A self-directed parenting program to reduce the risk of child maltreatment in rural China: A cluster randomized...

Child maltreatment is highly prevalent in rural areas, yet evidence-based parenting programs remain largely inaccessible because of caregivers' inflexible work schedules and the shortage of trained facilitators. To enhance its scalability and cost-effectiveness, we adapted the Chinese version of Parenting for Lifelong Health for Young Children (PLH-YC) program into a self-directed online format with two group discussions and evaluated its impact in rural China.

Twelve classes (191 caregivers) in one rural kindergarten were cluster-randomized 1:1 to either a self-directed online PLH-YC program (100 caregivers) or a book-reading control (91 caregivers). Assessments were conducted at baseline, two weeks post-intervention, and three-month follow-up. Analyses adhered to the intention-to-treat principle, using zero-inflated negative binomial regression for count outcomes (e.g., child maltreatment) and linear mixed-effects regression for continuous outcomes (e.g., positive parenting practices).

Two weeks post-intervention, caregivers in the self-directed group reported a 33% reduction in overall child maltreatment (IRR = 0.67, p < 0.001), a moderate increase in positive parenting (d = 0.53, p < 0.001), a small-to-moderate changes in parent-child relationship quality (d = 0.32, p < 0.001) and parenting stress (d = -0.31, p < 0.001) relative to controls. At the three-month follow-up, reductions in child behavior problems became significant (d = -0.40, p < 0.001). Parenting efficacy and parental depressive symptoms did not differ between groups at both time points.

The self-directed online PLH-YC program, combined with group discussions, provided an effective, low-cost, and scalable option for disadvantaged rural caregivers in China.