The development and testing of a multi-ethnic, low literacy, family support programme for the primary prevention of child abuse and neglect in the child under five years.

Abstract

The main aim of this research was to identify a family support programme which could be used as a primary prevention strategy against child abuse as a first positive step within the family, the basic unit of society, towards reducing community violence. The central focus of this intervention was that it should be appropriate for use in a multi-ethnic South African context and implementable by community health nurses or related lay health personnel with minimal training. No such programme was identified. The researcher attempted to integrate the most appropriate and scientifically substantiated features of existing programmes and develop a unique South African programme. This programme was developed and tested in a participatory manner with multiethnic communities. Community health nurse facilitators were trained and evaluated and the developed programme was then implemented by these facilitators in several sites. The influences of the developed programme were extensively evaluated. Changes in attitudes, feelings and behaviour of the child, the mother, the maternal-child interaction and the family system were explored. A quasi-experimental design with pre and post testing of the experimental group and two control groups (control 1 received social support and control 2 receiving routine clinic nursing only) was utilized. Completed analysis has yielded some exciting and provocative results. There are clear differences in each of the groups attitudes to their children. On the Mother-Child Relationship Evaluation (MCRE) positive gains in maternal-child relationship were established for the experimental group and this was greater than that of both controls (t-test = 4.151 @ alpha = 0.0013; H=4.0734 @ alpha = 0.04 and F=7.031 @ alpha = 0.0004). On the Family Assessment Device (FAD) some limited changes were observed in the experimental group over the controls (F= 3 .33 @ alpha = 0.05). This is a positive outcome indicating that the family support programme evidenced significant changes in the participants relationships with their children and in their families and wider social life. Mothers and facilitators qualitative feedback reported positive interaction with young and older children and changed maternal and child attitude and behaviour. Despite the critical shortage of staff in community health settings facilitators continue to implement the programme voluntarily in their service settings.