Effectiveness of a universal film intervention in reducing violence against children and increasing positive parenting among migrant and displaced caregivers from Myanmar: a community-based cluster randomised trial.

Background: Parenting interventions have been shown to reduce violence against children and promote positive parenting, but evidence on interventions to achieve population-level reach and impact is limited in low-resource settings. We assessed the impact of a universal film intervention for migrant and displaced caregivers from Myanmar living in Thailand. Methods: We implemented a two-arm, cluster randomised trial in Tak province, Thailand, on the border with Myanmar. 44 communities were stratified by district and randomly allocated to intervention or control (1:1) using a computer-generated list of random numbers. Intervention group participants received a screening of a 66-min narrative drama film about parenting, followed by a 30-40-min discussion and a 5-min video and poster summarising key messages. Control group participants received information about local health and social services. Eligible participants were primary caregivers aged 18 years or older with a child aged 4-17 years at enrolment. Participants were surveyed at baseline, endline approximately 4 weeks post-intervention, and follow-up approximately 4 months post-intervention. Primary outcomes were caregiver self-reported use of physical and psychological violence and positive parenting, analysed using both imputed and non-imputed multilevel models estimating differences between study arms at endline and follow-up. Due to the nature of the intervention, participants and assessors were not masked. The trial was prospectively registered with Thai Clinical Trials Registry TCTR20230222005. Findings: Between February and June 2023, 2249 participants in 44 communities completed baseline assessments and were randomly assigned to intervention (n = 1116) and control (n = 1133). 2023 caregivers (n = 998 in intervention and n = 1025 in control) completed the four-week endline survey and 1909 caregivers (n = 961 in intervention and n = 948 in control) completed the four-month follow-up. Intention to treat analyses showed the intervention reduced physical violence (IRR 0.91, 95% CI 0.85-0.97) and increased positive parenting (β 0.46, 95% CI -0.03 to 0.95). No meaningful differences were observed for psychological violence between intervention and control groups, with imprecisely estimated effects close to zero (β 0.47, 95% CI -0.62 to 1.57). Small effects were observed for the secondary and exploratory outcomes of parenting knowledge, belief in the need for harsh punishment, engagement in early learning, family functioning, and social support. Subgroup analyses suggest that the intervention may be more effective at reducing physical violence among female caregivers and caregivers of female children and younger children. There were no reported adverse effects. Interpretation: Universal parenting interventions using a film-based entertainment-education approach can effectively reduce physical violence against children and increase positive parenting, with potential for scalability in low-resource settings. Funding: This study is part of the Global Parenting Initiative, which is funded by The LEGO Foundation, Oak Foundation, the World Childhood Foundation, The Human Safety Net, and the UK Research and Innovation Global Challenges Research Fund ((ES/S008101/1).