中国農村部における児童虐待リスク低減のための自己主導型子育てプログラム：クラスターランダム化比較試験

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.