Effectiveness of a parental training programme in enhancing the parent–child relationship and reducing harsh parenting practices and parental stress in preparing children for their transition to primary school: a randomised controlled trial

The three hypotheses were:

This study was carried out in one of the largest public housing estates in Hong Kong. A randomized controlled trial, two-group pre-test and repeated post-test, between-subjects design was employed. A simple complete randomization was adopted in this study. We put two sealed opaque envelopes in a box, with one labelled experimental and another labelled control. Each parent was asked to draw one envelop from the box to determine group assignment. Another sealed opaque envelop with the same group assignment being drawn was then put back in the box again before the next assignment. A single-blinded technique was used, in which the person who was responsible for data collecting, was unaware of the intervention allocation of the study participants.

Chinese parents living in Tung Chung with a child to be promoted from kindergarten to primary one education, and meeting the inclusion criteria for the study, were invited to participate in it. The criteria were the following: (1) parent must be able to read and write Chinese, and (2) parent must have had primary school education or above. Parents with identified cognitive and learning problems were excluded, as were children with such problems. A convenience sampling of 142 parents was recruited during the school summer holidays in 2009.

In the control group, parents had no intervention except that an information leaflet for parents on helping children to adapt to the new primary school life published by Education Bureau was given to each parent at the end of data collection. The content of the information leaflet include the following:

In the experimental group, parents participated in the parental training programme approximately 1 month before the start of the academic year in primary school. Two social workers, each with a minimum of 5 years’ experience in providing family counselling, implemented the interventions. The parental training programme was set up for small groups of 8 to 12 parents each and ran for 4 consecutive weeks. The programme consisted of four group sessions, each lasting about 2 hours. Overall, the parental intervention included teaching parents (1) to use more active listening skills, (2) to engage less in harsh parenting practices, (3) to use more praise and encouragement and (4) to set reasonable expectations in the rearing of their children. Each session began with a review of the skills or concepts discussed in the previous sessions, i.e., each session built upon the previous session. The following three approaches were used to facilitate the learning process:

The parental training programme, which aims to enhance the parent–child relationship and reduce parental stress at the time of transition, was developed by the research team. The intervention components were selected on the basis of the theoretical framework of parenting styles put forth by Baumrind [31]. Under this framework, harsh parenting is a child rearing style that communicates high levels of demandingness but low levels of responsiveness. It is characterised by the use of corporal punishment or verbal hostility to convey high expectations without any explanation [31, 32]. In fact, according to the results of a published study, active listening and praising are positively associated with responsiveness, whereas setting reasonable expectations is negatively correlated with demandingness [32]. Therefore, the research team decided to include these components in the intervention to reduce harsh parenting.

The development of the intervention was based on the HAPA model, according to which risk perception is a distal antecedent for raising the intention to change in the pre-intentional motivation process. In the initial motivation stage, a parent might have already developed an intention to help his/her child adapt the transition. Within this stage, risk awareness is seen as a distal antecedent (for example, ‘My child and I are at risk of family health problems or disturbances in the family harmony or family happiness if the transition does not go well’). Parents in the group were therefore invited to discuss any potential problems that the family or child might encounter during the transition. This helped the parents to become aware of the negative consequences of a maladaptive transition and subsequently develop an intention to help their children through the transition. Further elaboration of the parents’ thoughts about the consequences and positive outcome expectancies in smoothing the transition was then facilitated.

In applying the HAPA to the parenting programme, self-regulation was emphasised in the motivation process, whereby role playing, demonstration and re-demonstration were applied. Parents were invited to demonstrate a quarrel they might have with their child and the usual ways they would deal with it. Other parents in the group were invited to suggest some alternative ways for handling the quarrel and techniques the role-players could use to control their own emotions. These activities helped parents to structure an appropriate strategy to refrain from harsh parenting practices and maintain a positive attitude.

The programme was designed as a cognitive-dissonance-based intervention for use in group therapy to help parents build supportive relationships with their children and thus help the families smoothen the transition to primary 1 education. Parents were encouraged to enhance their knowledge and parenting skills through an inductive learning approach. Parent–child relationships could then be enhanced by changing the attending parents’ parenting practices. Several goals may be particularly important in preventing adjustment problems:

The protocol, which covers the schedule of activities and the session contents, is described in Table 1.

To ensure the integrity of the intervention, the same social workers were responsible for the parental training. These social workers were required to complete a 2-hour training workshop that was provided by the principal investigator. The workshop covered children’s psychological needs, information regarding positive and negative parenting, practical tips and counselling techniques. The social workers were also required to record the total time spent in each parental training session.

Concerning the quality of the intervention, an intervention component checklist was developed by the research team. Ten intervention sessions were randomly chosen to be videotaped. The tapes were then audited by the research team using the checklist. Comments and suggestions were given to the social workers in the regular weekly evaluation meetings.

Recruitment and data collection were conducted during the summer in 2009. Participants were recruited through referrals from the Hong Kong Sheung Kung Hui Welfare Council in Tung Chung. Prior to the study, ethical approval was obtained from the Institutional Review Board of the University of Hong Kong. The centre’s head of Sheng Kung Hui integrated services in Tung Chung was fully informed of the study’s purpose, nature, design and duration. Written consent was obtained from parents after they were told the purposes of the study and agreed to participate. Parents were told that they were under no obligation to participate, could withdraw from the study with impunity at any time and were assured of the confidentiality of the data to be collected.

After they had signed consent forms, a research assistant collected demographic and baseline data from parents. Data collection was divided into three phases: at the time of recruitment (pre-intervention), at six weeks and three months after the intervention. Parents were asked to respond to the Chinese version of the parental acceptance-rejection scale, parental stress scale, and self-report scale on parent–child relationship in respect of the transition from kindergarten to primary school.

The results of mixed between-within subjects ANOVA on harsh parenting practices and parent–child relationships indicated that there was a statistically significant main effect for time. That is, there was a change in parents’ harsh parenting practices and the parent–child relationships in both groups across the three different time periods. There was also a statistically significant interaction between time and the intervention, indicating that the changes in parents’ harsh parenting practices and the parent–child relationships over the different time periods differed between the experimental group and the control group. Greater change across different time periods was found in the experimental group than in the control group. In comparison to parents in the control group, parents in the experimental (intervention) group engaged in significantly less harsh parenting practices and reported better parent–child relationships. There are some factors that shed light on these findings. It has been well documented that Hong Kong Chinese parents are influenced by the social-cultural emphasis on obedience, social conformity and academic performance [39]. Consequently, many parents in Hong Kong engage in harsh parenting practices in rearing their children. Although some parents do realise the importance of positive parenting, many of them find it difficult to refrain from engaging in harsh parenting practices. One of the major objectives of the parental training programme was to increase parents’ awareness of risk and reinforce in their minds the consequences of harsh parenting. Role playing, demonstration and re-demonstration not only provided opportunities for parents to act out their roles in front of group members, but also helped them structure an appropriate strategy to refrain from engaging in harsh parenting practices and to maintain positive parenting. Most importantly, parents were able to refine the plan and their skills and enjoy more self-confidence in actualising the plan with their children. This may explain why parents in the experimental group engaged less harsh parenting practices in rearing their children.

Transition creates a time of vulnerability for the parent–child relationship. Previous reports have pointed out that parents who adopt harsh parenting practices and criticism in rearing their children trigger child–parent conflicts and thus hamper the relationship between themselves and their children [6, 7]. Therefore, we reasoned that if parents engage in less harsh parenting practices in rearing their children, the parent–child relationships would be enhanced.

The results of the mixed between-within subjects ANOVA indicated that there was a statistically significant main effect for time. This finding suggests that there was a reduction in the level of parental stress following the transition to primary 1 (6 weeks and 3 months after the intervention), regardless of the type of intervention given. This is understandable because the parents and their children had already gone through the transition, and some of the problems encountered during the transition had been overcome; thus, the parents’ stress might have decreased. Yet, there was a statistically significant interaction between the time and intervention, which was revealed by the fact that the changes in the levels of parental stress over time were dissimilar between the experimental group and the control group. Parents in the experimental group had lower levels of stress than parents in the control group. Nevertheless, the differences were not statistically significant. The effect size for the intervention was relatively small (0.03), and the result of the power analysis was only 0.40, indicating a high chance of a type II error (60%). Low statistical power resulted in a non-significant difference when, in fact, the intervention might have been effective. The results suggest that the relationship between the particular intervention and parental stress might have been affected by the small sample size. Therefore, it would be interesting to see whether further studies involving larger samples would uncover a significant relationship between the parental training programme and parental stress.

There may be several other reasons for this non-significant finding in terms of the effect of parental training programme on parental stress. One possible explanation lies in the difficulty of determining whether we can even expect parental stress to respond to the parental training programme; the programme did not involve teaching parents any stress management skills. The training programme had a more specific effect in helping parents refrain from harsh parenting practices and enhancing the parent–child relationship. Parental stress as an outcome measure might be less responsive to the intervention.

The baseline parental stress and harsh parenting scores were clinically elevated. One possible explanation is that the stress levels and behaviour of parents might have changed markedly before the transition. Although we did not obtain any information about parents’ stress levels and behaviour at an earlier time, we expected that these outcome measures would have returned to normal with removal of the stressor (i.e., with the children having already transitioned to primary school). However, this study was designed to examine the net differences in mean scores between the experimental and control groups. The complete randomisation should have been able to eliminate such a confounding effect because the extent of decrease in outcome measures in both groups should have been similar. Therefore, the net differences in the stress and the parenting practices of participants in the experimental and control groups should be attributable mainly to the intervention effect.

The overall results provide evidence that the parental training programme was effective in facilitating a smooth transition from kindergarten to primary school. In fact, there was generally positive feedback from parents after their participation in the programme. One parent commented as follows:

‘I did not realise the negative effects of harsh parenting on children before attending the programme. Now, I will use more praise and encouragement instead of harsh parenting practices in rearing my child.’

This study was limited in that all data were collected in a district in Hong Kong, and a small, convenience sample was used, which might limit its generalizability. A multi-district, with larger sample size to examine the effectiveness of the parental training programme to helping their children attain a smooth transition is recommended in future studies. Another limitation of this study was that a simple two-item measure was adopted to assess the parent–child relationships, and the psychometric properties of this measure were not comprehensively examined before use. This limitation may affect the legitimacy of the findings and result in misleading numbers. A validated measure should be used to assess the parent–child relationship in future studies. Additionally, no observation measure was included in the study to assess whether the children moved smoothly into primary school. In Hong Kong, young children attend primary schools based on the geographical location of their homes. The teachers who work in primary schools are normally not the same teachers who work in the kindergartens. Therefore, information provided by teachers from either the kindergartens or primary schools may reflect whether the children better adapt to primary school life after the intervention. It is recommended that researchers consider the possibility of gaining access to both kindergartens and primary schools to obtain more reliable data by introducing observation measures in future studies.

The findings of this study have important implications for future practice. The results showed that many parents adopted harsh parenting skills in rearing their children during the transition period, which created a time of vulnerability for the parent–child relationship. The most important implications for practice from this study relate to the determination of the effectiveness of the parental training programme to enhance parent–child relationship and reduce harsh parenting practices in the preparation of children for transition to primary school. On the other hand, results showed that a child’s transition from kindergarten to primary school may create considerable stress for the parents. Apart from worrying about their children’s academic achievement and school performance, many parents reported that they had difficulty in accepting the role of teaching and helping their children deal with the emotional frustrations that may emerge during the transition period. Teaching parents some stress management skills in the preparatory parental training programme is therefore a matter of crucial importance. Indeed, problems that arise from a child’s transition to primary school are common around the world. Thus, health educators and healthcare professionals in other parts of the world may incorporate the findings from this study when developing and evaluating an appropriate programme to facilitate a smooth transition for children to primary school life.