Palestinian ParentText for Crisis: A Parenting Chabot in War

ParentText for Crisis: A Randomised Controlled Trial of Chatbot-Delivered Mental Health and Parenting Content For Palestinian Caregivers in Jordan

The primary aim of this research is to evaluate if ParentText for Crisis helps improve the following outcomes among Palestinian caregivers living in Jordan: a.) Improving caregiver mental health; b.) Improving positive parenting practices; c.) Reducing violence against children

Investigators are conducting an individually randomised controlled trial (cRCT) with 250 Palestinian participants recruited from Jerash Camp. This research is an evaluation of Palestinian ParentText for Crisis in Jordan, a rule-based chatbot to provide tips to strengthen parental mental health, improve parenting practices, and help parents support children in crisis settings. This randomised controlled trial is conducted through a collaboration with the University of Oxford, Parenting for Lifelong Health (PLH), and Sanadak. ParentText for Crisis content is adapted from PLH and "Hope Groups", which is a mental health and parenting programme originally developed from PLH for war and crisis settings. Hope Groups, delivered either in-person, have demonstrated effectiveness in improving caregiver mental health and parenting practices in crisis settings among Palestinians in Jerash Camp, Jordan. This study aims to evaluate the effectiveness of delivering this mental health and parenting content via 9 chatbot-delivered lessons over WhatsApp to Palestinian families within the same camp (Jerash Camp, Jordan). The RCT includes an intervention arm consisting of individuals who are randomised to join CrisisText immediately (n=125), and a waitlist control arm consisting of individuals who are randomised to join CrisisText (n=125) in a second cohort. This is an individually randomised study, with each individual participant as the unit of randomisation. Randomisation will be deployed using the treatment_assign function in the RCT package in R.

The primary aim is to test the effectiveness of ParentText for Crisis 30-days after enrolment, using an individually randomised controlled trial design. Investigators hypothesise that CrisisText will lead to statistically significant improvements in caregiver mental health and positive parenting practices, and reductions in violence against children.

• Timeline will be as follows:
• Individuals who are randomised to the intervention arm will be invited to join an in-person onboarding session. At this session, participants will be given a trigger word to message to the chatbot's number on WhatsApp. Once participants send this message, CrisisText will guide them through informed consent, followed by a short (8 question) baseline survey. After this, the chatbot will begin delivering the first intervention session. Participants will be encouraged to complete this first session at the in-person event, then complete one addition session every day for the next 8 days.
• After the intervention arm concludes the CrisisText intervention, survey questions will appear again. (This data is for exploratory pre-post comparisons.)
• At +30 days after onboarding, the chatbot will message participants to complete a follow-up survey including the same survey questions. (This +30 days follow-up is considered trial endline.)
• During the week of the +30-day follow-up for the intervention arm, the wait-list control arm will be gathered for an in-person meeting to begin the intervention. At this in-person meeting, participants will complete informed consent and a survey. This data from the control arm will be compared with the intervention arm at their +30 day follow up for the primary trial analysis.
• Therefore, this trial's primary analysis will involve a single timepoint comparison: Estimating differences between the intervention arm at 30-day follow-up and the untreated control arm at this same calendar timepoint. To assess baseline balance in this randomised trial, investigators will compare non-time-varying participant demographic variables (e.g., age, sex, number of children) between arms. If there is imbalance, investigators will control for demographic variables in the trial analysis.

Sanadak, a charity in Jordan, will collaborate with the camp to recruit a list of 250 participants. All N=250 individuals, who indicate interested in participating, will be randomised to the intervention or wait-list control arm.

• Inclusion Criteria:
• Adult (aged >=18)
• Parent or caregiver of >=1 child
• Living in Jerash Camp, Jerash, Jordan (a refugee camp for Palestinians from Gaza)
• Have access to a phone with WhatsApp