Violence against children is a serious global public health problem affecting one in two children, an estimated one billion children annually. Most perpetrators of physical and psychological violence for children of both genders of all ages are parents and caregivers. Well-documented negative effects of violence within childhood and adolescence have resulted in a huge impact on future health and social problems, including mental health disorders, substance abuse, suicidal tendencies, risky sexual behavior, obesity, and a higher possibility of becoming either the perpetrator or the victim of future violence. Although violence against children is an issue that pervades the globe, it tends to be higher in countries of poverty, experiencing armed conflict, or being displaced.
The studies done in different contexts of conflict and displacement reveal that parents and caregivers are more likely to engage in harsh parenting methods, including physical and psychological violence, due to increased exposure to trauma, the breakdown of social support systems, and the effects on the mental health of caregivers.
The study’s authors conducted a two-arm, single-blind cluster-randomized trial with parallel assignment adjudged by the quality of trial across 44 communities in Tak province, Thailand from February 2023 to January 2024. The province’s western border with Myanmar is a region that has experienced decades of armed conflict, and it is considered to be both politically and economically stable. The estimates of migrants and displaced people from Myanmar in Thailand are reported to vary between 2 to 3 million, although the movement of people across the border has intensified since the February 2021 military coup in Myanmar. It was a collaborative study with four community-based organizations that have been working with education and child protection programs for the migrant and displaced communities in Tak province: Mae Tao Clinic, Help without Frontiers Thailand Foundation, Inclusive Education Foundation, and Sermpanya Foundation.
Eligible participants included parents or caregivers aged 18 years or older, who were caring for a child aged 4-17 years residing with them, who was born in Myanmar and now spent most of their time in Thailand. Individuals with severe cognitive, neurological, or developmental impairments were assessed by the local research team and excluded from the study if these conditions prevented them from providing informed consent. The written informed consent was secured from all participants at the time of the baseline data collection before randomization. The study received approval from the Institutional Review Board of the Institute for Population and Social Research (IPSR) at Mahidol University in Thailand.
Between February and June 2021, 2249 participants from 44 communities assessed their conditions initially before they were assigned by random assignment to intervention or control groups (n = 1116 and n = 1133). 2023 caregivers (n = 998 in intervention and n = 1025 in control) completed the 4-week survey and the 1909 caregivers that responded to the four-month follow-up, there were 961 in the intervention and 948 in the control group.
Reductions in physical violence were found with intention-to-treat analyses for both IRR (0.91, 95% CI 0.85-0.97) and increases in positive parenting at β 0.46, 95% CI -0.03 to 0.95. Neither towards targets nor controls were any meaningful observed differences as effects were close to zero but imprecisely estimated (β 0.47, 95% CI -0.62 to 1.57). Some minor effects were found from secondary and exploratory outcomes of parenting knowledge, belief in the use of harsh punishment, opportunities for participation in early learning, familial well-functioning, and social support. Analyses of subgroup characteristics indicate that the intervention should have some stronger effects on the degree of physical violence by female caregivers and female children and younger children. No adverse effects were noted.
The limitations of the study mainly entailed dependence on caregiver self-reporting for all outcome measures. Most times, in low-resource and conflict settings, there tends to be greater reliance on caregiver self-report measures of parenting as child welfare administrative data are scarce. Children’s reports were not obtained because 40.5% of enrolled children were younger than nine years and of local ethical and safety considerations regarding commissioning children to report violence from their caregivers.
Results from this study, showing a 9% risk reduction for physical violence against children, suggest that entertainment-education interventions may be used for large-scale violence prevention at the population level. The unique advantages of an entertainment-education approach include reaching large audiences with standardized content at low ongoing delivery costs and hence can enhance parenting and family outcomes in other populations and implementation contexts, where structural and contextual barriers limit delivery on large scales.
This study covered investigations into the integration of mass media parenting interventions into public health systems, in a way that other models could be replicated and expanded in adapted contexts to reach populations served through other means.
Reference: Sima A, Lwin KZ, Eagling-Peche S, et al. Effectiveness of a universal film intervention in reducing violence against children and increasing positive parenting among migrant and displaced caregivers from Myanmar: a community-based cluster randomised trial. Lancet Reg Health Southeast Asia. 2025;0(0):100526. doi:10.1016/j.lansea.2024.100526
