Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes
Bibliographic record
Abstract
Previous studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low- and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings. This study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomes – parenting and maltreatment reported by caregivers and adolescents aged 10–18 ( N = 270 pairs), 14 outcome constructs. Fidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01). Our study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.032 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".