Effectiveness of a multicomponent parenting intervention for promoting social-emotional school readiness among children from low-income families in Hong Kong: A cluster randomized clinical trial

Cynthia LEUNG, Anna N. N. HUI, Rosa Sze Man WONG, Nirmala RAO, Wally KARNILOWICZ, Kelly CHUNG, Jess CHAN, Patrick IP

Research output: Contribution to journalArticlespeer-review

2 Citations (Scopus)


Importance: Most parenting programs target parents of children with severe behavioral problems. There is limited evidence on the effectiveness of universal parenting programs, especially for families with low income. 

Objective: To evaluate the effectiveness of the KeySteps@JC Parent-Child Interaction Program for low-income families in Hong Kong. 

Design, Setting, and Participants: A parallel, unblinded, cluster, randomized clinical trial was conducted from September 2018 to June 2019. Eight participating preschools in Hong Kong were randomly assigned (1:1) using an online randomization plan generator into intervention (immediate) and waiting list control (delayed) groups. Intervention participants included the parents of children in kindergarten grade 1. The results were processed by an intention-to-treat analysis. 

Interventions: KeySteps@JC Parent-Child Interaction program. 

Main Outcomes and Measures: The primary outcome was child behavioral problems, which were assessed using the Strength and Difficulties Questionnaire. Secondary outcomes were parental emotion coaching, involvement in child reading and play, and parent stress levels, which were assessed using Chinese-validated versions of the Parent Reading Belief Inventory, the Chinese Parent-Child Interaction Scale, the Emotion-Related Parenting Styles, and the Parental Stress Scale questionnaires. Parents in the intervention group participated in a training program consisting of 20 weekly 1.5-hour sessions on child behavior management, emotion coaching, dialogic reading, and interactive play. The primary hypothesis was that child behavior problems would be reduced after the intervention. The main analysis was a mixed-method regression with group status as the independent variable. 

Results: A total of 267 parents (mean age, intervention group: 33.8 years; 95% CI, 32.9-34.7 years; waiting list group: 35.7 years; 95% CI, 34.5-36.9 years) participated in the program. The intervention group included 153 participants (57.3%), and the waiting list group included 114 participants (42.7%). Among the target children (mean age, intervention group: 3.5 years; 95% CI, 3.4-3.5 years; waiting list group: 3.4 years; 95% CI, 3.4-3.5 years), there were 88 boys (57.5%) in the intervention group and 59 boys (51.8%) in the waiting list group. At postintervention, the intervention group reported a statistically significant improvement in children's behavior (Cohen d, 0.29; 95% CI, 0.04-0.53); parents' use of emotion-coaching strategies, including feelings of uncertainty or ineffectiveness in emotion socialization (Cohen d, 0.26; 95% CI, 0.01-0.50) and parental rejection of negative emotion (Cohen d, 0.33; 95% CI, 0.08-0.57); and involvement in child reading (Cohen d, 0.17; 95% CI, -0.07 to 0.41). 

Conclusions and Relevance: The results of this randomized clinical trial provide promising evidence on the effectiveness of a multicomponent parenting intervention in preparing children from low-income families to be more socially and emotionally ready for school. 

Trial Registration: ClinicalTrials.gov Identifier: NCT03615937.

Original languageEnglish
Pages (from-to)357-364
JournalJAMA Pediatrics
Issue number4
Publication statusPublished - Apr 2022


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