Prevalence of negative child disciplinary practices and its associated factors as reported by mothers in the West Bank: a cross-sectional study

Background: For parents, how to manage child discipline is a difficult question in the task of raising a socially, emotionally, and physically mature adult. Negative discipline can be physical or psychological, and can negatively affect child development, mental health, and wellbeing. This study aimed to assess the prevalence of negative disciplinary methods (NDMs) and their associated factors in the West Bank, occupied Palestinian territory, as reported by mothers.

Methods: The survey was conducted in November and December, 2014, to explore the disciplinary methods that mothers used for one of their children (aged 0-12 years) during the previous 12 months. 1195 Palestinian mothers were studied based on a stratified multistage cluster sampling method and using the International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse and Screening Tool for Parents (ICAST-P). A scale was built from mothers' reports on the use of NDMs, with good internal consistency (Cronbach's α=0·75). The dataset was split according to whether the mother used 0-6 NDMs or 7-20 NDMs in the previous 12 months. Bivariate analyses were performed using the chi squared test to compare these two categories in terms of demographic and socioeconomic variables, and exposure to Israeli political violence. Binary logistic regression was performed to check for confounders. The Institute of Community and Public Health and Birzeit University approved the use of the data.

Findings: The mothers were aged between 15 and 55 years. 11·3% of mothers (135 of 1195) were 15-25 years old, 45·4% (541) were 26-35 years old, and 43·2% (515) were 36-55 years old. 52·5% of children (627 of 1195) were male, 34·0% (406) were 0-3 years old, and 66·0% (789) were 4-12 years old. 5·2% of children (62) were the only child, 4·4% of children (53) were the first child, 27·6% (330) were the middle child (a child that is not the first or the last child), and 62·8% (750) were the last child. 45·8% of the mothers and children (547) lived in the north of the West Bank, 23·3% (278) lived in the middle of the West Bank, and 31·0% (370) lived in the south of the West Bank. 5·3% of mothers (63) reported that their homes were bombed or shelled by the Israeli army. 83·8% of mothers (1002) reported using 0-6 NDMs and 16·2% (193) used 7-20 methods. Other demographic and socioeconomic variables collected were not significantly associated with NDMs. Binary logistic regression revealed that females were less likely to be exposed to NDMs than males (OR 0·63, 95% CI 0·45-0·88, p=0·0074), and that children aged 0-3 years were less likely to be exposed to NDMs than children aged 4-12 years (0·50, 0·33-0·76, p=0·0014). Compared with last children, first children (2·84, 1·46-5·51, p=0·0020) and middle children (1·49, 1·02-2·17, p=0·0375) were more likely to be exposed to NDMs. Compared with mothers aged 36-55 years, mothers aged 15-25 years (2·67, 1·47-4·85, p=0·0010) and 26-35 years (1·54, 1·05-2·26, p=0·0289) used more NDMs. Compared with children in the north of the West Bank, children in the south of the West Bank (2·46, 1·66-3·64, p<0·0001) and middle of the West Bank (1·90, 1·24-2·93, p=0·0034) were more likely to be exposed to NDMs. Compared with mothers whose houses were not bombed or shelled by the Israeli army, mothers whose houses were bombed or shelled were more likely to use a higher number of NDMs (2·71, 1·84-1·95, p=0·0012).

Interpretation: Negative child discipline is prevalent in Palestine and is associated with factors such as the child's gender, their age, their index in the family (whether they are the only child, first, middle, or last child), the mother's age, the district, and the political conditions in Palestine. Effort should be made to help families to understand alternative methods to address child discipline, through education, discussion, and parenting programmes.

Funding: This study is part of a larger study of child discipline in Qatar and the occupied Palestinian territory. The study was conceptualised and planned with the funding of Qatar National Research.