The Parenting for Lifelong Health Caring Families programme with parents of young children in North Wales: a qualitative study of participant feedback

The Parenting for Lifelong Health for Young Children (PLH-YC) programme was originally developed as a low-cost, evidence-based parenting intervention for families in low- and middle- income countries. However, in response to reductions in early intervention service funding in the UK, the programme was piloted in two socioeconomically disadvantaged communities in North Wales. Building on quantitative feasibility findings that demonstrated high retention, strong participant satisfaction, and significant improvements in parenting practices and parental wellbeing, this qualitative study explored the lived experiences of ten parents who participated in the programme. Semi-structured interviews were analyzed using Braun and Clarke's thematic analysis approach. Three major themes emerged: learning to parent differently, creating a circle of support, and wanting more time. Parents reported increased confidence, improved emotional regulation, and enhanced relationships with their children. These findings reinforce the feasibility and acceptability of the PLH-YC programme in a UK context and align with the quantitative evidence of its positive impact internationally. Together, the UK studies indicate that PLH-YC is a promising, low-cost intervention that with further evidence has the potential to contribute to services to strengthen parenting practices in the UK for parents of children at risk of poor outcomes.

Parenting interventions have consistently been shown to improve parenting practices and reduce child behavioral difficulties, particularly when based on social learning theory approaches that strengthen positive parent-child relationships and encourage consistent behavior management strategies (Gardner et al., 2019; Hutchings et al., 2023; Reitman and McMahon, 2013; Ward et al., 2020).

Evidence from meta-analyses shows that improvements in parenting practices such as consistent, logical, and non-violent discipline, emotional attunement (i.e., accurately noticing, understanding, and responding sensitively to a child's emotional states), parental self-management skills, and positive parent-child interaction are associated with reductions in child conduct problems and emotional dysregulation (Gardner et al., 2019; Leijten et al., 2019; Sigurðardóttir et al., 2025). Parenting programmes are increasingly positioned as family support interventions as well as scalable public mental health strategies for child outcomes, particularly in socioeconomically disadvantaged contexts where the risk for child mental health difficulties and poor longer term outcomes is elevated (Hillis et al., 2016). Research examining large-scale implementation of parenting interventions demonstrates that such programmes can be successfully disseminated across diverse settings while maintaining effectiveness (Hutchings et al., 2024; Ward et al., 2020).

Although evidence-based parenting programmes can be successfully transported from high- to low-income countries when core behavioral principles are maintained (Gardner et al., 2016) many evidence-based programmes originate in high-income countries and often come with licensing costs that limit their accessibility in low- and middle-income countries (LMICs). The Parenting for Lifelong Health for Young Children (PLH-YC) programme is one of four programmes developed as a low-cost, open-source alternative for parents in LMICs. Licensed under a Creative Commons Attribution-Share-alike 4.0 license, PLH programmes are freely available on the World Health Organization (WHO) website (World Health Organization [WHO], n.d.) and in over 20 languages on the PLH charity website (Parenting for Lifelong Health, n.d.). The PLH-YC programme was designed to be culturally relevant, parent-centered, and evidence based (Alampay et al., 2018; Hutchings et al., 2024; Lachman et al., 2016; Tǎut et al., 2021; Ward et al., 2020). In its original form, PLH-YC was designed as a 12-session, group-based programme, although it has since been delivered in other lengths and formats including online and digital versions.

Whilst there has been significant work to support parents and babies living in low resourse settingsover the first 1,000 days (e.g., Rabadi et al., 2026) the PLH group identified the need for resources to support parents of older children. The PLH-YC programme was initially developed as a low cost intervention to support parents of 2–9 year old children in global south countries, where levels of violence against children are high and resources to address this are limited (Ward et al., 2020). Formative work in low income countries established that adaptation primarily required changing names and language and providing country relevant examples of illustrations and activities since the core parenting principles were shown to be relevant across societies (Alampay et al., 2018; Gardner et al., 2019). The 12 session group based version of the PLH-YC programme is delivered in line with World Health Organization [WHO] guidance and has demonstrated significant evidence of benefits to both parents and children from randomized trials in several countries including South Africa, Thailand, the Philippines and across Eastern Europe (Alampay et al., 2018; Hutchings et al., 2024; Katzef et al., 2026; Ward et al., 2020).

The twelve-session PLH-YC group-based intervention is grounded in the Hanf two-stage model of parenting interventions (Alampay et al., 2018; Hutchings et al., 2024; Lachman et al., 2016; Tǎut et al., 2021; Ward et al., 2020). To ensure that it is low cost and easily adaptable to new environments, the PLH-YC programme uses illustrated stories (comic strips) showing examples of parent and child behaviors. The 12 weekly sessions cover the core, well established, parenting skills (Forehand and McMahon, 1981) starting with activities to promote positive child behavior before focussing on limit-setting and discipline strategies (Reitman and McMahon, 2013). It includes spending one-on-one time with children, naming feelings and actions, using praise and rewards, giving clear and positive instructions, establishing household rules, redirecting negative behaviors, ignoring attention-seeking and demanding behaviors, using realistic and appropriate consequences, and problem-solving. Sessions also include brief mindfulness based stress management activities. The programme is delivered collaboratively through discussion and role-play with weekly home activities that have previously been identified as important learning tools (Hutchings et al., 2004). Sessions present the illustrated stories to prompt discussion and role-play practice of activities that form the basis of home assignments. Facilitators make mid-week phone calls to encourage engagement and support parents in applying strategies between sessions. By strengthening positive parent-child relationships via increasing consistent and calm responses to child behavior and reducing parental stress and reactivity, the programme aims to interrupt coercive interaction patterns and promote healthy child socioemotional development.

This study situates the PLH-YC programme within the broader field of child mental health and intervention research through the examination of how participation influences parenting processes that are known mechanisms for supporting child socioemotional development and preventing behavioral difficulties.

Over the past decade, early intervention services for families in the UK have declined substantially as funding for children's centers and family support services has been reduced. Spending on early intervention services has fallen significantly whilst demand has increased following the COVID-19 pandemic, particularly in socioeconomically disadvantaged communities (Barnardos, 2022; Centre for Young Lives, 2025, April 8). This context has highlighted the potential utility of a low-cost, evidence-based programme like PLH-YC within the UK.

Building on this rationale, a recent feasibility study examined the implementation of the PLH-YC “Caring Families” programme in two socially disadvantaged Welsh communities (Hutchings et al., 2025). Two small pre-post trials were conducted across three groups, recruiting a total of 20 parents, of whom 17 provided pre- and post-course data. Programme retention was high (85%), with parents attending on average over 2/3 rds (mean 8.7) of the sessions. Baseline assessment indicated elevated levels of dysfunctional parenting practices and child behavior difficulties. Quantitative analyses showed significant improvements in parenting practices, particularly over-reactivity and verbosity, along with large reductions in stress related to managing a difficult child. Although the small-scale, pre-post design limited generalisability, the findings (Hutchings et al., 2025) suggested that the programme was both feasible and potentially useful in a UK context, justifying further evaluation.

The present qualitative study, the second author's masters project, complements the positive reported quantitative findings from the initial delivery of the programme in Wales (Hutchings et al., 2025) through post-course interviews exploring parents' experience of participating in the programme. Specifically, it examines how ten of the eleven parents recruited at one center perceived the programme's impact, how it influenced their relationships and parenting approaches, and what features contributed most to its acceptability and perceived success through thematic analysis of post-programme interviews. The purpose of this study was to establish what if any further programme adaptation was needed.

Design

The present study explores parental experience as a result of participation in the PLH-YC programme. The study uses a qualitative design with thematic interview analysis, as described by Braun and Clarke (2006), to identify patterns and meanings within the parents' experience with the programme and how they perceived its impact.

Participants and setting

Participants were ten (90.9%) of the 11 parents, all mothers, who completed the PLH-YC programme in a rural Welsh community. Parents lived in a former slate-mining community in North Wales, an area with a high level of social disadvantage. The mean age of the 11 children was 2.9 years (range 2–5 years). At baseline, the (Hutchings et al., 2025), previously reported, total and all three parenting sub-scales, laxness, over-reactivity and verbosity scores on the Arnold–O'Leary parenting scale (Arnold et al., 1993) were above the mean for parents of children with behavioral problems, with particularly high scores on the verbosity subscale. For child behavior, median Strengths and Difficulties (SDQ; Goodman, 1997) scores were within the clinical range for the conduct problems and hyperactivity subscales as well as for the total difficulties score. The mean Parenting Stress Index (Abidin et al., 2006) score of 103.9 (SD 21.01) was above the clinical cutoff of 90 for levels of stress (for more information on the quantitative results see Hutchings et al., 2025).

Parents were invited to take part in a post-programme interview conducted by an independent researcher from the local University at the same time as completing the post course quantitative measures.

The programme

The 12 session group based PLH-YC programme was delivered in two sites in North Wales (Hutchings et al., 2025). Although the illustrated stories were developed for the initial randomized controlled trial in South Africa (Ward et al., 2020) the original version of the programme was written in English by the UK based third author and a UK based colleague. The stories were subsequently adapted for a large European trial (Tǎut et al., 2021; Williams et al., 2022) and this version was used in the present trial. Adaptations were intentionally limited to culturally relevant names, language, and examples. The programme content, sequence of sessions, collaborative delivery process, and underlying behavioral principles remained unchanged to maintain fidelity to the intervention whilst adapting it for the Welsh context.

Recruitment

Recruitment was undertaken by community staff working for Barnardo's, a non-governmental organization (NGO) funded by the local authority to provide community support programmes for preschool children and families. The staff were based in a community center in the socially disadvantaged former slate quarrying community. The center provided a range of services for families including delivering support to parents of preschool children and providing pre-school child care for many years. The programme recruited from parents who were using the facilities of the Center. Ten of the 11 (91%) participants to receive the programme participated in the follow-up interviews. Whilst programme enrolment and recruitment literature made it clear that the group was open to either or both parents, in recruitment at this site all participating parents were mothers.

Programme delivery

The programme was delivered by an experienced parent group programme facilitator, along with two community workers from the center, one co-leading in each group. All three facilitator attended the three day accredited training course, delivered by a certified PLH trainer, covering both the content and collaborative delivery processes. Facilitators were provided with training in recruitment, recruitment literature, detailed delivery manuals and parent weekly hjandouts. Fidelity measures included facilitator completed checklists of content delivered and attendance records after each session. They also attended weekly supervision with the trainer at which they decribed challenges and presented videotaped footage from their group. The center provided childcare whilst parents attended sessions (for further information on programme delivery and quantitative outcomes see Hutchings et al., 2025).

Ethical considerations

Participation was voluntary, and all participants provided informed consent. Ethical approval was granted by Bangor University Ethics Committee (17259-2023) on 2 July 2023.

Data

Semi-structured interviews were conducted face-to-face by an independent researcher (the second author) during home visits at the same time as collecting post-course quantitative measures and occurred within a 6 week period following course copmpletion. The interview questions covered five areas that were drawn from informal parent feedback from the initial delivery of the programme in Wales and discussions with the parenting professionals who had previously delivered the programme to explore any necessary adaptations to content or the delivery process. They explored participants' views on the (i) the usefuleness of the programme, (ii) the most helpful content areas and feedback on the delivery strategies, (iii) challenges experienced during attendance, (iv) impact of the programme on their parenting behavior, and (v) possible improvements needed. It concluded with an opportunity for any other comments. The interview schedule was developed by the research team and sense tested with the professionals with whom the programme had been discussed and was also informed by the objectives of the feasibility study and previous evaluations of parenting interventions (Mamaug et al., 2021; Williams et al., 2022).

Data collection

Interviews were recorded, transcribed verbatim to ensure accuracy of participant feedback, and anonymised. Interviews were undertaken at the same time as the collection of post-course quantitative measures and lasted for between 10 min and half an hour.

Data analysis

Thematic analysis is a flexible method of identifying, analyzing, and reporting themes within qualitative data (Braun and Clarke, 2006). The six-phase process includes: (1) familiarization with the data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report.

Coding was carried out manually using Excel, by the first author. who made a preliminary classification into themes. These were discussed and confirmed by the third author with whom any coding disagreements were resolved. This systematic approach allowed for themes relevant to the participants' experiences with the PLH-YC programme to be developed inductively. Three major themes were identified using this method: (1) Learning to parent differently, (2) Creating a circle of support, and (3) Wanting more time.

Coding decisions and theme development were discussed between the first and third authors until consensus was reached. Throughout the analytic process, the researchers engaged in reflexive discussion regarding how their experiences and assumptions might influence interpretation of the data. Coding decisions and theme development was documented in an excel file to support transparency and consistency during analysis.

Theme 1: learning to parent differently

Participants reflected on concrete changes in their parenting practices, particularly around discipline, communication, and emotional regulation. Seven participants reported being more emotionally aware in their parenting, which they described as leading to fewer child tantrums, calmer household interactions, and improved child emotional expression. They discussed being able to redirect thoughts and behaviors, letting things go, apologizing to their children, and explaining their emotions to their children. One participant said:

“ It's made me look at things like explaining emotions, like sitting her down when she was having a meltdown…We still have our spats with each other, we argue, but it's a lot better.” (P7)

The programme also helped participants establish clearer house rules and routines, which parents perceived as contributing to improved child behavior and reduced conflict at home. One participant noted a decrease in stress:

“ It has lessened what I normally felt, whereas normally by this time, my stress levels are up here and I'm pulling my hair out.” (P5)

Parents frequently linked their reduced stress and reactivity to more positive parent-child interactions and improved child cooperation. One participant said:

“ The programme encouraged us to think more about what kind of parents we want to be rather than just, oh we're parents and we're winging it.” (P4)

Participants reported finding tools like redirecting negative behaviors, one-to-one time, and positive instructions particularly effective (six out of ten participants). The concept of spending one-to-one time with their child was a new and impactful idea for some. One participant noted:

“ [It] made me think outside the box.” (P1)

The programme's visual materials (e.g., illustrative stories), weekly themes and stress management exercises were described as “easy to understand” and “really useful” (six out of ten participants). The illustrative stories were particularly effective in conveying key concepts (as highlighted by six of the participants). Participants also appreciated the stress management exercises, with one commenting:

“ The stress management exercises, they were good. You know, just having that minute to sit back and unwind….” (P5)

Theme 2: creating a circle of support

Participants emphasized the importance of the group setting in breaking down isolation and creating a sense of belonging. Six of the ten participants mentioned enjoying being able to socialize with other parents, which made them feel “less alone” (five out of ten participants) or affirmed that they were “on the right path in parenting” (P2). Two participant quotes highlight the value of peer support:

“ It's really nice to get together and just feel like you're not alone…” (P2)

“ It was nice to talk to the mums and, you know, know that you're not the only one”. (P10)

The shared experiences helped to normalize challenges and created a space where parents could learn from one another without judgement. Group discussions, facilitated by experienced leaders, were described as “honest” (P8) and “comforting” (P1). Seven participants specifically noted the group discussions as being valuable for the opportunity for collaboration, problem-solving, and sharing tips. Several participated indicated the group feedback was comforting for them:

“ I think the group discussions have been really good; it makes you appreciate that it's not just you….” (P1)

“ The problem solving was really good because you sat in the group and you could hear other people's experiences, what worked for them, what didn't.” (P6)

Additionally, participants valued the accessibility of the facilitators, who were available for phone calls or texts during the week (five out of ten participants). The facilitators were described as “brilliant” and “excellent” (eight out of ten participants).

Theme 3: wanting more time

Whilst participants reported almost no challenges with the programme, one consistent piece of feedback for enhancing the programme involved session length. The sessions were scheduled to run for 2 h, with an important part of the session exploring parents' home activities. Feedback was varied with some participants reporting that certain sessions were rushed, and nine of the ten of the participants wanted either more or longer sessions (e.g., adding half an hour):

“ It may be possible [to learn more] with another two weeks, because I did feel at times, it was certain sessions that were rushed, but because there was just so much content involved.” (P2)

“ It would be good to have the course over 12 weeks to elaborate more or concentrate on one aspect per week.” (P4)

This suggests a desire for deeper engagement and more time to practice skills. Three parents also suggested having refresher sessions or recaps at the end of sessions in order to better help them to digest the weekly theme:

“ I'd like if there were regular refresher sessions and if the course was longer or maybe if the sessions were a bit longer.” (P9)

This paper reports feedback from interviews with ten of the eleven parents recruited from a highly socially disadvantaged community in North Wales who attended the PLH-YC programme for parents of 2–9 year olds. The programme was developed to be low-cost and to support parents in global south countries where it has achieved positive outcomes (Alampay et al., 2018; Hutchings et al., 2024; Katzef et al., 2026; Ward et al., 2020). An earlier paper (Hutchings et al., 2025) reported on the quantitative data from two projects in North Wales, of which the present sample was part. This paper analyzed qualitative feedback from the ten parents, collected as part of a Masters project by the second author, and were classified into three themes: learning to parent differently, creating a circle of support and suggested programme changes.

A number of factors contributed to the decision to trial the programme in the UK. The need for early intervention support for families experiencing socio-economic disadvantage, whose children are at significant risk of poor outcomes, drove policy in the UK in the 2000s with the Sure Start programme (Department for Department for Education, 2013, April). Initially Sure Start projects struggled to recruit and retain socially disadvantaged families and services provided failed to make a difference for them (Belsky et al., 2006). However, once the importance of using evidence-based programmes, delivered with fidelity, was appreciated, evidence showed positive subsequent impact with 10 years outcomes reporting significant improvement in educational attainment, conduct disorder and attention-deficit hyperactivity disorder, with the greatest improvements reported for children from low socio-economic and ethnic minority backgrounds (Carneiro et al., 2024; Melhuish et al., 2010). As part of Sure Start, a number of well established commercially available parenting progammes reported evidence of benefits to both parents and children (e.g., Hutchings et al., 2007; Little et al., 2012). However these licensed commercially available programmes were expensive to deliver (Ward et al., 2020) and not realistic for low income countries with limited budgets. So the Parenting for Lifelong Heath suite of programmes was developed of which the PLH-YC is one.

Lack of basic skills compromises children's futures when they start school and manifests in non-compliant and aggressive behavior (Beard, 2018; Bercow, 2018; Petersen et al., 2013). This was already a significant problem in the UK prior to COVID. However since COVID, 33% of children starting school in the UK in 2022/23 lacked these essential school readiness skills and among socially disadvantaged children this was 45% (University of Leeds., 2024) with persistent disruptive behavior the most common reason for subsequent school exclusion (Bekaert et al., 2025) with over-representation of minoritised and marginalized groups of young people (Timpson, 2019).

This study explored how parents living in a low-income Welsh community experienced the PLH-YC programme. The qualitative findings were consistent with the high levels of satisfaction reported as part of the outcomes from the feasibility study (Hutchings et al., 2025), in which the parental session feedback questionnaires reported that 97% of sessions were rated as “very helpful” and the remaining 3% as “helpful” (Hutchings et al., 2025). The emphasis on practical skills like redirecting negative behaviors, one-to-one time, and positive instructions resonated with the participants, which participants perceived as contributing to changed in their parenting practice that were evidenced both in this qualitative feedback and from the quantitative data (Hutchings et al., 2025).

The first theme reflects shifts in parenting style consistent with social learning theory models of parenting interventions. Research has consistently demonstrated that increasing positive parent-child interaction and reducing harsh or inconsistent discipline are associated with improvements in child behavior and emotional regulation (Gardner et al., 2019; Hutchings et al., 2025; Reitman and McMahon, 2013). These mechanisms are central to many evidence-based parenting programmes and are reflected in parents' reports of increased emotional awareness and calmer responses to child behavior.

The group-based format was reported as a significant strength, encouraging a sense of community and reducing feelings of isolation among participants. This social support aspect appears to be an important component of the programme's success in this context and highlights how peer interaction created a non-judgemental space for reflection and learning. This aligns with broader literature on group-based interventions, which suggests that relational aspects are critical for programme success (e.g., Barlow et al., 2012; Hutchings et al., 2004; Wittkowski et al., 2016).

The second theme reflects shifts in parenting style consistent with the quantitative data: reductions in over-reactivity and verbosity, and increased calm, consistent responses to child behavior (Hutchings et al., 2025). The illustrative stories and stress management exercises are reported to be particularly effective teaching strategies, making the programme accessible and engaging. The lack of reported challenges further highlights the programme's accessibility and adaptability. Participants' suggestions for more or longer sessions indicate a desire for continued engagement and skill development rather than dissatisfaction. Similar findings have been reported in evaluations of group-based parenting programmes, where participants often express interest in longer interventions or booster sessions to consolidate learning and maintain behavioral change (Barlow et al., 2012; Wittkowski et al., 2016). In the Welsh feasibility study, both parents and facilitators similarly recommended extending the programme to allow more time for discussion and practice of skills (Hutchings et al., 2025). This points to the programme's success in building parental confidence and a desire for further skill development.

These findings align with the literature on effective parenting interventions in disadvantaged contexts, where accessibility, cultural fit, and relational support are key to success (Alampay et al., 2018; Hutchings et al., 2004; Lachman et al., 2016; Tǎut et al., 2021; Ward et al., 2020). The PLH-YC programme's low-cost, open-source nature makes it a suitable and sustainable intervention for socially disadvantaged communities where early intervention services have faced significant reductions. Its adaptability and effectiveness speak to its robust design and clear methodology.

Although initially designed for delivery in low- and middle-income countries, the reductions in early intervention funding and pressure on services prompted exploration of the potential for the PLH-YC programme to contribute to UK services. Parents described improvements in parenting confidence, emotional regulation, and communication with their children in addition to a strengthened sense of community and peer support. Other than the desire for a longer programme the feedback obtained suggested that,in the short term, the programme worked as intended and achieved the desired outcomes that matched the previously reported quantitative findings (Hutchings et al., 2025). No specific content or process adaptation were required for further use in Welsh, and potentially UK, settings. Despite the small sample, given the earlier reported positive quantitative changes, in terms of both parent and child behavior, the high level of retention, the feasibility and acceptability of the programme for delivery and the positive parental feedback reported in this paper, with further more robust evidence the programme has the potential to meet the needs of socioeconomically disadvantaged families in the UK.

Whilst further, more rigorous UK research with larger samples and longer-term follow-up data are required, the consistency between the qualitative experiences and the quantitative improvements documented in the feasibility trial provides a justification for a more rigorous evaluation. These findings suggest that the PLH-YC Caring Families programme represents a promising, evidence-based approach to supporting families and promoting positive child mental health trajectories among children and parents in disadvantaged communities across the UK.