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Ladnaan : evaluation of a culturally tailored parenting support program to Somali-born parents
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.ORCID iD: 0000-0002-0038-9402
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Research shows that immigrant families encounter different complexities and challenges in a new host country, such as acculturation, isolation and lack of social support. These challenges have been shown to have negative impacts on immigrant families’ mental and emotional health, family function, parenting practices and parents’ sense of competence. Parental support programmes have been shown to positively affect parental skills, strengthen the parent-child relationship, and promote the mental health of parents and children. However, universal parenting support programmes face challenges in reaching and retaining immigrant parents. In addition, there is limited knowledge on the effectiveness of parenting support programmes among immigrant Somali-born parents and their children.

Aim: The overall aim of this thesis was to develop and evaluate the effectiveness of a culturally tailored parenting support programme (Ladnaan intervention) on the mental health of Somali-born parents and their children. A further aim was to explore the parents’ experience of such a support programme on their parenting practises.

Methods: The thesis involved two explorative qualitative studies and one randomised controlled trial (RCT). Study I employed qualitative focus group discussions (FGDs) to explore Somali-born parents’ need for parenting support. Study II involved an RCT study in which 120 parents with children aged 11–16 years, and parents with self-perceived stress relating to their parenting were randomised to an intervention group or a wait-list control group. The Ladnaan intervention consisted of three components: societal information (two sessions), the Connect parenting programme (10 sessions), and a cultural sensitivity component. The Ladnaan intervention was delivered in the participants’ native language by group leaders of similar background and experience, and modifying the examples and role plays in the Connect programme. The primary outcome was a reduction in children’s emotional and behavioural problems as measured by the Child Behaviour Checklist 8-16. The secondary outcomes were improved mental health among parents, as assessed by the General Health Questionnaire (GHQ12); and greater sense ofparenting competence, as measured by the Parent Sense of Competence (PSOC) scale. Study III comprises a qualitative study using individual semi-structured interviews (conducted two months after the Ladnaan intervention) to explore parents’ experiences of participating in a culturally tailored parenting support programme.

Results: The results in study I, shows that Somali-born parents encountered challenges in the host country, which impacted their confidence in parenting and the parent-child relationship. These challenges included insufficient knowledge of the parenting system and social obligations as a parent in the new host country. Other parental challenges in the host country included a stressful society, isolation, role changes, and parent-child power conflict. The Somali parents experienced opportunities to rethink and modify their parenting and strengthen their relationship with their children in the new country, but needed support from the local authority and others in these endeavours. In study II, the Ladnaan intervention showed that, according to the parents’ self-reports, children in the intervention group showed significantly decreased aggressive behaviour, social problems, attention problems, externalising ofbehavioural problems, and in total problems at the two-month follow-up. Moreover, parents in the intervention group showed significantly and clinically improved mental health and sense of competence in parenting at the two-month follow-up. The improved mental health of the parents could, in part, be explained by their satisfaction in parenting. In study III, parents who participated in the culturally tailored intervention programme reported that it enhanced their confidence in parenting and contributed to their ability to become emotionally aware and available for their children. The parents attributed this to the combination of societal information, the Connect programme, and the cultural sensitivity ofthe Ladnaan intervention, which were most supportive for their parenting. The culturally sensitive approach ofthe parenting programme (i.e., conducted in their native language by bicultural and bilingual group leaders) was viewed by the parents as valuable for their participation in the programme, as well as for modifying their parenting practices.

Conclusion: The culturally tailored parenting support programme helped parents overcome transition challenges related to social obligation as parents in the host country, and to modify their parenting orientation and styles in the new country. Furthermore, it improved the parents’ mental health and sense of competence in parenting, as well as reduced their children’s behavioural problems. When tailoring and delivering a parenting support programme to immigrant parents it is crucial to consider their specific needs and preferences and to ensure that the programme is culturally sensitive. Such an approach is more likely to contribute to participants’ engagement, retention, and acceptance of the parenting programme; and also improve their parenting practices and strengthen parent-child relationship, leading to improvements in children’s behaviour and parents’ mental health.

Place, publisher, year, edition, pages
Karolinska institutet , 2017. , p. 86
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-26841ISBN: 978-91-7676-881-5 (print)OAI: oai:DiVA.org:du-26841DiVA, id: diva2:1167648
Public defence
2017-12-08, Skandia salen (Q2:1), Astrid Lindgrens barnsjukhus, 10:29 (English)
Supervisors
Available from: 2017-12-20 Created: 2017-12-19 Last updated: 2017-12-20Bibliographically approved
List of papers
1. Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes
Open this publication in new window or tab >>Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes
2016 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 16, no 1, article id 82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting.

METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied.

RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities.

CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Keyword
immigrant, mental health, migration, parenting, parenthood in transition, qualitative method, Somali parents
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21064 (URN)10.1186/s12914-016-0082-2 (DOI)000370315600001 ()26883321 (PubMedID)
Available from: 2016-02-18 Created: 2016-02-18 Last updated: 2017-12-19Bibliographically approved
2. A support program for Somali-born parents on children's behavioral problems
Open this publication in new window or tab >>A support program for Somali-born parents on children's behavioral problems
2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 3Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives of this study were to evaluate a culturally tailored parenting support program (Ladnaan) for Somali-born parents and to determine its effectiveness on children’s emotional and behavioral problems.

METHODS: This randomized controlled trial included 120 Somali-born parents with children aged 11 to 16 years. The parents reported self-perceived stress in relation to parenting practices. The intervention consisted of culturally tailored societal information combined with the parenting program Connect. Parents received 12 weeks of intervention, 1 to 2 hours each week, in groups of 12 to 17 parents. Nine group leaders with a Somali background who received a standardized training program delivered the intervention. The primary outcome was a decrease in emotional and behavioral problems based on a Child Behavior Checklist. Parents were randomly allocated either to an intervention group or a wait-list control group. Covariance analyses were conducted according to intention-to-treat principles.

RESULTS: The results showed significant improvement in the children in the intervention group for behavioral problems after a 2-month follow-up. The largest effect sizes according to Cohen’s d were in aggressive behavior (95% confidence interval [CI], 1.06 to 3.07), social problems (95% CI, 0.64 to 1.70), and externalizing problems (95% CI, 0.96 to 3.53).

CONCLUSIONS: The large effect sizes in this study show that this 12-week culturally tailored parenting support program was associated with short-term improvements in children’s behavior. The study adds to the field of parenting interventions by demonstrating how to culturally tailor, engage, and retain parenting programs for immigrant parents.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23732 (URN)10.1542/peds.2016-2764 (DOI)28235795 (PubMedID)
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2017-12-19Bibliographically approved
3. Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes
Open this publication in new window or tab >>Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes
2016 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 16, no 1, article id 82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting.

METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied.

RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities.

CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Keyword
immigrant, mental health, migration, parenting, parenthood in transition, qualitative method, Somali parents
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21064 (URN)10.1186/s12914-016-0082-2 (DOI)000370315600001 ()26883321 (PubMedID)
Available from: 2016-02-18 Created: 2016-02-18 Last updated: 2017-12-19Bibliographically approved

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