Effectiveness of a Parenting Programme to Reduce Violence in a Cash Transfer System in the Philippines: RCT With Follow-up

Background Parenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over two years of age. This study examined the effectiveness of a locally adapted parenting programme delivered as part of a government CCT system to low-income families with children aged two to six years in Metro Manila, Philippines. Methods Participants were randomly assigned (1:1) to either a 12-session group-based parenting programme or treatment-as-usual services (N= 120). Participation in either service was required among the conditions for receiving cash grants. Baseline assessments were conducted in July 2017 with one-month post-intervention assessments in January-February 2018 and 12-month follow-up in January-February 2019. All assessments were parent-report (ClinicalTrials.gov: NCT03205449). Findings One-month post-intervention assessments indicated moderate intervention effects for primary outcomes of reduced overall child maltreatment (d = -0.50 [-0.86, -0.13]), emotional abuse (d= -0.59 [-0.95; -0.22]), physical abuse (IRR = 0.51 [0.27; 0.74]), and neglect (IRR = 0.52 [0.18; 0.85]). There were also significant effects for reduced dysfunctional parenting, child behaviour problems, and intimate partner violence, and increased parental efficacy and positive parenting. Reduced overall maltreatment, emotional abuse, and neglect effects were sustained at one-year follow-up. Interpretation Findings suggest that a culturally adapted parenting intervention delivered as part of a CCT programme may be effective in sustaining reductions in violence against children in low- and middle-income countries. Funding This research was supported by UBS Optimus Foundation and UNICEF Philippines, and by the Complexity and Relationships in Health Improvement Programmes of the Medical Research Council MRC UK and Chief Scientist Office (Grant: MC_UU_00022/1 and CSO SPHSU16, MC_UU_00022/3 and CSO SPHSU18)

Learner Performance and Usability of MCCOD e-learning intervention

Introduction: We examined the effectiveness of a locally-developed medical certification of cause-of-death (MCCOD) e-learning intervention in improving knowledge outcomes among medical interns and clerks in the Philippines, and evaluated its usability as an alternative method for MCCOD training. Methods: A nonequivalent control group pretest-posttest quasi-experimental study was conducted. We recruited medical interns and clerks from seven accredited medical institutions from February to April 2020. Learners were conveniently assigned to intervention and control groups. Pretest and posttest data were collected using a 25-item questionnaire while usability was assessed using a cross-sectional survey. Results: There were 1078 learners: 869 (80.6%) received intervention and 209 (19.4%) were controls. Results revealed improvement in pretest-to-posttest mean scores and passing rates in both study groups. The intervention group gained a 16.49±3.17 mean pretest score and 3364.3% passing rate, which increased to 19.89±1.88 and 99.3% in posttest respectively, while the control group received 16.20±3.30 and 61.7% in pretest, which increased to 18.29±3.39 and 83.7% in posttest. The intervention group obtained a significantly higher mean change in score compared to controls (p<0.001) and better score distribution with around 95% of learners having posttest scores between 17 to 23 (or within 2 standard deviations from the intervention group’s posttest mean). In contrast, only 68% of the control group received scores within the same range. Medical students in the intervention group gained the highest improvement in score compared to other groups. The overall mean usability score of the MCCOD online course was 3.86±0.88 with lowest dimension means noted in Learning and Support and Interactivity. Conclusion: E-learning is an effective means of improving MCCOD knowledge outcomes among medical clerks and interns. Enhancing its usability is critical to maximize its impact on learning outcomes and improve its adoption