Effectiveness and cost-effectiveness of a parenting programme to improve family wellbeing in England (TOGETHER): a multicentre, single-blind, randomised controlled trial

Background
Stark socioeconomic health inequalities exist in the UK, with families from ethnic minority backgrounds disproportionally affected. Robust evidence is needed on interventions that can improve family wellbeing. We aimed to assess the effectiveness and cost-effectiveness of a group-based parenting intervention (Strengthening Families, Strengthening Communities [SFSC]) in enhancing parental mental wellbeing.

Methods
We conducted a randomised, multicentre, waiting list controlled trial of a parenting intervention in socially and ethnically diverse urban areas in England. Participants were invited from 34 areas and were randomly assigned with an allocation ratio of 1·154:1·000 to the SFSC parenting programme or waiting list control. The randomisation sequence was made by a researcher using an online algorithm and was stratified by site, parent gender, and self-referral status. Researchers collecting outcome data and those analysing data were masked to randomisation but participants were not. Participants were any adult caregivers (aged ≥18 years) of children aged 3–18 years. The intervention was delivered in weekly, 3-h group sessions over 13 weeks. The primary outcome was parental mental wellbeing assessed with the Warwick-Edinburgh Mental Well-Being Scale at post-intervention and a 6-month follow-up. Cost-effectiveness was evaluated using a within-trial cost-utility analysis. All analyses were conducted on an intention-to-treat basis. The trial was prospectively registered (ISRCTN15194500).

Findings
Between Aug 5, 2019, and Dec 17, 2022, 1214 individuals were screened for eligibility, of whom 674 participants were randomised to the waiting list control (n=314) and to the intervention group (n=360). Most participants were women (641 [95%]; 33 [5%] men) and from diverse social and ethnic minority backgrounds (350 [52%] had a household income less than £20 000 per year and 420 [62%] from ethnic minority groups). The attrition rate at the 6-month follow-up was 30% (200 participants). Participants in the intervention group reported higher mental wellbeing at both post-intervention (mean difference 1·89 [95% CI 0·64–3·13]) and the 6-month follow-up (1·66 [0·30–3·02]) compared with the waiting list control group. The mean cost per participant attending the SFSC programme was £1081. There were three adverse events recorded, all in the control group and unrelated to the intervention.

Interpretation
The SFSC parenting programme can improve parental mental wellbeing in a diverse sample of families living in disadvantaged areas across England, with no significant increase in cost. Evidence-based parenting interventions, such as SFSC, should be implemented at scale to promote family and child health.

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