Implementation Study With Embedded RCT of a Digital System of Parenting Support Within Government Services in South Africa

ParentText, a WhatsApp‐based parenting support programme, is designed as a universalintervention to improve parent‐child relationships (module 1) and promote child safety(module 2). The SWIFT study is an explanatory sequential time series design with anembedded randomised controlled trial. The time‐series design aims to assess whether adigital parenting support programme, ParentText, can be embedded effectively into theregular services offered by the Department of Health and Wellness in the Western Cape,South Africa, and to explore factors affecting parent engagement. The embedded randomisedcontrolled trial tests whether the second module affects sexual violence reductionagainst children. Participants include caregivers 18 years and older, living in SouthAfrica, and caring for at least one child aged 2 to 17 years.The primary outcome measures of the study are both implementation 1): Assessing which offour approaches to advertising the ParentText programme leads to the highest rates ofprogramme uptake, engagement, and completion; and programmatic: Testing the effectivenessof the additional Child Safety Module in 2) ‐ reducing child sexual violencevulnerability, 3) ‐ increasing child sexual violence risk planning and 4) ‐ reducingchild sexual violence exposure.The secondary outcomes assess changes in programme users' self‐reported parentingbehaviour in terms of 1) positive involvement, 2) positive parenting, 3) parent mentalhealth, 4) parent support of education, 5) caregiver child/ adolescent communication, 6)online safety, 7) harsh parenting, 8) child or adolescent behavioural problems; andassessing users' experience of the 9) accessibility of the chatbot, 10) acceptability ofthe chatbot; and 11) adolescents' report of their sexual violence risk and safetyplanning communication..In the first period of the time series design, participants will be recruited viaposters, which provide a WhatsApp number for the programme, at their local clinic. Oncethey join, they will be provided with information on the study and be invited to consentto participate. If they consent, they will complete a baseline survey and then be able tomove on to the first 5‐day module. On consent to the study, participants will be placedrandomly into either the group that receives the second module (intervention group) or acontrol group that will receive the module only after the study is completed. Both theintervention group and the control group receive the one‐month and three‐month surveys.In the second, third, and fourth time periods, everything remains the same except theencouragement method. In the first time period, only posters were used for recruitment.Within the second period, one month later, recruitment will be via both posters andadditional encouragement from clinic staff. Clinic staff will encourage either verballyor by providing the caregiver with a flyer during their clinic visit. Throughout boththese recruitment periods (1) and (2), caregivers who have completed the programme canshare it on social media by posting predesigned tiles that include the joininginformation for the chatbot. Should our ideal sample size (4,000 participants) not bereached through these mechanisms, there will be an additional time period (3‐4 weeks;time period three) during which the study team will advertise directly on Facebook.Finally, should our sample size not be reached in this third period, there will be afourth time period of advertising that offers ZAR50 (approximately USD3) in airtime tothose who sign up. This ZAR50 will be provided in sums of: ZAR15 for completing each ofthe baseline and one‐month questionnaires, and ZAR20 for completing the three‐monthquestionnaire.Once the three‐month questionnaires are completed, participants will also be invited to afocus group discussion or telephonic interviews. Participants will be purposivelyselected from the group of participants who consent to the qualitative data collectionphase.The focus groups will be conducted with participants residing in the Western Capeprovince, who completed one or both modules, and will discuss topics such as theirexperience of the ParentText programme, and the encouragement.For the telephonic interviews, participants will be purposely selected for interviews,looking at a) caregivers' experience of the child safety module, b) reasons forengaging/not engaging with the programme, and c) which referral services they accessed.Further, adolescents (over the age of 12 years) will be recruited via their caregivers ‐upon completion of the 3‐month survey, parents or legal guardians will be asked toprovide consent for the team to contact their adolescent to undertake a telephonic surveyand, in some cases, a qualitative interview with them. Teens will complete informedassent.