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Parenting and physical punishment: primary care interventions in Latin America
C López Stewart1, M G Lara, L D Amighetti
1República de Chile, Ministerio de Salud, Unidad de Salud Mental, Santiago, Chile.
Insights
Primary health care providers can help parents learn alternatives to physical punishment. Training and resources are needed to support providers in discussing discipline and reducing intrafamilial violence.
Area of Science:
- Public Health
- Child Development
- Family Violence
Background:
- Physical punishment is a prevalent form of intrafamilial violence with negative mental health consequences.
- Early childhood is a critical period when discipline practices are established.
- Existing parenting information sources often exclude primary health care providers.
Purpose of the Study:
- To assess the feasibility of engaging public sector primary health care providers in educating parents on alternatives to physical punishment.
- To explore parental and provider perspectives on discipline and health care interactions.
Main Methods:
- Qualitative study employing focus groups and survey questionnaires.
- Involved parents and health care providers across six public sector clinic sites in Costa Rica and Santiago, Chile.
- Data collection occurred between 1998 and 1999.
Main Results:
- Parents acknowledged physical punishment's common use but preferred other discipline methods.
- Parental belief in effectiveness and satisfaction with child behavior influenced punishment frequency.
- Parents sought parenting advice from family more than health care providers, citing time and knowledge constraints.
- Providers felt ill-equipped but expressed interest in training; both groups identified systemic barriers to discussing discipline in clinics.
Conclusions:
- A primary care-based program on physical punishment alternatives is welcomed by parents and providers.
- Program customization is essential to address local variations in attitudes and clinic settings.
- Enhanced training for health care professionals in child discipline and parent interaction skills is crucial.
Abstract:
Physical punishment is a form of intrafamilial violence associated with short- and long-term adverse mental health outcomes. Despite these possible consequences, it is among the most common forms of violent interpersonal behavior. For many children it begins within the first year of life. The goal of this study was to determine the feasibility of involving public sector primary health care providers to inform parents about alternatives to physical punishment. The study used a qualitative design utilizing focus groups and survey questionnaires with parents and providers at six clinic sites chosen to be representative of public sector practice settings in Costa Rica and in metropolitan Santiago, Chile. The data were collected during 1998 and 1999. In the focus groups and surveys the parents voiced a range of opinions about physical punishment. Most acknowledged its common use but listed it among their least preferred means of discipline. Frequency of its use correlated positively with the parents' belief in its effectiveness and inversely with their satisfaction with their children's behavior. Some parents wanted to learn more about discipline; others wanted help with life stresses they felt led them to use physical punishment. Parents reported they chose other family members more frequently as a source of parenting information than they did health care providers. Some parents saw providers as too rushed and not knowledgeable enough to give good advice. Providers, in turn, felt ill equipped to handle parents' questions, but many of the health professionals expressed interest in more training. Parents and providers agreed that problems of time, space, and resources were barriers to talking about child discipline in the clinics. Many parents and providers would welcome a primary-care-based program on physical punishment. Such a program would need to be customized to accommodate local differences in parent and provider attitudes and in clinic organization. Health care professionals need more training in child discipline and in the skills required to interact with parents on issues relating to child behavior.