A Pilot Study of a 6-Week Parenting Program for Mothers of Pre-school Children Attending Family Health Centers in Karachi, Pakistan

Document Type : Original Article


1 School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan

2 Community Health Sciences Department, Aga Khan University, Karachi, Pakistan

3 Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan

4 Health promotion and disease prevention, Texas Woman’s University, Houston, TX, USA


Recently, parenting programs to address behavioural and emotional problems associated with child maltreatment in developing countries have received much attention. There is a paucity of literature on effective parent education interventions in the local context of Pakistan. This study aimed to assess the feasibility of offering a 6-week parenting program for mothers of pre-school children attending family health centres (FHCs) in Karachi, the largest metropolitan city of Pakistan.
A pilot quasi-experimental trial was conducted. Two FHCs were selected, one as the intervention and the second as the control. A total of 57 mothers of pre-school children (n = 30 intervention; n = 27 control) participated in this study. Mothers in the intervention group received SOS Help for parents module, while mothers in the control group received information about routine childcare. A parenting scale (PS) was administered before the program was implemented and repeated 2 weeks after the program was completed in both groups. Statistical analysis was performed to compare participants’ attributes. Descriptive analysis was conducted to compare pre- and post-test mean scores along with standard deviation for parenting subscales in the intervention and control groups.
A total of 50 mothers (n = 25 intervention; n = 25 control) completed the 6-week program. Attrition was observed as 5/30 (17%) in the intervention arm and 2/27 (2%) in the control arm. Mothers commonly reported the burden of daily domestic and social responsibilities as the main reason for dropping out. Furthermore, the majority of participants in the control group recommended increasing the duration of weekly sessions from 1 to 1.5 hours, thereby decreasing the program period from 6 to 4 weeks. Mothers in intervention group reported substantial improvement in parenting skills as indicated by mean difference in their pre- and post-test scores for laxness and over-reactivity.
Parenting programs can be implemented for mothers attending FHCs in Pakistan. Mothers require positive reinforcement and constant encouragement at the participant level. Integrating such programs into primary healthcare at the population level has the potential to maximize child health benefits and to improve parenting skills at the country level.


Main Subjects

  1. Westby CO. Child maltreatment: a global issue. Lang Speech Hear Serv Sch. 2007;38(2):140-148. doi:10.1044/0161-1461(2007/014)
  2. Holt S, Helen B, Sadhbh W. The impact of exposure to domestic violence on children and young people: a review of the literature. Child Abuse Negl.  2008;32(8):797-810. doi:10.1016/j.chiabu.2008.02.004
  3. Gilbert R, Cathy SW, Kevin B, David F, Elspeth W, Staffan J. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657):68-81. doi:10.1016/s0140-6736(08)61706-7
  4. Mejia A, Rachel C, Matthew RS. A review of parenting programs in developing countries: opportunities and challenges for preventing emotional and behavioral difficulties in children. Clin Child Fam Psychol Rev. 2012;15(2):163-175. doi:10.1007/s10567-012-0116-9
  5. Akmatov MK. Child abuse in 28 developing and transitional countries—results from the Multiple Indicator Cluster Surveys. Int J Epidemiol. 2011;40(1):219-227. doi:10.1093/ije/dyq168
  6. Pazdera AL, McWey LM, Mullis A, Carbonell J. Child sexual abuse and the superfluous association with negative parenting outcomes: the role of symptoms as predictors. J Marital Fam Ther. 2013;39(1):98-111. doi:10.1111/j.1752-0606.2011.00272.x
  7. Rodriguez CM. Analog of parental empathy: association with physical child abuse risk and punishment intentions. Child Abuse Negl.  2013;37(8):493-499. doi:10.1016/j.chiabu.2012.10.004
  8. Ahmed K, Laurie W, Stephen S. In their own words: abused children's perceptions of care provided by their birth parents and foster carers. Adoption & Fostering. 2015;39(1):21-37. doi:10.1177/0308575914565068
  9. Sousa C, Herrenkohl TI, Moylan CA, et al.  Longitudinal study on the effects of child abuse and children’s exposure to domestic violence, parent-child attachments, and antisocial behavior in adolescence. J Interpers Violence. 2011;26(1):111-136. doi:10.1177/0886260510362883
  10. Knerr W, Frances G, Lucie C. Improving positive parenting skills and reducing harsh and abusive parenting in low-and middle-income countries: a systematic review. Prev Sci. 2013;14(4):352-363. doi:10.1007/s11121-012-0314-1
  11. Bornstein MH. Positive parenting and positive development in children. In: Lerner RM, Jacobs F, Wertlieb D, eds. Handbook of Applied Developmental Science: Promoting Positive Child, Adolescent, and Family Development Through Research, Policies, and Programs. Thousand Oaks: Sage; 2003:187-209.
  12. Olds DL, Sadler L, Kitzman H. Programs for parents of infant and toddlers: recent evidence from randomized trials. J Child Psychol Psychiatry. 2007;48:355-391. doi:10.1111/j.1469-7610.2006.01702.x
  13. Lundahl BW, Nimer J, Parsons B. Preventing child abuse: a meta-analysis of parent training programs. Res Soc Work Pract. 2006;16:251-262. doi:10.1177/1049731505284391
  14. World Health Organization (WHO). Preventing violence through the development of safe, stable and nurturing relationships between children and their parents and caregivers. Available from: http://apps.who.int/iris/handle/10665/44088. Published 2009.
  15. The News International. Child abuse cases increasing in Pakistan. http://www.thenews.com.pk/Todays-News-6-91603-Child-abuse-cases-increasing-in-Pakistan. Published February 08, 2012.
  16. Manizeh B. Har bacha mehfooz-safe, secure and protected. Annul Report 2013. http://sahil.org/wp-content/uploads/2014/06/Annual-Report-2013.pdf
  17. Malik F. Determinants of child abuse in Pakistani families: parental acceptance-rejection and demographic variables. International Journal of Business and Social Science. 2010;1(1):67-80.
  18. Ali M, Shahab S, Ushijima H, de-Muynck A. Street children in Pakistan: a situational analysis of social conditions and nutritional status. Soc Sci  Med. 2004;59(8):1707-1717. doi:10.1016/j.socscimed.2004.01.031
  19. Aga Khan Health Services Pakistan website. http://www.akdn.org/akhs. Updated 2007.
  20. SOS Help. Helping people help themselves. Programs and Parents Press. http://www.sosprograms.com/index.html
  21. Oveisi S, Ardabili HE, Dadds MR, et al. Primary prevention of parent-child conflict and abuse in Iranian mothers: A rondomized-controlled trial. Child Abuse Neglect. 2010;34:206-213.  doi:10.1016/j.chiabu.2009.05.008
  22. Clark, L. SOS Help for Parents. 3rd ed. Bowling Green, USA: SOS programs and parents press; 2005.
  23. Cowen PS. Effectiveness of a parent education intervention for at-risk families. Journal of Specialists in Pediatric Nursing. 2001;6(2):73-82. doi:10.1111/j.1744-6155.2001.tb00124.x
  24. MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM,  Taussig HN. Interventions to prevent child maltreatment and associated impairment. Lancet. 2009;373:250-266. doi:10.1111/j.1744-6155.2001.tb00124.x
  25. Arnold DS, O'Leary SG, Wolff LS, Acker MM. The parenting scale: a measure of dysfunctional parenting in discipline situations. Psychol Assess. 1993;5(2):137-144.
  26. Rhoades KA,  O’Leary SG. Factor structure and validity of the parenting scale. J Clin Child Adolesc Psychol. 2007;36(2):137-146. doi:10.1037//1040-3590.5.2.137
  27. Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR. Population-based prevention of child maltreatment: the US Triple P system population trial. Prev Sci. 2009;10(1):1-12. doi:10.1080/15374410701274157
  28. World Health Organization (WHO). Preventing child maltreatment: a guide to taking action and generating evidence 2006. http://apps.who.int/iris/bitstream/10665/43499/1/9241594365_eng.pdf 
  29. Turner KM, Richards M, Sanders MR. Randomised clinical trial of a group parent education programme for Australian Indigenous families. J Paediatr Child Health. 2007;43:429-437. doi:10.1046/j.1440-1754.2002.00077.x-i1
  30. López SC, George LM, Herrera ALD, et al. Parenting and physical punishment: primary care interventions in Latin America. Revista Panamericana de Salud Pública. 2000;8(4):257-267. doi:10.1590/s1020-49892000000900005
  31. El-Mohandes AA, Katz KS, El-Khorazaty MN, et al. The effect of a parenting education program on the use of preventive pediatric healthcare services among low-income, minority mothers: a randomized, controlled study. Pediatrics. 2003;111(6):1324-1332. doi:10.1542/peds.111.6.1324
  32. Fujiwara T, Kato N, Sanders MR. Effectiveness of group positive parenting program (Triple P) in changing child behavior, parenting style, and parental adjustment: an intervention study in Japan. J Child Fam Stud. 2011;20:804-813. doi:10.1007/s10826-011-9448-1
  33. Gylfason G, Sigurðardóttir Z, Skúlason S, et al. Private parenting coach : an intervention that improves the parenting techniques of parents with a long history of social service support. Sálfræðiritið. 2009;14:93-101.
  34. Kirby JN, Matthew RS. A randomized controlled trial evaluating a parenting program designed specifically for grandparents. Behav Res Ther. 2014;52:35-44. doi:10.1016/j.brat.2013.11.002