Effectiveness of a Facilitator-Led Internet-Based Parent Management Training (Net PAMA Program) on Positive Parenting Skills Among Parents of Children Aged 7-12 Years: A Quasi-Experimental Study in Thailand

Korawan Kongamnuaisak, M.D., Chanvit Pornnoppadol, M.D., Sirinda Chanpen, M.Sc., Wanlop Atsariyasing, M.D.*

256-265.

*Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

*Corresponding author: Wanlop Atsariyasing E-mail: wanlop.atr@mahidol.ac.th

Received 20 October 2025 Revised 12 January 2026 Accepted 13 January 2026 ORCID ID: http://orcid.org/0000-0001-8868-8302 https://doi.org/10.33192/smj.v78i4.278403

All material is licensed under terms of the Creative Commons Attribution 4.0 International (CC-BY-NC-ND 4.0) license unless otherwise stated.

INTRODUCTION

Behavioral problems in children, including externalizing problems such as aggression, defiance, and internalizing behaviors like withdrawal, anxiety, and depression, are considered one of the most severe mental health issues in childhood. These issues can negatively impact a child›s development and family relationships, and if left untreated, may increase the risk of future problems like peer rejection, academic failure, and criminal activity.1-3 Parenting is a crucial factor influencing a child’s mental and behavioral well-being.4 Parent Management Training (PMT) is an evidence-based intervention grounded in social learning theory5, with substantial empirical support for its effectiveness in treating children childhood behavioral problems. Numerous studies have demonstrated that PMT improves child behavior, with evidence showing a positive effect on reducing children’s externalizing behavior problems, enhancing parenting skills, and reducing parenting stress.6-8 Several well-established PMT models have been developed and validated internationally, including the Parent Management Training-Oregon Model (PMT-O)9, The Incredible Years (IY)10, the Positive Parenting Program (Triple P)11, and Parent-Child Interaction Therapy (PCIT).12 The primary goal of these programs is to reduce child behavioral problems through promotion of positive parenting skills.

To address challenges of accessibility, high costs,

and the shortages of trained personnel, many PMT programs have transitioned to internet-based parent training. Emerging research supports the effectiveness of internet-based PMT in reducing childhood behavioral problems. Multiple randomized controlled trials have demonstrated that online PMT can effectively reduce conduct problems and improve parenting skills, with outcomes comparable to in-person interventions.13-19 However, most existing internet-based PMT programs were designed in developed countries with different cultural and socioeconomic contexts from Thailand. Previous studies conducted in Thailand have emphasized the importance of caregivers’ psychosocial factors in relation to children’s psychosocial outcomes. For example, caregivers’ parenting attitudes and mental health were found to be significantly associated with self-esteem among children and adolescents, highlighting the influential role of caregivers in child development.20

In Thailand, the first internet-based parenting program, Net PAMA, was developed in 2021. A previous randomized controlled trial confirmed its effectiveness, showing that parents who completed the self-paced program showed significant improvements in positive parenting skills and reductions in their children’s behavioral problems (p<0.001).21 Despite this success, a follow-up survey of Net PAMA users in August 2021 identified technology-related issues and low motivation as two main factors affecting

course completion. To overcome these challenges, a new facilitator-led model, known as Net PAMA Classroom, was developed. In this model, facilitators guide groups of 10–12 parents through the Net PAMA curriculum over six weekly three-hour sessions. This group-based approach fosters a supportive learning environment where parents can acquire knowledge, practice new skills, and share experiences, ultimately leading to improved parenting and better child outcomes.

This study aimed to examine the effectiveness of the facilitator-led Net PAMA program (Net PAMA Classroom) in increasing positive parenting, reducing child behavioral problems, and improving child self-esteem. This was a comparative study between a group of parents who received the six-session training and a control group who did not.

MATERIALS AND METHODS

Study design

This was a quasi-experimental study conducted from June 2023 to April 2024.

Participants

Participants were recruited via online platforms from Bangkok and Nakhon Nayok provinces. The study included parents aged 25-60 years who had been the primary caregiver of a child for at least six months and were able to read and write Thai. The children of these parents had to be between 7-12 years old and able to read and write Thai. Parents were excluded if they had previously completed the self-paced Net PAMA course or a similar parenting program. Additionally, children with a physical or mental health condition, such as severe autism or Down syndrome, as reported by parents, were excluded. Participants in the intervention group were withdrawn if they attended fewer than five classes. Participants in the control group were withdrawn if they participated in other child behavior modification programs during the study.

Sample size

The sample size was calculated based on a previous study reporting mean POPS scores of 42.1 (SD = 3.9) for the intervention group and 39.1 (SD = 6.5) for the control group after the program. With a 95% confidence level (α = 0.05) and 80% power (β = 0.20), 51 participants per group were required. Allowing for potential errors and a 15% dropout rate, the final sample size was 60 participants per group.

Intervention

Net PAMA program

The Net PAMA program is an online parenting curriculum adapted from the Parent Management Training (PMT), accessible at www.netpama.com. The content is delivered through online video lessons in an interactive format to simulate a group training setting. The course consists of six main lessons covering behavior modification techniques, including knowledge about children’s behavioral modification, communication skills, effective praise, rewarding techniques, effective punishment and token economy.

Facilitator-led Net PAMA program (Net PAMA classroom)

In this study, facilitators were carefully selected through a rigorous four-step training and evaluation program. This program included: (1) a half-day online training session; (2) completion of the full Net PAMA curriculum, culminating in a certification; (3) a three-day practical workshop at Siriraj Hospital; and (4) leading at least one six-week Net PAMA group. Candidates who successfully completed all four steps were then evaluated by experts and only those who passed were chosen to be facilitators for this study. For the intervention groups, two facilitators were assigned per class who remained with the same group throughout the entire three-hour session per week for the six-week training period. The facilitators guided parents through lessons, exercises, and group discussions to reinforce positive parenting skills and peer learning. However, a formal inter-rater reliability assessment was not conducted.

Measurements Demographic questionnaire:

The study collected data on parent gender, age, education level, health conditions, and relationship with the child, as well as the child’s gender, age, grade level, and health conditions.

Positive Parenting Scale (POPS)22:

This 16-item self-report scale was developed by Pornnoppadol et al. and measured positive parenting skills across three domains: Relationship, Respect, and Rules. It is rated on a 4-point scale (from "never" to "regularly"). The scale had a Cronbach's Alpha of 0.87 for the parent version and 0.86 for the child version.

Pediatric Symptom Checklist (PSC-17) - Thai version23:

This 17-item self-report scale for both parents and

children was adapted from Jellinek and Murphy’s PSC-

35. Its Thai version was developed by Pornnoppadol et al. It assesses three areas of child emotional and behavioral problems: depression/anxiety, attention-deficit, and conduct problems. The Cronbach's Alpha was 0.85 for the self-report version and 0.82 for the parent version. A score of 15 or higher indicates the presence of emotional and behavioral problems.

Pictorial Self-Esteem Scale for Elementary Students in Grades 2-624

This scale was also developed by Pornnoppadol et al. and consists of 17 questions to assess self-esteem across three domains: self-satisfaction, ability and achievement, and self-worth. The Cronbach's Alpha was 0.91.

Study procedure

The research team advertised and recruited interested parents online. Those who met the inclusion criteria were invited to participate and were informed of the study's details, benefits, and risks. If parents agreed to the terms, they signed a consent form. Recruitment occurred in four separate rounds in Bangkok and Nakhon Nayok provinces. Participants were randomly assigned to either the intervention or control group using simple randomization. If a parent assigned to the intervention group could not attend the training, they were invited to join the control group. The intervention group participated in the six-week facilitator-led training, while the control group received written information on positive parenting. Data were collected from both groups at three time points: before the program (T0), immediately after (T1), and at three months post-intervention (T2). Parents completed their questionnaires independently, and for children’s questionnaires, parents either supervised or read the questions aloud if the child was not a proficient reader or writer.

Data analysis

Data were analyzed using Linear Mixed Models (LMM) to assess changes in outcomes across three time points. The models included fixed effects for Time, Group, and the Time × Group interaction, with a random intercept for each participant. The primary effect of interest was the Time × Group interaction, indicating whether the rate of change differed between the groups.

RESULTS

A total of 99 parent-child pairs participated in the study — 59 pairs in the intervention group and 40 pairs

in the control group. Nineteen pairs in the intervention group withdrew or were terminated for attending fewer than five sessions, being unreachable for follow-up, or a change in the parent completing the questionnaire. In the control group, 16 pairs withdrew due to loss to follow-up. At the 3-month follow-up, 64 pairs remained: 40 in the intervention group and 24 in the control group (Fig 1).

Participant characteristics

At baseline, there were no significant demographic differences between the intervention and control groups. The average age of parents in both groups was around 41 years, with the majority being mothers. Most families had sufficient income and lived in nuclear family settings, with children primarily raised by their parents. The average age of the children was nine years, with no significant difference in the proportion of males and females. Most children did not have pre-existing physical or mental health conditions (Tables 1&2). The baseline scores for POPS, PSC-17, and self-esteem (child versions) were not statistically different between the two groups (Table 3).

Primary outcome (Table 3)

Parent-Reported POPS:

At the 3-month follow-up, the mean parent-reported POPS score was 42.26 (0.56) in the intervention group and 40.57 (0.73) in the control group, with no statistically significant between-group difference (P=0.066). Within the intervention group, the parent-reported POPS scores significantly increased from a mean of 40.05 (0.47) at baseline to 42.26 (0.56) at the 3-month follow-up (p<0.001).

Child-Reported POPS:

At the 3-month follow-up, the mean child-reported POPS score was 39.56 (0.98) in the intervention group and 37.47 (1.24) in the control group, with no statistically significant between-group difference (P=0.188). Within the intervention group, the child-reported POPS scores significantly increased from a mean of 37.72 (0.83) at baseline to 39.56 (0.98) at the 3-month follow-up (p=0.017).

Secondary outcomes (Table 3)

Parent-Reported PSC-17:

At the 3-month follow-up, the mean parent-reported PSC-17 score was 9.31 (0.54) in the intervention group and 10.22 (0.70) in the control group, with no statistically significant between-group difference (P=0.306). Within the intervention group, the scores significantly decreased from a mean of 11.35 (0.45) at baseline to 9.31 (0.54) at the 3-month follow-up (p=0.002).

Fig 1. CONSORT flow diagram of the study.

Child-Reported PSC-17:

At the 3-month follow-up, the mean child-reported PSC-17 score was 10.65 (0.6) in the intervention group and 9.82 (0.76) in the control group, with no statistically significant between-group difference (p=0.393). There was also no significant change in scores within the intervention group from baseline (p=0.433).

Child Self-Esteem:

At the 3-month follow-up, the mean child self-esteem score was 57.57 (1.12) in the intervention group and 52.24 (1.36) in the control group. The child self-esteem scores in the intervention group were significantly higher than in the control group (P=0.003). Within the intervention group, the scores significantly increased from a mean of

TABLE 1. Baseline demographic and clinical features of parents in the intervention and control groups.

TABLE 2. Baseline demographic and clinical features of children in the intervention and control groups.

51.54 (0.91) at baseline to 57.57 (1.12) at the 3-month follow-up (p<0.001).

DISCUSSION

Although the within-group analysis showed that participants in the intervention group demonstrated improvements in POPS and reductions in PSC scores over time, indicating a positive impact, a statistically significant difference was not found in either the POPS or PSC scores when comparing the intervention and control groups. This suggests that while the intervention was effective, its effect size may not have been large enough to be clearly distinguished from the control group. This finding can be attributed to several plausible explanations, including the study’s small sample size, the lack of true randomization and the potential influence of the Hawthorne effect in the control group, where participants may have sought out other positive parenting information. Furthermore, we did not track whether participants in the control group received other interventions during the study.

These findings are consistent with existing literature. A systematic review by Martin et al.25 reported that the relationship between facilitator performance and program outcomes is often inconsistent, highlighting a limitation relevant to this study, which did not include a formal assessment of facilitator competence or inter-rater reliability, factors that could affect the results, especially with a small sample size. Similarly, Rogers et al.26 found that perceived facilitator effectiveness can be influenced by participant characteristics and training context, which

aligns with our finding of significant occupational differences between the groups. These demographic differences may have acted as a confounding variable, impacting participants’ perceptions of the program. Given the lack of prior research with a similar study design, these findings provide a valuable foundation for future research. These findings are consistent with previous Thai studies demonstrating that caregivers’ psychosocial characteristics and parenting-related factors are closely linked to children’s psychosocial outcomes.20 The present study extends this evidence by demonstrating that positive parenting skills can be enhanced through a structured, facilitator-led intervention.

The study’s strengths include its focus on addressing parent needs in underserved areas and the use of diverse measurement tools incorporating both parent and child perspectives, thereby, enhancing the reliability of the findings by reducing subjective bias. Additionally, the 3-month follow-up allowed for a more comprehensive evaluation of the program’s sustained impact.

However, the study also has several limitations. The quasi-experimental design may have introduced confounding factors. The outcome measures relied on self-report instruments, which are prone to bias. During the classroom session, there was no systematic monitoring to verify that the facilitators genuinely adhered to the teaching guidelines, which could affect the quality of training across different groups. The study also had a high attrition rate and the smaller-than-anticipated final sample size may have reduced the statistical power. Lastly,

TABLE 3. POPS, PSC-17, and self-esteem scores in the intervention and control groups across three time points.

Abbreviations: SE, Standard error; POPS: Positive Parenting Scale; PSC: Pediatric Symptom Checklist.

the study did not track whether the control group sought out other parenting resources, which could have affected the comparison results. From a broader developmental perspective, positive parenting practices may function as protective environmental factors. Prior Thai research has highlighted the role of resilience in buffering the impact of adverse experiences on behavioral problems27, suggesting that parenting interventions may contribute to strengthening such protective processes.

Future research should aim to replicate these findings using a larger sample size and a more rigorous research design to better control for confounding variables. Additional studies could also explore the program’s impact on other variables, such as parent-child relationships, parental stress, or depression, to gain a more complete understanding of its overall effectiveness.

CONCLUSION

The facilitator-led Net PAMA program demonstrated effectiveness in enhancing child self-esteem, but it failed to significantly improve positive parenting skills or reduce child behavioral problems. These promising results warrant a future study with a larger sample size and more rigorous methodology to fully assess the program’s potential.

Data Availability Statement

The data underlying the results of this study are not accessible to the public due to ethical and confidentiality constraints. However, de-identified data can be made available upon request to the corresponding author, subject to approval from the institutional ethics review board. Relevant secondary data sources are cited in the bibliography.

ACKNOWLEDGMENTS

The authors wish to express their sincere gratitude to all individuals who contributed to the success of this research. We are especially thankful to the dedicated team of facilitators, Ms. Natthanun Thanankanthanath, Mr. Kerati Limsuepchuea, Ms. Dhonnaya Onlaor, Ms. Jutturaporn Homnol, Ms. Phalasinee Srisongmuang, Ms. Nattawara Chaneiam and Mr. Thitipat Joompathong, for their invaluable commitment and time in leading the parent groups. We also extend our deep appreciation to Sirinda Chanpen for her tireless coordination, which was instrumental in the project’s completion, and to Ms. Naratip Sa-nguanpanich for their essential expertise and assistance with the data analysis.

DECLARATIONS

Grants and Funding Information

This study was funded by the Thai Health Promotion Foundation (Grant number: 65-10083).

Conflict of Interest

The research team declares no conflict of interest in this study.

Registration Number of Clinical Trial

The study was retrospectively registered with the Thai Clinical Trials Registry on February 22, 2026 (identification number TCTR20260222004). The trial registration record is publicly available at: https://www. thaiclinicaltrials.org/show/TCTR20260222004.

Author Contributions

Conceptualization and methodology, K.K., C.P.,

W.A. and S.C.; Investigation, K.K. and S.C.; Formal analysis, K.K. and W.A.; Visualization and writing – original draft, K.K.; Writing – review and editing, K.K., C.P., W.A. and S.C.; Funding acquisition, C.P. and S.C.; Supervision, W.A. and C.P. All authors have read and agreed to the final version of the manuscript.

Use of Artificial Intelligence

During the preparation of this manuscript, the authors used Google Gemini 2.5 Pro to improve language and readability. After using this tool/service, the authors reviewed and edited the content as needed and took full responsibility for the final content for publication.

Ethical Statement

This study was approved by the Siriraj Institutional Review Board at the Faculty of Medicine Siriraj Hospital, Mahidol University, on January 14, 2023. The Certificate of Approval (COA) number is Si 033/2023.

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