Building caregivers' emotional, parental and social support skills to prevent violence against adolescent girls: findings from a cluster randomised controlled trial in Democratic Republic of Congo

Lindsay Stark, Ilana Seff, Khudejha Asghar, Danielle Roth, Theresita Bakamore, Mairi MacRae, Cecile Fanton D'Andon, Kathryn L Falb, Lindsay Stark, Ilana Seff, Khudejha Asghar, Danielle Roth, Theresita Bakamore, Mairi MacRae, Cecile Fanton D'Andon, Kathryn L Falb

Abstract

Introduction: Parenting programmes are increasingly popular for reducing children's exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls' exposure to violence (sexual and others) and caregivers' gender attitudes and parenting behaviours.

Methods: In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10-14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls' self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted.

Results: At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes.

Conclusion: While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls' violence exposure in humanitarian settings.

Trial registration number: NCT02384642.

Keywords: child health; cluster randomised trial; prevention strategies; public health.

Conflict of interest statement

Competing interests: None declared.

Figures

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Figure 1
CONSORT Diagram

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