cost per unit of effect that supports decision-making by relevant stakeholders.

Hypothesis 3b: Higher engagement with intervention components (i.e., in-person onboarding, NKText, and WhatsApp support groups) will be associated with greater improvements in the aforementioned primary and secondary outcomes.

• Study Type: Interventional
• Enrollment (Actual): 772
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Malaysia
  • Kuala Lumpur, Malaysia
    • Universiti Putra Malaysia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Preschools (clusters):

• Registered Ministry of Rural Development (KEMAS) preschool
• Has a class of 20 or more children aged 4-6 years
• Selected by KEMAS leadership as available to participate
• Class teacher is willing to deliver the programme and participates in programme training

Parents/Caregivers:

• Responsible for a child aged 4-6 years enrolled in a participating KEMAS preschool
• Aged 18 years or older
• Has access to a mobile phone compatible with WhatsApp
• Provides informed consent

Children:

• Enrolled in a participating KEMAS preschool
• Aged 4-6 years
• Parent provides consent
• Provides verbal assent

Teachers (Facilitators):

• Registered employee with a KEMAS preschool
• Aged 18 years or older
• Diploma/certificate in Early Childhood Education (ECE) or equivalent
• Provides consent
• Completed training
• Available to deliver intervention

Exclusion Criteria:

• Parents/caregivers who do not meet inclusion criteria
• Children who do not meet inclusion criteria

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group; Intervention group participants will receive one in-person onboarding session, NKText - a self-guided chatbot providing parenting support, and facilitated WhatsApp support groups.	Behavioral: Naungan Kasih Positive Parenting Programme; The programme is facilitated by teachers from Malaysian preschools for low-income families, consisting of a) one in-person session to introduce caregivers to the programme, b) teacher-facilitated WhatsApp support groups, and c) an interactive chatbot-led parenting programme featured on WhatsApp, called "Naungan Kasih-Text".
No Intervention: Control Group; The control group will not receive the intervention until after the completion of the intervention period and the final follow-up data collection. Throughout the study period, participants in all groups may access any other interventions, programs, or services that are not part of the study intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child early learning and development	Children's early learning and development (caregiver- and teacher-report) will be measured using 23 items from the National Preschool Standards-Based Curriculum Assessment (Malaysia); scale = 0-2; higher score indicates better outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Positive Parenting	Positive parenting will be measured using 14 items from the Parenting Young Children Scale (PARYC) (McEachern et al., 2012). (Caregiver Report); (0-6); higher score indicates better outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Child Literacy and Numeracy	Direct child assessments of child learning and development will be conducted by trained research assistants and assessed using an adapted version of the Remote Assessment of Learning (ReAL) High-Access version (Save the Children International, 2021), specifically the Literacy and Numeracy subscales. 12 domains, total score = mean of % correct for each domain; higher score indicates better outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parent involvement in playful learning	Parent involvement in playful learning will be measured using four items from the UNICEF Multiple Indicator Cluster Surveys (MICS) Child Development Module/Family Care Indicators (Kariger et al., 2012). (4 items) (0-8 times in last two weeks) - higher indicates more playful learning activities (better outcome)	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Child Maltreatment	Child maltreatment will be measured using six items from the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool (Meinck et al., 2018), covering physical violence (two items) and psychological violence (four items). (Parent Report); (0-8 times in last two weeks) - higher indicates more incidence of abuse (worse outcome)	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Child externalising symptoms	Child externalising symptoms will be assessed using 12 items from the externalising subscale of the Child and Adolescent Behavior Inventory (CABI) (Cianchetti et al., 2013); (0-2); higher score indicates worse outcome	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Parenting Stress	Parenting stress will be assessed using six items from the Parenting Stress Scale (Berry & Jones, 2016); (0-5); higher score indicates worse outcome	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Anxiety and depression	Anxiety and depression will be assessed using four items from the Patient Health Questionnaire (PHQ-4) Scale (Kroenke et al., 2009); (0-3); higher score indicates worse outcome	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Father involvement with the child	Father involvement with the child will be assessed using seven items from an adapted version of the Alabama Parenting Questionnaire Involvement Subscale (Frick, 1991); (0-4); higher score indicates better outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Gender equitable behaviours	Gender equitable behaviours will be assessed using four items informed by measures commonly used in violence prevention research (Abramsky et al., 2020; Doyle et al., 2018); (1-5); higher score indicates better outcome	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Co-parenting support	Co-parenting support will be assessed using six items from the Co-parenting Relationship Scale (Feinberg et al., 2012); (0-3); higher score indicates better outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Marital health/quality	Marital health/quality will be assessed using five items developed by the research team; (1-5); higher score indicates better outcome	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Intimate partner violence	Intimate partner violence will be assessed using four items adapted from the World Health Organisation study on women's health and domestic violence against women (World Health Organization, 2005); (0-3); higher score indicates worse outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline
Financial Stress	Financial stress will be assessed using six items adapted from the Financial Self-Efficacy Scale (Lown, 2012); (0-3); higher score indicates worse outcome.	Baseline, 3-5 months post-baseline, 12-15 months post-baseline

Collaborators and Investigators

• Sponsor: University of Oxford
• Collaborators: Universiti Putra Malaysia

Publications and helpful links

Helpful Links

• OSF Pre-Registration
• Statistical Analysis Plan (SAP)

Study record dates

Study Major Dates

• Study Start (Actual): July 10, 2024
• Primary Completion (Actual): October 17, 2025
• Study Completion (Actual): October 17, 2025

Study Registration Dates

• First Submitted: May 14, 2026
• First Submitted That Met QC Criteria: May 14, 2026
• First Posted (Actual): May 20, 2026

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: parenting; child development; parenting intervention
• Additional Relevant MeSH Terms: Behavior; Child Behavior
• Other Study ID Numbers: R94406/RE001; 10.17605/OSF.IO/AZ3NY (Registry Identifier: Prospectively registered on Open Science Framework on 17/08/24; ClinicalTrials.gov entry retrospective and consistent.)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the results reported in publications, including demographic variables, caregiver-reported outcomes, and child assessment outcomes.
• IPD Sharing Time Frame: Deidentified participant data will be available beginning 12 months after publication of the planned article publication to allow completion of planned secondary analyses by the study team; no end date for availability.
• IPD Sharing Access Criteria: Requests for access will require submission of a brief description of the intended use. Requests will be reviewed by the study team. Access will be granted following approval of the request and completion of appropriate data access procedures.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No