Online interventions for the mental health and well-being of parents of children with additional needs: Systematic review and meta-analysis

INTRODUCTION

Parents of children with additional needs experience compromised physical and mental health and higher stress, and their ability to engage in meaningful occupations is impacted by their additional caregiving tasks. Online interventions targeting mental health, stress, and well-being for parents of children with additional needs have potential to increase supports alongside occupational therapy direct services. The aims of this review are to systematically identify and synthesise evidence of effectiveness of online interventions aimed at improving mental health, stress, and well-being of parents of children with additional needs.

METHOD

Eight databases were searched up to July 2024 to identify online interventions for parents of children with additional needs. Studies were appraised for methodological quality. Standardised effect sizes were calculated, and meta-analyses of randomised control trials (RCTs) were conducted on outcomes of mental health, well-being, and stress.

CONSUMER AND COMMUNITY INVOLVEMENT

There was no consumer or community involvement.

RESULTS

Systematic screening identified 30 papers that met inclusion criteria. Most were RCTs or controlled clinical trials (CCTs) with 'moderate' quality ratings: Three were designed by occupational therapists. There was substantial variation in intervention types, methods of delivery, outcomes, and outcome measures used. The pooled standardised effect size estimates (ES) and the lower and upper confidence intervals (CI) of online interventions from RCTs post-interventions were significant for mental health ES = 0.47, 95% CI (0.18, 0.77), p = 0.002; stress ES = 1.27, 95% CI (0.56, 1.98), p = 0.000; and well-being ES = 0.65, 95% CI (1.2, 0.06), p = 0.03, respectively.

CONCLUSION

The online interventions that aimed to improve mental health, stress, and well-being included in this meta-analysis were effective. Occupational therapists supporting families play an important role in guiding parents of children with additional needs to evidence-based interventions to support them with addressing their own mental health and well-being needs.

Mothering occupations: A review identifying mothering occupations

INTRODUCTION

This review aimed to retrieve and collate a list of culturally relevant mothering occupations in the New Zealand context with mothers positioned as experts of their experience. Mothering occupations influence wellbeing and this study aimed to better inform on the daily occupations mothers participate in that contribute to feelings of maternal confidence.

METHODS

Two main sources were used to identify mothering occupations: A systematic search of mothering literature, and participant additions. The first step involved mothering literature being searched, collated and condensed. The second step involved presenting the compiled list of mothering occupations to a panel of mothers for review and to invite additions. Mothers were asked to consider the occupations they participate in that evoke feelings of confidence and mastery in their mothering. Fifteen mothers with infants 12 to 18 months old were recruited, eight contributed to the mothering occupations list.

RESULTS

A list of 203 items was collated then condensed based on the inclusion criteria for the participant group, and was tracked in a table. The list was reduced to 36 items. Eight participants added to the mothering occupations list, bringing the total number of items to 47. Mothers indicated through their contributions to the list that some types of mothering occupations are more relevant to them when considering feelings of maternal confidence and mastery. The mothers of this study indicated that connecting with their infant, their culture and nature are of high value to them.

CONCLUSION

Developing a list of culturally relevant and relatable mothering occupations is a significant undertaking, highlighting the subjective experiences of mothers. Mothering occupations are vast and influenced by context. Mothers valuing some types of occupation more in relation to maternal confidence indicates a role for occupational therapy with this population to support with engagement and participation in occupations that promote wellbeing.

Mothering Occupations Ranked for Maternal Confidence

This study exploring the impact of everyday mothering occupations on maternal confidence may have implications for maternal wellbeing, with New Zealand mothers positioned as experts to rank the occupations that evoke feelings of maternal confidence. This study was investigating general mothering experiences, and therefore did not screen for mothers at risk. Delphi surveys were used as a facilitation technique to reach consensus. Participants (N = 7) were presented with a list of mothering occupations informed by literature and additional items previously identified by participants and asked to rank the items for their efficacy at evoking feelings of maternal confidence. A second ranking round was completed, following the collated response from the first ranking. Consensus was reached between surveys. The top nine of 47 items did not change their ranked positions and a list of the top mothering occupations for evoking maternal confidence, as ranked by a panel of mothers, was developed. This study found that mothers ranked co-occupations and watching their babies highly for evoking feelings of maternal confidence. The influence on maternal confidence of specific occupations and tasks demonstrates the potential value of occupational therapy input during the perinatal phase.