Preventing interpersonal violence in Panama:is a parenting intervention developed in Australia culturally appropriate?

OBJECTIVES: To explore cultural appropriateness of a transported parenting intervention in Panama. METHODS: Panamanian parents (n = 25) were interviewed after participation in an Australian parenting intervention. A thematic analysis was conducted to interpret qualitative data. RESULTS: Three themes emerged; cultural context, appropriateness of the intervention, and development of support networks. In terms of cultural context, parents described economic difficulties, living in a dangerous world, struggling to balance parenting and work, and using aggressive communication patterns. In terms of appropriateness of the intervention, they rated materials as appropriate, although suggested modifications to its delivery by including children and teachers in the training. Finally, parents commented that the intervention prompted the development of social networks within their communities. CONCLUSIONS: Overall, parents considered a transported parenting intervention as appropriate to their local needs. This study might be useful to local governments and international funders in charge of deciding whether transporting parenting interventions North to South as a strategy for violence prevention would be respectful of local needs. Our findings cannot be generalized beyond Panama, but the methodology can be replicated to answer this question in other settings

CONDUCTAS DEL ESTILO DE VIDA DEL HIJO RELACIONADAS CON EL PESO Y AUTOEFICACIA MATERNA PARA MANEJARLAS.

Introduction: parenting represents challenges. Mothers of overweight (OW) - obesity (OB) children face their children's lifestyle behaviors related to body weight. Objectives: 1) To assess the reliability of The Lifestyle Behaviour Checklist (LBC) in Spanish, 2) To evaluate the children's lifestyle behaviour that represent for the mother a problem for managing (PB) and self-efficacy (SE) to manage them in mothers of children with and without OW-OB and 3) To verify the differences between groups. Methods: participated 367 dyads (mother / child). Mothers answered the LBC with two scales, problems behaviour scale (PBS) and self-efficacy to managing them scale (SMS). The dyads' weight and size were measured. Cronbach's alpha coefficient, descriptive statistics and ANOVA were calculated. Results: Cronbach's alpha for PBS was 0.86 and 0.96 for SMS. Watches too much television was the greatest problem in managing for mothers of children with and without OW-OB (F = .232, p = .630). The mothers of children with OW-OB had lower self-efficacy compared to mothers of children without OW-OB (F = 14,155, p = .001). The mothers of children with OW-OB perceived more PB (Mean = 55.40) and less SE compared to mothers of children without OW-OB (F = 15.45, p Conclusions: LBC in Spanish had acceptable internal consistency. The mothers of children with OW-OB perceived more PB and had less SE. We recommend the implementation of programs that would strengthen the maternal SE

Protecting Adolescents in Low- And Middle-Income Countries from Interpersonal Violence (PRO YOUTH TRIAL):Study Protocol for a Cluster Randomized Controlled Trial of the Strengthening Families Programme 10-14 (“Familias Fuertes”) in Panama

Background Interpersonal violence can significantly reduce adolescents’ opportunities for becoming happy and healthy adults. Central America is the most violent region in the world and it is estimated that adolescents are involved in 82% of all homicides in this region. Family skills training programmes have been designed to prevent interpersonal violence in adolescents. Several studies in high-income countries suggest they are effective. However, there are no published trials assessing effectiveness of these programmes in low- and middle-income countries (LMIC). The aim of this study is to test the effectiveness of the Strengthening Families Programme 10–14 (SFP 10–14 or “Familias Fuertes”) in Panama, a LMIC in Central America. An embedded process evaluation will examine the extent to which the intervention is delivered as intended, variation across trial sites, influences on implementation and intervention-context interactions. Cost-effectiveness will also be assessed. Methods This is a cluster randomised controlled trial. The 28 townships with the highest homicide rates in Panama will be randomly allocated to implementation of SFP 10–14 alongside services-as-usual or to services-as-usual only. Approximately 30 families will be recruited in each township, a total sample of 840 families. Families will be assessed at baseline, approximately eight weeks after baseline (i.e. post intervention), six months and 12 months after. The primary outcome measure will be the parent reported externalising subscale of the Child Behaviour Checklist at T3 (i.e., which is approximately 12 months after baseline). For the process evaluation, recruitment, attendance, fidelity and receipt will be measured. Qualitative interviews with facilitators, trainers, parents and adolescents will explore barriers/facilitators to implementation and intervention receipt. For the cost-effectiveness analysis, service use information will be gathered from parents and adolescents with a three-month recall period. Costs and consequences associated with implementation of the intervention will be identified. Discussion This trial will be the first to evaluate SFP 10–14 in a LMIC. Results have the potential to guide public policies for the prevention of interpersonal violence in Central America and beyond

Parenting programs for underserved populations: Issues of scientific integrity and social justice

Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing, and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the USA and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the USA, Latin America, Africa, and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale-up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities

Strengthening a culture of prevention in low- and middle-income countries: Balancing scientific expectations and contextual realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central México, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed

Hepatitis C infection: eligibility for antiviral therapies

peer reviewedBackground Current treatments of chronic hepatitis C virus (HCV) are effective, but expensive and susceptible to induce significant side effects. Objectives To evaluate the proportion of HCV patients who are eligible for a treatment. Methods In a database comprising 1726 viraemic HCV patients, the files of 299 patients who presented to the same hepatologist for an initial appointment between 1996 and 2003 were reviewed. Results Patients' characteristics were age 43.1 +/- 15.6 years, 53% male and 92% Caucasian. The main risk factors were transfusion (43%) and drug use (22%). Genotypes were mostly genotype 1 (66%), genotype 3 (12%) and genotype 2 (10%). These characteristics were not different from those of the whole series of 1726 patients. A total of 176 patients (59%) were not treated, the reasons for non-treatment being medical contraindications (34%), non-compliance (25%) and normal transaminases (24%). In addition, 17% of patients declined therapy despite being considered as eligible, mainly due to fear of adverse events. Medical contraindications were psychiatric (27%), age (22%), end-stage liver disease (15%), willingness for pregnancy (13%), cardiac contraindication (7%) and others (16%). Only 123 patients (41%) were treated. A sustained viral response was observed in 41%. The treatment was interrupted in 16% for adverse events. Conclusions The majority of HCV patients are not eligible for treatment. This implies that, with current therapies, only 17% of patients referred for chronic HCV become sustained responders. Some modifications of guidelines could extend the rate of treatment (patients with normal transaminases), but an important barrier remains the patients' and the doctors' fear of adverse events

Accommodating race and ethnicity in parenting interventions

There are several parenting programs available, but few have considered the need for adapting content, format, and implementation frameworks to fit the needs of culturally diverse parents worldwide. A recent systematic review only identified eight studies (including Triple P) in which evidence-based parenting programs underwent refinement when delivered across different cultures (Baumann et al., 2015). International organizations such as the World Health Organization (2009) and the United Nations Office on Drugs and Crime (2009) recommend the adaptation of parenting interventions and to tailor manuals to fit the needs of specific cultural and contextual settings to respect and not undermine the cultural values, aspirations, traditions, and needs of different ethnic groups. This chapter explores how Triple P achieves this objective when delivered in different host countries and contexts. We start by reviewing main theories addressing cultural differences across contexts, followed by discussing the implications of delivering parenting support in such diverse settings and the efficacy of Triple P across cultures

Protecting Adolescents in Low- And Middle-Income Countries from Interpersonal Violence (PRO YOUTH TRIAL):Study Protocol for a Cluster Randomized Controlled Trial of the Strengthening Families Programme 10-14 (“Familias Fuertes”) in Panama

Background: Interpersonal violence can significantly reduce adolescents' opportunities for becoming happy and healthy adults. Central America is the most violent region in the world and it is estimated that adolescents are involved in 82% of all homicides in this region. Family skills training programmes have been designed to prevent interpersonal violence in adolescents. Several studies in high-income countries suggest they are effective. However, there are no published trials assessing effectiveness of these programmes in low- and middle-income countries (LMIC). The aim of this study is to test the effectiveness of the Strengthening Families Programme 10-14 (SFP 10-14 or "Familias Fuertes") in Panama, a LMIC in Central America. An embedded process evaluation will examine the extent to which the intervention is delivered as intended, variation across trial sites, influences on implementation and intervention-context interactions. Cost-effectiveness will also be assessed. Methods: This is a cluster randomised controlled trial. The 28 townships with the highest homicide rates in Panama will be randomly allocated to implementation of SFP 10-14 alongside services-as-usual or to services-as-usual only. Approximately 30 families will be recruited in each township, a total sample of 840 families. Families will be assessed at baseline, approximately eight weeks after baseline (i.e. post intervention), six months and 12 months after. The primary outcome measure will be the parent reported externalising subscale of the Child Behaviour Checklist at T3 (i.e., which is approximately 12 months after baseline). For the process evaluation, recruitment, attendance, fidelity and receipt will be measured. Qualitative interviews with facilitators, trainers, parents and adolescents will explore barriers/facilitators to implementation and intervention receipt. For the cost-effectiveness analysis, service use information will be gathered from parents and adolescents with a three-month recall period. Costs and consequences associated with implementation of the intervention will be identified. Discussion: This trial will be the first to evaluate SFP 10-14 in a LMIC. Results have the potential to guide public policies for the prevention of interpersonal violence in Central America and beyond.</p