Transporting western-derived evidence-based parenting intervention for reducing child disruptive behaviour to Vietnam

Abstract

Brief behaviour parent training (BBPT) intervention, which aims at improving parenting practices (PPs), is a practical solution for areas with limited resources for treating child disruptive behaviour (DB). However, available research has been conducted in western and high-income countries. This thesis investigates the effects of a western-derived parenting intervention in Vietnam, a low-middle-income country in Asia, through exploring the nature of PPs to develop a BBPT program and evaluating the effects of the program to families of preschool children with persistent DBs. Study 1 included 365 parents (95% females) of 3 to 6 year-old children with persistent DBs via an online questionnaire. Generally, most parents often employed positive PPs rather than inconsistent and harsh strategies. However, 80% of parents still used the latter at certain times. Risk factors for harsh discipline were parents' unemployment, age under 30, and education level under grade 12; two-child families; rural residence; and male gender of the target child. Two-child families were the only risk factor for inconsistent PPs. Higher levels of harsh, inconsistent parenting and more coercive interactions were strongly associated with more child DB. Higher levels of involved parenting and better parenting self-efficacy (PSE) predicted lower child DBs. Surprisingly, there was no significant correlation found between child DB and the techniques of "reward", "praise," "planned ignoring," and "sending the child to a room". Higher levels of positive PPs, such as "time-out" and "taking privileges away," were associated with more DB in children. These results suggest that cultural factors may influence parenting strategies' implementation and contribute to deviations in their effectiveness. Study 2, a randomised controlled trial, compared the effects of a therapist-assisted online BBPTViet program with a short consultation, the current treatment, for reducing DB in preschool children in 109 families. Two months after the interventions, child DB intensity, parent-child coercive interactions, and marital conflicts in parenting in the BBPTViet group improved better than those in the short consultation. Six months after the interventions, child DB intensity and problems, harsh PPs, and coercive interactions in the BBPTViet declined more significantly than those in the short consultation. There was no significant difference in the improvement of PSE and parents' mental health conditions between the two treatment across the trial. Most participants agreed that the parenting strategies taught in the program were beneficial and expressed their willingness to implement them in the future. However, some participants had concerns about the efficacy and acceptance of specific techniques, which indicated that they were less inclined to use them regularly in the future. Study 3 compared the clinic-based BBPTViet program with the short consultation. Due to the impact of the Covid-19 pandemic, there was only 21 participants, and the attrition rates were 38%, 47.6%, and 71.4% one, two, and six months after the interventions, respectively. The study found no meaningful difference in all outcome variables between the two intervention two months after the interventions. The Parent-Child Interaction Observation System, which was first used, revealed that the parents utilised "commanding" and "giving statements" more often than "praising" and "providing tangible rewards", further confirming the cultural characteristic in the child-rearing of Vietnamese parents. This project identifies the cultural factors that influence PPs and demonstrates the effectiveness of a therapist-assisted online BBPT program in decreasing child DB in Vietnam. The results emphasise the importance of incorporating cultural nuances when creating parent training programs and demonstrate the potential for success in adapting evidence-based interventions from Western to Eastern cultures. Show more