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.

Abstract

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. 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). 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. The results demonstrate that the Hope Groups intervention improves caregiver mental health, strengthens parenting practices, and reduces violence against children amidst war and displacement. 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.