A hybrid digital parenting programme delivered within the Malaysian preschool system: protocol for a feasibility study of a small scale cluster randomised factorial trial

Background: Achieving Sustainable Development Goal 4, and in particular target 4.2, to ensure that all children have access to quality early childhood development, care and preprimary education so that they are ready for primary education, is far from being attained. COVID-19 further compromised progress by disrupting early education, reducing access to wellbeing resources, and increasing family violence. Evidence from low- and middle-income countries suggests in-person parenting interventions are effective at improving child learning and preventing violence. Scaling-up these programmes, however, is challenged because of resource constraints. Integrating digital and human-delivered intervention components is one potential solution to addressing these challenges. There is a need to understand the feasibility and the effectiveness of such interventions in low resource settings including Malaysia. Objectives: This study aims to determine the feasibility and the effectiveness of a digital parenting programme (Naungan Kasih) delivered with varying combinations of two components included to encourage engagement in Malaysia. The study is framed around the following objectives 1) to determine the recruitment, retention, and engagement rates in each intervention conditions; 2) to document implementation fidelity; 3) to explore programme acceptability among key stakeholders; 4) to estimate the costs of the intervention; and 5) to provide preliminary indications of the effectiveness of the different components. Methods: This ten week factorial cluster randomised trial compares ParentText, a chatbotled intervention that delivers parenting and violence prevention content to caregivers of preschool aged children, in combination with two engagement components 1) a WhatsApp support group, and 2) either one or two in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children (aged between four and six years) from eight schools split equally across two states in Malaysia: Kuala Lumpur and Negeri Sembilan. Primary outcomes relate to the feasibility and acceptability of the intervention and its components, including recruitment, retention and engagement. Effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child developmental and behavioural outcomes. The evaluation involves mixed methods research utilising quantitative surveys among caregivers, digitally tracked engagement data of caregivers’ usage of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders of the preschool system. Results: Recruitment took place in December 2023. 208 parents were recruited at baseline: 151 primary caregivers, and 57 secondary caregivers. In January 2024, 168 parents enrolled in the programme. Results will be reported in the second half of 2024. Conclusions: This is the first factorial randomised trial to assess the feasibility of a hybrid human-digital playful parenting programme in Southeast Asia. The results of this study will inform a large-scale optimisation trial to establish the most effective, cost-effective, and scalable version of the intervention in Malaysia. Trial Registration: The trial was registered on the Open Science Framework on 5 December 2023 (https://doi.org/10.17605/OSF.IO/F32KY).