Evaluating health-promoting parenting programs for migrant families

<p dir="ltr">Background: For many immigrant families, the journey doesn't end at the border. While recently settled families often demonstrate considerable resilience, navigating life in a new culture can be highly stressful, placing immense strain on their well-being. These stressors, combined with the challenges experienced by all parents to adolescents due to the intensive development phase that young people go through, highlight the need of support for immigrant families. Parenting support programs are well- established tools for promoting positive parenting and youth well-being. However, programs tailored for underserved groups, such as migrants, remain limited. There is a particular scarcity of culturally sensitive programs aimed at strengthening parents' resilience early in the resettlement process and delivered in the parents' native language.</p><p dir="ltr">Aim: The overall aim of the thesis was to provide an overview of existing health-promoting and preventive parenting interventions for forcibly displaced families. Informed by these previous interventions, and by parents expressed needs, the thesis also aimed to develop and evaluate a new brief, resilience- focused parenting program delivered in mother tongue for recently settled immigrant parents of adolescents in Sweden. Study I systematically evaluated available empirical knowledge regarding the efficacy of health-promoting and/or preventive parenting programs for forcibly displaced families. Study II explored the experiences and challenges of newly settled parents of adolescents to inform program development. Study III piloted the newly developed program, assessing its feasibility, acceptability and preliminary effects. Study IV evaluated the program's effectiveness for recently settled immigrant parents. Study V explored parents' perceptions of the program.</p><p dir="ltr">Methods: A mixed-methods approach guided the thesis with both qualitative and quantitative components. Study I is a systematic review and meta- analysis of parenting interventions for forcibly displaced families. Study II is a qualitative study were 28 recently settled refugee parents were interviewed in native language regarding their experiences of coming to Sweden. Study III is a mixed-method pilot study combining quantitative self-reports with qualitative data from leader interviews and session reports. Study IV is a cluster randomized controlled trial involving 130 parents (90 intervention, 40 control), analyzed using Latent Change Models. Thereafter 17 parents who had participated were interviewed about their experiences (Study V).</p><p dir="ltr">Results: Study I found growing research interest in parenting programs for forced migrant families. A total of 20 publications were included, showing that parenting interventions led to reduced externalizing behavior in children and improved parenting strategies, self-efficacy, and parental mental health. However, there was high heterogeneity, and more high-quality studies are needed to identify effective components and optimize interventions. Study II highlighted refugee parents' strengths and motivations, with language emerging as a central theme for integration and navigating parenthood in the new cultural context. This theme encompassed four categories: "parents' motivation and hope as driving forces," "navigating between past and present cultures and values," "loneliness as a risk factor," and "a new way of parenting and relating to the acculturation gap." A culturally sensitive parenting program should acknowledge and validate bicultural experiences, strengthen parental self- efficacy, and offer alternative strategies that align with both protective factors for child development and the sociocultural realities of the host context. Study III showed that the program was feasible and acceptable, with cultural bridging and relationship-building being crucial. Preliminary effects were observed in parents' ability to provide a safe haven for their adolescents, as well as in their increased sense of societal belonging. The integration of quantitative and qualitative findings suggested that the parenting program was a space where parents could explore new parenting strategies, engage in discussions and openly talk about challenges. Study IV demonstrated the program's effectiveness in improving parental resilience and self-efficacy in supporting the child's schooling. Notably, parents who entered the program with greater difficulties experienced significantly greater advances compared to those starting from a more favorable position. The program was well received, and parents expressed a strong willingness to recommend it to other parents. Study V confirmed that the program was both well accepted and effective in strengthening parental self-efficacy. The categories included learning about the new society, balancing cultural contrasts, enhancing general parenting skills, and recognizing both barriers and facilitators - such as fear of social institutions and the value of social support. The program's cultural sensitivity, in both its design and delivery, appears to be essential to its perceived value and acceptability among participants.</p><p dir="ltr">Conclusions. In summary, parenting programs for migrant families represent a growing research field yet remain an underutilized resource in contemporary societies. Recently settled parents often demonstrate remarkable resilience and motivation during the resettlement process, while also encountering challenges in adapting to new cultural contexts. This new, brief, and culturally sensitive parenting program shows promise as an empowering intervention for immigrant families with adolescents, in the face of an often stressful post- migration reality. With thoughtful implementation and continued research, such programs can serve as important tools in promoting family resilience and advancing equity in health promoting interventions globally.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Västhagen, M.</b>, Giles, CJ., Hollander, A-C., Ghaderi, A., Van Leuven, L., Edenius, A. & Enebrink, P. The efficacy of parenting interventions for forced migrant families on child internalizing and externalizing symptoms, parental self-efficacy, and parental competence: A systematic review and meta-analysis. Transcultural Psychiatry. [Accepted]</p><p dir="ltr">II. <b>Västhagen, M.</b>, Özdemir, M., Ghaderi, A., Kimber, B., Giles, CJ., Bayram Özdemir, S., Oppedal, B., & Enebrink, P. (2022). Refugee parents' experiences of coming to Sweden: A qualitative study. International Journal of Intercultural Relations, 91, 97-109.<br><a href="https://doi.org/10.1016/j.ijintrel.2022.08.010">https://doi.org/10.1016/j.ijintrel.2022.08.010</a><br><br></p><p dir="ltr">III. <b>Västhagen, M.</b>, Özdemir, M., Kimber, B., Ghaderi, A., Place, V. & Enebrink, P. (2025). A brief universal parenting program for recently settled immigrants in Sweden: a feasibility study. [Submitted].</p><p dir="ltr">IV. <b>Västhagen, M.</b>, Enebrink, P., Kimber, B., Ghaderi, A., Bayram Özdemir, S., Oppedal, B. & Özdemir, M. (2025). The Effectiveness of a Universal Parenting Program for Immigrants in Sweden: A Cluster Randomized Controlled Trial. [Submitted].</p><p dir="ltr">V. <b>Västhagen, M.</b>, von Schreeb, A., Özdemir, M., Kimber, B. & Enebrink, P. (2025). A qualitative study of immigrant parents' experiences of participating in a universal parenting program in Sweden. [Submitted].</p>