What are the impacts of parenting programmes on adolescents? A review of evidence from low- and middle-income countries Rachel Marcus, Krista Kruja and Jenny Rivett December 2019 Acknowledgements Thanks to Caroline Harper and Kim Miller for comments on a previous version and to Kathryn O’Neill for copy-editing. With thanks also to Jojoh Faal Sy for layout and design support. Suggested citation Marcus, R., Kruja, K. and Rivett, J. (2019) What are the impacts of parenting programmes on adolescents? A review of evidence from low and middle-income countries. London: Gender and Adolescence: Global Evidence Table of contents Acronyms VI Executive summary i Study methodology i Overview of programmes examined ii Key findings ii Conclusions and recommendations 2 1 Introduction 4 1.1 What are parenting programmes and what do they aim to do? 4 1.2 Rationale for this review 6 1.3 Methodology 7 2 Overview of programmes 12 2.1 Geographical distribution 12 2.2 Participants 17 2.3 Programme activities and foci 18 2.4 Programme implementation, scale and duration 19 3 Impacts on parenting skills 20 3.1 Parents’ communication skills 20 3.2 Improved parent–child relationships 22 3.3 Positive discipline 23 3.4 Parental monitoring of adolescents 27 4 Impacts on psychosocial well-being 31 4.1 Parents’ mental health 31 4.2 Adolescents’ psychosocial well-being 33 4.3 Impacts on substance abuse-related outcomes 37 5 Impacts on sexual and reproductive health issues 39 5.1 Parents’ knowledge of SRH and condom self-efficacy 40 5.2 Parents’ ability to discuss SRH issues with adolescents 40 5.3 Adolescents’ knowledge about SRH 44 5.4 Parents’ attitudes and behaviour towards adolescents’ use of contraceptives 45 6 Impacts on gender equality 49 6.1 Extent of programmes’ focus on gender-inequitable norms and practices 49 6.2 Gendered impacts of parenting programmes 52 6.3 Impact of participants’ gender on outcomes 53 7 What contributes to positive impacts? 55 7.1 Programme duration, frequency and completion rates 55 7.2 Tailoring programme design to context 56 7.3 Facilitator training and quality 59 What are the impacts of parenting programmes on adolescents? A review of evidence from low- and middle-income countries 8 Conclusions 61 8.1 A note on the nature of the evidence 61 8.2 Key change strategies 61 8.3 Recommendations 62 Bibliography 65 Annex 1: Programme details 70 Annex 2: Review methodology 77 A2.1 Keywords 77 A2.2 Inclusion/exclusion criteria 78 Annex 3: Indicators and measurement scales used 80 Parenting skills 80 Annex 4: Supplementary tables 93 Figures Figure 1: Conceptual framework 8 Figure 2: Distribution of programmes in this review 12 Figure 3: Geographical distribution of programmes 12 Figure 4: Distribution of participants by gender (number of programmes) 17 Figure 5: Parent and adolescent reports of programme impacts on general parent–adolescent communication 21 Figure 6: Parent and adolescent reports of programme impacts on parent–child relationships 22 Figure 7: Parent and adolescent reports of programme impacts on parent use of positive discipline 24 Figure 8: Distribution of changes in attitudes towards harsh punishment 25 Figure 9: Parent and adolescent reports of programme impacts on verbal/emotional violence 26 Figure 10: Parent and adolescent reports of programme impacts of physical violence 26 Figure 11: Parents’ and adolescents’ reports of programme impacts on parent neglect of adolescents 28 Figure 12: Distribution of programme impacts on mental health 32 Figure 13: Parent and adolescent reports of programme impacts on adolescent mental health 33 Figure 14: Parent and adolescent reports of programme impacts on adolescent psychosocial protective factors 34 Figure 15: Parent and adolescent reports of programme impacts on adolescent behavioural problems 35 Figure 16: Parent and adolescent reports of programme impacts on communication about substance abuse 37 Figure 17: Parent and adolescent reports of programme impacts on adolescent substance abuse 38 Figure 18: Adolescents’ and parents’ reports of programme impacts on parent–adolescent communication about SRH issues 41 Figure 19: Adolescents’ and parents’ reports of programme impacts on adolescents’ SRH knowledge 44 Figure 20: Distribution of programmes with gender-disaggregated outcomes by topic 53 Figure 21: Gender-disaggregated outcomes by parents’ and adolescents’ reports of programme impacts 53 Tables Table 1: Summary of methodological approaches in studies reviewed 9 Table 2: Comparison of insights from parents’ and adolescents’ reports in the Sinovuyo Teen parenting programme in South Africa 9 Table 3: Locations of programmes 12 Table 4: Overview of programmes discussed in this review 13 Table 5: Distribution of programmes by parents and adolescent participation 17 Table 6: Distribution of ages of adolescents whose parents took part in parenting programmes 17 Table 7: Distribution of programme delivery methods 18 Table 8: Thematic foci of programmes 19 Table 9: Scale of programmes 19 Table 10: Rates of participation, completion, and availability for follow-up, by study 55 Boxes Box 1: Research questions 6 Box 2: Terminology 7 Box 3: Case study: Parenting for Lifelong Health: Sinovuyo Teen 28 Box 4: Evidence of programme impact on adolescents’ experience of sexual violence 45 Box 5: Case study: Families Matter! programme 46 Box 6: Gender-focused content in the Families Matter! programme 50 Box 7: Breaking the Voice: focusing on gender norms to promote mother–daughter communication 51 What are the impacts of parenting programmes on adolescents? A review of evidence from low- and middle-income countries Acronyms BFOOY Bahamian Focus on Older Youth CDC Centers for Disease Control and Prevention CHAMP Collaborative HIV/AIDS and Adolescent Mental Health Programme (South Africa) CImPACT Caribbean Informed Parents and Children Together COMPASS Creating Opportunities through Mentorship, Parental Involvement, and Safe Spaces DREAMS Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (USAID) EWA Exploring the World of Adolescents (Viet Nam) FMP Families Matter! programme FOYC Focus on Youth in the Caribbean FSI Family Strengthening Intervention for HIV-affected Families (Rwanda) GAGE Gender and Adolescence: Global Evidence GGI Go Girls! Initiative ILO International Labour Organization IMAGE Intervention with Microfinance for AIDS and Gender Equity IPV intimate partner violence LGBTQI+ lesbian, gay, bisexual, transgender, queer/questioning, intersex + LMIC low- and middle-income country NGO non-governmental organisation OCD obsessive compulsive disorder PAHO Pan American Health Organization PEPFAR US President’s Emergency Plan for AIDS Relief RCT randomised control trial SRH sexual and reproductive health STI sexually transmitted illness UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children’s Fund UNODC United Nations Office on Drugs and Crime USAID United States Agency for International Development Executive summary Recognising the critical role of families in adolescents’ They also had to involve a valid comparison; beyond development and well-being, and the widening set of this, we did not require specific research designs or challenges facing adolescents today, governments methodologies, as we were keen to include insightful and non-governmental organisations (NGOs) in low- studies from a range of approaches. However, 83% of and middle-income countries (LMICs) are increasingly studies included in the review were based on rigorous implementing parenting programmes to better equip quantitative designs (randomised control trials (RCTs) families to support healthy adolescent development. In and quasi-experiments) and almost all quantitative this review, we define parenting programmes as ‘activities studies used previously validated scales for measurement. oriented to improving how parents approach and carry out This high percentage of RCTs reflects the unusually their role as parents and to increasing parents’ child-rearing high proportion of experimental and pilot initiatives. resources, including, knowledge, skills and social support’.1 A substantial number of the studies (40%) included Such programmes initially focused on the parents of young qualitative insights, indicating that mixed methods were children; their expansion to parents of older children is common. Only six studies of four programmes were relatively recent, and there is no synthesised analysis of undertaken a year more after participants completed the their impact. programme, following participants for up to four years. Qualitative research by the Gender and Adolescence: Encouragingly, all showed lasting effects. Global Evidence (GAGE) programme highlights the high All studies examined parents’ self-reported outcomes priority adolescents give to warm and supportive intra-family and just under half (48%) accompanied these insights with relationships, but also the extent to which they experience adolescents’ reports of changes in their parents’ behaviour violence from parents and caregivers. This review aims to and attitudes towards them, which sometimes confirmed understand how far parenting programmes are useful tools and sometimes challenged changes reported by parents. for policy-makers and programmers aiming to promote The indicators used by each review varied significantly; adolescent well-being and development. It also aims to hence we simply classify changes as positive, negative synthesise what is known about gender-differentiated or no change,