Supporting parenting to address social inequalities in health: a synthesis of systematic reviews

How do exhausted parents experience their interactions with their children? A qualitative and participative study

Introduction

Parental burnout, known as a state of physical and psychological exhaustion, results in an imbalance between the parent's perceived stressors in relation to parenting, and the resources available to the parent to cope with such stressors. The causes and consequences of parental burnout for the parents themselves have been studied from the parents' point of view, but the perception of parents regarding the impact of parental burnout on the parent-child relationship has not yet been documented.

Methods

We conducted a qualitative study through semi-structured interviews with exhausted parents (n=21). We aimed to better understand their general interactions with their children, as well as the way they communicate with them about their state of exhaustion, knowing that dealing with parental suffering can have a long-term impact on the child.

Results

Our results reveal that exhausted parents experience a widespread loss of control in all areas of their lives, particularly in their interaction with their children, which generates feelings of guilt and shame. Communicating their experience to their children can create various difficulties for both parents and children. This may complicate the process of seeking help and reinforce the feeling of isolation.

Discussion

An emerging result from our analysis leads us to identify a need for the parents to be heard and validated in their suffering who took part in this research.

Socioeconomic inequalities in child and adolescent mental health in Australia: the role of parenting style and parents' relationships

BACKGROUND

Socioeconomic inequalities in health and their determinants have been studied extensively over the past few decades. However, the role of parenting style and parents' couple relationships in explaining mental health inequalities is limited. Therefore, this study aims to investigate the distributional impact of parenting style (angry parenting, consistent parenting, and inductive parenting) and parents' couple relationships (e.g., argumentative, happy relationships) on socioeconomic inequalities and by extension on mental health status of Australian children and adolescents.

METHODS

This study utilized data from the Longitudinal Study of Australian Children (Waves 1-7), specifically focusing on intact biological parent families, while excluding single-parent and blended-family households. We applied the decomposition index and the Blinder Oaxaca method to investigate the extent of the contribution and temporal impact of parenting style and parents' couple relationships on the mental health status of Australian children and adolescents.

RESULTS

This study revealed that poor parenting style is the single most important factor that leads to developing mental health difficulties in children and adolescents, especially from low socioeconomic status, and it contributes almost 52% to socioeconomic inequalities in mental health status. Conversely, household income, maternal education, employment status, and parents' couple relationships contributed 28.04%, 10.67%, 9.28%, and 3.34%, respectively, to mental health inequalities in children and adolescents.

CONCLUSION

Overall, this study underscores the importance of parenting style and parents' couple relationships as significant predictors of mental health outcomes in children and adolescents. These results highlight the need for targeted interventions to support families from low socioeconomic backgrounds to address the significant mental health inequalities observed in the study population.

Investigating the factors related to protective behaviors against COVID-19 in healthcare workers: Application of extended parallel process model

Background and Aims

Preventive behaviors against coronavirus disease 2019 (COVID-19) are important, and messages that create a sense of danger are necessary to create these behaviors. One of the widely used models for designing risk messages is the Extended Parallel Process Model (EPPM). The present study was conducted to investigate the factors related to protective behaviors against COVID-19 in the personnel of the health department based on EPPM.

Methods

In this cross-sectional study, 699 personnel of the deputy health department of Chaharmahal and Bakhtiari province were included in the study by census method. Data were collected online using valid questionnaires, including demographic questions and history of contracting COVID-19 and the questionnaire of EPPM constructs. Data were analyzed in SPSS24 software, using descriptive and analytical statistics.

Results

The results showed that there were positive correlations between the protective behaviors and the constructs of perceived severity (p < 0.001, r = 0.542), perceived susceptibility (p < 0.001, r = 0.260), self-efficacy (p < 0.001, r = 0.594), response efficiency (p > 0.001, r = 0.522), and risk control (p > 0.001, r = 0.501). There was a negative correlation between protective behaviors and fear control (p < 0.001, r = 0.329). The results of multiple linear regression showed that these six constructs explained 49.8% of protective behaviors against COVID-19, among which the role of the perceived severity construct was stronger than other constructs.

Conclusion

Regarding the results, it is suggested that the results of this research be used in the development of training programs to improve protective behaviors in high-traffic offices, and by focusing on fear and risk control.

Does Social and Economic Disadvantage Predict Lower Engagement with Parenting Interventions? An Integrative Analysis Using Individual Participant Data

There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Resesearch 5, 1-144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs-an 8-19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.

Timely support for promoting mental wellbeing among families with young children -an interview study exploring the experiences of multi-professional practitioners in Finland

BACKGROUND

Childhood is a critical period for promoting mental wellbeing and previous research suggests that various family-focused mental health promotion and early prevention initiatives are effective. The aim of the study was to explore Finnish health and social care practitioners' views and experiences of mental health promotion practice targeting families with young children.

METHODS

Individual semi-structured interviews with 14 practitioners representing various municipal services, faith-based and third sector organizations were conducted in 2021 and analysed using thematic analysis.

RESULTS

Various challenges and opportunities for supporting mental health related to both structural features of the health and social care landscape and the varying needs of families were identified. The lack of resources as well as the social stigma associated with mental health problems and with public welfare services, hindered proactive work approaches and timely support. However, low-threshold initiatives and adapted information to families as well as further training about mental health for practitioners together with multi-professional collaboration and teamwork were suggested as potential enablers for mental health promotion.

CONCLUSIONS

The study highlights the importance of reaching families in a timely manner in order to promote mental wellbeing and prevent mental health problems. The findings, bringing to the fore the practitioners' own experiences and views, suggest how current practice could be developed in order to safeguard mental health and wellbeing for all families with young children. The practitioners' views and experiences are key components when building future sustainable and proactive health and social care services.

Using participatory action research to co-design perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma

PROBLEM & BACKGROUND

Support is important for all parents but critical for those experiencing complex trauma. The The Healing the Past by Nurturing the Future project uses participatory action research to co-design effective perinatal support for Aboriginal and Torres Strait Islander parents.

AIM

This research aims to identify and refine culturally appropriate support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma.

DESIGN

We presented our synthesised eight parent support goals and 60 strategies, collated from Elder and parent focus groups, previous participatory workshops, and evidence reviews, for discussion at a stakeholder workshop. Stakeholder perspectives were captured using a three-point agreement activity and, self- and scribe-recorded comments. Aboriginal and non-Aboriginal researchers analysised the qualitative data, to identify core factors which might facilitate or help enact the parenting related goals.

FINDINGS

Overall, stakeholders (n = 37) strongly endorsed all eight goals. Workshop attendees (57% Aboriginal) represented multiple stakeholder roles including Elder, parent and service provider. Four core factors were identified as crucial for supporting parents to heal from complex trauma: Culture (cultural traditions, practices and strengths), Relationality (family, individual, community and services), Safety (frameworks, choice and control) and Timing (the right time socio-emotionally and stage of parenting).

DISCUSSION

Context-specific support tailored to the Culture, Relationality, Safety, and Timing needs of parents is essential. These four factors are important elements to help enact or facilitate parenting support strategies.

CONCLUSION

Further work is now required to develop practical resources for parents, and to implement and evaluate these strategies in perinatal care to address cumulative and compounding cycles of intergenerational trauma.

Supporting parents by combatting social inequalities in health: a realist evaluation

BACKGROUND

To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period.

METHODS

To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires.

RESULTS

The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so.

CONCLUSIONS

This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents' needs.

Parental educational level and childhood wheezing and asthma: A prospective cohort study from the Japan Environment and Children's Study

BACKGROUND

The influence of mothers' and fathers' educational levels in separate evaluations of asthma has not been fully investigated. This study aims to examine the associations of the mother's and fathers' educational levels with childhood wheeze and asthma adjusting for crude and pre-and post-natal modifiable risk factors.

METHODS

We conducted a prospective cohort study using data from the Japan Environment and Children's Study, which recruited pregnant women from 2011 to 2014. The mother's and father's educational levels were surveyed by a questionnaire during the pregnancy, and childhood wheezing and doctor-diagnosed asthma were estimated using a 3-year questionnaire. Multilevel logistic regression analysis was performed to evaluate the association between the mother's and father's educational levels and childhood wheezing and asthma, adjusted for pre-and post-natal factors.

RESULTS

A total of 69,607 pairs of parents and their single infants were analyzed. We found 17.3% of children had wheezing and 7.7% had asthma. In crude analyses, lower educational level of parents was associated with an increased risk of childhood wheezing and asthma. After full adjustment, a lower educational level of mothers was associated with an increased risk of childhood asthma (junior high school (reference: high school); odds ratio (OR): 1.17, 95% CI, 1.01-1.36), and higher educational level, especially the mother's, was associated with an increased risk of childhood wheezing (technical junior college, technical/vocational college, or associate degree (ECD3); OR: 1.12, 95% CI, 1.06-1.18, bachelor's degree, or postgraduate degree; OR: 1.10, 95% CI, 1.03-1.18), and asthma (ECD3; OR: 1.13, 95% CI, 1.04-1.21).

CONCLUSIONS

Parents' lower educational level was a crude risk factor for childhood wheezing and asthma. However, an increased risk of wheezing due to mothers' higher educational level was found after adjusting for pre-and post-natal factors.

[Research advances in assessment tools for feeding problems in children]

As one of the most important non-nutritional factors associated with children's growth and development, feeding problems in children are getting more and more attention from medical professionals and guardians. The evaluation of feeding problems has developed from the single-factor and descriptive research in the past to the multi-factor and analytical research at present, and thus a good quantitative analysis system is increasingly important for researchers. However, the development of localized quantitative analysis tools remains a weak link in this field. Therefore, it is a research hotspot to develop child feeding assessment scales and questionnaires with high reliability, validity, and operability in combination with China's cultural background and eating habits and provide effective assessment tools for feeding problems in Chinese children. Through classification based on research mode and screening, this article reviews the research findings in the field of child feeding, so as to provide a basis for future research.

Incidence of and improvement in inappropriate parental behaviors of mothers with young children: a retrospective cohort study conducted in collaboration with a local government

Background

Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors.

Methods

Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0.

Results

In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was “yelling at the child using emotional words” (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13–4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03).

Conclusions

It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

Child Development and Early Interaction: PERL Research Protocol, a Preventive Home Visiting Program, Randomized Controlled Trial in France

Background: Early childhood is a key period for reducing the social inequalities that affect health. Some parenting support and home visitation programs have proven to be effective in assisting parents during this period. France's Protection Maternelle et Infantile (maternal and child welfare) services (PMIs) are at the heart of this primary prevention and may adapt their intervention to improve parenting support. In this manuscript, we describe the protocol of the PERL study, an intervention based on a home visiting program. Method and design: The PERL study is a single-center, randomized, controlled interventional trial. The aim was to assess the impact of a preventive home visiting program on the development of young children and parent-baby interaction. Visits were made by PMI nurses to 64 randomly recruited families from the general population. All families who had a baby born after 37 weeks of pregnancy between September 2018 and December 2019, and who resided in the trial area were eligible. Participants were randomly allocated to the intervention group or the control group. The PMI nurses made 12 home visits in the first year, 6 in the second year, and 4 in the third and fourth years of the child's life. Primary and secondary outcomes were measured when the child was 4 and 24 months old. These measurements recorded (i) the child's developmental milestones, in particular, language and socio emotional skills, (ii) early interaction, maternal sensitivity, and attachment patterns, (iii) maternal psychopathology including depression. Discussion: This study aims to assess the impact of home visits, made by specifically-trained and supervised nurses, on the child's development and parent-child interactions. Such interventions are complementary to other preventive programs addressing the impact of social inequalities on perinatal health. Placing nurses' professional skills at the center of this project may prove an effective and cost-saving intervention compared to existing programs. The study proposes a prevention model that is in keeping with the principle of reducing social inequalities in health by providing support from the earliest age through public service. Clinical Trial Registration: The clinical trial number is NCT03506971, registered on April 24, 2018.