Facilitators and barriers to engagement in parenting programs: a qualitative systematic review

Automation of systematic reviews of biomedical literature: a scoping review of studies indexed in PubMed

BACKGROUND

The demand for high-quality systematic literature reviews (SRs) for evidence-based medical decision-making is growing. SRs are costly and require the scarce resource of highly skilled reviewers. Automation technology has been proposed to save workload and expedite the SR workflow. We aimed to provide a comprehensive overview of SR automation studies indexed in PubMed, focusing on the applicability of these technologies in real world practice.

METHODS

In November 2022, we extracted, combined, and ran an integrated PubMed search for SRs on SR automation. Full-text English peer-reviewed articles were included if they reported studies on SR automation methods (SSAM), or automated SRs (ASR). Bibliographic analyses and knowledge-discovery studies were excluded. Record screening was performed by single reviewers, and the selection of full text papers was performed in duplicate. We summarized the publication details, automated review stages, automation goals, applied tools, data sources, methods, results, and Google Scholar citations of SR automation studies.

RESULTS

From 5321 records screened by title and abstract, we included 123 full text articles, of which 108 were SSAM and 15 ASR. Automation was applied for search (19/123, 15.4%), record screening (89/123, 72.4%), full-text selection (6/123, 4.9%), data extraction (13/123, 10.6%), risk of bias assessment (9/123, 7.3%), evidence synthesis (2/123, 1.6%), assessment of evidence quality (2/123, 1.6%), and reporting (2/123, 1.6%). Multiple SR stages were automated by 11 (8.9%) studies. The performance of automated record screening varied largely across SR topics. In published ASR, we found examples of automated search, record screening, full-text selection, and data extraction. In some ASRs, automation fully complemented manual reviews to increase sensitivity rather than to save workload. Reporting of automation details was often incomplete in ASRs.

CONCLUSIONS

Automation techniques are being developed for all SR stages, but with limited real-world adoption. Most SR automation tools target single SR stages, with modest time savings for the entire SR process and varying sensitivity and specificity across studies. Therefore, the real-world benefits of SR automation remain uncertain. Standardizing the terminology, reporting, and metrics of study reports could enhance the adoption of SR automation techniques in real-world practice.

Play Well Triple P: Developing and Evaluating a Program to Promote Positive Parental Involvement in Junior Sport

Parents play a central role in children's ongoing participation and enjoyment of sport. Despite compelling evidence that parental behaviour can undermine the quality of children's experiences in sport, little research has examined whether strategies to support parents to engage in positive sports parenting behaviour are effective. In this paper, we report two studies that had the overall aim of developing, implementing and evaluating a program designed to promote positive parental involvement and improve spectator behaviour in junior rugby league in Australia. Study 1 involved the development of a prototype version of the program, named Play Well Triple P, which was qualitatively evaluated through interviews with 19 parents about their satisfaction with the program. In Study 2, we used feedback from Study 1 to refine the program and develop a pilot version, which was then evaluated in a quasi-experimental feasibility study with 101 parents (mean age = 38.42 years; 72% mothers) of junior rugby league players. The pilot version involved one interactive online module and text messages to reinforce content and prompt strategy implementation across the season. Participation in Play Well Triple P was associated with increased positive sports parenting behaviour and reduced controlling and intrusive sports parenting behaviour, with a trend towards reducing over-reactive parenting practices at home. These findings are discussed in relation to the feasibility of implementing a brief and engaging sports parenting intervention in the context of a broader integrated system designed to facilitate ongoing participation of children in sport.

The process in-between: Parents' perceptions about how practitioners promote the outcomes of the Incredible Years Basic program

Practitioners are recognized as one of the key components that make parenting interventions meaningful and helpful to families, and the impact of practitioners' skills on the outcomes of parenting interventions has been consistently recognized in research. However, the mechanisms and ongoing processes through which the practitioners' actions and skills may impact parental engagement and other outcomes remain unknown. This qualitative study explored parents' perceptions about the processes through which specific practitioners' skills contribute to the outcomes of the Incredible Years Basic Parent Program (IYPP). Twenty-four Portuguese parents who had completed the IYPP were interviewed in four focus groups, and the data were analyzed through thematic analysis. Practitioners' skills were perceived by parents as having an impact on their engagement in the program, their process of change, and their interpersonal relationships. Practitioners were perceived to demonstrate their influence in the intervention process through six different roles: the roles of a confidant, a positive coach, a partner, a maestro, a tailor, and a congruent person. This study reinforces the prominent role of practitioners in enabling parental outcomes of an evidence-based parenting program and suggests that more attention should be paid to continuing supervision and other professional development processes.

Mandated Parent Education: Applications, Impacts, and Future Directions

Mandated participation in parent education programs is a common practice across the United States for families who are undergoing divorce or who are involved in the child welfare or juvenile justice systems. Mandates to participate in parenting programs create substantial challenges for families, service providers, and service systems. Furthermore, the type and quality of the parenting services accessed vary widely, and their impacts need to be better understood. To address this need, an overview of the current state of the empirical literature on the impacts and outcomes of mandated parenting interventions for divorce and in child welfare and juvenile justice settings is provided, and suggestions to the field are offered to refine research related to mandated parenting programs. Given the challenges that mandated parenting programs pose, an alternative approach that views parenting through a public health lens is highlighted to build on the growing body of research on the impacts of population-wide applications of parenting support programs, and as a possible way to decrease the number of parents who are required to attend parenting programs. Opportunities to advance universal parenting support within a range of community settings, including primary care, early childhood education, and community mental health systems are offered. Gaps in knowledge regarding mechanisms of action of universal supports and impacts on the number of parents mandated to treatment are highlighted, and future directions for research in this area are suggested.

Parental acceptance of brain health programs for preschool children: a mixed-methods study exploring barriers, facilitators and future approaches

Background

Recent research proposes that as much as 40% of dementia risk is amendable. Promoting healthy lifestyle behaviors in early life through educational methods can cultivate habits that may decrease dementia risk in later life. This study explores parental acceptance of brain health programs tailored for preschool children, aiming to identify barriers and facilitators affecting parental and child engagement.

Methods

Mixed-methods cross-sectional study. Urban and suburban parents (N = 187, M age = 37.3 SD = 5.53, range = 29) of children aged three to five years across Australia. Parents participated in an online survey containing both open and closed questions exploring their personal views and opinions on brain health programs for their preschool children. Descriptive statistics, multiple linear regression analyses, and thematic analysis were used to explore sociodemographic factors associated with parental program acceptance.

Results

Most participants accepted a brain health program with over 98% agreeing a program would be useful for their child(ren). Participants with younger aged children were more likely to exhibit acceptance of a program (β = -0.209, p = 0.007). Three main categories emerged: dual home and preschool environments, the need for engaging brain health programs that were hands-on and screen-free, and addressing key barriers such as time and financial constraints to support implementation.

Conclusion

Participants valued educating their children for a healthy life and viewed brain health programs favorably. This study contributes to early childhood education discussions, offering guidance for future generations' brain health and wellbeing.

Development and implementation of a worksite-based intervention to improve mothers' knowledge, attitudes, and skills in sharing information with their adolescent daughters on preventing sexual violence: lessons learned in a developing setting, Sri Lanka

BACKGROUND

Sexual violence among adolescents has become a major public health concern in Sri Lanka. Lack of sexual awareness is a major reason for adverse sexual health outcomes among adolescents in Sri Lanka. This study was intended to explore the effectiveness of a worksite-based parent-targeted intervention to improve mothers' knowledge, and attitudes on preventing sexual violence among their adolescent female offspring and to improve mother-daughter communication of sexual violence prevention with the family.

METHODS

"My mother is my best friend" is an intervention designed based on previous research and behavioral theories, to help parents to improve their sexual communication skills with their adolescent daughters. A quasi-experimental study was conducted from August 2020 to March 2023 in randomly selected two Medical Officer of Health (MOH)areas in Kalutara district, Sri Lanka. Pre and post-assessments were conducted among a sample of 135 mothers of adolescent girls aged 14-19 years in both intervention and control areas.

RESULTS

Out of the 135 mothers who participated in the baseline survey, 127 mothers (94.1%) from the intervention area (IA) physically participated in at least one session of the intervention. The worksite-based intervention was effective in improving mothers' knowledge about adolescent sexual abuse prevention (Difference in percentage difference of pre and post intervention scores in IA and CA = 4.3%, p = 0.004), mother's attitudes in communicating sexual abuse prevention with adolescent girls (Difference in percentage difference of pre and post intervention scores in IA and CA = 5.9%, p = 0.005), and the content of mother-daughter sexual communication (Difference in percentage difference of pre and post intervention scores in IA and CA = 27.1%, p < 0.001).

CONCLUSIONS AND RECOMMENDATIONS

Worksite-based parenting program was effective in improving mothers' knowledge about sexual abuse prevention among adolescent daughters and in improving the content of mother-daughter communication about sexual abuse prevention. Developing appropriate sexual health programs for mothers of different ethnicities, and cultures using different settings is important. Conduction of need assessment programs to identify the different needs of mothers is recommended.

Multiple Perspectives on Motivating Parents in Pediatric Primary Care to Initiate Participation in Parenting Programs

OBJECTIVE

To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents.

METHODS

We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups.

RESULTS

Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy.

CONCLUSIONS

Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.

Barriers and Facilitators to Engaging Mothers and Fathers in Family-Based Interventions: A Qualitative Systematic Review

The current systematic review examined the similarities and differences between mothers' and fathers' reported barriers and facilitators to engaging in family-based interventions for child and adolescent behavioural problems (aged 2-17 years). Systematic searches of six electronic databases and grey literature alongside a two-way screening process identified twenty eligible qualitative studies from 2004 to 2019. A thematic meta-synthesis identified similarities in major themes of psychological, situational, knowledge/awareness, programme/intervention, co-parenting, practitioner, and beliefs/attitudes factors, alongside group experiences and stages of engagement. However, differences emerged in subthemes related to parental, treatment, and service delivery factors that included individual ideologies of parenting, parental roles, and treatment participation; the role of mothers in facilitating engagement; and individual preferences for treatment content and delivery. Overall, findings suggest that while mothers and fathers experience similar challenges to engagement, they can also experience distinct challenges which need to be addressed at the treatment outset to maximise engagement.

Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review

BACKGROUND

Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal.

OBJECTIVE

This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement.

METHODS

Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values.

RESULTS

We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes.

CONCLUSIONS

This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context.

TRIAL REGISTRATION

PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.

Non-specialist delivery of the WHO Caregiver Skills Training Programme for children with developmental disabilities: Stakeholder perspectives about acceptability and feasibility in rural Ethiopia

LAY ABSTRACT

Children with developmental disabilities including autism who live in low- and middle-income countries have very limited access to care and intervention. The World Health Organization initiated the caregiver skills training programme to support families with children with developmental disabilities. In Ethiopia, contextual factors such as poverty, low literacy and stigma may affect the success of the programme. In this study, we aimed to find out if the caregiver skills training programme is feasible to deliver in rural Ethiopia and acceptable to caregivers and programme facilitators. We trained non-specialist providers to facilitate the programme. Caregivers and non-specialist facilitators were asked about their experiences in interviews and group discussions. Caregivers found the programme relevant to their lives and reported benefits of participation. Facilitators highlighted the skills they had acquired but also emphasised the importance of support from supervisors during the programme. They described that some caregiver skills training programme topics were difficult to teach caregivers. In particular, the idea of play between caregiver and child was unfamiliar to many caregivers. Lack of available toys made it difficult to practise some of the caregiver skills training programme exercises. Participants indicated that the home visits and group training programme components of the caregiver skills training were acceptable and feasible, but there were some practical barriers, such as transportation issues and lack of time for homework practice. These findings may have importance to non-specialist delivery of the caregiver skills training programme in other low-income countries.

Swedish parents' satisfaction and experience of facilitators and barriers with Family Check-up: A mixed methods study

Family Check-up (FCU) was introduced in Sweden more than a decade ago. Little is known about what parents experience as FCU's key mechanisms leading to changes in parenting. The aim of this study was to investigate Swedish parents' satisfaction with FCU, and their experiences of facilitators and barriers for making changes in their parenting. A mixed methods approach was employed using a parent satisfaction questionnaire (n = 77) and focus groups (n = 15). General satisfaction with FCU was adequate, with an average rating of 4 on a five-point scale (range 3.1-4.6). The analysis of quantitative and qualitative data resulted in eight themes representing facilitators and four themes representing barriers, organized into three categories: (1) access and engagement; (2) therapeutic process; and (3) program components. Ease of access to FCU facilitated initial engagement. Individual tailoring and access to FCU during different phases of change facilitated sustained engagement and change. Therapeutic process facilitators were a meaningful, supportive relationship with the provider, psychological benefits for parents and benefits for the whole family. Program components that facilitated change in parenting were new learning of parenting strategies and use of helpful techniques such as videotaping and home practice. Negative experiences with service systems prior to starting FCU, parent psychological barriers, and parent-provider mismatch were described as potential barriers. Some parents desired other program formats that were not offered, and some felt that new learning was insufficient to improve child behavior. Understanding the parent perspective can contribute to successful future work with implementing FCU.

Parent Training via Internet or in Group for Disruptive Behaviors: A Randomized Clinical Noninferiority Trial

OBJECTIVE

To evaluate if an internet-delivered parent training program is noninferior to its group-delivered counterpart in reducing child disruptive behavior problems (DBP).

METHOD

This noninferiority randomized clinical trial enrolled families seeking treatment in primary care in Stockholm, Sweden, for DBP in a child 3-11 years of age. Participants were randomized to internet-delivered (iComet) or group-delivered (gComet) parent training. The primary outcome was parent-rated DBP. Assessments were made at baseline and 3, 6, and 12 months. Secondary outcomes included child and parent behaviors and well-being and treatment satisfaction. The noninferiority analysis was determined by a one-sided 95% CI of the mean difference between gComet and iComet using multilevel modeling.

RESULTS

This trial included 161 children (mean age 8.0); 102 (63%) were boys. In both intention-to-treat and per-protocol analyses, iComet was noninferior to gComet. There were small differences in between-group effect sizes (d = -0.02 to 0.13) on the primary outcome with the upper limit of the one-sided 95% CI below the noninferiority margin at 3-, 6-, and 12-month follow-up. Parents were more satisfied with gComet (d = 0.49, 95% CI [0.26, 0.71]). At 3-month follow-up, there were also significant differences in treatment effect on attention-deficit/hyperactivity disorder symptoms (d = 0.34, 95% CI [0.07, 0.61]) and parenting behavior (d = 0.41, 95% CI [0.17, 0.65]) favoring gComet. At 12-month follow-up, there were no differences in any outcomes.

CONCLUSION

Internet-delivered parent training was noninferior to group-delivered parent training in reducing child DBP. The results were maintained at 12-month follow-up. This study supports internet-delivered parent training being used as an alternative to group-delivered parent training in clinical settings.

CLINICAL TRIAL REGISTRATION INFORMATION

Randomized Controlled Trial of Comet via the Internet or in Group Format; https://www.

CLINICALTRIALS

gov/; NCT03465384.

Implementing Parenting Programs in Primary Care: A Framework and a Call for Action

Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being of children. Rigorous evidence has demonstrated the efficacy of these programs. Rising rates of child and youth depression, anxiety, grief, and suicide, both prior to and compounded by the COVID-19 pandemic, provide further reasons to implement parenting programs that support all parents in their essential roles. Parents can act as a buffer to stressors and support for children's well-being when they have the knowledge and skills to do so. Pediatric primary care practices are a natural setting for parenting programs, but challenges, including stigma, technology, workflow issues, and funding, have prevented their broad dissemination, implementation, and sustainability. In this article, we develop a framework for implementing parenting programs in primary care and present key considerations for selecting programs that fit the needs of parents, providers, patients, and the practice. We offer lessons from our experiences in overcoming these challenges, using the updated Consolidated Framework for Implementation Research to structure our discussion. We also provide an initial stepwise process which readers may use to plan their own parenting program implementation. Pediatric clinicians and practices can use this article and associated resources to plan, implement, and evaluate parenting programs in their practices as a strategy to help address the growing youth mental health crisis. Improving parenting behaviors can reduce the need for current or future mental health interventions by supporting optimal child development, emotional regulation, and parent-child relationships.

Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts

Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.

A Meta-Analysis of Parenting Interventions for Immigrants

In light of increasing migration rates and the unique experiences of immigrants, this meta-analysis examined the effects of parenting interventions for immigrants. Specifically, we described the characteristics of parenting interventions for immigrants, examined cultural and/or linguistic adaptations made to the interventions, analyzed intervention effects, and examined potential moderating variables. Four electronic databases were searched in February 2021 for peer-reviewed articles published in English. Studies that involved immigrant parents, used an experimental design, and investigated an intervention targeting skills that parents could use directly with their children were included. Sixteen group design and two single-case design studies met inclusion criteria. The risk of publication bias was examined using funnel plots and found to be low. Overall, most parenting interventions for immigrants focused on young children and were delivered in groups. Interventions produced small to moderate effects on parent and child outcomes, which is comparable to those for the general population. All studies made cultural adaptations, with the most common being language. Moderator analyses indicate that the effects of interventions with surface structure adaptations were similar to those with deep structure adaptations. Limitations included the low methodological rigor of included studies and the exclusion of grey literature. More works of research on the relative effects of specific adaptations, such as ethnicity matching, are needed to better serve this population.

Parent Perceptions of an Early Childhood System's Community Efforts: A Qualitative Analysis

Understanding how parents, and other primary caregivers, perceive and experience early childhood programs and services is essential for identifying family-centered facilitators and barriers to service utilization. Therefore, this paper aims to explore parent knowledge of and experiences with community efforts of an early childhood system in Illinois: the All Our Kids Early Childhood Networks (AOK Networks). Our research team conducted focus group interviews with 20 parents across four Illinois counties. A semi-structured interview guide was used to examine parent perceptions of an early childhood system's community efforts in promoting the health and well-being of children aged from birth to five. Thematic network analysis was used to analyze all focus group data. Parents indicated three salient themes, including: (1) comprehensive information sharing practices, (2) diverse service engagement, and (3) barriers to service access. Overall, parents reported general satisfaction with the quality of available services and provided feedback regarding identified areas of need to increase the accessibility and utilization of local services. Engaging parents as partners is essential to the effective implementation of family-centered early childhood services. Families are the experts of their lived experiences, and incorporating their voices in program development and evaluation efforts works to increase positive child and family outcomes.

Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis

The consequences of Serious Mental Illness (SMI) on parent and child outcomes can be profound. Supporting parents to manage their caregiving roles alongside parental SMI successfully has been recognised as a public health priority. To meet this priority and develop effective and acceptable interventions, it is imperative that parents' experiences and support needs are understood. This systematic review aimed to synthesise qualitative research that explored parents' experiences and perceptions of the impact of SMI on their parenting and their corresponding support needs. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Five databases were searched for terms associated with SMI, parenting, and qualitative research. Twenty-nine studies involving 562 parents who experienced SMI met inclusion criteria, and the methodological quality of included studies was appraised using the Critical Appraisal Skills Programme. After findings were synthesised using thematic synthesis, six themes were identified: (1) The constrained parent, (2) parenting difficulties, (3) the strained child, (4) inescapable threat, (5) combatting threat, and (6) wrap-around support needs. Novel insights into the centrality of SMI-related parenting difficulties and threat perceptions across parent, family, healthcare, and wider social systems on strained parent-child and distanced parent-support relationships were highlighted. Systemic practice change initiatives via compassionate and inclusive system-wide support were recommended.

A mixed-methods evaluation of the ¡Vamos por Más! parenting program implementation in Chile

INTRODUCTION AND AIMS

Substance use is a significant global concern. Strengthening parenting in families with adolescents has been shown to reduce substance use initiation. The ¡Vamos por Más! (¡VxM!) program is a positive-parenting program developed in Chile to improve family relations and reduce adolescent substance use that combines in-person school workshops, multimedia messaging and personalized support. This manuscript reports a mixed-methods evaluation of the pilot implementation of the ¡VxM! program utilizing the Consolidated Framework for Implementation Research and Proctor's taxonomy for process outcomes.

METHODS

An explanatory sequential design was used. Quantitative methods evaluated program use, acceptability, appropriateness, and fidelity, and were followed by qualitative focus groups (FGs) to assess the implementation process and understand these outcomes. Thirteen FGs stratified by school and role, including school leaders, program facilitators, participants, and researchers, were conducted.

RESULTS

The program was implemented in three schools, reaching 253 families with in-person workshops (40.5% of potential participants), 257 parents who viewed on average 72.1% of sent multimedia messages, and 2 families who used the personalized support (0.3%). Overall, the program was viewed as acceptable and appropriate by participants and implementers due to the high quality of program materials, targeted content, and activities. Implementation differed by schools. Key implementation factors were the outer context, inner school setting, and implementation processes.

CONCLUSIONS

This comprehensive evaluation, including both intervention implementers and participants, identified implementation facilitators, barriers, and outcomes. Future ¡VxM! implementations should alter program components of schools with lower engagement to improve program implementation and outcomes.

A preliminary evaluation of Kids Matter: A community-based parenting intervention

Parents living in deprived communities are more likely to report lower parental self-efficacy and wellbeing. Poor parental wellbeing and self-efficacy are known risk factors in the development of a range of health and behavioural problems in childhood, adolescence and adulthood. Parenting interventions are key to prevent adverse outcomes in children, however, the mechanisms by which parents learn to understand and support their children are still not well understood. This study evaluated the acceptability of Kids Matter, a parenting intervention targeting parents who are struggling with financial adversity. Secondarily, the relationship between parental wellbeing and and self-efficacy was examined. The present is a retrospective, consecutive case series design study, comparing routinely collected data at pre-intervention, post-intervention, and at 3-month follow-up. Descriptive frequencies were drawn to explore parents' impressions of the programme. Multivariate analysis of variance and regression modelling were used to evaluate associations between parental wellbeing and self-efficacy at different time points. Parents found the programme enjoyable and useful. The intervention led to significant improvements in parental wellbeing and self-efficacy. Improvements in parental wellbeing were significantly associated with improvements in self-efficacy. This study provides evidence of the acceptability and effectiveness of Kids Matter.

"There's more love between us": The parental experience of attending Mellow Babies, a targeted, early intervention program for parents and their babies

It is recognized that parenthood in the context of psychosocial adversity can have negative implications for infant development. Parenting programs are the first line of intervention to improve outcomes for families; however, evidence for the effectiveness of group-based, targeted early interventions is still scarce. Preliminary findings indicate Mellow Babies (MB) as a promising group-based parenting program for families at risk for parenting difficulties. Using thematic analysis, we aimed to understand: (i) the aspects of the intervention that enabled parents to complete the program and (ii) the relational and behavioral changes perceived as valuable for parents and their babies post-intervention. In total, 68 parents residing in the United Kingdom were interviewed after completing MB (49 mothers and 19 fathers; 88% self-identified as British). Three themes and six subthemes were generated from the data. Parents identified several intervention components as beneficial, including the facilitators' interpersonal skills and multi-dimensional, group-based approach. Participant reflections highlighted three underlying mechanisms that enabled positive change: (i) the sense of community cultivated within the group, (ii) the process of formulating and re-conceptualizing one's difficulties, and (iii) the opportunity to reshape interpersonal interactions. Findings are discussed within the context of perinatal and infant mental health.

The BEM Program: An innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil

Objective

To describe the BEM Program, an innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil.

Methods

The Template for Intervention Description and Replication checklist was used to describe the BEM Program in detail.

Results

The BEM Program (an acronym for Brincar Ensina Mudar in Portuguese, "Play Teaches Change" in English) refers to the change in adult, child, and dyad outcomes that can be observed through incorporating playful interactions between the caregiver and their child into their daily household chores. Content consisting of 8 videos and 40 text and audio messages was sent entirely online through WhatsApp®. Thus, the Program could be accessed wherever caregivers wanted, if they had their smartphone and Internet access.

Conclusions

The detailed description of an innovative online parenting program focused on caregiver-child interaction and child development contributes to the scarce evidence on this type of programs. Adherence to the program continues to represent one of the main challenges to overcome.

My Early Relational Trust-Informed Learning (MERTIL) for Parents: A study protocol for a brief, universal, online, preventative parenting program to enhance relational health

BACKGROUND

Early relational health is a key determinant of childhood development, while relational trauma in the parent-infant dyad can instigate a cascading pattern of infant risk. Fortunately, early relational trauma is detectable and modifiable. In 2018, Australian Maternal and Child Health (MCH) nurses participated in MERTIL (My Early Relational Trauma-Informed Learning), a program to identify and prevent relational trauma. Program evaluations revealed nurses felt competent and confident to identify and respond to relational trauma; however, response capacity was inhibited by inadequate parent referral options. In response, MERTIL for Parents (My Early Relational Trust-Informed Learning) was developed, which is an online, evidence-based, self-paced parenting program that focuses on enhancing parental knowledge of relational trust and its significance for infant development. This low-cost, accessible prevention resource targets emerging relational concerns to reduce later service system engagement. The potential for universal preventative online programs that target parental and relational wellbeing remains under-explored. This paper reports on a protocol for implementing a MERTIL for Parents pilot study describing practitioners' and parents' perspectives on program feasibility and efficacy.

METHODS

This study is a mixed methods, parallel armed, uncontrolled, repeated measures design. We aim to recruit 48 Australian MCH practitioners from the states of Victoria and New South Wales. These professionals will in turn recruit 480 parents with a child aged 0-5 years. All parents will receive MERTIL for Parents, which entails a 40-minute video, tipsheets, posters, and support resources. Parent data will be obtained at three periods: pre-program, program exit, and program follow-up. Practitioner data will be collected at two periods: pre-parent recruitment and program follow-up. Data collection will occur through surveys and focus groups. Primary parent outcomes will be socioemotional assessments of program efficacy. Practitioners and parents will each report on program feasibility.

DISCUSSION

This protocol describes the feasibility and efficacy of a new online parenting program, MERTIL for Parents, with pilot field studies commencing in March 2023. We anticipate that this resource will be a valuable addition to various child and family services, for use in individual support and group work.

Protocol for the Feasibility Randomised Controlled Trial of Being a Parent- Enjoying Family Life (BAP-EFL): A peer-led group intervention for parents and caregivers with significant emotional and interpersonal difficulties

Group-format parenting interventions are well-established at reducing challenging child behavior and risk for psychopathology. However, there is significantly less evidence about the performance of these interventions for parents with significant emotional and interpersonal difficulties, including personality disorder. This protocol presents the rationale and design of a two-arm parallel group feasibility Randomised Controlled Trial and nested process evaluation of Being a Parent (BaP)- Enjoying Family Life, a novel peer-led intervention. The trial compares BaP-Enjoying Family Life to the well-established Empowering Parents Empowering Communities-Being a Parent (EPEC-Being a Parent) in a sample of parents who experience significant emotional and interpersonal difficulties and who are concerned about their child's, aged 2-11 years, behavior. 72 parents will be recruited and randomised to receive either BaP-Enjoying Family Life or EPEC-Being a Parent group-format interventions. The primary aim of this study is to examine the feasibility and acceptability of BaP-Enjoying Family Life and the proposed trial methods. Secondary clinical outcomes include child behavioral difficulties, parenting, parental reflective function, parent wellbeing, satisfaction and self-efficacy. An observational assessment of parent and index child will also assess changes in the home environment. Outcome measures will be collected pre-intervention, post-intervention and at 6-month follow up. A parallel process evaluation will use qualitative data from interviews to assess parents' experience of the intervention delivery and trial methods. Findings will be evaluated against pre-determined feasibility criteria. The results will be used to determine the planning of a definitive clinical trial. The wider methodological and clinical implications are also discussed.

Experiences of nurses and coordinators in a childhood obesity prevention trial based on motivational interviewing within Swedish child health services

Purpose

To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity.

Methods

Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis.

Results

Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses’ commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended.

Conclusions

Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints. .

Benefits of a Universal Intervention in Pediatric Medical Homes to Identify and Address Health-Related Social Needs: An Observational Cohort Study

OBJECTIVE

Compare rates of identification of families with health-related social needs (HRSN) and connection to resources by targeted versus universal, pediatric clinic-based interventions.

METHODS

This observational cohort study included 1677 families that received care (January 2017-May 2020) at 8 pediatric medical homes in 3 states implementing Developmental Understanding and Legal Collaboration for Everyone (DULCE)-a universal, evidence-based intervention that addresses HRSN for families with infants. We divided the cohort into 2 groups using 4 common risk criteria in targeted programs serving families with infants; 862 families had no high-risk characteristics (Risk Criteria Absent [RCA]); 815 families had high-risk characteristics (Risk Criteria Present [RCP]). We compared both groups by prevalence of HRSN and connection to supports and estimated the performance of high-risk criteria to identify HRSN.

RESULTS

DULCE identified 990 families with HRSN, compared to an estimated 274 families, if a risk-targeted approach had been used. More than half of RCA families had HRSN, 11% used resources at enrollment, and 42.5% accessed resources through DULCE. Simultaneously, 68.8% of RCP families had ongoing HRSN although 46.0% used resources at enrollment; 63.9% accessed additional resources through DULCE. Commonly used risk criteria had a sensitivity of 55.3% (95% confidence interval [CI], 52.2%-58.5%), specificity of 61.1% (95% CI, 57.2%-64.9%), positive predictive value of 68.8% (95% CI, 65.4%-72.0%), and negative predictive value of 46.9% (95% CI, 43.5%-50.4%).

CONCLUSIONS

Risk criteria commonly used to identify families for targeted interventions are imperfect proxies for HRSN. Universal, medical home-based approaches can play a key role in supporting families with infants.

A virtuous circle: Stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China

While much knowledge about autism derives from high-income countries, most people diagnosed with autism reside in low- and middle-income countries, where little is documented in terms of local interventions. This is also true for parent training programmes for families of autistic children. An evaluation was conducted to understand the effects of a short-term intensive parent training programme delivered in routine services for families of autistic children in China. This study reported results from the in-depth interviews with 14 participating caregivers and group discussions with eight group leaders. The interviews and discussions were aimed at learning (1) to what extent the programme components were deemed acceptable, (2) what affected caregivers' attendance and engagement in the programme and (3) what affected group leaders' delivery of the programme. Findings suggested that future parent training programmes provide adequate opportunities for caregivers to practice and receive feedback; group support; coaching experience tailored to individual challenges; more autism-related knowledge, resources and activities for children and extended family members; and organisational support to group leaders. This study highlights the value of qualitative research and points to the need for more empirical studies to address the recommendations, so that research findings can be better utilised to promote practices.

The implementation of a culturally tailored parenting support programme for Somali immigrant parents living in Sweden—A process evaluation

Background

Parental support programmes aim to strengthen family functioning and the parent–child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components of the implementation process with a focus on Reach, Adaptation, and Fidelity of Ladnaan intervention.

Method

This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Council’s guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes and observations of the sessions. The data were then analysed using content analysis and descriptive statistics.

Results

Of the 60 parents invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the parenting programme’s implementation facilitated reaching Somali-born parents. To retain the programme participants, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme and reported increased knowledge about children’s rights and the support they could seek from social services.

Conclusions

This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to attract immigrant parents to and engage them in participating in parenting support programmes.

Lessons for a COVID-19 era: Barriers and facilitators to court ordered online parenting programs for divorcing and separating parents

Family courts are increasingly interested in online parenting programs for divorcing and separating parents, particularly during the COVID-19 pandemic. To our knowledge, no previous study has evaluated the barriers to and facilitators of parent participation in these programs for family law cases. We interviewed 61 parents in the midst of family law cases regarding their perspectives. While many parents viewed online parent programs positively (e.g., convenient), they also reported barriers to participation (e.g., technology problems). We offer recommendations (e.g., communication about program benefits) to support courts as they decide whether to continue ordering online parent programs following the pandemic.

The Role of Parent Engagement in a Web-Based Preventive Parenting Intervention for Child Mental Health in Predicting Parenting, Parent and Child Outcomes

Although parents’ engagement in parenting programmes has frequently been posited to influence the efficacy and dissemination of these programmes, its relationship with intervention outcomes in parenting programmes is understudied. This study examined the predictive value of parental engagement on preventive parenting outcomes in a tailored online parenting programme aimed at enhancing parental protective factors and reducing risk factors for child depression and anxiety disorders. The present study also explored the associations between parental engagement and other parent, child and family outcomes. Data were collected from a community sample of 177 parents who received a tailored online parenting programme (‘Parenting Resilient Kids’; PaRK) and their children as part of a randomised controlled trial. Participants completed measures on parenting, child anxiety and depressive symptoms, health-related quality of life and family functioning on three occasions. Multiple regressions showed that parental engagement explained additional variance in preventive parenting (most proximal outcomes) at post-intervention and 12-month follow-up. Indicators of higher levels of parental engagement, operationalised by greater proportions of recommended programme modules and intended goals completed, uniquely predicted higher levels of preventing parenting. Higher levels of parental engagement also predicted higher levels of parental acceptance and parental psychosocial health-related quality of life, lower levels of parental psychological control and lower levels of impairments in child health-related quality of life. However, parental engagement did not explain additional variance in parent or child reported anxiety or depressive symptoms. This study provides support for the role of parental engagement in facilitating parenting changes in parenting-focused interventions.

Effectiveness of a peer group-based online intervention program in empowering families of children with disabilities at home

BACKGROUND

The empowerment of families raising children with disabilities (CWD) is crucial in maintaining their health. We developed an evidence-based, family empowerment intervention program focusing on social resource utilization and reducing care burden.

OBJECTIVE

This study aimed to determine the program's effectiveness in promoting family empowerment.

METHODS

We compared an intervention group that started the online intervention program a week after initial evaluation and a group that received delayed intervention (waitlist-controlled group) at three time points: initial (T1), post-course (T2), and follow-up (T3). The required sample size was 52.

RESULTS

There were 60 participants who applied to the program. One participant dropped out due to scheduling issues, and the others were assigned to either the intervention group (n = 29) or the waitlist-controlled group (n = 30). Those who responded to the baseline questionnaire (T1: 26 from the intervention group; 29 from the waitlist-controlled group) comprised the final sample. Among them, 20 members of the intervention group and 20 of the waitlist-controlled group attended all four sessions (completion rates of 77% and 69%, respectively). The attendance rate for sessions 1-4 was 94%, 89%, 81%, and 83%, respectively. The participant numbers in each session ranged from 5 to 18 per month. The baseline outcome score did not differ between the groups. The primary outcome, family empowerment, measured using the family empowerment scale (FES), was significantly higher at T2 for the intervention group than in the waitlist-controlled group and was sustained in the sensitivity analysis. The intervention group's FES, in the family relationships (FA) and relationships with service systems (SS) subdomains, increased significantly, unlike involvement with the community (SP). The intervention group experienced lower care burden and higher self-compassion, especially in the isolation and over-identification items of the self-compassion scale-short form (SCS-SF). The intervention group's FES (total, FA, SS) and SCS-SF (total, common humanity, isolation) changed significantly between T1 and T2, and all, except common humanity, were sustained up to T3; this group's FES (SP) and SCS (negative score, over-identification) changed significantly between T1 and T3. The waitlist-controlled group's FES (total, FA) and SCS (total) changed significantly and were sustained between T2 and T3.

CONCLUSIONS

The developed intervention program promotes family empowerment in families of CWD.

CLINICAL TRIAL REGISTRATION

This study is registered as a clinical trial in the UMIN Clinical Trials Registry (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050422, UMIN000044172).

Participants' Engagement With Telephone Support Interventions to Promote Healthy Feeding Practices and Obesity-Protective Behaviours for Infant Obesity Prevention

BACKGROUND

Participant engagement with program interventions is vital to support intended behaviour changes and outcomes. The aim of this research was to investigate participant engagement with the Communicating Healthy Beginnings Advice by Telephone (CHAT) program, an early childhood obesity prevention program that included interventions for promoting healthy infant feeding practices and obesity-protective behaviours via telephone, and whether engagement with the telephone support program varied by participants' sociodemographic characteristics.

METHODS

This study used de-identified CHAT program data of participants who received the interventions via telephone. Data analysed included 1) participant engagement in telephone support from late pregnancy to 12 months of child's age, 2) demographic characteristics collected at late pregnancy and 3) intervention providers' observations and notes (qualitative data) for 10 participants from each engagement group (low, medium, high) to explore issues discussed during telephone support.

RESULTS

Call completion rate by participants was above sixty percent for all six stages of the telephone support program with more than half of the participants (57%) demonstrating high level of engagement. We found that participants' country of birth, employment status and annual household income were predictors of engagement with the telephone support provided in the CHAT program. The odds of participants' engagement with the telephone support program were 1.68 times higher for Australian born (95% CI 1.07 - 2.62), 1.63 times higher for participants who were employed (95% CI 1.01 - 2.66) and 1.63 times higher for participants with annual household income ≥AUD$80,000 (95% CI 1.02 - 2.60).

CONCLUSIONS

Participant engagement with the program interventions was good. Participants' engagement with the telephone support program was significantly associated with certain socio-demographic characteristics. Australian born participants, and participants associated with higher household income and employment engaged significantly more with the telephone support provided in the CHAT program. Additionally, the program engaged more participants older than 30 years of age and those who spoke English at home. The program provided unintended personal benefits to some participants with high engagement level due to their various psychosocial needs such as domestic violence, mental health and sleep related issues. Although not an intended benefit of the intervention, psychosocial needs of participants were met which was a likely factor for mothers' engagement with the program. This is an important factor that needs to be considered while implementing future programs or scale up of this program.

Profiles of Parents' Preferences for Delivery Formats and Program Features of Parenting Interventions

Parents are the targeted consumers of parenting interventions but a small body of research has examined parental preferences for program characteristics to incorporate them in the adaptation and implementation of such programs. Furthermore, the relationship between parents' preferences for program characteristics and their cognitions and behaviours has not yet been explored. This study aimed to identify profiles of parental preferences for delivery formats and program features of parenting interventions. Data from 6949 participants from the International Parenting Survey was analysed. Two-step cluster analyses were conducted to determine clusters of delivery formats and program features of parenting interventions. Preferences for delivery formats showed two clusters, a face-to-face cluster and a media-based cluster. In terms of program features, two clusters were also obtained, a personalised cluster and logistic cluster. While these clusters differed in some demographics, parents' report of child emotional and behavioural problems and parent factors were the key differentiating variables.

A cluster RCT and process evaluation of an implementation optimisation intervention to promote parental engagement enrolment and attendance in a childhood obesity prevention programme: results of the Optimising Family Engagement in HENRY (OFTEN) trial

Background

Poor and variable implementation of childhood obesity prevention programmes reduces their population impact and sustainability. We drew upon ethnographic work to develop a multi-level, theory-based implementation optimisation intervention. This intervention aimed to promote parental enrolment and attendance at HENRY (Health Exercise Nutrition for the Really Young), a UK community obesity prevention programme, by changing behaviours of children’s centre and local authority stakeholders.

Methods

We evaluated the effectiveness of the implementation optimisation intervention on HENRY programme enrolment and attendance over a 12-month implementation period in a cluster randomised controlled trial. We randomised 20 local government authorities (with 126 children’s centres) to HENRY plus the implementation optimisation intervention or to HENRY alone. Primary outcomes were (1) the proportion of centres enrolling at least eight parents per programme and (2) the proportion of centres with a minimum of 75% of parents attending at least five of eight sessions per programme. Trial analyses adjusted for stratification factors (pre-randomisation implementation of HENRY, local authority size, deprivation) and allowed for cluster design. A parallel mixed-methods process evaluation used qualitative interviews and routine monitoring to explain trial results.

Results

Neither primary outcome differed significantly between groups; 17.8% of intervention centres and 18.0% of control centres achieved the parent enrolment target (adjusted difference − 1.2%; 95% CI − 19.5%, 17.1%); 17.1% of intervention centres and 13.9% of control centres achieved the attendance target (adjusted difference 1.2%; 95% CI − 15.7%, 18.1%). Unexpectedly, the trial coincided with substantial national service restructuring, including centre closures and reduced funds. Some commissioning and management teams stopped or reduced delivery of both HENRY and the implementation optimisation intervention due to competing demands. Thus, at follow-up, HENRY programmes were delivered to approximately half the number of parents compared to baseline (n = 433 vs. 881).

Conclusions

During a period in which services were reduced by external policies, this first definitive trial found no evidence of effectiveness for an implementation optimisation intervention promoting parent enrolment to and attendance at an obesity prevention programme.

Trial registration

ClinicalTrials.govNCT02675699. Registered on 4 February 2016

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05757-w.

Behavioral Economics and Parent Participation in an Evidence-Based Parenting Program at Scale

Evidence-based and culturally relevant parenting programs strengthen adults' capacity to support children's health and development. Optimizing parent participation in programs implemented at scale is a prevailing challenge. Our collaborative team of program developers, implementers, and researchers applied insights from the field of behavioral economics (BE) to support parent participation in ParentCorps-a family-centered program delivered as an enhancement to pre-kindergarten-as it scaled in a large urban school district. We designed a bundle of BE-infused parent outreach materials and successfully showed their feasibility in site-level randomized pilot implementation. The site-level study did not show a statistically significant impact on family attendance. A sub-study with a family-level randomization design showed that varying the delivery time of BE-infused digital outreach significantly increased the likelihood of families attending the parenting program. Lessons on the potential value of a BE-infused approach to support outreach and engagement in parenting programs are discussed in the context of scaling up efforts.

SCENE: A novel model for engaging underserved and under-represented audiences in informal science learning activities

Inequitable access to science, technology, engineering, arts and mathematics (STEAM) has been explored by multiple studies which have shown that some publics are underserved by existing informal educational and cultural provision, and under-represented in related study choices and careers. Informal science learning (ISL) and public engagement with research activities (such as science festivals) tend to attract audiences which are largely white, middle class and already engaged with STEM (science, technology, engineering and mathematics). This article describes the development of an engagement approach and model through a story-based festival (SMASHfestUK) which was specifically designed to attract new and diverse audiences, including Black and mixed-heritage families, and families living with socio-economic disadvantage. The festival was delivered on five annual occasions, each co-designed with a wide selection of stakeholders, including audiences, researchers, performers, institutions and organizations, and considered as an iterative prototype.

Capturing the voices of mothers: Delivery and content efficacy of a community attachment parenting program

This qualitative case study sought to examine the delivery and content efficacy of a community attachment parenting program developed and hosted by an attachment and trauma-informed organization that services infants and their pre- or postnatal mothers in Ontario, Canada. A focus group and participant reflective journals were employed to amplify the voices of mothers who engaged in the 8-week program. Five overarching themes surfaced in the data which include (1) infant/mother attachment, (2) program delivery validations and recommendations, (3) program content validations and recommendations, (4) facilitator delivery, content and relational competencies and (5) connections with others. The findings of this study are intended to inform future offerings of this program, as well as incite further research to illuminate the voices of mothers and other participants who engage in attachment-postured community parenting programs across the globe.

Engaging Parents of Lower-Socioeconomic Positions in Internet- and Mobile-Based Interventions for Youth Mental Health: A Qualitative Investigation

Growing literature supports the use of internet- and mobile-based interventions (IMIs) targeting parenting behaviours to prevent child and adolescent mental health difficulties. However, parents of lower-socioeconomic positions (SEP) are underserved by these interventions. To avoid contributing to existing mental health inequalities, additional efforts are needed to understand the engagement needs of lower-SEP parents. This study qualitatively explored lower-SEP parents’ perspectives on how program features could facilitate their engagement in IMIs for youth mental health. We conducted semi-structured interviews with 16 lower-SEP parents of children aged 0–18 to identify important program features. Participants were mostly female (81.3%) and aged between 26 and 56 years. Transcriptions were analysed using inductive thematic analysis. Twenty-three modifiable program features important to lower-SEP parents’ engagement in IMIs were identified. These features aligned with one of three overarching themes explaining their importance to parents’ willingness to engage: (1) It will help my child; (2) I feel like I can do it; (3) It can easily fit into my life. The relative importance of program features varied based on parents’ specific social and economic challenges. These findings offer initial directions for program developers in optimising IMIs to overcome barriers to engagement for lower-SEP parents.

Teaching Parents to Be Responsive: A Network Meta-analysis

CONTEXT

Children who receive more responsive care during their early childhood tend to exhibit stronger cognitive development, mental well-being, and physical health across their life course.

OBJECTIVE

Determine how to design effective responsivity training programs for caregivers.

DATA SOURCES

We searched seven electronic databases through October 2020.

STUDY SELECTION

Randomized trials (k = 120) of programs training parents of children ages 0 to 6 to be more responsive.

DATA EXTRACTION

Two reviewers independently extracted data. Data were pooled by using random-effects pairwise and network meta-analyses.

RESULTS

Programs had, on average, a medium effect (d = 0.56; 95% confidence interval [CI]: 0.47 to 0.65). The most effective programs included didactic teaching and opportunities for parents to observe models, practice skills, and receive feedback (d = 1.07; 95% CI: 0.37 to 1.77), or all these instructional methods in addition to reflection (d = 0.86; 95% CI: 0.64 to 1.09). Programs that had participants observe examples of responsivity (d = 0.70; 95% CI: 0.57 to 0.83), used researchers as facilitators (d = 0.89; 95% CI: 0.66 to 1.12), assigned homework (d = 0.85; 95% CI: 0.66 to 1.02), and had a narrow scope (d = 0.72; 95% CI: 0.57 to 0.87) were more effective than those that did not.

LIMITATIONS

Most samples included only mothers from Western countries and lacked follow-up data.

CONCLUSIONS

Having parents observe examples of responsive caregiving and complete home-practice in short, focused programs may be an effective, scalable approach to enhancing responsivity in the general population and reducing inequalities in child development.

Improving a Parent Coaching Model of Music Interventions for Young Autistic Children

Parenting a child on the autism spectrum can be rewarding and enriching, but it may also increase risk of parental fatigue, stress, anxiety, and depression. Parent-mediated interventions contribute to increase family satisfaction and child social communication while helping to decrease parental stress and fatigue. Parent coaching, the education of parents in evidence-based strategies, has become common in the autism field. However, parent coaching in music therapy has only recently emerged and has limited research with families with an autistic member. In this study, we attempted to improve a previously published model of parent coaching, adapting only one aspect of the Early Start Denver Model (ESDM), the sensory social routine (SSR) to create a music intervention. Four parents participated in this 6-session parent coaching study. We compared the SSR-based intervention with and without music, in an alternating treatment design. Measures included parental responsiveness, child receptive and initiation joint attention, parent-child similar affect and synchronized gaze, and the Parent Coaching-ESDM (PC-ESDM) parent fidelity rating system. Results from these observational measures were mixed, with better parental responses in the no-music condition, but improved child responses and parent-child synchrony in the music condition for 3 out of the 4 participants. Parent learning increased for all participants, and 3 out of the 4 reached fidelity (a score of at least 80%), according to the PC-ESDM. Although mixed results were observed across participants, implications for practice are possible. Better outcome measures of this complex intervention are needed.

Barriers and facilitators to successful implementation of sustainable school meals: a qualitative study of the OPTIMAT™-intervention

Background

There is an urgent need to align human diets with goals for environmental sustainability and population health. The OPTIMAT™-intervention study was developed to implement and evaluate a nutritionally adequate and climate-friendly 4-week lunch menu in Swedish primary schools. This study aimed to explore pupils’ and kitchen staff’s experiences of the intervention and to identify barriers and facilitators to successful implementation of sustainable school meals.

Methods

An inductive manifest qualitative method was used. Nine focus group discussions (FGDs) were conducted, six with pupils in grades 5 (ages 10–11) and 8 (ages 14–15) (n = 29) and three with kitchen staff (n = 13). Data were analyzed using qualitative content analysis.

Results

Five main categories and 11 subcategories at a manifest level emerged. The five main categories were: 1) Experiences with the new menu, unfolding variations in how the new menu was received and kitchen staff’s experiences of working with it; 2) The meaning of diet sustainability, comprising pupils’ and kitchen staff’s perceptions about diet sustainability as a concept and part of their everyday lives; 3) Factors influencing plant-based food acceptance, covering aspects such as the influence of sensory factors, habits and peer pressure; 4) Opportunities to increase plant-based eating, including factors related to pupils’ and kitchen staff’s ideas for how to increase plant-based food acceptance; and 5) Need for a supportive environment to achieve dietary change, comprising pupils’ and kitchen staff’s thoughts on the importance of more knowledge, resources and involvement of stakeholders to eat more plant-based meals in schools.

Conclusions

Successful implementation of sustainable school meals would require more knowledge among pupils and kitchen staff. Staff also need more training in cooking of sustainable meals. Barriers among pupils could be tackled by introducing new plant-based meals more gradually and by more carefully considering the seasoning, naming and aesthetics of dishes. An increased leadership support for change and involvement of stakeholders from multiple levels within society will be key in the transition to sustainable school meals at scale.

Trial registration

The trial registration for the OPTIMAT™-intervention may be found at clinicaltrials.gov (NCT04168632 Fostering Healthy and Sustainable Diets Through School Meals (OPTIMAT)).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01158-z.

Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial

BACKGROUND

There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation.

OBJECTIVE

This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time.

METHODS

A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents.

RESULTS

Less than half (88/206, 42.7%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations.

CONCLUSIONS

Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03521115; https://clinicaltrials.gov/ct2/show/NCT03521115.

Parental Self-Efficacy to Promote Children's Healthy Lifestyles: A Pilot and Feasibility Study

Positive parenting programs are a key strategy to promote the development of parental competence. We designed a pilot study based on parental self-efficacy to promote healthy lifestyles in their children aged between 2 to 5 years old. In this pilot study, we aimed to assess the effects of a parenting program on parental self-efficacy and parenting styles. Twenty-five parents were allocated into intervention (N = 15) and control group (N = 10). Parents from the intervention group received four group sessions (120 mi per session) to develop a positive parenting, parenting styles and parenting skills regarding to children’s diet, exercise, and screen time, and two additional sessions about child development and family games. Parents from the control group received these two latter sessions. Parental self-efficacy, parenting styles, and meal-related parenting practices were measured before and after the intervention and at 3-month follow-up. Acceptability and feasibility of the program was also measured. Quantitative data were analyzed using the repeat measures ANOVA and ANCOVA tests and the effect size calculation. Content analysis was used to analyse open questions. Positive trends were found regarding parental self-efficacy and the use of authoritative parenting style. Parents also reported a great acceptability of the program getting high satisfaction. According to the feasibility barriers and facilitators aspects were identified. The positive trends founded in this study support the development of parenting programs to promote healthy lifestyle in children.

Promoting sensitive parenting in 'at-risk' mothers and fathers: A UK outcome study of Mellow Babies, a group-based early intervention program for parents and their babies

BACKGROUND

The objective of this study was to evaluate the effectiveness of Mellow Babies (MB) in the UK. MB is a 14-week early parenting intervention program that is delivered in groups and is targeted at 'at-risk' parents (both mothers and fathers) and their babies up to 18 months old.

METHOD

The study used a pragmatic pre-post intervention design. Outcomes were parental mental health, parenting confidence, quality of life, socio-emotional development of children, and perceived parent-child relationship. Fifteen groups representing n = 91 parent-baby dyads were recruited across the UK between 2017-2018. The sample consisted of 10 Mellow Mums groups (70 mother-baby dyads) and 5 Mellow Dads groups (21 father-baby dyads). Intention-to-treat and 'completer' analyses were performed.

RESULTS

Findings suggest short-term positive outcomes for parents attending MB. Completion of the program was associated with significant improvements in anxiety and overall wellbeing, parenting confidence, and perceived closeness of the parent-child relationship. The significance of these improvements, except for parenting confidence, was maintained in the intention-to-treat analysis. MB engaged and retained a high proportion of parents who could be considered 'at-risk' and benefitted fathers and mothers attending the intervention equally.

CONCLUSIONS

This is the first prospective study to explore MB participation for both mothers and fathers and to indicate engagement and potential benefits specifically for 'at-risk' parents. Findings further demonstrate the effectiveness of MB as an early intervention program for parents experiencing psychosocial difficulties. Replication by studies using a contrast or control group also incorporating follow-up data would further improve the evidence base for MB.

The Development of a Multilevel Intervention to Optimise Participant Engagement with an Obesity Prevention Programme Delivered in UK children's Centres

Poor participant engagement threatens the potential impact and cost-effectiveness of public health programmes preventing meaningful evaluation and wider application. Although barriers and levers to engagement with public health programmes are well documented, there is a lack of proven strategies in the literature addressing these. This paper details the development of a participant engagement intervention aimed at promoting enrolment and attendance to a community-based pre-school obesity prevention programme delivered in UK children’s centres; HENRY (Health, Exercise, Nutrition for the Really Young). The Behaviour Change Wheel framework was used to guide the development of the intervention. The findings of a coinciding focused ethnography study identified barriers and levers to engagement with HENRY that informed which behaviours should be targeted within the intervention to promote engagement. A COM-B behavioural analysis was undertaken to identify whether capability, opportunity or motivation would need to be influenced for the target behaviours to occur. APEASE criteria were used to agree on appropriate intervention functions and behaviour change techniques. A multi-level participant engagement intervention was developed to promote adoption of target behaviours that were proposed to promote engagement with HENRY, e.g. ensuring the programme is accurately portrayed when approaching individuals to attend and providing ‘taster’ sessions prior to each programme. At the local authority level, the intervention aimed to increase buy-in with HENRY to increase the level of resource dedicated to engagement efforts. At the centre level, managers were encouraged to widen promotion of the programme and ensure that staff promoted the programme accurately. HENRY facilitators received training to increase engagement during sessions, and parents that had attended HENRY were encouraged to recruit their peers. This paper describes one of the first attempts to develop a theory-based multi-level participant engagement intervention specifically designed to promote recruitment and retention to a community-based obesity prevention programme. Given the challenges to implementing public health programmes with sufficient reach, the process used to develop the intervention serves as an example of how programmes that are already widely commissioned could be optimised to enable greater impact.

A Scoping Review of Interventions Designed to Support Parents With Mental Illness That Would Be Appropriate for Parents With Psychosis

The experience of psychosis can present additional difficulties for parents, over and above the normal challenges of parenting. Although there is evidence about parenting interventions specifically targeted at parents with affective disorders, anxiety, and borderline personality disorder, there is currently limited evidence for parents with psychotic disorders. It is not yet known what, if any, interventions exist for this population, or what kinds of evaluations have been conducted. To address this, we conducted a scoping review to determine (1) what parenting interventions have been developed for parents with psychosis (either specifically for, or accessible by, this client group), (2) what components these interventions contain, and (3) what kinds of evaluations have been conducted. The eligibility criteria were broad; we included any report of an intervention for parents with a mental health diagnosis, in which parents with psychosis were eligible to take part, that had been published within the last 20 years. Two reviewers screened reports and extracted the data from the included reports. Thirty-eight studies of 34 interventions were included. The findings show that most interventions have been designed either for parents with any mental illness or parents with severe mental illness, and only two interventions were trialed with a group of parents with psychosis. After noting clusters of intervention components, five groups were formed focused on: (1) talking about parental mental illness, (2) improving parenting skills, (3) long-term tailored support for the whole family, (4) groups for parents with mental illness, and (5) family therapy. Twenty-three quantitative evaluations and 13 qualitative evaluations had been conducted but only eight interventions have or are being evaluated using a randomized controlled trial (RCT). More RCTs of these interventions are needed, in addition to further analysis of the components that are the most effective in changing outcomes for both the parent and their children, in order to support parents with psychosis and their families.

Understanding Initial and Sustained Engagement of Spanish-Speaking Latina Mothers in the Legacy for Children Program™: A Qualitative Examination of a Group-Based Parenting Program

Culturally congruent parenting programs delivered during early childhood have the potential to support diverse families. Legacy for Children™ (Legacy) is a group-based prevention program designed to promote child development by reinforcing sensitive, responsive mother-child relationships, building maternal self-efficacy, and fostering peer networks of support among mothers living in poverty (Perou et al., 2012). The Legacy program was translated and culturally adapted for Spanish-speaking Latina mothers and their infants (hereafter referred to as Latina mothers) with a feasibility trial conducted to determine the cultural congruency of the adaptation. Feasibility results were positive with no previous studies validating the adapted Legacy Spanish language program (Legacy Spanish). The current manuscript focuses on understanding factors of engagement of the culturally adapted model. Specifically, we examined the factors that were perceived to have enhanced or hindered both initial and sustained engagement in the adapted Legacy Spanish program for Latina mothers. Individual interviews were conducted with Latina mothers (N=26) who attended the Legacy Spanish program. We used a template approach within NVivo 11^© software to identify broad themes in Latina mothers' responses. Themes emerged regarding the importance of using home-based recruitment strategies and pairing verbal information with written brochures to foster initial engagement. Sustained engagement themes focused on the provision of support from other Latina mothers in the Legacy group and the relationships with the group leaders. Having group leaders who were perceived as genuine, kind, positive, "good" at teaching, and persistent emerged as themes that facilitated initial and ongoing engagement. Barriers to engagement centered primarily on logistics rather than characteristics of the program itself. Thus, Latina mothers attributed importance to aspects of the curriculum, logistics, and implementation with respect to program engagement. Application of similar engagement strategies could enhance the success of early childhood parenting programs and linkages with early educational programming.

Informing the personalisation of interventions for parents of children with conduct problems: a qualitative study

BACKGROUND

Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit.

METHODS

Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective.

RESULTS

Parents' accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child's teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child's individual issues were never considered.

CONCLUSIONS

Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances.

Evaluating Incentive Strategies on Parental Engagement of the PACE Parenting Program

OBJECTIVES

Evaluate whether various incentive strategies were associated with parental engagement in an 8-week parenting program offered through daycare centers.

METHODS

Parents were randomly assigned to four conditions. The conditions differed in their strategy to recruit and retain parents. The conditions were: (1) Program-as-usual, (2) Monetary Incentive, (3) Mindfulness training, and (4) Monetary Incentive and Mindfulness. The sample included 610 parent-child dyads.

RESULTS

Results showed no differences between conditions on intentions to enroll, but they did differ on attendance and quality of participation. Specifically, parents in the program-as-usual condition, compared to all other conditions, were more likely to attend at least a session. Parents in the monetary incentive condition were more likely to be rated as more engaged in sessions compared to parents in the program-as-usual condition. However, for participants who attended at least six sessions, results revealed that parents in the mindfulness training condition were significantly more likely to be rated as engaged compared to those in the treatment-as-usual condition.

CONCLUSIONS

These results highlight the potential tailoring of different recruitment strategies for different stages of the engagement process and reflect the importance of operationalizing "engagement" in more than one way (e.g., attendance versus level of participation).

Parents' Perceptions and Experiences of Parenting Programmes: A Systematic Review and Metasynthesis of the Qualitative Literature

Supporting parents to meet the challenges of their caregiving role is identified as a public health concern and a priority in policies internationally. Quantitative research has established the efficacy of parenting programmes but less is understood about the key aspects that make interventions meaningful and helpful to families. We aimed to explore parents' experiences and perceptions of parenting programmes in order to highlight the parent voice and identify key factors that parents perceive to be meaningful and improve our understanding of the acceptability and perceived benefits of parenting programmes. Six key electronic databases were searched systematically for qualitative research and eligibility for inclusion was established. A thematic synthesis was undertaken. Twenty-six studies were included, spanning 17 years of parenting research and involving 822 parents. Three main themes and nine subthemes were identified: (1) a family's journey (prior to the parenting programme, outcomes (including changes in the parent, child and wider family) and post-intervention), (2) aspects perceived to be important or valuable (group leader or facilitator, programme content and delivery and value of the group) and (3) challenges or difficulties (barriers to engagement or attendance, programme content and suggestions for improvement). Reported outcomes of parenting programmes included changes in the parent alongside changes in the child and family more widely. Key recommendations to improve provision of accessible, clinically and cost-effective interventions for parents include ensuring high-quality training and supervision of facilitators, balancing flexibility and fidelity to ensure tailored content to meet individual needs, a sensitivity to parental adversity, the need for wider familial support and the availability of ongoing support following the end of a parenting programme.