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S T U D Y P R O T O C O L Open Access
Evaluating the dissemination and scale-up
of two evidence-based parenting
interventions to reduce violence against
children: study protocol
Yulia Shenderovich
1*
, Catherine L. Ward
2
, Jamie M. Lachman
1,3
, Inge Wessels
1,2
, Hlengiwe Sacolo-Gwebu
2
,
Kufre Okop
2
, Daniel Oliver
4
, Lindokuhle L. Ngcobo
5
, Mark Tomlinson
6,7
, Zuyi Fang
1
, Roselinde Janowski
1,2
,
Judy Hutchings
8
, Frances Gardner
1
and Lucie Cluver
1,9
Abstract
Background: Eliminating violence against children is a prominent policy goal, codified in the Sustainable
Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we
know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-
income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young
Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized
trials, provides a unique opportunity to study their dissemination in 25 LMICs.
Methods: The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the
dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up,
(2) how the programs are implemented and factors associated with variation in implementation, (3) violence
against children and family outcomes before and after program implementation, (4) barriers and facilitators to
sustained program delivery, and (5) costs and resources needed for implementation.
Primary data collection, focused on three case study projects, will include interviews and focus groups with
program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational
characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary
data analysis of routine data collected within ongoing implementation and existing research studies will explore
family enrolment and attendance, as well as family reports of parenting practices, violence against children, child
behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on
staff sociodemographic and professional background, and their competent adherence to the program, collected as
part of staff training and certification.
(Continued on next page)
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: yulia.shenderovich@spi.ox.ac.uk;
y.shenderovich@gmail.com
1
Department of Social Policy and Intervention, University of Oxford, Oxford,
UK
Full list of author information is available at the end of the article
Implementation Scienc
e
Communications
Shenderovich et al. Implementation Science Communications (2020) 1:109
https://doi.org/10.1186/s43058-020-00086-6
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(Continued from previous page)
Discussion: This project will be the first study of its kind to draw on multiple data sources and methods to
examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study
reports on the implementation of two specific parenting programs, we anticipate that our findings will be of
relevance across the field of parenting, as well as other violence prevention and social programs.
Keywords: Evidence-based practice implementation, Parenting, Violence against children, Scale-up, Dissemination
Background
The United Nations Sustainable Development Goal 16
has set the aspiration to “end abuse, exploitation, traf-
ficking and all forms of violence against and torture of
children”(target 16.2). This is no small challenge: over a
billion children each year experience some form of vio-
lence, with most of the burden in low- and middle-
income countries (LMICs) [1,2]. Parenting programs
are one of the seven strategies to prevent and reduce
violence against children identified in the INSPIRE
guidelines led by the World Health Organization
(WHO) [3–5]. Parenting programs involve group-based
or individual family meetings that aim to build effective
parenting practices, strengthen positive parenting, re-
duce harsh or violent parenting, and improve child out-
comes. Delivery of parenting programs may also help
address multiple global goals such as reducing prevent-
able deaths of infants and children under age five (target
3.2), reducing substance use (target 3.5), and violence
(target 16.1) among children and young people, improv-
ing child’s and caregiver’s mental health (target 3.4), and
promoting education (targets 4.1) [6–9].
There is growing interest in the scale-up of parenting
programs [10–12]. Scale-up can be conceptualized as
reaching wider geographical areas and more people, as
well as embedding delivery into lasting systems, for
Contributions to the literature
We describe a plan for learning from the widespread
dissemination and scale-up of two parenting programs in a
range of low- and middle-income country settings. Few pre-
vious studies have explored this scale of dissemination of a
social program.
The study will combine primary qualitative and
organizational data, as well as secondary quantitative data
collected by implementing agencies and other research
teams.
The results will provide insights into dissemination and
implementation across the implementation stages identified
in the Exploration, Preparation, Implementation and
Sustainment framework.
instance, by integrating new programs into existing ser-
vice systems [13–17]. In the field of parenting programs,
as in other areas, many research-informed initiatives are
not taken up widely [18,19]. When programs are indeed
taken up, several questions arise. One frequent concern
is whether transporting a program from one cultural
context to another may reduce family engagement and
program effectiveness [20]. A recent systematic review
found that parenting programs may have comparable or
even greater effectiveness when implemented in regions
and with populations different from where they were
developed, with relatively minimal content adaptation
[21,22]. Yet not all transported family programs show
effects [23,24]. Another key question is whether pro-
gram effects achieved in research trials can be replicated
in routine services [25,26]. Studies of parenting pro-
grams implemented across entire areas have shown that
establishing and maintaining quality delivery is a chal-
lenge if programs are delivered by overburdened volun-
teers or staff [27–30].
Parenting for Lifelong Health (PLH) is an initiative led
by individuals from the WHO, UNICEF, and the Univer-
sities of Bangor, Cape Town, Oxford, and Stellenbosch.
It aims to develop, test, and scale-up parenting programs
to reduce violence against children and improve child
wellbeing in LMICs. Since starting work in 2012, PLH
supported a suite of low-cost, Creative Commons-
licensed parenting programs, including developing PLH
for Young Children (2 to 9 years), and PLH for Parents
and Teens (10 to 17 years). Both programs are group-
based and can be supplemented with home visits. Group
sessions normally take place in community venues, such
as village halls. Initially tested in randomized controlled
trials in South Africa with promising results [31–33], the
programs have subsequently been tested by the devel-
opers and other researchers in multiple countries (e.g.,
the Philippines and Thailand; [34–36]). Program man-
uals are freely available online [37].
These two programs have experienced rapid dissemin-
ation in over 25 LMICs in sub-Saharan Africa, Eastern
Europe, Southeast Asia, and the Caribbean (Czech
Republic, Democratic Republic of the Congo, Federal
Democratic Republic of Ethiopia, Kingdom of Eswatini,
Kingdom of Lesotho, Kingdom of Thailand, Malaysia,
Montenegro, Republic of Botswana, Republic of
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Cameroon, Republic of Côte d’Ivoire, Republic of Haiti,
Republic of India, Republic of Kenya, Republic of
Malawi, Republic of Moldova, Republic of North
Macedonia, Republic of South Africa, Republic of South
Sudan, Republic of the Philippines, Republic of Uganda,
Republic of Zambia, Republic of Zimbabwe, Romania,
and United Republic of Tanzania).
Delivery has been led by non-governmental organiza-
tions working with varying numbers of families. For ex-
ample, in South Sudan, delivery by Catholic Relief
Services reached several hundred families in 2017–2018
[38], while Pact Tanzania worked with 16,000 families in
11 districts in 2018–2019 and plans to work with ap-
proximately 47,800 families in 2020–2021 in 8 districts
of Tanzania. In several countries, including Montenegro,
South Africa, the Philippines, and Thailand, govern-
ments have led delivery. In many cases, PLH programs
have been integrated into packages of services, such as
the existing government conditional cash transfer system
in the Philippines [34]. Adaptations of the programs
have been tailored for a variety of populations, such as
families reunited after children exit residential care in
Kenya, and families with orphans and vulnerable chil-
dren as well as families of adolescent girls in the context
of HIV prevention in Tanzania.
In 2020, as part of the COVID-19 response, core pro-
gram components were converted into tip sheets for
families with an interagency collaboration including the
WHO, UNICEF, UNODC, USAID, the Centers for Dis-
ease Control and Prevention, and the Global Partnership
to End Violence Against Children, as well as NGOs [39].
Focusing on parenting during lockdown and school clo-
sures, the tips have been disseminated to an estimated
over 72 million families in 178 countries.
Two non-profit organizations, Clowns Without Bor-
ders South Africa (CWBSA), and the Children’s Early
Intervention Trust (CEIT) in Wales provide the main
support in Africa and Europe, respectively. PLH uses a
cascading dissemination model in which CWBSA and
CEIT (i.e., the program purveyors [40]) transfer technical
capacity to implementing agencies. Agencies interested
in implementing PLH typically request technical sup-
port, which includes the following:
1) Adapting the programs to fit the local context and
culture;
2) Conducting an implementation readiness
assessment;
3) Providing materials and tools for implementation,
monitoring, and evaluation;
4) Training frontline service providers including
program facilitators, coaches, trainers, and
coordinators;
5) Assessing and certifying personnel.
PLH facilitators range from community volunteers to
professional psychologists depending on the context. Fa-
cilitators deliver the program to families—caregivers
only for PLH for Young Children, and caregivers and
their teens for PLH for Parents and Teens—and receive
ongoing supportive supervision during delivery. To en-
sure high-quality program delivery, facilitator certifica-
tion is done via structured live or video observations and
is a requirement to be eligible to be trained as a PLH
coach; coaches (usually professionals) provide ongoing
support to facilitators. Likewise, PLH coaches are
assessed for certification, which is a requirement before
being trained as a PLH trainer who is licensed to train
facilitators and coaches.
The global uptake of the PLH programs provides an
unprecedented opportunity to explore questions of
scale-up across multiple LMICs. As a blueprint for the
Scale-Up of Parenting Evaluation Research (SUPER)
study, this paper will (1) describe research questions and
their rationale, (2) outline study structure and methods,
and (3) discuss challenges and opportunities.
Research questions
The study will use the Exploration, Preparation, Imple-
mentation and Sustainment (EPIS) framework [41,42].
EPIS is a comprehensive model of implementation stages
and their determinants. It organizes the study of imple-
mentation into the following stages: (1) exploration—the
process of intervention selection; (2) preparation—set-
ting up for implementation; (3) implementation—deliv-
ery of evidence-based practices and ongoing monitoring
of the implementation process; and (4) sustainment—the
process of program embedding in ongoing services. We
use these stages to inform data collection, and analysis—
for instance, to structure our key informant interview
and focus group questions.
The SUPER study focuses on the following research
questions.
(1) What is the process and extent of dissemination and
scale-up of PLH programs?
Dissemination of evidence-informed practices is at the
heart of implementation research. It is important to
understand how and why PLH has been taken up by
funders and implementers since this will inform dissem-
ination of similar programs in future and of the same
programs in new settings [18]. The dissemination ap-
proach may also influence the quality and sustainment
of the program. We will map the types of organizations,
contexts, populations, and service combinations where
PLH has been adopted, as well as identifying several
cases where it was considered but not taken up.
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(2) How are the PLH programs implemented in various
contexts and what are the factors associated with variation
in implementation?
Program fidelity and adaptation exist in constant tension
[43]. While strict adherence to protocols may ensure fi-
delity to the program as it was originally tested, adapta-
tion is often considered necessary to fit new settings and
populations [44]. In addition to formal systematic adap-
tation, adaptation often occurs during delivery in a more
ad hoc, informal manner. Facilitators may change ses-
sion content to address the concerns of the families with
whom they work. Due to external factors, such as fund-
ing cycles or agricultural seasons, implementation agen-
cies may adjust intervention length or facilitator
recruitment processes. This cannot only lead to inter-
vention drift [45] but also to innovations and maturation
that could strengthen program outcomes [46]. During
the COVID-19 pandemic, PLH adaptations have in-
cluded remote training of implementation staff and re-
mote provision of family support instead of in-person.
To understand how PLH is implemented at scale, we
will examine data on program delivery, adaptation, and
participant engagement, and factors associated with
these implementation outcomes.
(3) Are there changes in violence against children and other
targeted family outcomes, following program delivery?
Previous studies of parenting programs within routine
delivery have examined family outcomes using various
data sources. These include examining administrative
data from social services in the USA [28], data collected
by teachers in Scotland [29], families completing ques-
tionnaires in England [47], and data collected by re-
search assistants in Kenya from several hundred families
[48]. These studies have found mixed results in terms of
changes in family outcomes. To the best of our know-
ledge, no large-scale data analysis of family outcomes
has been reported in LMICs during ongoing parenting
program delivery. We will conduct a secondary analysis
of family-level pre-post outcome data collected by
implementing partners in an estimated 5–8 countries
through existing monitoring systems.
(4) What are barriers and facilitators to sustainment of PLH
programs?
Since the two PLH programs have been implemented
for only a few years, it is important to examine the pros-
pects and challenges for sustainment, such as via inte-
gration into existing service structures [45]. For
example, factors such as community support and leader-
ship consistency were identified as important for sus-
taining delivery of an early years maternal and child
health intervention in South Africa [19]. We will exam-
ine from interviews and organizational records whether
organizations are continuing to deliver PLH after the ini-
tial work with program purveyors is completed. We will
also explore, using interviews and focus groups, the
stakeholder perceptions of barriers and facilitators to
continued delivery.
(5) What are the costs and resources needed for PLH
delivery?
An essential first step to financial and resource sustain-
ability is understanding the costs in practice and at scale.
While it is possible to extrapolate from implementation
with smaller numbers of families, costs at scale may differ
[49]. There may be economies of scale, for instance, when
facilitators deliver multiple rounds of the program after a
single training. Therefore, we will explore the costs and
resources required for PLH delivery, as well as how the
PLH program delivery is currently being funded.
Study design
This study will use a mixed-methods approach. The re-
search questions, and corresponding implementation
phases and data collection methods are outlined in
Table 1. The research team will collect primary data in a
sub-sample of implementation settings. Data will also be
collected by implementing agencies and intervention
purveyors as part of the program delivery and may be
shared with the research team in a de-identified or
anonymized form for secondary data analysis. Although
the study timeline is 2020–2024, some of the secondary
data has already been collected by implementing agen-
cies and research partners. There can be a tension be-
tween pre-specifying research plans and being
responsive to dynamic implementation realities. There-
fore, further methods and questions may be added, as
the study evolves in collaboration with stakeholders.
Study sample
All organizations implementing PLH for Young Children
and PLH for Parents and Teens, as well as researchers of
formal studies, will be invited to contribute to the study.
To allow a more in-depth understanding of our research
questions, we will examine three case studies in depth,
selected based on variation along the following dimen-
sions: (1) geographical region, (2) level of government
involvement in delivery, and (3) number of families
reached [18,50]. Given that the program development
and most dissemination have been in the African contin-
ent, the case studies will be in Africa.
Study recruitment and ethical procedures
The study has received ethical approval from the Univer-
sities of Oxford (SPICUREC1a__20_015) and Cape
Town (PSY2017-040). We have obtained country-level
ethics clearance from 15 participating countries, and
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further, country-level ethics will be collected as the study
recruits additional projects. We will seek agreement from
each of the organizations involved in the project before
approaching individuals within the organization. For pri-
mary data collection (Table 1), informed consent will be
obtained by the research team. In respect to data shared
for secondary analysis, implementation organizations and
research teams contributing data to the project are re-
sponsible for ensuring that families and staff can consent
or opt-out from being a part of the standard monitoring
and evaluation data collection, as appropriate. Before any
existing data are shared by organizations or investigators,
data sharing agreements will be signed; this includes the
requirement that partners will anonymize datasets before
sharing them.
Data collection tools and methods
Implementation and outcome measures
Implementation staff demographic data Partner orga-
nizations and intervention purveyors collect demographic
data about PLH facilitators and coaches. Demographic
Table 1 Overview of the study data sources
Type of
data
Data collectors Data collection method Study participants EPIS phase Research
questions
Primary
data
SUPER research team Interviews and focus groups Purveyor trainers and
program specialists
Preparation
Implementation
1,2,4,5
Donor agency staff Exploration
Preparation
Implementation
Sustainment
1,2,4
Local, regional and national
policymakers
Exploration
Preparation
Implementation
Sustainment
1,2,4
Other local stakeholders Exploration
Preparation
Implementation
Sustainment
1,2,3,4
Interviews and focus groups Program coordinators,
directors
Exploration
Preparation
Implementation
Sustainment
1,2,3,4,5
Monitoring and evaluation
team of the implementing
organization
Implementation
Sustainment
2,3,4,5
PLH facilitators, coaches,
trainers
Preparation
Implementation
Sustainment
2,3,4
Surveys on organizational
characteristics
Program coordinators,
directors
Implementation
Sustainment
1,2,4
Budgets, surveys, interviews on costs/
resources for delivery
Program coordinators,
directors
Implementation
Sustainment
5
Primary and
secondary
data
SUPER research team,
implementers, purveyors
Document review of other
background materials
Implementing organization,
local area
Exploration
Preparation
Implementation
Sustainment
1,2,3,4,5
Secondary
data
Implementers (usually collected by
program facilitators and other
research teams)
Family reports of parenting practices,
child behavior, child and caregiver
mental health
Families participating in
the PLH programs
Implementation
Sustainment
3
Implementers (usually collected by
program facilitators)
Family enrolment, attendance,
engagement, and dropout
Implementation
Sustainment
2,3
Purveyors Surveys on the sociodemographic and
professional background of staff
delivering the program
Facilitators, coaches Implementation
Sustainment
2
Assessments of competent adherence
to the program
Implementation
Sustainment
2
Program documentation, reports All Preparation
Implementation
1,2,3,4,5
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data will include questions on age, gender, marital status,
parental status, number and age of children, employment
status, previous experience, and educational level. The
questionnaire will also assess facilitator/coach self-efficacy,
and attitude to corporal punishment.
Facilitator competent adherence Facilitator competent
adherence to the program can be defined as following
the activities outlined in the program manual while also
exercising clinical and teaching skills and judgment [51].
Competent adherence to the program will be evaluated
using fidelity checklists of session activities and the
PLH-Facilitator Assessment Tool (PLH-FAT) [52]. The
PLH-FAT is an observation assessment tool used either
live during group sessions or with video recordings. The
PLH-FAT was developed by the study investigators and
program developers to assess the proficiency of program
delivery by facilitators as a prerequisite to certification.
Seven standard behavior categories outlined in the pro-
gram manuals are grouped into two scales based on (1)
core activities and (2) process skills outlined in the pro-
gram manuals.
Coach competent adherence Coach competent adher-
ence to the program will be collected using a similar ob-
servational assessment tool, the PLH-Coach Assessment
Tool (PLH-CAT). This tool assesses the quality of
coaching provided to facilitators based on either live ob-
servations or video recordings of coaching sessions, in-
cluding an activity subscale on the discussion of
highlights and challenges and similar items for process
skills as in the PLH-FAT.
Family enrollment and attendance Enrollment refers
to the share of recruited caregivers (and adolescents in
PLH for Parents and Teens) who attend at least one ses-
sion. Attendance refers to the number of sessions, out of
the total possible number, attended by an enrolled par-
ticipant. For the PLH programs, an overall attendance
rate is calculated by using both group sessions and home
visits, as well as an additional group session rate. Enroll-
ment and attendance data are collected using
organizational recruitment lists and attendance registers.
Family outcomes Program purveyors offer organiza-
tions implementing PLH a set of family outcome meas-
urement tools. Organizations are encouraged to add
these questionnaires to their monitoring and evaluation
data collection if they already have a system in place for
family data collection, for instance, on HIV risk factors
in the context of sub-Saharan Africa. The measures rec-
ommended for PLH implementers focus on caregiver
and child behaviors and wellbeing (Table 2). The tools
were chosen because they assess the core outcomes the
PLH programs target and are freely available. PLH for
Young Children surveys are parent-reported, while PLH
for Parents and Teens has both parent- and adolescent-
report versions. Versions of different lengths (short,
medium, and long) allow implementers to select the
most appropriate version for their needs. Family ques-
tionnaires are usually collected by intervention
Table 2 Family questionnaire measures recommended to implementing partners
Domain Source Respondents
Parents of young
children
Parents of
adolescents
Adolescents
Demographics Selected details (e.g., age, gender, education) ✓✓✓
Involved parenting Alabama Parenting Questionnaire involved parenting subscale [53]✓✓✓
Parental monitoring Alabama Parenting Questionnaire parental monitoring subscale [53]✓✓✓
Child behavior Strengths and Difficulties Questionnaire [54]✓✓✓
Child mental health Strengths and Difficulties Questionnaire [54] N/A N/A ✓
Harsh discipline ISPCAN Child Abuse Screening Tool [55,56]✓✓✓
Parenting stress Parenting Stress Scale [57]✓✓N/A
Acceptability of corporal
punishment
Multiple Indicator Cluster Survey item [58]✓✓N/A
Parental depression Centre for Epidemiological Studies-Depression [59]✓✓N/A
Risk avoidance Risk avoidance planning scale (Developed specifically for Sinovuyo
Teen intervention, based on [60]
✓✓✓
Economic strengthening Family financial coping scale (Developed specifically for Sinovuyo
Teen intervention, based on [61–63]
✓✓✓
Parental support of
education
Parental Support for Education Scale [64]✓✓✓
Note: The table presents the most comprehensive version of the questionnaires (“long”). The questionnaires are available on the study’s OSF page
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facilitators at the first and last program sessions, with
follow-up sessions at home, where possible, in case of
missed sessions.
Organizational data.
Organizational surveys To characterize the organiza-
tions delivering PLH programs, and explore any vari-
ation in uptake, implementation, and sustainment
between them, we will distribute a short survey to these
organizations to capture basic organizational characteris-
tics, such as size and focus of activity.
Policies, protocols, and progress reports Researchers
will review locally relevant policies, protocols, and pro-
gress reports to identify the context that affects PLH im-
plementation. Information on the implementation
process will be extracted from progress reports and
other routine documents, such as the implementation
readiness assessment, where available. Formal requests
will be sent to participating organizations to obtain per-
mission to review relevant documents.
Costing questionnaires for organizations We aim to
collect the program set-up and implementation costs
from at least the case study countries to examine how
much the delivery costs in different contexts. We will re-
view program budgets and collect data directly from the
organizations directly about resources involved, based
on the Global Health Consortium and J-PAL guidance
[65,66], as well as previous analyses of the PLH for Par-
ents and Teens costs [67].
Qualitative data
Key informant interviews Semi-structured interviews
will be conducted with representatives of governments,
funding agencies, implementing partners, program facili-
tators, coaches, and trainers. Interviews will be held in
person or virtually following interview guides, aiming for
approximately 4–8 interviews per implementation site or
until saturation is reached.
Focus group discussions Focus group discussions of
between 6 and 12 participants will be conducted with
PLH program facilitators and supervisors. The number
of focus groups per site will be determined by the scale
of implementation and heterogeneity of the participants.
An experienced moderator will lead the discussions fol-
lowing a discussion guide, assisted by notetakers.
The qualitative data collection will focus on the projects
selected as case studies, although it may also include add-
itional sites. Interviews and focus groups will be con-
ducted by experienced interviewers who either speak the
same language as the participants or are assisted by an in-
terpreter. Interviews and focus groups will be transcribed.
The transcripts will be either written in or translated into
English, the main language of analysis. Spot-checking will
be done during the translation and transcription phases to
ensure consistency and accuracy.
Fieldnotes In addition to interviews and focus groups,
fieldnotes will be compiled through stakeholder meet-
ings, such as community of practice meetings. In such
meetings, participants involved in the implementation of
the programs will be solicited to give an overview of
PLH programs in their countries, discuss challenges, and
deliberate on possible solutions.
Analysis plans
Since this is an overarching blueprint, we provide an
overview of planned analyses approaches. Where pos-
sible, data collection tools, protocols, and detailed plans
for specific analyses will be published separately and
listed on the project’s Open Science Framework page
(https://osf.io/v597r/).
Quantitative analyses
To address Research Questions 1 and 2 (examining the
dissemination and implementation of PLH programs), we
will examine the attendance rates and trends among par-
ticipating families, as well as variation in enrollment, at-
tendance, and program completion. We will also
summarize and examine variation in facilitator and coach
sociodemographic characteristics, key organizational char-
acteristics, and the relationship of these characteristics to
other implementation outcomes, such as facilitator and
coach competent adherence to the program, using regres-
sion and structural equation models. We will conduct
analyses to examine family behaviors and wellbeing before
and after participation in the program to address Research
Question 3 (impact of PLH at scale on family-level out-
comes), using regression-based models. We will also
examine variation in family outcomes based on baseline
family characteristics and program implementation. We
also plan to compare implementation and outcomes asso-
ciated with different combinations of services as PLH is
often delivered alongside other programs. For Research
Question 5 (costs and resources), we will summarize the
average program costs and their variation.
Techniques such as hierarchical linear modeling and
generalized estimating equations will be used to account
for the nesting of data—for example, families within
areas. Missing data will be addressed using methods
such as full information maximum likelihood or multiple
imputation [68], or other methods. Reporting will follow
STROBE standards [69] where appropriate. Since imple-
menting partners and PLH research teams may have
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used different measures to assess targeted outcomes,
where necessary and possible, data harmonization strat-
egies will be used for analyses involving data from mul-
tiple projects.
Where possible, the research team will support imple-
mentation teams to lead their own analyses and ensure
that data collected in a specific country remains stored
there, even if it is shared for additional analysis else-
where. It is also important to acknowledge that any ana-
lysis of routinely collected data, even in relatively high-
resource settings, poses challenges, such as with data
quality, social desirability, and selection biases [70–72].
In some countries, the study team is providing support
to agencies to strengthen data collection and manage-
ment systems, and a monitoring and evaluation manual
is in process of development to support best practices in
data collection.
Qualitative and mixed-method analyses
Thematic analysis [73] will be applied to qualitative
data from interviews and focus group discussions to
identify patterns within and between case study sites
on the dissemination, implementation, and sustain-
ment of PLH programs. Document analysis will be
two-phased, combining content and thematic analyses
[74]. Relevant information on will be extracted and
organized through content analysis guided by the
study research questions. The information will then
be analyzed thematically. Across our analyses, we will
examine how findings vary along key dimensions such
as scale of delivery and characteristics of implement-
ing organizations [27,45,75].
Reporting will follow the COREQ standards [76]. Sum-
maries of findings will be shared with the research team,
participants, and implementing partners for member
checking [77]. To support collaboration between re-
searchers, implementers, and other stakeholders [78], we
are setting up systems of advisory committees.
Where possible, we will combine multiple data sources
to answer research questions. For instance, to help an-
swer Research Question 2 (implementation and adapta-
tion of PLH programs), analysis will draw on the
qualitative interviews with facilitators and coaches, and
quantitative data on facilitator adherence. We will use
the FRAME framework to examine program adaptations
[79]. Analyses will include (1) timing and method of
adaptation; (2) whether the adaptation was planned or
ad hoc; the decision making process for making adapta-
tions; (3) the level and extent of adaptation; (4) whether
the adaptation targeted program content, delivery, struc-
ture or context of implementation; and (5) how adapta-
tion may have impacted fidelity to core components and
program effectiveness.
Discussion
This project will examine nested information about the com-
munity, implementing organizations, types of programs im-
plemented, implementation staff, and the caregivers and
children who participate in the PLH programs. The use of
multiple data sources and methods is designed to support
learning as violence prevention programs are tested, dis-
seminated, and scaled-up. No previous study that we are
aware of has collected and examined dissemination and
scale-up of a parenting program across multiple LMIC
contexts. While this study addresses two specific parent-
ing programs, we anticipate that our findings will be of
relevance across the field of parenting, as well as many
types of social programming, including those focused on
education and violence prevention.
Supplementary information
Supplementary information accompanies this paper at https://doi.org/10.
1186/s43058-020-00086-6.
Additional file 1: TIDieR checklist.
Abbreviations
PLH: Parenting for Lifelong Health; LMIC: Low- and middle-income countries;
EPIS: Exploration, Preparation, Implementation and Sustainment (framework);
WHO: World Health Organization
Acknowledgements
The PLH SUPER study would not be possible without the support of
wonderful colleagues at numerous organizations, including (to date):
Academic Model Providing Access to Healthcare (AMPATH) Kenya; Agency
for Research and Development Initiative, South Sudan; Botswana Stepping
Stones International; Catholic Relief Services and 4Children DRC and Haiti;
Catholic Relief Services Headquarters, USA; Catholic Relief Services South
Sudan, Zimbabwe, Côte d’Ivoire, Cameroon, and Lesotho; Emmanuel
Hospital Association, India; FHI 360 Ethiopia; Health for Youth Association,
Moldova; Institute for Marriage, Family and Systemic Practice (ALTERNATIVA),
North Macedonia; Institute for Security Studies Africa; Justice and Violence
Prevention Programme, South Africa; Manenberg People’s Centre, South
Africa; Project Hope, South Africa; Ikamva Labantu, South Africa; Pact
Eswatini, Tanzania, South Sudan, and Zambia; Lilongwe Catholic Health
Commission (LCHC), Malawi; Schola Empirica, Czech Republic; South Sudan’s
Ministry of Health; Tanzanian Ministry of Health, Community Development,
Gender, Elderly and Children; The Seven Passes Initiative, South Africa;
UNICEF HQ; UNICEF Montenegro; World Health Organization. This is a list of
our partners in the SUPER study at the time of publishing this paper: more
will be added as the study progresses.
We also thank colleagues at the Ateneo de Manila University and the
University of the Philippines, Philippines; Babes-Bolyai University, Romania;
Georgia State University, USA; St. Cyril and Methodius University Skopje,
North Macedonia; Stellenbosch University and University of Cape Town,
South Africa; Universitat Klagenfurt, Austria; University of Bremen, Germany;
Queens University Belfast, Bangor University, University of Glasgow, and Uni-
versity of Oxford, UK. We thank all the staff at the Children’s Early Interven-
tion Trust and Clowns Without Borders South Africa, in addition to those
who are authors. Thank you also to Professor Ana Baumann, Professor
George Howe, Professor J. Lawrence Aber, Dr. Thees Spreckelsen, Dr. Lesley
Gittings, and Professor Aaron Reeves for advice on study design.
Authors’contributions
LC, JML, and CW led the development of the original study idea. All authors
participated in the conceptual design of the study and/or the program
implementation. YS led the conceptualization and drafting of the
manuscript. CW, LC, JML, IW, FG, IW, LLN, MT, HS, and KO wrote the sections
and revised the manuscript. The authors read and approved the manuscript.
Shenderovich et al. Implementation Science Communications (2020) 1:109 Page 8 of 11
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Funding
The PLH SUPER study has received funding from the European Research
Council (ERC) under the European Union’s Horizon 2020 research and
innovation program (Grant agreement No. 737476 and No. 771468), Research
England, the UK Research and Innovation (UKRI) Global Challenges Research
Fund (GCRF) through the UKRI GCRF Accelerating Achievement for Africa’s
Adolescents Hub (Grant Ref: ES/S008101/1), the Complexity in Health
Improvement Program of the Medical Research Council (MRC) UK (Grant No.
MC_UU 12017/14), the National Research Foundation of South Africa (Grant
No. 118571), and the Oak Foundation.
Availability of data and materials
Key study materials are available on the project Open Science Framework
page: https://osf.io/v597r/
Ethics approval and consent to participate
Ethics committee approval for the SUPER project was granted by the
Department of Social Policy and Intervention at the University of Oxford
(SPICUREC1a_20_015) and University of Cape Town (PSY2017-040). Country-
specific ethics approvals were obtained by the implementation partners in
the Democratic Republic of Congo, Montenegro, Haiti, South Sudan,
Tanzania, Eswatini and by research partners in the Czech Republic, India,
Kenya, North Macedonia, Moldova, Romania, Philippines, and Thailand.
Consent for publication
Not applicable.
Competing interests
Cluver, Ward, Lachman, Hutchings, and Gardner were involved in the
development of the PLH programs. Shenderovich, Lachman, and Wessels
worked on the PLH trials in South Africa and based their doctoral work
on these. The work of Cluver, Shenderovich, Wessels, Ward, Lachman,
Okop, Sacolo-Gwebu, and Gardner is partly funded by the UKRI GCRF
Accelerating Achievement for Africa’sAdolescentsHub.Theworkof
Lachman has been supported by a GCRF Centre Hub Grant. The work of
Cluver, Shenderovich, Wessels, Ward, Lachman, Gardner, Hutchings, and
Janowski has been partly funded by grants under the European Research
Council’s Horizon 2020 program. The work of Lachman, Ward, and Gard-
ner has also been partly funded by UNICEF Thailand, the work of Hutch-
ings and Lachman by UNICEF Montenegro, and the work of Hutchings,
Lachman, Ward, and Gardner by UNICEF Philippines. Further, Lachman is
the former Executive Director of Clowns Without Borders South Africa
and receives income as a PLH Trainer. Ngcobo is Co-Director of Clowns
Without Borders South Africa. Ward reports grants from the National Re-
search Foundation of South Africa and the World Childhood Foundation.
Janowski reports a scholarship from the University of Cape Town. Hutch-
ings receives occasional income as a PLH Trainer.
Author details
1
Department of Social Policy and Intervention, University of Oxford, Oxford,
UK.
2
Department of Psychology, University of Cape Town, Cape Town, South
Africa.
3
MRC/CSO Social and Public Health Sciences Unit, University of
Glasgow, Glasgow, Scotland.
4
Catholic Relief Services, Baltimore, USA.
5
Clowns Without Borders South Africa, Cape Town, South Africa.
6
Institute for
Life Course Health Research, Department of Global Health, Stellenbosch
University, Stellenbosch, South Africa.
7
School of Nursing and Midwifery,
Queens University, Belfast, UK.
8
School of Psychology, Bangor University,
Bangor, Wales.
9
Department of Psychiatry and Mental Health, University of
Cape Town, Cape Town, South Africa.
Received: 22 September 2020 Accepted: 12 October 2020
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