Effectiveness of the hope groups intervention on mental health, parenting practices, and violence against children among Ukrainian parents and caregivers affected by war and displacement: a cluster randomised controlled trial.

Background: Almost two-thirds of the world's children live in conflict-affected countries, including Ukraine, where two-thirds of children were displaced after Russia's 2022 invasion. To address the urgent need for effective approaches to support parents and protect children in war, we designed Hope Groups-a group-based mental health, parenting, and violence prevention intervention-and used a cluster randomised controlled trial (cRCT) to evaluate its effectiveness. Methods: We conducted a two-arm, parallel cRCT comprising K = 90 clusters and N = 510 parents/caregivers, who were internally displaced, externally displaced, or at home in war-affected Ukraine. Primary outcomes, assessed at baseline and after completing the 12-session intervention (endline), included caregiver mental health, parenting practices, and violence against children. Clusters were randomly assigned to immediate Hope Groups intervention (K = 45; N = 255) or waitlist control (K = 45; N = 255). Interim analyses were conducted after the first 20 clusters reached trial endline. The trial was prospectively registered with Open Science Framework (https://osf.io/uvj67) and subsequently registered on ClinicalTrials.gov to align with ICMJE guidance (NCT07470333). Findings: After completion of the 12-session intervention, the Hope Groups intervention demonstrated medium-to-large effects across all measured primary outcomes compared with the control arm. Caregivers in the intervention arm reported 57.4% lower levels of parental depression and anxiety (β = -2.85; 95% CI = -3.49, -2.22; d = -0.86); 52.7% lower levels of violence against children (β = -0.5; 95% CI = -0.64, -0.36; d = -0.43); 33% higher parenting practices (β = 1.32, 95% CI = 0.92, 1.71, d = 0.57), compared to the control arm. Response rate was high: 98.6%. There were no adverse events or harms. Interpretation: The results demonstrate that the Hope Groups intervention improves caregiver mental health, strengthens parenting practices, and reduces violence against children amidst war and displacement. Funding: This study is supported by the Global Parenting Initiative (funded by the LEGO Foundation and Oak Foundation), the Moderna Foundation, and private donations to World Without Orphans.