Feasibility Study of the Masayang Pamilya Para sa Batang Pilipino (MaPa) Program From Families With Children and Adolescents
Phase: NA
Conditions: Parent-Child Relations, Child Maltreatment, Child Behavior Problem, Parenting
Sponsor: Ateneo de Manila University

 
1 
  
 
 
 
Appendix 1. Study Protocol 
 
Feasibility Study of the Masayang Pamilya Para sa Batang Pilipino (MaPa) Program  
 for Families with Children and Adolescents 
 
Lead Principal Investigator: 
Prof Liane Peña Alampay, Ateneo de Manila University 
Co-Principal Investigator: 
Dr Jamie Lachman, University of Oxford 
Co-Investigators: 
Dr Rosanne Jocson, Ateneo de Manila University 
Prof Catherine Ward, University of Cape Town 
Prof Frances Gardner, University of Oxford 
Mr Engels Del Rosario, Department of Social Welfare and Development 
Dr Bernadette Madrid, Child Protection Network  
 
 
Date: version 2.0 dated 31 March 2019 
 
Project funding by: United Nations Children’s Fund (UNICEF) Philippines 
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
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Table of Contents 
 
Protocol Summary ........................................................................................................................................... 3 
Full study protocol ........................................................................................................................................... 4 
A. Study team ............................................................................................................................................... 4 
A.1. Research team ................................................................................................................................... 4 
A.2. Project staff ....................................................................................................................................... 4 
A.3. Funder ................................................................................................................................................ 4 
B. Background ............................................................................................................................................. 4 
B.1. Literature review ............................................................................................................................... 4 
B.2. Research Aim .................................................................................................................................... 5 
B.3. Objectives .......................................................................................................................................... 5 
C. Pilot feasibility evaluation ...................................................................................................................... 5 
C.1 Study design ....................................................................................................................................... 5 
C.3 Outcome data collection ..................................................................................................................... 9 
C.4 Outcome measurements .................................................................................................................... 10 
C.4 Process data collection ..................................................................................................................... 23 
C.5 Process data analysis ........................................................................................................................ 24 
C.6 Outcome data analysis ...................................................................................................................... 25 
C.7 Data management ............................................................................................................................. 28 
D. Consequences of participation/ethical considerations ....................................................................... 28 
D.1 Research ethics ................................................................................................................................. 28 
D.2 Potential of harm .............................................................................................................................. 30 
D.3 Mitigating potential harm from the parenting modules ................................................................... 32 
D.4 Self-referral for participants ............................................................................................................. 32 
D.5 Benefits ............................................................................................................................................. 32 
D.6 Access to data ................................................................................................................................... 33 
References ....................................................................................................................................................... 34 
 
 
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
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Protocol Summary 
Research Aim 
The aim of this study is to test the feasibility of (1) an 8-session version of the Masayang Pamilya (MaPa) 
parenting program for families with children aged 2-9 (MaPa Kids) and (2) a 9-version culturally and 
contextually adapted MaPa parenting program for families with children aged 10-17 (MaPa Teens).  
This study protocol will be registered on ClinicalTrials.gov. 
Objectives 
1. 
To test the feasibility of the MaPa Kids 8-session and MaPa Teens 9-session training modules for low-
income families, by assessing: 
a. Implementation fidelity and quality;  
b. Recruitment, retention, and engagement of participants; 
c. Cultural and contextual relevance, acceptability, and satisfaction;  
2. 
To evaluate the initial effects of the MaPa Kids 8-session and MaPa Teens 9-session training modules at 
immediate post-test on the primary outcome of child maltreatment, and the proximal outcomes of positive 
parenting; dysfunctional parenting; and attitudes toward corporal punishment. 
3. 
To evaluate the initial effects of the MaPa Kids 8-session and MaPa Teens 9-session training modules at 
immediate post-test on the secondary outcomes of child neglect, parental monitoring, child behavior 
problems, parenting efficacy, parenting stress, self-efficacy in managing emotions, parental depressive 
symptoms, adolescent depressive symptoms, parent exposure to intimate partner violence, intimate 
partner coercion, family functioning, and community violence exposure.  
Participants 
Participants for the feasibility pilot for MaPa Kids and Teens will include 60 parents or primary caregivers, 30 
children between the ages of 10 and 17, and 8 facilitators who deliver the program.  
Data collection and analysis 
Feasibility pilot process data for Mapa Kids and Teens will be collected through focus group discussions with 
60 parents/primary caregivers, 30 children ages 10-17, and  facilitators. A self-report questionnaire will also 
be administered to 60 parents/primary caregivers and 30 children who participate in the program.   
The feasibility pilot outcome evaluation will be conducted using standardized, validated scales to assess the 
program’s effect on the primary outcome of child maltreatment, and the secondary outcomes of positive 
parenting; dysfunctional parenting; and attitudes toward corporal punishment, child neglect, parental 
monitoring, child behavior problems, parenting efficacy, parenting stress, self-efficacy in managing emotions, 
parental depressive symptoms, adolescent depressive symptoms, parent exposure to intimate partner violence, 
intimate partner coercion, family functioning, and community violence exposure. 
 
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
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Full study protocol 
A. Study team 
A.1. Research team 
Principal Investigator: Professor Liane Peña Alampay (Ateneo de Manila University) 
Co-Principal Investigator: Dr Jamie Lachman (University of Oxford) 
Co-Investigators: Dr Rosanne Jocson (Ateneo de Manila University); Prof Catherine Ward (University of Cape 
Town); Prof Frances Gardner (University of Oxford); Mr Engels Del Rosario (Department of Social Welfare 
and Development); Dr Bernadette Madrid (Child Protection Network) 
A.2. Project staff 
A Project Coordinator (Ms Jennel Reyes) will be contracted for the purpose of coordinating the administrative 
and logistical arrangements for the research and implementation aspects of the study.  
A.3. Funder 
United Nations Children’s Fund (UNICEF) Philippines 
B. Background 
B.1. Literature review 
The 2015 national baseline survey on violence against children (VAC) revealed that 80% of Filipino youth 
respondents had experienced violence in their childhood, with 60% of these cases occurring in the home. 
Mothers, fathers, and siblings were the most commonly reported perpetrators of harsh physical and 
psychological punishment [1]. A logical recourse to decrease child maltreatment in the country, therefore, is 
to implement intervention programs that improve parents’ relationships with their children and their 
knowledge and skills in child behavior management. 
There is extensive scientific evidence that parenting support programs are effective in reducing child 
maltreatment and associated risk factors such as corporal punishment and parent negative psychological health 
(e.g., [2, 3]). International development agencies including UNICEF and the World Health Organization 
(WHO) strongly advocate “parent and caregiver support” as among seven evidence-based strategies for ending 
VAC (i.e. INSPIRE strategies). Parenting for Lifelong Health (PLH) is one such initiative led by UNICEF HQ 
and WHO to support evidence-based parenting programs to reduce VAC in low and middle-income contexts. 
Likewise, the Philippine Plan of Action to End VAC 2017-2022 (PPAEVAC) has prioritized the development 
of “evidence-based parenting skills and positive discipline” as among its key result areas, the institutional lead 
of which is the DSWD. Thus, the department is a key partner in this proposed parenting program, which is 
also part of the Work Plan between DSWD and UNICEF. 
To support these national and global initiatives to address VAC, the multisectoral collaboration Parenting for 
Lifelong Health (PLH)-Philippines1 (of which ADMU is part) developed and tested a locally adapted parent 
support intervention based on a prototype program previously tested in South Africa. In 2016-2017, PLH-
Philippines embarked on the cultural adaptation, feasibility study (N=30), and pilot randomized control trial2 
(RCT) (N=120) of the Masayang Pamilya Para sa Batang Pilipino (MaPa) program in NCR, which was 
implemented with families with children ages 2-6 and who were beneficiaries of the Department of Social 
Welfare and Development (DSWD) Pantawid Pamilyang Pilipino Program (4Ps). The results of this initial 
RCT were promising: at post-intervention, families who participated in MaPa reported 53% less physical 
                                                   
1 PLH-Philippines is a collaboration between ADMU; Universities of Oxford, Bangor, Cape Town; Philippine Child Protection Network; 
Department of Social Welfare and Development (DSWD); UNICEF; UBS-Optimus Foundation 
2 Funded through a SSFA with ADMU 

MaPa Feasibility Study– Appendix 1. Study Protocol 
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abuse, 44% less emotional abuse, and 40% less child neglect compared to control group families who 
underwent the 4Ps Family Development Sessions (FDS).  
B.2. Research Aim 
The current program aims to expand the development, implementation, and evaluation of the MaPa program 
as part of a systematic effort to further assess the acceptability, feasibility, and effectiveness of the 
interventions. The aim of the study is to test the feasibility of (1) an 8-session version of the Masayang Pamilya 
(MaPa) parenting program for families with children aged 2-9 (MaPa Kids) and (2) a 9-session culturally and 
contextually adapted MaPa parenting program for families with children aged 10-17 (MaPa Teens).  
B.3. Objectives 
1. To test the feasibility of the MaPa Kids 8-session and MaPa Teens training modules for low-income 
families, by assessing: 
a. Implementation fidelity and quality;  
b. Recruitment, retention, and engagement of participants; 
c. Cultural and contextual relevance, acceptability, and satisfaction;  
2. To evaluate the preliminary effectiveness of the MaPa Kids 8-session and MaPa Teens 9-session training 
modules at immediate post-test on the primary outcome of child maltreatment, and the secondary outcomes 
of positive parenting, dysfunctional parenting, and attitudes toward corporal punishment. 
3. To evaluate the preliminary effectiveness of the MaPa Kids 8-session and MaPa Teens training modules 
at immediate post-test on the secondary outcomes of child neglect, parental monitoring, child behavior 
problems, parenting efficacy, parenting stress, self-efficacy in managing emotions, parental depressive 
symptoms, adolescent depressive symptoms, parent exposure to intimate partner violence, intimate partner 
coercion, family functioning, and community violence exposure.  
C. Pilot feasibility evaluation  
The MaPa Kids 8-session and Teens 9-session modules will be piloted through a pre-post feasibility study for 
60 families divided by child development age groups (i.e., 2-9 and 10-17). Piloting will include the following 
activities:  
a) implementation of parenting intervention modules by local facilitators and coaches in communities 
identified in collaboration with DSWD;  
b) monitoring of implementation feasibility including participation and engagement of families as well as 
quality of program delivery by facilitators;  
c) pre-post assessment of the impact of the intervention on reducing violence against children, improving 
positive parenting, and addressing risk factors associated with violence against children. 
C.1 Study design 
The feasibility pilot of the program modules has a pre-post design with no control group, with the aims of 
assessing program implementation, cultural and contextual relevance, and study feasibility. Although there 
will be no comparison group and it is not designed to test effects, the pilot also has a provisional goal of 
reductions in child physical and emotional abuse at immediate post-intervention. 
Setting 
The feasibility pilot will be conducted a low-income community in Quezon City, one of the 16 cities in the 
National Capital Region (NCR) in the Philippines. The primary criterion for site selection is that the 4Ps is 
operational in the community and includes a sizable number of recipient families with at least one child aged 
2-9 or 10-17 years old. The recommendations and readiness of the city DSWD and 4Ps personnel to coordinate 
with the researchers is also a factor in site selection.  

MaPa Feasibility Study– Appendix 1. Study Protocol 
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The outcome evaluation and self-report questionnaires with the 60 parents/primary caregivers and 30 children 
ages 10 to 17 will be conducted either in the homes of participants or a local community center, in a room that 
is relatively quiet and free from outside disturbance. Participants will also be invited to take part in focus group 
discussions (FGDs) at a meeting facility in the community where the modules are delivered (60 
parents/primary caregivers, 30 children ages 10 to 17, 8 facilitators, and 2 coaches). The focus group 
discussions with the expert advisory group will take place at a meeting facility in Ateneo de Manila University.  
Recruitment 
This pilot will use targeted/purposive sampling to recruit participating families (N = 60 parents/caregivers and 
30 child respondents for the Teens module). This study will rely on referrals from the 4Ps local municipal staff 
for recruitment of possible study participants. The research team will work closely with the 4Ps staff to identify 
potential eligible parents who are recipients of the conditional cash transfer program. 4Ps staff will provide the 
research team with a list of 50 participants with children ages 2 to 9 years and 50 participants with children 
ages 10 to 17 years, of which 30 will be randomly selected from each age group for initial recruitment in order 
to avoid potential issues regarding perceptions of fairness in the recruitment process. If less than 30 of the 
selected participants provide consent and are eligible from each age group, the remaining adults will be 
randomly selected from the original list until the full target sample size is reached. 
If participating families have more than one child between the ages 2-17, the Computer Assisted Self-
Interviewing tablets will randomly select one of the children for the parent to report on during the study. 
Research assistants from Ateneo de Manila University’s Bulatao Center will be employed to contact referred 
participants, conduct informed consent procedures, and administer baseline and post-intervention assessments. 
All staff will have extensive experience working with vulnerable families. They will be thoroughly trained and 
supervised by the co-principal investigators and co-investigators on recruitment, informed consent, and 
assessment procedures.  
All participating parents/primary caregivers and child participants and all 8 facilitators and 2 coaches will be 
invited to participate in the focus group discussion for the process evaluation at program completion.  
Three focus group discussions will be convened with 5 Filipino experts in the field of parenting interventions 
in order to guide program adaptation. This study will use targeted sampling to recruit experts.  
Eligibility criteria 
Participants must have provided written, informed consent prior to the occurrence of any study procedures.  
Inclusion criteria for participating parents or caregivers (n = 60): 
1. Age 18 or older; 
2. Primary caregiver responsible for the care of a child between the ages 2-9 (Kids) or 10-17 (Teens); 
3. Spend at least four nights a week in the same household as the child in the previous month; 
4. Recipient of the 4Ps conditional cash transfer program; 
5. Provision of consent to participate in the full study; 
6. Provision of consent for their child to participate in the full study (for MaPa Teens only).  
Exclusion criteria for adult parents: 
1. Any adult who has already participated in the Parent Effectiveness Service; 
2. Any adult exhibiting severe mental health problems or acute mental disabilities; 
3. Any adult that has been referred to child protection services due to child abuse.  
Inclusion criteria for child respondents (n = 30): 

MaPa Feasibility Study– Appendix 1. Study Protocol 
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1. Age 10 to 17 years at initial assessment 
2. Lives in the house at least 4 nights per week 
3. Must have an adult primary caregiver who lives in the household, who provides consent, and who 
participates in the study 
4. Provides assent to participate in the full study.  
Exclusion criteria for child respondents: 
1. Any child who is either experiencing severe mental health problems, has acute developmental 
disabilities,  
2. If the child participant has been referred to social services during baseline data collection due to 
reported or observed indications of significant harm. 
The study will also assess program fidelity and quality of delivery by program facilitators (N = 8) and coaches 
(N = 2).  
These facilitators and coaches will have the following inclusion criteria: 
1. Age 18 or older; 
2. Prior participation in a 5-day facilitator training workshop; 
3. Agreement to implement the entire program; 
4. Provision of consent to participate in the full study. 
The participants of the expert advisory group have the following inclusion criteria (N = 5): 
1. An academic expert, government official, NGO service provider, or practitioner who is involved in 
researching, advising, and/or providing services to families with children;  
2. Provision of consent to participate in the study 
Interventions 
This study will assess the feasibility of two evidence-based interventions from the Parenting for Lifelong 
Health program suite: Parenting for Lifelong Health for Young Children and Parenting for Lifelong Health for 
Adolescents [4]. These programs are being adapted and tested for the Filipino context as the Masayang 
Pamilya Para Sa Batang Pilipino Parenting Program for families with children (MaPa Kids) and adolescents 
(MaPa Teens) [5].  
The MaPa Kids program is delivered to groups of parents (N = 15 per group) and includes the following 
content: 1) spending one-on-one time with children; 2) describing actions and feelings for cognitive 
development and socio-emotional awareness; 3) using praise and rewards to encourage positive behavior; 4) 
establishing limits through effective instruction giving and consistent household rules; 5) nonviolent discipline 
such as ignoring negative attention seeking behavior, and consequences for noncompliance, rule-breaking, and 
aggressive behavior; 6) problem solving with children; 7) mindfulness based stress reduction for caregivers 
and adolescents; and 8) reflection and moving on. The MaPa Teens program is delivered to groups of parents 
(N = 15 per group) and groups of teens (N = 15 per group) and includes the following content: 1) one-on-one 
time with parents and teens; 2) positive reinforcement of positive behavior; 3) managing anger and stress; 4) 
establishing rules and routines; 5) family budgeting; 6) accepting responsibility for actions; 7) resolving family 
conflicts; 8) keeping safe in the community and resolving conflicts; and 9) reflection and moving on. 
In 2016-2017, PLH-Philippines embarked on the cultural adaptation, feasibility study (N=30), and pilot 
randomized control trial (RCT) (N=120) of MaPa Kids in NCR, which was implemented with families with 
children ages 2-6 and who were beneficiaries of the Department of Social Welfare and Development (DSWD) 
Pantawid Pamilyang Pilipino Program (4Ps). The results of this initial RCT were promising: at post-
intervention, families who participated in MaPa reported 53% less physical abuse, 44% less emotional abuse, 

MaPa Feasibility Study– Appendix 1. Study Protocol 
8 
and 40% less child neglect compared to control group families who underwent the 4Ps Family Development 
Sessions (FDS). Based on feedback from the DSWD regarding cost constraints, MaPa Kids will be adapted 
from 12 to 8 sessions in this study [6].  
The MaPa Teens program has been adapted from PLH Teens, one of the few low-cost parent-adolescent 
interventions that has been rigorously tested in a LMIC, as highlighted in the WHO’s INSPIRE: Seven 
Strategies to End Violence Against Children [7]. It has been implemented in 15 countries by international and 
local NGOs as part of multiple USAID-funded projects. Originally a 14-session parenting program delivered 
by community facilitators to groups of parents and their teens (girls and boys), the MaPa Teens program has 
been reduced to 8 parenting sessions plus 1 session on family budgeting to be in alignment with MaPa Kids. 
Grounded in social learning theory, it uses non-didactic, participatory methods to reduce adolescent exposure 
to violence in the home and community by improving positive parenting and parent-child communication, 
while reducing interpersonal conflict, harsh discipline, parenting stress, and adolescent conduct problems, 
risky behavior, and mental ill-health. Families are also assisted in developing child safety plans, responding to 
abuse, family budgeting, and accessing medical and social services [8]. 
Incentives 
Adult participants will be offered a gift card (PHP 500 or approximately £7 per participant) after baseline and 
again after post-intervention assessment. Child participants will receive a token worth PHP 200 (approximately 
£3 per participant) after baseline and again after post-intervention assessment. Refreshments (i.e., juice/soda, 
tea, sugar, and bread) will be provided during data collection. 
All participants will receive a certificate of completion at the end of the program, as well as a certificate for 
participating in the study at post-test. To date, we have consistently found a high level of willingness among 
communities to participate in research studies on parenting programs.  
Participants of focus group discussion will be offered refreshments (i.e., juice/soda, tea, sugar, and bread) 
during the sessions.   
C.2 Parenting experts working group 
a) Overview 
Three focus group discussions will be convened with five experts in the field of parenting interventions in 
order to guide program adaptation. Drawing from the results of the formative evaluation, the Parenting Experts 
Working Group will determine whether and to what extent the MaPa programs should be adapted, considering 
its contextual and cultural relevance and feasibility. The Working Group will advise the research team on the 
content of the program, including whether any components may need to be altered or excluded, as well as if 
additional components or aspects should be incorporated. The Working Group will also provide 
recommendations on adaptations to the structure of the program and methods of delivery, with a focus on 
ensuring a balance between fidelity and fit to the targeted population in the Philippines. On-going email 
communication and consultations with particular Working Group members on a one-on-one basis will assist 
in guiding the program developers in designing the curriculum for training facilitators and supervisors, as well 
as in the development of the facilitator manual and parent guidebook. Records (e.g., minutes of discussions) 
generated by this Expert Working Group will also form data for the study, as they will be used to inform data 
analysis and recommendations [9]. 
This study will use targeted sampling to recruit Filipino experts in the field of parenting interventions in order 
to guide program adaptation. These experts will be men and women who have provided written informed 
consent. It is anticipated that a total of five persons will be appropriate for this Working Group, in order to 
promote close collaboration and active engagement by all members. A limited Working Group size will also 
help to ensure that all focus group discussions can be held with all members present, which is necessary given 
the time limitations for this project. Potential respondents will be recruited via telephone or e-mail. 
b) Data collection 
Each of the three focus group discussions will last approximately 2-3 hours and will occur in office meeting 
rooms. If more time is required, the lead facilitator will ask the Working Group if members are willing to 

MaPa Feasibility Study– Appendix 1. Study Protocol 
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continue meeting for an additional 30 minutes; the time will only be extended if all members agree.  
Discussions will be audio recorded, transcribed verbatim, and translated into English when necessary. Co-
Investigator Jocson will also record simultaneous written notes in English, with particular attention paid to key 
decisions made and issues that particularly stirred debate. In the event that the audio or video recording fails 
or is incomplete, these notes will serve as a critical backup. 
c) Focus group protocol 
The Parenting Experts Working Group discussions will be conducted using an open-ended approach to 
soliciting views and feedback from Working Group members, in a manner that is unbiased and non-
judgmental. The lead facilitator (Co-Principal Investigator Alampay) and the co-facilitator (Co-Investigator 
Jocson), will conduct the Working Group discussions according to the major agenda items for each meeting 
(refer to Appendix 5), while simultaneously allowing additional items and tasks to emerge based on the 
importance placed on particular topics of discussion by Working Group members. The major agenda items 
may shift between Working Group discussions, depending on the flow of discussion and progress made in-
between meetings (e.g. via e-mail). 
d) Data analysis 
The research team will use a thematic approach within an experiential framework in order to analyze the data 
from the focus group discussion transcripts. An initial coding framework will be developed from the transcripts 
by two independent coders using NVivo. If translations of focus group discussions are required, any questions 
arising due to translation or context will be clarified with the lead facilitator and/or professional translators. 
The codes will then be grouped into themes based on the respondents’ feedback on PLH 2-9 core themes, 
program structure and schedule, program logistics, methods for program delivery, and implications of key 
findings from the feasibility pilot on further program adaptation. After the coders have agreed on the emergent, 
commonly expressed views and deviating opinions, transcripts will again be assessed. Findings will then be 
discussed within the research team with an emphasis on the validity and representativeness of individual 
themes. Finally, we will select data extracts that represent key themes as well as diverging viewpoints. 
C.3 Outcome data collection 
Ten data collectors who are fluent in Filipino (the local language) and who have prior experience working with 
vulnerable families in the Philippines will serve as research assistants. They will be extensively trained in 
ethics, informed consent, interviewing, and observational assessment techniques by the study investigators. 
All data collection points will have a detailed protocol, and will be scripted to ensure consistency across data 
collectors. Research assistants will be managed by co-PI Alampay and co-I Jocson. Quantitative self-report 
assessments and qualitative interview/focus group guides will be translated into Filipino by bilingual 
researchers and the translation checked by back-translation [10]  
The proposed study will use an innovative, low-cost technological data collection tool using Computer-
Assisted Self-Interviewing (‘CASI’) methods with e-tablet technology to administer consent forms and 
questionnaires. This method of data collection has been pilot-tested during previous feasibility RCT studies 
with high acceptability to respondents. Trained data collectors will explain the CASI procedures, read out 
questions, and assist participants to key in responses to their handsets. CASI supports multiple languages, and 
so can include English as well as local languages. Although ongoing studies report exceptionally high 
acceptability of CASI in the Philippines, if any participants are unable or uncomfortable with the use of tablets, 
a paper-and-pen interviewer-assisted questionnaire will also be available in English and Filipino.  
In addition, the study will be using audio-CASI to administer sensitive items on the questionnaires regarding 
child maltreatment, adolescent risk behavior, and intimate partner violence. Audio-CASI techniques have been 
shown to be especially effective in increasing participant willingness to disclose highly stigmatized activities 
or experiences [11, 12].. In particular, audio-CASI may decrease a respondent’s anxiety in answering questions 
face-to-face and thus increase disclosure of abuse [13]. Audio-CASI will also help to address low levels of 
literacy encountered in low-income populations. Participants will have the option to either read or use the 
audio function when responding to questions regarding child maltreatment and intimate partner violence. After 
a tutorial on how to use the audio function, Respondents will receive earphones during this part of the 
questionnaire while the interviewer completes paperwork in order to allow the respondent as much privacy as 

MaPa Feasibility Study– Appendix 1. Study Protocol 
10 
possible. In ongoing studies in the Philippines, the team has found this approach to result in a significant 
increase in the disclosure of sensitive items, as well as a high level of acceptability. The present study will also 
assess its efficacy and acceptability during the process evaluation. 
Data on implementation fidelity will be collected by video-recording all program sessions. While only a subset 
of sessions is required for the assessment of quality of delivery, all sessions will be recorded as some videos 
may not be easy to code due to poor recording, or may not be recorded due to human error. Also, it may provide 
a greater level of consistency for parents and facilitators to have all sessions recorded so that participants are 
more comfortable with the video assessments. It will be explained to parents that the purpose of the video is 
to assess facilitator skills and ensure that they are getting the best possible service. Nonetheless, recordings for 
assessment will be selected from videos of sessions eight, nine, or ten in order to assure that the facilitator 
assessed is leading the activity of interest.  
Transcripts of video recordings will be produced prior to assessment. Two assessors who are fluent in Filipino, 
and trained supervisors of the MaPa program will code impressions based on a 4-point Likert scale: a score of 
“0” is defined as “little or no evidence that the facilitator has exhibited competency;” a score of “1” is defined 
as “the facilitator has a general understanding of what is expected but does not meet expected level of 
proficiency;” a score of “2” is defined as “the facilitator exhibits the required skills and is able to perform the 
activity with a high level of proficiency;” and a score of “3” is defined as “the facilitator demonstrates 
exceptional ability to deliver required skills or activity.” Scores for overall proficiency as well as for each 
category and subscale will be normalized by calculating a ratio of facilitator score to the total possible score. 
In order to determine inter-rater reliability, both raters will code the same videos until assessors achieve at 
least an inter-cluster correlation coefficient threshold of 0.70 as an acceptable level of inter-rater reliability 
[14].  
Program adherence data will be collected using attendance registers administered by research assistants 
assigned to the process evaluation. Program participants will indicate whether they completed their home 
activity assignments using self-report checklists. 
Qualitative data will involve focus group discussions with all participating parents/primary caregivers and 
program facilitators and coaches. Data will be collected by co-PI Alampay or trained research assistants, all of 
whom speak fluent Filipino, using an interview schedule with an open-ended approach to soliciting views and 
feedback from participants. Interviewers will guide the focus groups along the following steps while allowing 
the discussion to evolve as themes emerge. Each step will begin with an overarching question followed by 
more specific questioning and inquiry:  
Question 1: What are participants’ overall experiences and observed change during program? 
Question 2: Are the program materials, delivery, and content culturally acceptable to participants and 
program facilitators and coaches? 
Question 3: What were any potential barriers to participation/implementation in the program and what 
are suggestions to overcome these barriers? 
Focus groups will be captured on digital recorders with written notes as a backup. All equipment will be tested 
onsite prior to use. Focus groups will last approximately 120 minutes and occur in a quiet room a local 
community center. Data will be transcribed verbatim and will be translated into English and verbally back-
translated into Filipino to verify accuracy.  
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
11 
C.4 Outcome measurements 
Data collection during the study will take place at two assessment points: baseline and immediate post-
intervention. See Tables 1 and 2 for summaries of feasibility study outcome and process evaluation 
measurements for parents/caregivers and adolescents. All measures will be translated into Filipino and back-
translated to check the accuracy of the translation. 
a) Adult questionnaire  
Sociodemographic information 
1. Basic caregiver and child demographic information 
 
Basic caregiver and child demographic information will be asked using items from the UNICEF Multiple 
Indicators Cluster Survey (MICS) Household Survey [15]. The MICS was developed to monitor the situation 
of children and women on a global level and is based on Demographic and Health Surveys. It has been used 
widely throughout low- and middle-income countries (LMIC) including the Philippines. It assesses 
caregiver/child age, gender, marital status, employment status, education level, basic literacy, child’s 
relationship to caregiver, presence of child’s biological parents (including reasons for absence), and other 
household members’ age, gender and relationship to caregiver. It also assesses other household socio-
demographic characteristics including household structure, family employment, and whether or not the family 
receives any government grants 
 
2. Household ladder 
Subjective social status will be assessed using the MacArthur Subjective Scale of Social Status [16]. Parents 
will be presented with a drawing of a 10-rung ladder that represents where people stand in their communities. 
The top of the ladder represents the highest standing in the community and the bottom ladder represents the 
lowest standing in their community. They will be asked to place themselves on the rung that best represents 
where they see themselves relative to their community (1 = lowest standing to 10 = highest standing). 
3. Household income 
An objective measure of household income will be obtained by asking parents to indicate their family’s 
monthly income using a 16-item scale with income ranges from 0 = no income to 15 = over 83,000 monthly 
[17].  
4. Adult history of child maltreatment 
Parental/primary caregiver history of experiencing child maltreatment will be measured through an adapted 
version of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse 
Screening Tools Retrospective version (ICAST-R) (4 items) [18]. This scale utilizes parental self-reports of 
maltreatment experiences during childhood (until age 18 years) to assess the history of ever experiencing 
physical abuse (e.g., “When you were growing up (before age 18), did your caregiver ever discipline or punish 
you physically by hitting, spanking, slapping, kicking, or shaking you?”) (2 items) and emotional abuse (e.g., 
When you were growing up (before age 18) did any person ever discipline or punish you by insulting or 
criticizing you, to make you feel that you were bad, stupid or worthless?”) (2 items). In this study, ever 
experiencing physical abuse or emotional abuse will be assessed on a frequency scale (0 = Never; 1 = Once or 
twice; 2 = 3-5 times; 3 = More than 5 times). There will also be a dichotomous score for overall indication of 
previous child abuse (0 = no abuse; 1 = previous abuse). 
5. Basic necessities 
Relative poverty will be assessed using the Basic Necessities Scale (8 items). Developed by the Center for 
South African Social Policy in the ‘Indicators of Poverty and Social Exclusion Project,’ the Basic Necessities 
Scale measures levels of economic deprivation by identifying basic household items that families are unable 
to afford [19]. These include food, toiletries, clothes, shoes, and school uniforms, equipment, and fees. Items 
are coded dichotomously for positive or negative responses and summed to create an overall score. Previous 

MaPa Feasibility Study– Appendix 1. Study Protocol 
12 
studies in have used this scale in multiple settings with high internal reliability (α = .84) [20, 21]. This 
information will be collected from both children and caregivers. 
6. Household hunger 
Relative poverty will be based on household hunger assessed using the Hunger Scale Questionnaire [22].  This 
scale examines food shortage and hunger in the household. Parents respond positively or negatively regarding 
the occurrence of hunger in the household, whether it occurred during the past 30 days, and if so, whether it 
occurred more than 5 times in the past 30 days (e.g., “the household has run out of money to buy food”). The 
scale produces scores for single occurrence and intensity of hunger 
7. Food consumption 
This study will also assess food consumption via caregiver report on average meals consumed per day in the 
past week for both the caregiver and child participants based on items from the UNICEF MICS Household 
Survey (e.g., “how many meals did you consumer per day”) [15]. 
8. Caregiver alcohol use 
Parental dependency on alcohol will be assessed by assessing alcohol consumption during the past month (1 
item). Dependency is based on 3 or more drinks per day for female participants and 5 or more per day for male 
participants [23]. Due to the sensitive nature of these items, additional items dealing with other activities to 
reduce stress have been included in this section to encourage accuracy (3 items; e.g., “In the past month, have 
you been for a walk or done some other exercise to help you relax?”). 
Primary outcome 
9. Child maltreatment – physical and emotional abuse 
Physical abuse (including abusive discipline) and emotional abuse will be measured using 21 items from an 
adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Parent version (ICAST-TP) 
[24]. The ICAST-T is an adaptation of the multi-national and consensus-based survey instrument ICAST-
Parent version (ICAST-P) [25], and has been used successfully in low and middle-income countries, including 
recently in the Philippines. The ICAST-TP measures parental reports of the incidence of abuse perpetrated 
against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., 
“In the past 4 weeks, how often did you discipline [Child Nickname] by pushing, grabbing, or kicking 
him/her?”). This study will assess incidence of child maltreatment for physical abuse (13 items), emotional 
abuse (8 items), as well as an overall indication of previous child abuse (0 = no abuse; 1 = previous abuse). 
We will also assess frequency of overall abuse by summing all of the subscales as well as for each individual 
subscale. 
Proximal outcomes 
10. Positive parenting – MaPa Kids Only 
Positive parenting behavior will be assessed using the Parenting of Young Children Scale (PARYC, 21 items) 
[26]. The PARYC measures the frequency of parent behavior over the previous month. Items are summed to 
create total frequency scores for positive parenting (7 items, e.g., “how often do you play with your child”), 
setting limits (7 items, e.g., “how often do you stick to your rules and not change your mind”) and proactive 
parenting (7 items, e.g., “how often do you explain what you want your child to do in clear and simple ways”). 
It has been used with strong reliability in previous studies on the program adapted in this study [27]. 
11. Dysfunctional parenting – MaPa Kids Only 
Dysfunctional parenting behavior will be assessed using the Parenting Scale (PS, 30 items) [28]. This scale 
examines parent attitudes and beliefs regarding discipline practice. Responses are based on a 7-point Likert 
scale in which parents are presented with a situation and then are asked to choose between two alternative 
responses to a situation (1 = most effective; 7 = most ineffective; i.e., situation: “When I say my child can’t do 
something;” response, score = 1: “I stick to what I said;” or response score = 7: “I let my child do it anyway”). 
Items are summed to create an overall score as well as for three subscales: Laxness, Over-reactivity, and 

MaPa Feasibility Study– Appendix 1. Study Protocol 
13 
Verbosity. The PS has been used widely to assess the effectiveness of parenting programs, including in low-
resource settings such as Panama [29].  
12. Parenting behavior – MaPa Teens Only 
Parent-child interaction, will be measured using two subscales from the Alabama Parenting Questionnaire – 
Adult Report [30]: Positive Parenting (8 items, e.g., “you praise your child if s/he behaves well”) and Parent 
Involvement (8 items, e.g., “you take your child to a special activity”). The APQ has been shown to have 
moderate to strong internal reliability for both parent and child reports (Cronbach’s α = 0.50 to 0.89). It has 
been used widely including in LMIC such as South Africa and Mexico [31-36]. Caregivers report on the 
frequency of parenting behavior based on a 4-point Likert scale (0 = never; 3 = Often, more than 5 times). 
Items are summed to create total frequency score (range 0 to 24) as well as for each subscale. 
13. Attitudes toward punishment 
Attitudes toward punishment will be assessed using one item from the UNICEF Multiple Indicator Cluster 
Survey (MICS) 5 Child Discipline module[15], five items from the ISPCAN Child Abuse Screening Tool-
Intervention Efficacy and Attitudes sub-scales (ICAST-I) [25]. The MICS item asks the parent/primary 
caregiver: “In order to bring up, raise up, or educate a child properly, the child needs to be physically 
punished.” Parents/primary caregivers will report whether they disagree or agree with the statement based on 
a 5-point Likert scale of 0 to 4 (0 = Disagree strongly; 4 = Agree strongly). The two ICAST-I Efficacy items 
asks how often parents/primary caregivers reacted to child misbehavior over the past month using a frequency 
score on a scale of 1 to 7, or 8 or more times (e.g., “In the past 4 weeks, how often did physical discipline seem 
like the only option for stopping [Child Nickname’s] bad behavior?” Four of the ICAST-T Attitudes sub-scale 
items assess parent/primary caregiver refer to a scenario in which a child is “always getting into trouble,” and 
asks about the level of effectiveness of various disciplinary responses based on a 5-point Likert scale of 1 to 5 
(1 = Very ineffective; 5 = Very effective). The fifth item on this sub-scale then asks “Which of the above 
approaches do you feel is most effective for disciplining children?” and permits a single select response. 
Secondary Outcomes 
14. Child neglect 
Child neglect will be assessed using an adapted version of the ICAST-T Caregiver (mentioned above) Neglect 
subscale. This subscale has 3 items for assessing medical, physical, and educational neglect, including “In the 
past month, how often was [Child Nickname] not taken care of when sick or injured, even when you or another 
caregiver were able to do so and could afford it?” and “In the past month, how often was [Child Nickname] 
not given a meal that he or she needed, even when you or another caregiver was able to afford it?” 
15. Parental monitoring – MaPa Teens Only 
 
Parental monitoring and supervision practices will be measured using an adapted parental monitoring scale 
(11 items) [37]. The scale measures parents’ solicitation of information (5 items, i.e., “How much do you try 
to know…”) concerning their child’s activities and friendships (e.g., who your child spends time with) using 
a 3-point scale (0 = I don’t try; 2 = I try a lot); rule-setting, or how often parents set rules or limits about the 
same items using a 4-point scale (0 = Never; 3 = Always). Four items on monitoring of online activities were 
added to the solicitation of information subscale (e.g., “How much do you try to know the websites your child 
visits?) and two items were added to the rule-setting subscale (e.g., “How much do you set rules or limits on 
how long your child uses his or her device?), derived from the Global Kids Online survey [38]. Mean scores 
on the two subscales are standardized and summed to create a total parental monitoring score, with higher 
scores indicating higher levels of monitoring.  
 
16. Child behavior problems 
Child behavior problems will be measured using the Child and Adolescent Behavior Inventory (CABI) [39]. 
The CABI assesses a wide range of internalizing and externalizing symptoms in children and adolescents and 
is relatively shorter than the Child Behavior Check List (CBCL), making it a practical and reliable tool for 
measuring behavior problems. Parents report on their child’s behavior during the past month (0 = Not True, 1 
= Somewhat or Sometimes True, 1 = Very True). The irritability subscale (4 items, e.g., “has frequent mood 

MaPa Feasibility Study– Appendix 1. Study Protocol 
14 
changes”) and the externalizing subscale (10 items, e.g., often lies or cheats) will be used to measure problem 
behaviors. Items on both subscales are summed to create a total score of child behavior problems.  
17. Three Problem Rating Scale – Parent Report 
The Three Problem Scale-Parent Report was adapted from developed by Scott [40] to assess whether specific 
concerns or issues parents are having with their children change during an intervention. Parent-defined 
concerns from the Three Problem Scale that is consistent or larger than other measurements such as the 
Strengths and Difficulties Questionnaire or Child Behavior Check List. Parents are asked to identify up to 3 
areas of concern with their children that are causing them the most distress and to rate each problem area from 
1 to 10 (1 = “not a problem,” 10 = “couldn’t be worse”). The same problem areas are then asked at post-
assessment to assess whether these problems have changed. Each single item will be analysed separately as 
well as a total problem rating score for the 3 issues. 
18. Parenting efficacy 
Parenting efficacy will be assessed using the Efficacy Subscale of the Parenting Sense of Competence Scale 
(8 items; PSOC-ES) [41]. The PSOC has been widely used in studies to evaluate parenting self-esteem, 
efficacy, or competence [41]. The PSOC Efficacy Subscale measures parental perception of competence, 
problem-solving ability, and capability in the parenting role (e.g., “I honestly believe I have all the skills 
necessary to be a good mother/father to my child”). Each item is rated on a 6-point scale that ranges from 1 
(strongly disagree) to 6 (strongly agree). Items are summed to create a total score of parental self-efficacy. 
19. Parenting stress 
Parenting stress will be assessed using the Parental Stress Scale (PSS; 18 items) [42]. PSS has been widely 
used to measure parenting stress, including in LMIC, such as Pakistan [43] and China [44]. The scale has also 
been used with non-parent caregivers such as grandparents [45]. Caregivers report current positive attitudes (n 
= 8, e.g., “I feel close to my child”) and negative attitudes (n = 10, e.g., “I feel overwhelmed by the 
responsibility of being a parent”) related to parenting stress based on a five-point Likert scale (0 = strongly 
disagree; 4 = strongly agree). Positive items are reversed and then all items are summed to create a total 
parenting stress score (range 0 to 90). 
20. Self-efficacy in managing emotions 
Self-efficacy in managing emotions is measured using an adapted version of the Regulatory Emotional Self-
Efficacy Scale [46]. The anger-irritation subscale includes four items. Parents indicate how well they think 
they can control their emotions (e.g., How well can you manage negative feelings when reprimanded by 
significant others?) using a 5-point scale (1 = Not well at all to 5 = Very well). Scores are averaged to create 
a total score for self-efficacy in managing emotions.   
21. Parental depressive symptoms 
Parental depressive symptoms will be measured using the adult version of Moods and Feelings Questionnaire 
(MFQ) [47, 48]. The scale includes 13 items indicating depressive symptoms (e.g., I didn’t enjoy anything at 
all). Parents indicate how they have been feeling or acting in the past two weeks using a 3-point Likert scale 
(0 = Not true, 1 = Sometimes True, 2 = True). Items are summed to create a total parental depression score.  
22. Child depressive symptoms 
Child depressive symptoms will be measured using the short parent report version of Moods and Feelings 
Questionnaire (MFQ) [47, 48]. The scale includes 13 items indicating depressive symptoms (e.g., I didn’t 
enjoy anything at all). Parents indicate how their child has been feeling or acting in the past two weeks using 
a 3-point Likert scale (0 = Not true, 1 = Sometimes True, 2 = True). Items are summed to create a total child 
depressive symptoms score. 
23. Parent exposure to IPV and intimate partner coercion 
Adult self-report of experiencing intimate partner violence over the past month will be assessed using an 
adapted version of the Revised Conflict Tactics Scale Short Form (CTS2S, 8 items) [49] and adapted items 

MaPa Feasibility Study– Appendix 1. Study Protocol 
15 
from the WHO Multi-Country Study Questionnaire on Women’s Health and Life and Domestic Violence 
against Women (WHO, 10 items) [50]. The CTS2S scale includes 2 items on the frequency of negotiation 
(e.g., “partner suggested a compromise for a disagreement”), 5 items on physical assault (e.g., “partner pushed, 
shoved, or slapped me”), and 1 item on psychological aggression (e.g., “partner insulted, shouted, yelled, or 
swore at me”). The adapted WHO questionnaire includes 7 items on coercion and emotional violence (e.g., 
“my partner tried to keep me from seeing my friends” and “my partner insisted on knowing where I was at all 
times”), and 3 items on restriction of financial autonomy (e.g., “my partner took my earnings or savings from 
me against my will.”) All answers are coded on a frequency scale of 0 to 3 (0 = never happened; 1 = once or 
twice; 2 = 3-5 times; 3 = more than 5 times). Both the CTS2S and the WHO will determine an overall indication 
of intimate partner violence on a level of severity (sum of items across both scales) and prevalence 
(dichotomous variable indicating experience of conflict or not), as well as for each subscale. 
24. Family functioning 
Family functioning will be measured using the Burmese Family Functioning Scale [51]. It includes subscales 
on family cohesion (12 items, e.g., having understanding towards one another), family communication (7 
items, e.g., expressing love through words or actions), and negative family interactions (4 items, e.g., having 
a lot of bad feelings in the family). Parents indicate how much they agree with statements regarding their 
family in the last four weeks on a 4-points Likert scale (1 = Almost Never True; 4 = Almost Always True). 
Items are summed to create total frequency score as well as for each subscale. 
25. Parental Support for School Scale 
Parental support for school will be measured using an adapted Parental Support for School Scale asking how 
often the parent engages in behaviours that support learning (6 items, e.g., talk to my child about the importance 
of finishing high school, support my child’s schoolwork in any way that I can) using a 5-point Likert scale (1 
= never, 2 = hardly ever, 3 = sometimes, 4 = most of the time, 5 = always). Higher scores reflect more parental 
support and value for school.    
26. Educational aspirations and expectations  
Educational aspirations will be measured one item asking the parent “How far would like your child to go in 
school?” rated on a 5-point scale (1 = finish some high school, 2 = graduate from high school, 3 = graduate 
from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical or graduate school).  
Educational expectations will be measured using one item asking the parent how far they think their child 
will actually go in school rated on the same 5-point scale (1 = finish some high school, 2 = graduate from high 
school, 3 = graduate from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical 
or graduate school).       
27. Community violence exposure 
Exposure to community violence will be measured using 6 items from each of the subscales of the Violence 
Exposure Scale: Witnessing Community Violence and Experiencing Community Violence (12 items total) 
[52]. Parents report on whether they witnessed or experienced community violence in the past month based on 
4-point Likert scale (0 = never; 4 = Often, more than 5 times). They also have the option to report that the 
incident has occurred before but not in the past month. Items from each subscale are summed to create a total 
subscale score as well as to create an incidence rating of exposure to community violence. 
b) Child questionnaire 
Sociodemographic information 
1. Basic child demographics 
Basic child demographic information will be asked using items from the UNICEF Multiple Indicators Cluster 
Survey (MICS) Household Survey [15]. The MICS was developed to monitor the situation of children and 
women on a global level and is based on Demographic and Health Surveys. It has been used widely throughout 
low- and middle-income countries (LMIC) including the Philippines. It assesses caregiver/child age, gender, 

MaPa Feasibility Study– Appendix 1. Study Protocol 
16 
marital status, employment status, education level, basic literacy, child’s relationship to caregiver, presence of 
child’s biological parents (including reasons for absence), and other household members’ age, gender and 
relationship to caregiver. It also assesses other household socio-demographic characteristics including 
household structure, family employment, and whether or not the family receives any government grants. 
2. Basic necessities 
Relative poverty will be assessed using the Basic Necessities Scale (8 items). Developed by the Center for 
South African Social Policy in the ‘Indicators of Poverty and Social Exclusion Project,’ the Basic Necessities 
Scale measures levels of economic deprivation by identifying basic household items that families are unable 
to afford [19]. These include food, toiletries, clothes, shoes, and school uniforms, equipment, and fees. Items 
are coded dichotomously for positive or negative responses and summed to create an overall score. Previous 
studies in have used this scale in multiple settings with high internal reliability (α = .84) [20, 21]. This 
information will be collected from both children and caregivers. 
Primary outcome 
3. Child maltreatment – physical, emotional, and sexual abuse 
Physical abuse (including abusive discipline) and emotional abuse will be measured using 26 items from an 
adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Adolescent version (ICAST-
TA) [24]. The ICAST-TA measures child reports of the incidence of abuse perpetrated against them over the 
past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., “In the past 4 weeks, how 
often did your caregiver push, grab, or kick you?”). This study will assess incidence of child maltreatment for 
physical (10 items), emotional (10 items), and sexual abuse (6 items), as well as an overall indication of 
previous child abuse (0 = no abuse; 1 = previous abuse). We will also assess frequency of overall abuse by 
summing all of the subscales as well as for each individual subscale. 
Proximal outcomes 
4. Parenting behavior 
Parent-child interaction, will be measured using two subscales from the Alabama Parenting Questionnaire – 
Child Report [30]: Positive Parenting (8 items, e.g., “your parent/caregiver praises you when you behave well”) 
and Parent Involvement (8 items, e.g., “your parent/caregiver takes you child to a special activity”). The APQ 
has been shown to have moderate to strong internal reliability for both parent and child reports (Cronbach’s α 
= 0.50 to 0.89). It has been used widely including in LMIC such as South Africa and Mexico [31-36]. 
Caregivers report on the frequency of parenting behavior based on a 4-point Likert scale (0 = never; 3 = Often, 
more than 5 times). Items are summed to create total frequency score (range 0 to 24) as well as for each 
subscale. 
5. Three Problem Rating Scale – Child Report 
The Three Problem Scale-Child Report was adapted from the Three Problem Scale for parents developed by 
Scott [40]. This scale measures whether specific concerns or issues parents are having with their children 
change during an intervention. Parent-defined concerns from the Three Problem Scale that is consistent or 
larger than other measurements such as the Strengths and Difficulties Questionnaire or Child Behavior Check 
List. This study adapted the parent-report scale for children to report on specific issues or problems they are 
having with their parents. Children are asked to identify up to 3 areas of conflict with their parents that are 
causing them the most distress and to rate each problem area from 1 to 10 (1 = “not a problem,” 10 = “couldn’t 
be worse”). The same problem areas are then asked at post-assessment to assess whether these problems have 
changed. Each single item will be analysed separately as well as a total problem rating score for the 3 issues.  
6. Attitudes to punishment 
Attitudes toward punishment will be assessed using one item from the UNICEF Multiple Indicator Cluster 
Survey (MICS) 5 Child Discipline module[15], five items from the ISPCAN Child Abuse Screening Tool-
Intervention Efficacy and Attitudes sub-scales (ICAST-I)[25]. The MICS item asks the child: “In order to 
bring up, raise up, or educate a child properly, the child needs to be physically punished.” Children will report 
whether they disagree or agree with the statement based on a 5-point Likert scale of 0 to 4 (0 = Disagree 

MaPa Feasibility Study– Appendix 1. Study Protocol 
17 
strongly; 4 = Agree strongly). Four of the ICAST-T Attitudes sub-scale items refers to a scenario in which a 
child is “always getting into trouble,” and asks about the level of effectiveness of various disciplinary responses 
based on a 5-point Likert scale of 1 to 5 (1 = Very ineffective; 5 = Very effective). The fifth item on this sub-
scale then asks “Which of the above approaches do you feel is most effective for disciplining children?” and 
permits a single select response. 
Secondary outcomes 
7. Child behavior problems 
Child behavior problems will be measured using the Child and Adolescent Behavior Inventory (CABI) [39]. 
The CABI assesses a wide range of internalizing and externalizing symptoms in children and adolescents and 
is relatively shorter than the Child Behavior Check List (CBCL), making it a practical and reliable tool for 
measuring behavior problems. Children report on their own behavior during the past month (0 = Not True, 1 
= Somewhat or Sometimes True, 1 = Very True). The irritability subscale (4 items, e.g., “has frequent mood 
changes”) and the externalizing subscale (10 items, e.g., often lies or cheats) will be used to measure problem 
behaviors. Items on both subscales are summed to create a total score of child behavior problems.  
8. Child prosocial behavior 
Child prosocial behavior will be measured using a Prosocial Behavior Scale [53]. Children report how often 
they engage in prosocial behaviors (16 items, e.g., “I share things I have with my friends”) using a 5-point 
Likert Scale (0 = Never/Almost Never; 5 = Almost Always/Always True). Items are averaged to create a total 
score for child prosocial behavior.   
9. Child risk behavior 
Child risk behavior will be measured using a Risk Behavior Scale [54]. Children report how many times they 
have engaged in risky behaviors in the past month (9 items, e.g., “drinking beer or wine”) using a using a 
frequency score on a scale of 0 to 7, or 8 or more times. Items are summed to create a total score for child risk 
behavior. This measure will be administered using audio-CASI to increase response rate. 
10. Child depressive symptoms 
Child depressive symptoms will be measured using the short child report version of Moods and Feelings 
Questionnaire (MFQ) [47, 48]. The scale includes 13 items indicating depressive symptoms (e.g., I didn’t 
enjoy anything at all). Children indicate how they have been feeling or acting in the past two weeks using a 3-
point Likert scale (0 = Not true, 1 = Sometimes True, 2 = True). Items are summed to create a total child 
depressive symptoms score. 
11. Parental monitoring 
Parental monitoring and supervision practices will be measured using an adapted parental monitoring scale 
(11 items) [37]. Children report on their parents’ solicitation of information (5 items, i.e., “How much do your 
parents try to know…”) concerning their child’s activities and friendships (e.g., who you spend time with) 
using a 3-point scale (0 = They don’t try; 2 = They try a lot); rule-setting, or how often their parents set rules 
or limits about the same items using a 4-point scale (0 = Never; 3 = Always). Four items on monitoring of 
online activities were added to the solicitation of information subscale (e.g., “How much do your parents try 
to know the websites you visit?) and two items were added to the rule-setting subscale (e.g., “How much do 
your parents set rules or limits on how long you use a device?), derived from the Global Kids Online survey 
[38]. Mean scores on the two subscales are standardized and summed to create a total parental monitoring 
score, with higher scores indicating higher levels of monitoring.  
12. Neglect 
Neglect will be assessed using an adapted version of the ICAST-T Child (mentioned above) Neglect subscale 
[24]. This subscale has 6 items for assessing medical, physical, and educational neglect, including “In the past 
month, how often were you not taken care of when sick or injured, even when your family was able to do so 
and could afford it?” Items are added to create a total neglect score as well as to create an incidence of neglect 
in the previous month. 

MaPa Feasibility Study– Appendix 1. Study Protocol 
18 
13. Parental Support for School Scale (child-report) 
Parental support for school will be measured using an adapted Parental Support for School Scale asking how 
often the parent engages in behaviours that support learning (6 items, e.g., talk to my child about the importance 
of finishing high school, support my child’s schoolwork in any way that I can) using a 5-point Likert scale (1 
= never, 2 = hardly ever, 3 = sometimes, 4 = most of the time, 5 = always). Higher scores reflect more parental 
support and value for school.    
14. Educational aspirations and expectations  
Educational aspirations will be measured one item asking the child “How far would you like to go in school?” 
rated on a 5-point scale (1 = finish some high school, 2 = graduate from high school, 3 = graduate from a 2-
year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical or graduate school).  
Educational expectations will be measured using one item asking the child how far they think they 
will actually go in school rated on the same 5-point scale (1 = finish some high school, 2 = graduate from high 
school, 3 = graduate from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical 
or graduate school).       
15. Witnessing family violence 
The incidence and frequency of witnessing family violence will be assessed by using 2 items from the ICAST-
T Child (e.g., “How many days in the past month were there arguments with adults shouting in your home?”) 
[24]. Items will be summed to create a total frequency of witnessing family violence as well as dichotomized 
to create an incidence variable. 
16. Community violence exposure 
Exposure to community violence will be measured using 6 items from each of the subscales of the Violence 
Exposure Scale: Witnessing Community Violence and Experiencing Community Violence (12 items total) 
[52]. Children report on whether they witnessed or experienced community violence in the past month based 
on 4-point Likert scale (0 = never; 4 = Often, more than 5 times). They also have the option to report that the 
incident has occurred before but not in the past month. Items from each subscale are summed to create a total 
subscale score as well as to create an incidence rating of exposure to community violence. 
17. Family functioning 
Family functioning will be measured using the Burmese Family Functioning Scale [51]. It includes subscales 
on family cohesion (12 items, e.g., having understanding towards one another), family communication (7 
items, e.g., expressing love through words or actions), and negative family interactions (4 items, e.g., having 
a lot of bad feelings in the family). Children indicate how much they agree with statements regarding their 
family in the last four weeks on a 4-points Likert scale (1 = Almost Never True; 4 = Almost Always True). 
Items are summed to create total frequency score as well as for each subscale. 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
19 
Table 1. Summary of parent/caregiver-report outcome evaluation tools and questionnaires for MaPa Kids and 
Teens pilots 
Outcome 
MaPa Kids Pilot 
Measurement 
Items MaPa Teens Pilot 
Measurement 
Items  
 
 
 
 
 
 
Demographic factors (33/33) 
Parent, child and family 
demographics 
General demographics 
questions [15] 
16 
General demographics 
questions [15] 
16 
 
Household ladder 
MacArthur Subjective 
Scale of Social Status 
[16] 
1 
MacArthur Subjective 
Scale of Social Status 
[16] 
1 
 
Household income 
Income measure [17] 
1 
Income measure [17] 
1 
 
Household assets 
Basic Necessities Scale 
[18] 
8 
Basic Necessities Scale 
[18] 
8 
 
Household poverty 
The Hunger Scale 
Questionnaire  [19] 
3  
The Hunger Scale 
Questionnaire  [19] 
3  
 
Parent history of child 
maltreatment 
ISPCAN Child Abuse 
Screening Tool-
Retrospective Version 
[20] 
5 
ISPCAN Child Abuse 
Screening Tool-
Retrospective Version 
[20] 
5 
 
Parent alcohol abuse 
Self-report on alcohol 
use 
1 
Self-report on alcohol 
use 
1 
 
Primary outcome (21/20) 
Child maltreatment  
ISPCAN Child Abuse 
Screening Tool-
Intervention – Physical 
and Emotional Abuse 
Subscales [21] 
21 
ISPCAN Child Abuse 
Screening Tool-
Intervention – Physical 
and Emotional Abuse 
Subscales [21] 
20 
 
Proximal outcomes (57/22) 
Positive parenting  
Parenting of Young 
Children Scale [22] 
21 
Alabama Parenting 
Questionnaire [23] 
16 
 
Dysfunctional parenting  
The Parenting Scale [24] 
30 
N/A 
 
 
Attitudes to corporal punishment  Multiple Indicator 
Cluster Survey [15] 
1  
Multiple Indicator 
Cluster Survey [15] 
1  
 
Attitudes to corporal punishment  ICAST Attitudes 
Subscale [25] 
5 
ICAST Attitudes 
Subscale [25] 
5 
 
Secondary outcomes (117/144) 
Child neglect  
ISPCAN Child Abuse 
Screening Tool-
Intervention – Neglect– 
3 items  [21] 
3 
ISPCAN Child Abuse 
Screening Tool-
Intervention – Neglect– 
3 items [25] 
3 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
20 
Parental monitoring 
N/A 
 
Parental Monitoring 
Scale [26] 
Global Kids Online [27] 
10 
6 
 
Child behaviour problems 
Child and Adolescent 
Behaviour Inventory 
[28] 
Three Problem Rating 
Scale [29, 30] 
 
14 
3 
Child and Adolescent 
Behaviour Inventory 
[28] 
Three Problem Rating 
Scale [29, 30] 
 
14 
3 
 
Parenting efficacy 
Parenting Sense of 
Competence, Efficacy 
Subscale [31] 
ICAST – Efficacy 
Subscale [21] 
8 
 
2 
Parenting Sense of 
Competence, Efficacy 
Subscale [31] 
ICAST – Efficacy 
Subscale [21] 
8 
 
Parenting stress 
Parenting Stress Scale 
[32] 
18 
Parenting Stress Scale 
[32] 
18 
 
Self-efficacy in managing 
emotions 
Adapted from 
Regulatory Emotional 
Self-Efficacy Scale [33] 
4 
Adapted from 
Regulatory Emotional 
Self-Efficacy Scale [33] 
4 
 
Parental depression 
Moods and Feelings 
Scale - Adult [34, 35] 
13 
Moods and Feelings 
Scale - Adult [34, 35] 
13 
 
Adolescent depression  
N/A 
 
Moods and Feelings 
Scale - Child [34, 35] 
13 
 
Parent exposure to IPV 
Revised Conflict Tactics 
Scale Short Form [36] 
8 
Revised Conflict Tactics 
Scale Short Form [36] 
8 
 
Intimate partner coercion 
WHO Multi-Country 
Questionnaire on 
Women’s Health and 
Domestic Violence 
against Women (WHO) 
[37]  
10 
WHO Multi-Country 
Questionnaire on 
Women’s Health and 
Domestic Violence 
against Women (WHO) 
10 
 
Family functioning 
Burmese Family 
Functioning Scale [38] 
23 
Burmese Family 
Functioning Scale [38] 
23 
 
Witnessing and exposure to 
community violence 
Violence Exposure Scale 
[39] 
12 
Violence Exposure 
Scale [39] 
12 
 
Parent support of education 
 
 
Parent Support of 
School Scale 
6 
 
Educational aspirations 
 
 
Aspirations and 
expectations 
2 
 
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
21 
Process evaluation outcomes 
Implementation fidelity 
Facilitator check-lists 
Parenting for Lifelong 
Health Facilitator 
Assessment Tool (PLH-
FAT) [40] 
n/a 
51 
 
Facilitator check-lists 
Parenting for Lifelong 
Health Facilitator 
Assessment Tool (PLH-
FAT) [40] 
n/a 
51 
 
 
Adherence/exposure/engagement Attendance registration 
Activity check-list 
(parent report) 
n/a 
n/a 
Attendance registration 
Activity check-list 
(parent report) 
n/a 
n/a 
 
Satisfaction/acceptability 
Parent overall 
satisfaction 
40 
Parent overall 
satisfaction 
40 
 
Acceptability and feasibility 
Parent FGDs 
n/a 
Parent FGDs 
n/a 
 
 
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
22 
Table 2. Summary of child-report outcome evaluation tools and questionnaires MaPa Teens pilot 
Outcome 
Measurement 
Items 
 
 
 
Demographic factors (potential subgroups and moderators) 
18 
 
Child demographics 
General demographics questions [15] 
10 
 
Household assets 
Basic Necessities Scale [18] 
8 
 
Primary outcome 
20 
 
Child maltreatment (Physical and 
Emotional Abuse) 
ISPCAN Child Abuse Screening Tool-Intervention 
[21] 
20 
 
Proximal outcomes 
25 
 
Parenting  
Alabama Parenting Questionnaire  
Adapted from Three Problem Rating Scale [29] [30] 
16 
3 
 
Attitudes to corporal punishment  
Multiple Indicator Cluster Survey [15] 
1  
 
Attitudes to corporal punishment  
ICAST Attitudes Subscale [25] 
5 
 
Secondary outcomes 
86 
 
Child behaviour problems 
Child and Adolescent Behaviour Inventory [28] 
 
13 
 
Child prosocial behaviour 
Prosocial Behaviour Scale [41]  
16 
 
Risk behaviour 
Adapted from Risky Behaviour Scale [42] 
9 
 
Child mental health 
Moods and Feelings Scale [34, 35] 
13 
 
Parental monitoring 
Parental Monitoring Scale [26] 
Global Kids Online [27] 
10 
6 
 
Neglect 
ISPCAN Child Abuse Screening Tool-Intervention 
[21] 
3 
 
Family functioning 
Burmese Family Functioning Scale [38] 
23 
 
Witnessing family violence 
ISPCAN Child Abuse Screening Tool-Intervention 
[21] 
2 
 
Witnessing and exposure to 
community violence 
Violence Exposure Scale [43] 
12 
 
Parent support of education 
Parent Support of School Scale 
6 
 
Educational aspirations 
Aspirations and expectations 
2 
 
Process evaluation outcomes 
20 
 
Satisfaction/acceptability 
Teen overall satisfaction 
20 
 
Acceptability and feasibility 
Teen FGDs 
n/a 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
23 
C.4 Process data collection 
a) Quantitative process evaluation 
1. Implementation fidelity 
Implementation fidelity by program facilitators of the MaPa program will be measured using self-report 
checklists by program implementers will examine the extent to which core intervention components are 
delivered. These checklists will include specific activities for each session, such as home practice discussion 
and role-playing exercises. Then, in order to produce a basic level of fidelity, a ratio of program 
implementation to program design will be created for both self-report and observational scores [44]. According 
to Borrelli and colleagues, a standard of 80% program fidelity will be considered as “high treatment fidelity” 
[45]. 
2. Quality of delivery 
Quality of delivery will be assessed using the Parenting for Lifelong Health Facilitator Assessment Tool (PLH-
FAT) [40]. The PLH-FAT was developed by the study investigators and program developers to assess the 
proficiency of program delivery by facilitators as a prerequisite to certification. Seven standard behavior 
categories are grouped into two scales based on the core activities (23 items) and process skills (28 items) as 
outlined in the program manual [5]. Assessment of core activities includes quality of delivery during home 
activity review (14 items, e.g., “identify specific challenges when shared by at least one parent”), illustrated 
story discussion (7 items, e.g., “discuss possible solutions for negative stories”), and practicing skills (10 items, 
e.g., “debrief with the participants about experience and feelings”). Assessment of process skills includes 
modelling skills (6 items, e.g., “give positive, specific, and realistic instructions”), collaborative facilitation 
approach (5 items, e.g., “accept participant responses verbally by reflecting back what the participant says”), 
encouragement of participation (7 items, e.g., “participants appear comfortable and involved in session”), and 
leadership skills (6 items, e.g., “use open-ended questions during group discussions”). 
3. Program adherence 
Program adherence will be assessed by examining rates of enrolment, attendance, dropout, completion, and 
engagement of home activities. Enrolment rates will be based on the ratio of those completing baseline 
assessments to those who attend at least one session. Mean attendance rates for enrolled participants will be 
determined based on the ratio of number of attended sessions to the total number of program sessions. Dropout 
rates for enrolled participants will be defined as the percentage of participants who fail to attend at least three 
consecutive sessions and do not attend any sessions at a later stage. Completion rates for the entire allocation 
group will be determined based on the number of enrolled participants who attend a cut-off threshold of at 
least 66% of the program [46].  
4. Participant satisfaction 
Participant satisfaction will be examined for families who attend at least one session of the MaPa program 
[47]. Mean and standard deviation scores will be reported for the overall participation satisfaction scale (40 
items), as well as for subscales (i.e., whether the program fulfilled their expectations, acceptability of delivery 
and teaching methods, acceptability of theoretical parenting techniques, and evaluation of program 
facilitators). Responses will be based on a 5-point Likert scale (1 = Very unhelpful; 5 = Very helpful). 
b) Qualitative process evaluation 
 
5. Program acceptability and participation 
The study will conduct qualitative focus group discussions (FGDs) with all parents/caregivers who participated 
in the program (n = 4 FGDs; 15 participants per FGD), adolescents who participate in the program (n = 2 
FGDs; 15 participants per FGD), and facilitators and coaches who deliver the programs (n = 2 FGDs; 5 
participants per FGD).  
Qualitative data collection will occur after program delivery. All data collection instruments will be translated 
into local languages, and the translations checked by back-translation. Ateneo de Manila researchers assisted 
by trained research assistants will conduct all of the interviews and FGDs with parents, adolescents and service 

MaPa Feasibility Study– Appendix 1. Study Protocol 
24 
providers in local languages. FGDs will last approximately 120 minutes and occur in local community centers. 
Interviews will last 60 minutes and occur onsite at the community centers or in participant homes as 
appropriate. Participants will be provided lunch and transportation to focus groups.  
Interviews and focus groups will occur during the post-evaluation and examine the following themes:  
1. Participants observed change in parent-child relationships at home during program;  
2. Cultural acceptability and appropriateness of program materials, delivery, and key program 
components; and  
3. Existing barriers to participation during sessions and engagement in home practice and other activities.  
Focus groups and interviews will be captured on digital recorders with written notes as a backup. All equipment 
will be tested onsite prior to use. Data will be transcribed verbatim and will be translated into English and 
back-translated into local languages to verify accuracy.  
C.5 Process data analysis 
Qualitative process data analysis 
Qualitative data analysis will explore views and experiences of participants and facilitators using a thematic 
analysis approach with open, axial, and selective coding. Two independent raters will assess and code data 
from focus group transcripts. The study will investigate emergent themes regarding 1) participants observed 
change in parenting practices and child behavior at home during program; 2) acceptability and appropriateness 
of program materials, delivery, and key program components; and 3) existing barriers to participation during 
sessions and engagement in home practice and other activities.  
Quantitative process data analysis 
Quantitative process data will also be analyzed to assess: 1) implementation fidelity, recruitment, and retention; 
and 2) cultural and contextual relevance, including acceptability and satisfaction. These assessments will rely 
on self-reports by parents/primary caregivers, weekly facilitator self-report checklists, program session 
attendance registers, and data from outcome evaluation questionnaires. Analyses will be conducted using SPSS 
25.0 or STATA 14.2. 
Implementation fidelity will be analyzed by examining data from the facilitator self-report checklists. In order 
to produce a basic level of fidelity, a ratio of program implementation to program design will be created for 
both self-report and observational scores [44]. According to Borrelli and colleagues, a standard of 80% 
program fidelity will be considered as “high treatment fidelity” [48] 
Program adherence will be measured through assessments of rates of enrolment, attendance, dropout, 
completion, and home activity engagement. The enrolment rate will be determined by calculating the ratio of 
those parents/primary caregivers who have been successfully recruited into participating in the feasibility pilot, 
and those who attend a minimum of one session. Mean attendance rates for enrolled participants will be 
calculated based on the ratio of the number of attended sessions to eight sessions (the total number of program 
sessions). Dropout rates for enrolled participants will be calculated as the percentage of participants who do 
not attend at least three consecutive sessions and fail to attend any further sessions. Completion rates will be 
determined based on the number of enrolled participants who participate in at least 75% of the program (six 
sessions or more).  
Participant satisfaction will be assessed using a satisfaction questionnaire administered post-intervention to 
parents/primary caregivers who have attended at least one session. Mean and standard deviation scores will be 
calculated for the overall participation satisfaction scale (45 items), as well as for the different subscales, 
including: fulfilment of participant expectations, impact on the parent/primary caregiver-child relationship, 
acceptability of delivery and teaching methods, acceptability of content themes and parenting techniques, and 
evaluation of program facilitators. 

MaPa Feasibility Study– Appendix 1. Study Protocol 
25 
C.6 Outcome data analysis 
Quantitative data analyses of the effects of the intervention will be in line with the procedures adopted by the 
PLH-Philippines study in Taguig, Philippines (ClinicalTrials.gov Identifier NCT03205449). Analyses will be 
conducted using SPSS 25.0 or STATA 14.2 in order to respond to the two main objectives of the feasibility 
pilot. For multiple imputation and pooling of estimates, the R package ‘MICE’ will be used, potentially 
together with Microsoft Excel to define inputs to the R imputation functions. Mixed models will be fitted using 
the R package ‘nlme’.  
Given that this feasibility pilot is a single-arm study and is not designed to test hypotheses about effectiveness, 
estimates of effects on primary and secondary outcomes will be reported as estimates with 95% confidence 
intervals and without P values, in line with CONSORT guidance [49]. All intervention effects will be analyzed 
using an intention-to-treat design, which includes all participants recruited into the study regardless of whether 
or not they complete the program or complete all assessment points [50]. Multiple imputations will be 
conducted at the item level in order to account for missing data [51], while Little’s Missing Completely at 
Random (MCAR) test with an expectation maximization algorithm will be used for the purpose of assessing 
response rates and the randomness of missing data [52]. The Multiple Imputation by Chained Equations 
(MICE) method will also be used with a fully conditional specification and a Markov Chain Monte Carlo 
(MCMC) algorithm with 10 maximum iterations; based on the assumption that the tolerance for a preventable 
fall in power will be low, a total of 20 multiple imputed datasets will be used in this process [53]. Furthermore, 
in order to prevent a violation of the assumption of independence underlying common statistical methods, data 
analysis will consider within-group correlation by calculating intra-cluster correlation coefficients within the 
sample to measure the level of dependency of outcomes for members in the six parenting groups [51]. 
Effects on primary and secondary outcomes will be analyzed using the instruments described in Table 2. 
Internal consistency with means and standard deviation will be calculated for each measurement at baseline 
and immediate post-intervention. However, given that it is affected by the number of scale items, item inter-
correlations, and dimensions within scales, it will be noted that Cronbach’s alpha will only provide a limited 
assessment of reliability [54]. 
Paired t-tests and chi-square crosstab analyses will be used to compare differences between means for all 
outcome measures. Pearson’s r, means, standard deviations, standard errors, confidence intervals, and Cohen’s 
d will be reported. 
Construction of outcome variables 
A select number of composite scores will be constructed and analyzed, with each score consisting of the sum 
of measurements for several individual items that are either all continuous (Likert) scales or dichotomous 
responses. Some items will be reverse coded prior to summation, as appropriate. These scores will provide the 
primary and secondary outcomes for this study, with each outcome comprising a baseline measurement 
collected during the baseline interview, and a post-intervention measurement collected one month following 
the end of the intervention. In the primary analysis, each outcome will be separately assessed. In order to test 
reliability, Cronbach’s alpha will be calculated for each score, with scores constructed from individual items 
within the data imputation process (described below). 
Preliminary data exploration 
Using descriptive statistics, baseline family, household, socioeconomic, and outcome variables will be 
described. Summaries of baseline characteristics will be reported for each group, along with data variability 
and average values for continuous variables [55]. For normally distributed outcome data, continuous variables 
will be summarized by observed mean and standard deviation; for data with skewed distributions, continuous 
variables will be described using the median and inter-quartile ranges. Categorical variables will be described 
using frequencies and proportions. Characteristics will be summarized and stratified according to whether 
subjects were lost to follow-up.  
Treatment of missing data 
Multiple imputations will be used at the outset to create multiple, plausible ‘complete’ datasets, which are then 
analyzed using a likelihood-based imputation model (described below). The pooling of the final results (the 

MaPa Feasibility Study– Appendix 1. Study Protocol 
26 
estimated effect sizes) from the multiple ‘complete’ datasets will account for the imputation process (discussed 
below under ‘Data analysis: Estimation of effect sizes.’) 
The multiple imputation of missing data will follow these steps: 1) inspection of the missing data; 2) 
application of the imputation model to create multiple ‘complete’ datasets; 3) Assessing convergence of the 
imputation model and checking the imputations. In addition, two sensitivity analyses will be conducted. 
Inspection of data 
The patterns of missing data will be examined and reported, including calculations of the frequencies of 
different patterns of missing data, and the plotting of the distributions of key variables stratified by whether 
other variables are missing. 
Imputation model 
The covariates to be included in the analysis are arm (control or intervention), sex (child and parent/primary 
caregiver), and age (child and parent/primary caregiver). If any outcome data is missing, the MICE method, 
also known as Fully Conditional Specification (FCS), will be used for imputation. MICE is used under the 
assumption that the variables used in the imputation procedure are Missing at Random (MAR), which means 
that the probability of observations being missing depends only on the observed data, but not on the underlying 
values of the incomplete variable [56]. MAR allows values for missing observations to be predicted using 
patterns found in the observed observations. A series of regression models will be run in which each variable 
with missing data is modelled conditional on other variables in the data; each variable is modelled according 
to its distribution, with binary variables modelled using logistic regression [51] and Likert-scale variables 
modelled using predictive mean matching (PMM) [57]. This is an iterative process that uses MCMC 
techniques. 
The imputation model will be able to address one or more of the following reasons for which a subject may 
have missing outcome data: 
1. The subject was lost to follow-up, resulting in no post-intervention measurements; 
2. The subject did not provide all data on all items to construct a specific score (at baseline, post-
intervention, or follow-up); and 
3. The subject did not provide data for a subset of items that contribute to a specific score (at baseline, 
post-intervention, or follow-up). 
For the purpose of ensuring that the imputation model does not change when follow-up data is analysed, only 
data collected at the same time point or at earlier time points will be used to impute missing values. When 
imputing values for a particular variable, the following predictors will be used: 
• 
Child sex (male or female); 
• 
Parent/primary caregiver sex (male or female); 
• 
Module (2-9 years, 10-17); 
• 
All other items used to construct the specific score at the same time point (baseline, post-intervention, 
or follow-up); 
• 
All items used to construct the same specific score at baseline, if there is an earlier time point; 
• 
Other scores falling into the corresponding group of scores, at that time point and any earlier time 
points; and 
• 
All remaining primary and secondary scores at that time point and any earlier time points. 
In the case of dichotomous variables, a dichotomous predictor will enter the imputation model as a 
dichotomous categorical variable, while Likert-scale predictors will enter as continuous variables. Flat-file 

MaPa Feasibility Study– Appendix 1. Study Protocol 
27 
imputation will be applied to the 2 assessment points during the feasibility pilot. For flat-file imputation, a 
particular item/score which is measured at each time point will be included as separate variables, rather than 
as measurements of the same variable. If there is evidence of a group effect, the approach for including Group 
will be explored during the implementation of the imputation model (as a fixed effect categorical variable, 
random effect in a mixed effects regression model, or through data stratification). In the event that the size of 
the imputation problem becomes too large (which may exceed available computer resources or result in 
multicollinearity due to instabilities), the process will be simplified and the number of predictors will be 
reduced. 
Self-reported and observed outcomes will be imputed separately. In addition, a random number generator will 
be used to initiate the imputation model. 
Assessment of convergence and checking imputations 
Plots of summary statistics (mean and standard deviation) of the imputed measurements by iteration number 
per variable will be used to identify model misspecifications and determine whether the number of iterations 
is sufficient. Plots of variable distributions, both observed and imputed, will also be generated. 
Sensitivity analyses 
In order to examine the sensitivity of results to the assumptions of the imputation model, two alternative 
imputation approaches will be conducted. The first will also adopt a MAR assumption, but will alter the 
underlying imputation model form. The second sensitivity analysis will extend the aforementioned multiple 
imputation model to encompass the assumption that data is Missing Not at Random (MNAR), meaning that 
the probability of observations being missing is systematically related to the hypothetical values that are 
missing [56]. 
For the main imputation model and each of the two alternative approaches, the effect size of interest and 
statistical uncertainty will be estimated. 
Data analysis: Estimation of effect sizes 
Given that the main focus of the pilot is to test the feasibility of the adapted parenting program content and 
study procedures in preparation for a RCT, and consists of a single-subject pre-post design with no control 
group, the estimation of differences between pre- and post-intervention scores will only be exploratory in 
nature. 
Prior to fitting models to the data, the observed changes in measurements from baseline to post-intervention 
will be described. For each outcome, the average differences across subjects between post-intervention and 
baseline scores will be calculated with a 95% confidence interval and without P values [55]. 
Each of the outcomes will be analyzed in turn. The analysis using the substantive model will be applied to 
each of the imputed or ‘complete’ datasets; thus, the analysis is described below in terms of a single outcome 
and a single dataset. Despite the fact that each item in the dataset is categorical in nature, the composite score 
(the outcome to be analyzed) is constructed as the sum of a number of individual items. Therefore, the pseudo-
continuous outcome will approximately follow a conventional parametric distribution and be normally 
distributed, allowing parametric regression to likely be used for data analysis. The distribution of the outcome 
will be visually assessed. 
Paired-samples t-tests will be conducted to examine whether there are mean differences between pre- and post- 
tests.  A paired-sample t-test is appropriate for comparing means when those means are from the same entities, 
and assumes a normal distribution or a curve that is bell shaped and symmetrical [58].  First, to correct the 
repeated-measures error bars in SPSS, the average scores for each participant and each outcome will be 
calculated, followed by the calculation of the grand mean of all scores. In order to equalize the means between 
participants, an adjustment factor will be calculated by subtracting each participant’s mean score from the 
grand mean. Next, adjusted values for each variable will be calculated in order to eliminate any between-
subjects differences. 
Paired-samples t-tests will then be conducted, with the means, standard error, confidence interval, t test 
statistic, significance level, and Cohen’s d reported for each outcome. 

MaPa Feasibility Study– Appendix 1. Study Protocol 
28 
Pooled parameter estimates will be calculated by averaging the multiple imputed datasets. In secondary 
analyses (as discussed below), effects sizes by sex and age group will be reported. The appropriateness of the 
model assumptions and fit will be assessed using the plots of standardized residuals against the fitted values 
(and covariates) and histograms of the residuals. Model fit will be examined using one of the multiple imputed 
datasets per outcome. 
For each outcome, analyses will be performed on multiple imputed or ‘complete’ datasets, which will result 
in multiple effect sizes estimates. Pooled effect size estimates and confidence intervals (which account for 
variability arising from imputing the missing data), will be calculated using Rubin’s rules [59]. 
C.7 Data management 
All non-electronic data including signed consent forms, transcripts from FGDs and quantitative paper 
questionnaires will be stored in a locked filing cabinet at the Bulatao Center at Ateneo de Manila University. 
Digital recordings of FGDs will be copied onto an external hard drive and also kept in this locked filing cabinet. 
All data collected on CASI tablets will be encrypted as soon as the questionnaire is finalized (i.e., completed 
by interviewer) and accessible only by senior research personnel. Access to general functioning of the tablets 
will be password protected, and each tablet will have a GPS tracking application installed and activated. This 
application will allow for remote deletion of all information on the tablet in case of theft. Tablets will be stored 
in a locked cabinet at the Bulatao Center office every week, which is under 24-hour security protection. 
The study will use two methods to upload and store data at the end of each day of data collection. First, the 
CASI tablets will transmit encrypted data using a 256-bit encryption via wireless networks to the study’s Open 
Data Kit server (www.opendatakit), which will be housed at a central server managed by the University of 
Oxford’s Information Technology Services. Only senior research personnel will have access to this server (PIs, 
co-Is, and data management consultants). It has a robust security system with firewalls and frequent backing 
up of all data. Transmission will occur on a daily basis from the Bulatao Center site, which will have a reliable 
3G wireless network (i.e., not dependent on electric power), and the local research manager in the Philippines 
will manually upload data from tablets onto a local server on a daily basis. This local server will also be 
password protected and serve as a backup of the central server system. Once data is uploaded onto the local 
server, it will be erased on a daily basis so that no information remains on the tablet.  
Data cleaning will be conducted at the end of each data collection phase. Individual datasets from the baseline 
and post-test evaluations will be stored separately from the final merged dataset, so that data reference points 
are available in the data validation process.  All electronic data, including transcripts of qualitative data as well 
as quantitative data, will be stored on at least two servers, each of which will be accessible by a password 
known only to members of the research team. Thus, data will be protected from both server failure and 
confidentiality breaches.  Video recordings will be stored on a password-protected hard drive in a locked 
cabinet for a minimum of 5 years with access only to authorized members of the research team. Non-electronic 
data (for instance, signed consent forms) will be stored in a locked filing cabinet.   
Non-anonymized paper data will be kept for 3 years in a locked storage cabinet at the Bulatao Center at the 
Ateneo de Manila University after which it will be shredded and disposed of by the lead researchers. 
Anonymized data will be stored using United Kingdom Data Archive standards (www.data-
archive.ac.uk/create-manage/planning-for-sharing). Anonymizing data will include removal of direct 
identifiers (names, addresses, postcode information, telephone numbers or pictures) as well as indirect 
identifiers (information on location, occupation or any other information that could be linked to a public 
source). This will include removing or aggregating variables or reducing the precision or detailed textual 
meaning of a variable in the dataset. Access to this data will be controlled and require authorization from the 
research team for further use. 
D. Consequences of participation/ethical considerations  
D.1 Research ethics 
Ethical approval 
Ethical approval will be obtained from the respective research ethics committees and/or institutional review 
boards from the following institutions prior to inception of the study: University of Oxford Central University 

MaPa Feasibility Study– Appendix 1. Study Protocol 
29 
Research Ethics Committee, the Ateneo de Manila University’s Research Ethics Committee, and the 
University of Cape Town Department of Psychology’s Research Ethics Committee. 
Informed consent procedures for parents and adolescents 
Trained interviewers supervised by the research team will conduct informed consent procedures at either 
community centers or in the family households. Information sheets will be read to participants in Filipino to 
prevent illiteracy from hindering a participant’s understanding about the methods and purpose of the study. 
All participants should be capable of giving their own consent, and we will not include any participants that 
are deemed incompetent. Special care will be taken to ensure that all participants are fully aware of and 
understand the research. 
The informed consent process involves presenting a detailed verbal and written description of the study as it 
is described on the printed information and consent forms. Staff will emphasize that participation is voluntary 
for adults, and that participants can refuse to participate in either the intervention or research and/or can 
discontinue participation at any time without penalty, including their ongoing participation in the Department 
of Social Welfare and Development’s 4Ps program. Interviewers will ask whether any participants have 
experienced any coercion to take part in the study; those that describe any pressure or coercion to participate 
will be excluded, and any other household members will also be excluded. Potential subjects will receive an 
item-by-item reading of the consent form by the study interviewer.  
Participants will be informed of the procedures for ensuring their confidentiality, including: the use of unique 
non-personally identifying ID numbers instead of names on research materials, the video recording of sessions 
(and permission to refuse being recorded with no penalty to participation in either the program, study, or 4Ps), 
and maintenance of electronic and non-electronic data in locked computer databases and in locked filing 
cabinets in locked rooms. Tracking and contact procedures for scheduling follow-up interviews will be 
explained. Participants will be reminded that they may receive information regarding health or social services 
without participating in the study. All participants will be given the contact numbers of the co-PIs to answer 
questions about the study or one’s rights as a human subject, as well as a 24-hour site contact number. All 
consenting and assenting participants will be offered a copy of the informed consent form.   
Participants may consent to participate only after having the information sheet been read to them and there has 
been an opportunity for questions. The research team will assure that they are fully informed about the study 
and have had the chance to ask any questions that might have arisen. 
Participants will have the opportunity to consider consent for up to a week, before interviewers return for the 
baseline assessments. However, when we have previously offered participants periods of 24 hours to 1 week 
to consider consent, the vast majority have actively requested to participate immediately. In light of this, we 
propose that participants are offered the choice of whether to consent or refuse immediately, or to have 1-7 
days to consider whether they choose to consent. 
Informed consent procedures for facilitators and coaches will be similar to those described above for parents.  
A random subset of informed consent procedures will be reviewed by senior research personnel. 
Informed consent procedures for parenting experts 
Informed consent for parenting experts will follow a similar procedure as above. Potential Working Group 
members may consent to participate only after being provided with a written copy of the information sheet in 
Tagalog or English according to their preference, and having an opportunity to ask questions prior to the first 
focus group discussion. Participants will have the opportunity to consider consent for up to a week, before the 
research team will contact them to ask about their interest in joining the Working Group. The participant and 
the co-Investigator, Joscon, will then sign the Participant Consent Form on the same date prior to the start of 
the first Working Group discussion. However, when senior members of the research team have previously 
offered study participants periods of 24 hours to one week to consider consent, the vast majority have actively 
requested to participate immediately. The research team will ensure that participants are fully informed about 
the study and have had the chance to ask any questions. 

MaPa Feasibility Study– Appendix 1. Study Protocol 
30 
All participants will be informed that they have the right to decline to participate and to drop out at any time. 
They will also be informed that all the points made during Working Group discussions will remain confidential 
and only reviewed by the research team, unless information is shared that a child (person under aged 18) has 
been seriously harmed or is at risk of serious harm. In the event of such a disclosure, the research team will 
consult with one another and decide on an appropriate course of action in line with the 2003 Child Protection 
Act.  
It will also be explained to participants that participation in the study will not be related to any future potential 
funding opportunities from the donor.  
Prior to the submission of reports and manuscripts for publication, the research team will consult with each 
Working Group member as to whether his/her role in the project can be specifically acknowledged by name 
and affiliation. Members will have the option to remain anonymous 
Confidentiality 
All precautions will be taken to ensure confidentiality for all participants. Participants will be given an 
individual research identification number to assure that their personal names are not disclosed. Research 
assistants will not be able access information from the electronic tablets as soon as they have completed and 
finalized the questionnaires. The electronic tablets will be password protected with the capability to remotely 
erase all data stored on them in the event of theft. Electronic data will be stored on a secured, password-
protected, and encrypted server accessible only the principal investigators. Finally, all assessment data will be 
anonymized prior to statistical analysis. 
Other ethical issues 
We recognize that answering long surveys can potentially be a burden to research participants as well as have 
an adverse effect on the accuracy of self-report data [60]. We have estimated that each visit will last 
approximately 90 minutes per respondent. At approximately halfway through the assessments, we will offer 
participants the opportunity to stretch and take a break from answering questions during which refreshments 
will be provided.  
Computer Assisted Self-Interviewing (CASI) methods have also been shown to reduce respondent burden 
while improving the efficiency and accuracy of data collection. The CASI technology was shown to: have a 
high degree of acceptability to research assistants and participants; decrease data collection time; and be more 
accurate than paper questionnaires [61]. 
Ethical issues regarding staff 
All staff will be experienced in working on community research projects in the same or similar communities 
to the one in our study.  Nevertheless, it is important to secure the mental wellbeing of interviewers and other 
research staff as well as mitigate any potential harm caused by working on the study. Thus, it is one of our 
utmost priorities. We will ensure that all research assistants are trained in awareness and safety measures. Staff 
will not undertake assessments in any situation in which they feel uncomfortable or unsafe, and are encouraged 
to travel in pairs in areas that are less safe.   
In addition, we are aware that research with vulnerable families can result in increased stress due to the 
disclosing of difficult personal information and the demands of meeting deliverables. We will also conduct 
weekly debriefing meetings with research personnel to discuss any potentially distressing events that may have 
occurred during data collection. Staff will also participate in one-on-one reviews at the end of each data 
collection wave to assess their performance and psychological needs. The local investigator, Dr Alampay, is 
trained in providing psychological support and counselling. 
D.2 Potential of harm 
The focus of this study is to strengthen and evaluate the impact of a community-based parenting program. We 
believe that the overall potential benefits of the research and intervention in reducing the risk of child 
maltreatment and improving family wellbeing will outweigh potential risks of harm against participants. 
Nevertheless, we must consider two levels of potential harm: participation in the study and participation in the 
intervention.  

MaPa Feasibility Study– Appendix 1. Study Protocol 
31 
Potential harm from the study 
It is important to consider potential harm from participation in the study, no matter how small. There is a 
possibility that the opportunity to discuss parenting and parent-child relationships during FGDs may prompt 
distress in the respondents [62].  
This study has an obligation to plan for the possibility of participants becoming distressed during FGDs. All 
interviewers will be trained and experienced in working with vulnerable families. The research team will 
include a qualified doctor (Dr Madrid) skilled in paediatrics, child health, public health, and community health 
as well as qualified psychologists (Dr Alampay, Dr Jocson) who will be able to discuss or supervise discussion 
of any issues with participants following the interviews. If there is a need for a participant to access more 
extensive support (such as seeing a counsellor or attending a clinic) referrals will be made. This includes 
support from the Department of Social Welfare and Development, Ateneo Bulatao Center, UP-PGH Child 
Protection Unit, and Philippine Ambulatory Pediatric Association (Please see appendices for child protection 
protocol). 
All research personnel will be trained in ethical procedures and protocols concerning research with human 
subjects. During the consent stage, we will inform all participants that everything said will be confidential 
unless it becomes clear that they are at risk of significant harm or of putting anyone else at risk of harm. We 
will also inform participants that they do not have to answer any questions that they feel uncomfortable with 
and that they can stop the interview at any time without any negative consequences. In the case of participants 
not completing the baseline assessment, they will be excluded from the study. 
Disclosure of harm 
There is the possibility that participants may disclose harsh parenting practices that would reflect potential 
abuse or neglect of children. This study recognizes that researchers have a responsibility towards children who 
may be at risk of abuse or neglect or any other risk of severe harm. It is to be noted that it is an ethical principle 
to provide help for children whom the research identifies as in need.  
As a result, the following protocol is proposed to mitigate any potential harm to children or adults that might 
occur during the study: 
1. If information is disclosed that suggests that any member of the household is at risk of significant 
harm, the researcher will discuss concerns with the respondent at the end of the interview; 
2. If the household member at risk of harm is a child, the researcher will discuss with the parent the 
possibilities for referral to child welfare, health organizations, and other services; 
3. If the harm is considered to be significant, the research staff will inform local child protection services 
via the DSWD;  
4. If severe abuse is disclosed in data collection, children will be immediately referred to social or 
medical services and the participant will be automatically excluded from the study; 
5. If the decision is made to act, the participant(s) will be informed and referral will be made (Please see 
attached draft referral form); 
6. All staff will also receive additional training from the research team on how to respond to these 
situations in alignment with the study’s referral protocols; 
7. Weekly supervision meetings with all field interviewers will allow discussion of issues that arise 
concerning harm to research subjects and children; 
8. Finally, if we determine that respondents or their families have experienced significant harm as a result 
of participation in the research study (i.e., severe abuse, suicidality, intimate partner violence, or other 
potential psychological or physical injuries), we will cease further activities until these issues can be 
addressed adequately. 

MaPa Feasibility Study– Appendix 1. Study Protocol 
32 
Consistent with the abovementioned protocols, the informed consent form will indicate that relevant 
information may have to be disclosed without respondents’ consent if the participant or a household member 
poses a serious danger to the self or to others, or if there is evidence to suggest child abuse or neglect (See 
Appendices 11 and 12 for Child Protection Protocol and Referral Form). 
There is the possibility that participants may disclose harsh parenting practices that would reflect potential or 
actual abuse or neglect of children. This study recognizes that researchers have a responsibility towards 
children who may be at risk of or experiencing abuse or neglect, or any other risk of severe harm. It is to be 
noted that it is an ethical principle to provide help for children whom the research identifies as in need.  
All staff will also receive additional training from the research team on how to respond to these situations in 
alignment with the study’s referral protocols. Weekly supervision meetings with all field interviewers will 
allow discussion of issues that arise concerning harm to research subjects and children. If the research team 
determines that respondents or their families have experienced significant harm as a result of participation in 
the research study (i.e., severe abuse, suicidality, intimate partner violence, or other potential psychological or 
physical harm), activities will be stopped until these issues can be adequately addressed. 
D.3 Mitigating potential harm from the parenting modules 
We have also considered the potential risk of harm from participating in the intervention, and will be 
monitoring this throughout the project [63]. There may be potential psychological harm as a result of 
participation in the parenting program as a result of bringing up difficult experiences in caregivers’ own 
childhoods or confronting intimate partner violence at home. However, decades of research on parenting 
interventions, including many randomized trials in LMICs [64], have not shown any evidence of harm from 
these interventions with plenty of evidence of benefit for parents and children, and high parent satisfaction. As 
a result, this study will be explicitly looking at potential benefits and risks of the parenting programs on both 
children and parents. Our statistical analyses plan will use two-tailed tests for differences between groups to 
examine potential negative and positive intervention effects. We will also monitor research subjects to assess 
whether participation in the intervention is placing any individuals at potential risk of harm. In addition to 
post-test assessments, monitoring will occur at specific time points when we are also monitoring 
implementation fidelity.  
We do not anticipate any direct harm as a result of withdrawing from the intervention. Participation in the 
program will be completely voluntary with no direct penalties for refusing to participate. Furthermore, there 
is no evidence of harm from termination of parenting interventions in numerous other trials, including a 
number of evaluations in other low-resource settings [64]. Finally, if there is any indication of significant harm 
from either intervention condition at post-test, we will cease implementation of the program until harm has 
been adequately addressed and the programs have been adapted accordingly.  
D.4 Self-referral for participants 
In addition to our rigorous referral procedure described above, we will provide a self-referral document 
detailing available services to all participants as part of the informed consent stage as suggested. This 
information will include services for family and child support, substance use, gender-based violence and rape, 
child abuse and protection, physical, mental, and sexual health, government financial support, and contact 
details for available helplines. Self-referral forms will also be available during subsequent assessments at the 
request of participants. We will also provide up-to-date information regarding self-referral services at the end 
of the final wave of data collection. 
D.5 Benefits  
Adult participants will be offered a gift card (PHP 500 or approximately £7 per participant) after baseline and 
again after post-intervention assessment. Child participants will receive a token worth PHP 200 (approximately 
£3 per participant) after baseline and again after post-intervention assessment. Refreshments (i.e., juice/soda, 
tea, sugar, and bread) will be provided during data collection. All participants will receive a certificate of 
completion at the end of the program. Any participant who chooses to leave the study early will also receive a 
certificate stating how many sessions s/he attended. Participants of focus group discussion will be offered 
refreshments (i.e., juice/soda, tea, sugar, and bread) during the sessions. 

MaPa Feasibility Study– Appendix 1. Study Protocol 
33 
Facilitators and coaches will be provided with a daily fee as confirmed through a written contract with you. 
The daily fee for facilitators will be PHP 2,500 and PHP 3,000 per day for coaches. Participants will also be 
reimbursed for transportation costs to the parenting programme venue and focus group discussion.   
D.6 Access to data 
Only the Principal Investigators (Lachman and Alampay) and Co-Investigator (Jocson) will have access to raw 
datasets. Access to cleaned, anonymized datasets will be provided to the other investigators. Anonymized 
datasets will also be stored online with password protection. 
 
 

MaPa Feasibility Study– Appendix 1. Study Protocol 
34 
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