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Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities

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Abstract

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

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Notes

  1. In South Africa, the term “colored” is used to describe people of mixed-race descent as a distinct ethnic population group.

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Funding

This work was supported by grants to the following principal investigators: Lucie Cluver: European Research Council [FP7/2007-2013], the John Fell Fund [103/757], the Leverhulme Trust [PLP-2014-095], the University of Oxford’s Economic and Social Research Council Impact Acceleration Account (1311-KEA-004 and 1602-KEA-189), UNICEF Innocenti Office of Research, the South African National Department of Social Development, and the Ilifa Labantwana Fund [Cluver co-PI, Ward, co-PI; T141/79]. Jamie Lachman: the South African National Lottery [43137], UNICEF South Africa, and the Canadian International Development Agency. Jose Ruben Parra-Cardona: NIMH [R34MH087678], NIDA [K01DA036747]. Nancy Amador Buenabad: CONACYT [115150]. Bradley Evanoff: NCTAS [UL1 TR000448]. Enola Proctor NIMH [R25MH08091607]. Anilena Mejia & Rachel Calam: Medical Research Council UK [MR/P010849/1].

Author information

Authors and Affiliations

  1. Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., Stop, D3500, Austin, TX, 78712, USA

    Rubén Parra-Cardona

  2. Research Institute of Child Development and Education & Research Priority Area YIELD, University of Amsterdam, Amsterdam, Netherlands

    Patty Leijten

  3. Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK

    Jamie M. Lachman, Lucie Cluver, Jenny Doubt & Frances Gardner

  4. Complexity in Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK

    Jamie M. Lachman

  5. Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama

    Anilena Mejía

  6. George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA

    Ana A. Baumann

  7. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico

    Nancy G. Amador Buenabad

  8. Department of Psychiatry, University of Cape Town, Cape Town, South Africa

    Lucie Cluver

  9. Centre for Evidence Based Early Intervention, Department of Psychology, Bangor University, Bangor, UK

    Judy Hutchings

  10. Department of Psychology, University of Cape Town, Cape Town, South Africa

    Catherine L. Ward & Inge M. Wessels

  11. Division of Psychology and Mental Health, The University of Manchester, Manchester, UK

    Rachel Calam

  12. Regional Instituto for the Family (IREFFAM), Chihuahua, Mexico

    Victoria Chavira

  13. Department of Psychology, Utah State University, Logan, USA

    Melanie M. Domenech Rodríguez

Authors
  1. Rubén Parra-Cardona
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  2. Patty Leijten
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  3. Jamie M. Lachman
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  4. Anilena Mejía
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  5. Ana A. Baumann
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  6. Nancy G. Amador Buenabad
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  7. Lucie Cluver
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  8. Jenny Doubt
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  9. Frances Gardner
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  10. Judy Hutchings
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  11. Catherine L. Ward
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  12. Inge M. Wessels
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  13. Rachel Calam
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  14. Victoria Chavira
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  15. Melanie M. Domenech Rodríguez
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Corresponding author

Correspondence to Rubén Parra-Cardona.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The PLH 2-9 and PLH 10-17 programs were developed by Lachman, Cluver, Ward, Hutchings, Tsoanyane, Doubt, and Gardner. Intellectual property for the interventions is held under a Creative Commons Attribution-No Derivatives and Noncommercial 4.0 International Public License. Jamie M. Lachman is the Executive Director of Clowns Without Borders South Africa, the not-for-profit partner organization responsible for implementation of the programs during in this study.

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Parra-Cardona, R., Leijten, P., Lachman, J.M. et al. Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities. Prev Sci 22, 7–17 (2021). https://doi.org/10.1007/s11121-018-0935-0

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