Parenting for life long health: Assessing the feasibility, acceptability, implementation aspects and outcomes of an adapted parenting course for parents in North India

Parenting for Lifelong Health (PLH) for adolescents is an intervention designed and developed in South Africa, for parents and adolescents from the age of 13 to 18 years. This intervention is an evidence based program on parenting principles such as parent teen communication and parent teen problem solving for risks inside and outside homes. The intervention has 14 modules which were adapted for the Indian context, in consultation with an Experts by Experience group, and called 'Parwarish'. Parwarish seeks to reduce harsh parenting and violence within families through new attitudes and skill building between parents and adolescents. Module content includes spending quality time together, communicating positively, managing strong emotions such as anger and finding safe support when needed as well as problem-solving, conflict resolution and finance skills, including how to manage a household budget and uses role-plays, activity-based learning and home rehearsal and activities building on social learning. Parwarish was implemented by the Emmanuel Hospital Association (EHA) Community Health and Development Programme teams based in Agra, Robertsganj (Uttar Pradesh - UP) and Khunti (Jharkhand). A coach was appointed and trained face to face for each location and took responsibility for recruiting facilitators as well as training and coaching facilitators. Trainers from PLH-Teens South Africa facilitated a 10-day face to face course for Parwarish facilitators, and a 3-day face to face training for coaches (total n=25 participants) less than 2 months before the start of the intervention. The facilitators were then coached/trained face to face once every two weeks by the coaches. The facilitators then led the 14 Parwarish modules over 14 - 18 weeks with groups of 10 - 15 parent-teens dyads, with meetings of 1.5 to two hours and encouraged participants to complete the weekly activity to try at home using a hard copy home-work booklet specifically designed for this intervention E.g., family eats dinner together. Home visits by facilitators, with those who missed a session to review the topic for the week, included a summary of the discussion topic and encouragement to attend the next session and was not more than 30 minutes for each visit. In each site, a local ‘coach’ supported facilitators with weekly meetings during the intervention, reflecting on their facilitation while a fortnightly coach-the-coaches meeting was led online with someone from PLH-Teens South Africa. Implementation of Parwarish groups was conducted by pairs of community facilitators with the following criteria for facilitation selection: Parents of adolescents who were resident in the target community. Represent an equal mix of genders willing to work as a pair in facilitation (over half of facilitators worked as a married couple). Trusted and accepted as a leader by the community. Effective communicators. Had at least passed class 10th and were fluent in the local dialect or language. Quality of implementation (adherence to training) was monitored using attendance and checklists filled by coaches and facilitators (summarised below). Separately, a project officer at each location was responsible for research components of the project and supported baseline and endline data collection as well as monitoring and evaluation of Parwarish sessions with other EHA community coordinators in the team. Coaches filled a paper register at each site on the following measures for monitoring adherence to intervention: • Facilitation and fidelity: 14 of 14 sessions self-reported by facilitators using a 5-point checklist where a score of 1 indicated Poor quality and a score of 5 indicated High quality. The following components of the intervention were assessed with this scale: physical exercise, emotional check in, main teaching topic, role play and completion of home activity. • Facilitation and fidelity: 4 of 14 sessions for each Parwarish group were observed and measured by the coach, EHA project manager or a researcher who had all been trained to fill using the same criteria. Fidelity assessed the five aspects above and two additional aspects, namely: facilitator engagement, and completion of registers. • Attendance of facilitators and coaches at trainings and coaching: attendance register. • Attendance of parents and adolescents: attendance register • Completion of assigned home activities: register. • Home visits completed by facilitators: register.