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Razzazi A, Griffiths MD, Alimoradi Z. The effect of nutritional education based on the health action process approach (HAPA) on the pregnancy outcomes among malnourished pregnant mothers. BMC Pregnancy Childbirth 2024; 24:83. [PMID: 38273226 PMCID: PMC10809742 DOI: 10.1186/s12884-024-06276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To examine the effectiveness of nutritional education based on the health action process approach (HAPA) on pregnancy outcomes among malnourished pregnant mothers utilizing nutritional support. METHODS In a randomized controlled trial, 234 malnourished pregnant women under nutritional support from the fourth month of pregnancy participated. Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, 'question and answer' sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software. RESULTS Pregnancy outcomes including optimal weight gain during pregnancy (p = 0.47), neonate's birth weight (p = 0.58), gestational age at delivery (p = 0.83), type of delivery (p = 0.48) gestational anemia (p = 0.22), diabetes (p = 0.59) and hypertension (p = 0.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta2: 0.664). CONCLUSION A nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly. PRACTICE IMPLICATIONS Nutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women.
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Affiliation(s)
- Atieh Razzazi
- Students research committee, School of Nursing & Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, 34197-59811, Iran.
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Tu Y, Sarkar K, Svirydzenka N, Palfreyman Z, Parry YK, Ankers M, Parikh P, Raghavan R, Lakhanpaul M. Interventions to promote the health and well-being of children under 5s experiencing homelessness in high-income countries: a scoping review. BMJ Open 2024; 14:e076492. [PMID: 38216205 PMCID: PMC10806763 DOI: 10.1136/bmjopen-2023-076492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Homelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these 'invisible' children often fall through the gaps in policy and services. The study's primary objective is to map the content and delivery methods of culturally sensitive interventions for children under 5 experiencing homelessness in HICs. DESIGN A scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SOURCES Databases include PubMed, Medline, SCOPUS, The Cochrane Library and Google Scholar were searched up to 24 March 2022. ELIGIBILITY CRITERIA This scoping review includes studies that describe, measure or evaluate intervention strategies aimed at improving child health programmes, specifically those yielding positive outcomes in key areas like feeding, nutrition, care practices and parenting. DATA EXTRACTION AND SYNTHESIS Articles were selected and evaluated by two independent reviewers, with a dispute resolution system involving a third reviewer for contested selections. The methodological quality of the studies was assessed using various tools including the Risk of Bias (RoB) tool, Cochrane RoB V.2.0, the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), each selected according to the type of article. RESULTS The database search yielded 951 results. After deduplication, abstract screening and full review, 13 articles met the inclusion criteria. Two predominant categories of intervention delivery methods were identified in this research: group-based interventions (educational sessions) and individual-based interventions (home visits). CONCLUSION This review highlights effective interventions for promoting the health and well-being of children under 5 experiencing homelessness, including educational sessions and home visits. Research has supported the importance of home visiting to be instrumental in breaking down language, cultural and health literacy barriers.
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Affiliation(s)
- Yanxin Tu
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Nadia Svirydzenka
- School of Applied Social Sciences, De Montfort University Faculty of Health and Life Sciences, Leicester, UK
| | - Zoe Palfreyman
- School of Applied Social Sciences, De Montfort University Faculty of Health and Life Sciences, Leicester, UK
| | - Yvonne Karen Parry
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Ankers
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Priti Parikh
- The Bartlett School of Sustainable Construction, University College London, London, UK
| | - Raghu Raghavan
- School of Nursing and Midwifery, De Montfort University Faculty of Health and Life Sciences, Leicester, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
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Doove BM, Feron FJM, van Os J, Drukker M. Preschool Communication: Early Identification of Concerns About Preschool Language Development and Social Participation. Front Public Health 2021; 8:546536. [PMID: 33585376 PMCID: PMC7874213 DOI: 10.3389/fpubh.2020.546536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Adverse communication development in preschool children is a risk factor influencing child health and well-being with a negative impact on social participation. Language and social skills develop and maintain human adaptability over the life course. However, the accuracy of detecting language problems in asymptomatic children in primary care needs to be improved. Therefore, it is important to identify concerns about language development as a risk factor for child health. The association between parental and professional caregivers' concerns about language development and the level of preschool social participation was assessed, as well as the possible mediating/moderating effect of the perception of social competence. In addition, validity and predictive value of parental and professional caregivers' concerns about language development were tested. Methods: To identify emerging concerns about development and social participation, a community sample of 341 preschool children was systematically assessed with a comprehensive preventive child health care "toolkit" of instruments, including parent-completed tools like the Parents' Evaluation of Developmental Status (PEDS) and child competence Visual Analog Scales (VAS). At baseline, children were aged 3 years and at follow-up ~4 years. Results: There was a statistically significant association between parental and professional caregivers' concerns about language development and the level of preschool social participation, with a mediating effect of child social competence at the age of 3 years as well as 4 years. Negative predictive value of parental and professional caregiver language concerns at the age of 3 and 4 years were 99 and 97%, respectively. Furthermore, this article showed that while some preschool children grow out of language problems, others may develop them. Conclusion: Short but valid pediatric primary care tools like the PEDS and child competence VAS can support monitoring and early identification of concerns about language development and social competence as a risk factor for preschool social participation. Personalized health care requires continued communication between parents, professional caregivers and preventive child health care about parental and professional caregiver perceptions concerning preschool language development as well as the perception of a child's social competence.
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Affiliation(s)
- Bernice M Doove
- Youth Health Care Division, Regional Public Health Service South Limburg, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Frans J M Feron
- Department of Social Medicine, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Jim van Os
- King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, Maastricht, Netherlands.,Department Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, Maastricht, Netherlands
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Hodgkinson S, Godoy L, Beers LS, Lewin A. Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting. Pediatrics 2017; 139:peds.2015-1175. [PMID: 27965378 PMCID: PMC5192088 DOI: 10.1542/peds.2015-1175] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
Poverty is a common experience for many children and families in the United States. Children <18 years old are disproportionately affected by poverty, making up 33% of all people in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.
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Affiliation(s)
- Stacy Hodgkinson
- Children's National Health System, Washington, District of Columbia; and
| | - Leandra Godoy
- Children’s National Health System, Washington, District of Columbia; and
| | - Lee Savio Beers
- Children’s National Health System, Washington, District of Columbia; and
| | - Amy Lewin
- University of Maryland School of Public Health, College Park, Maryland
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Michie S, Wood CE, Johnston M, Abraham C, Francis JJ, Hardeman W. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess 2016; 19:1-188. [PMID: 26616119 DOI: 10.3310/hta19990] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Meeting global health challenges requires effective behaviour change interventions (BCIs). This depends on advancing the science of behaviour change which, in turn, depends on accurate intervention reporting. Current reporting often lacks detail, preventing accurate replication and implementation. Recent developments have specified intervention content into behaviour change techniques (BCTs) - the 'active ingredients', for example goal-setting, self-monitoring of behaviour. BCTs are 'the smallest components compatible with retaining the postulated active ingredients, i.e. the proposed mechanisms of change. They can be used alone or in combination with other BCTs' (Michie S, Johnston M. Theories and techniques of behaviour change: developing a cumulative science of behaviour change. Health Psychol Rev 2012;6:1-6). Domain-specific taxonomies of BCTs have been developed, for example healthy eating and physical activity, smoking cessation and alcohol consumption. We need to build on these to develop an internationally shared language for specifying and developing interventions. This technology can be used for synthesising evidence, implementing effective interventions and testing theory. It has enormous potential added value for science and global health. OBJECTIVE (1) To develop a method of specifying content of BCIs in terms of component BCTs; (2) to lay a foundation for a comprehensive methodology applicable to different types of complex interventions; (3) to develop resources to support application of the taxonomy; and (4) to achieve multidisciplinary and international acceptance for future development. DESIGN AND PARTICIPANTS Four hundred participants (systematic reviewers, researchers, practitioners, policy-makers) from 12 countries engaged in investigating, designing and/or delivering BCIs. Development of the taxonomy involved a Delphi procedure, an iterative process of revisions and consultation with 41 international experts; hierarchical structure of the list was developed using inductive 'bottom-up' and theory-driven 'top-down' open-sort procedures (n = 36); training in use of the taxonomy (1-day workshops and distance group tutorials) (n = 161) was evaluated by changes in intercoder reliability and validity (agreement with expert consensus); evaluating the taxonomy for coding interventions was assessed by reliability (intercoder; test-retest) and validity (n = 40 trained coders); and evaluating the taxonomy for writing descriptions was assessed by reliability (intercoder; test-retest) and by experimentally testing its value (n = 190). RESULTS Ninety-three distinct, non-overlapping BCTs with clear labels and definitions formed Behaviour Change Technique Taxonomy version 1 (BCTTv1). BCTs clustered into 16 groupings using a 'bottom-up' open-sort procedure; there was overlap between these and groupings produced by a theory-driven, 'top-down' procedure. Both training methods improved validity (both p < 0.05), doubled the proportion of coders achieving competence and improved confidence in identifying BCTs in workshops (both p < 0.001) but did not improve intercoder reliability. Good intercoder reliability was observed for 80 of the 93 BCTs. Good within-coder agreement was observed after 1 month (p < 0.001). Validity was good for 14 of 15 BCTs in the descriptions. The usefulness of BCTTv1 to report descriptions of observed interventions had mixed results. CONCLUSIONS The developed taxonomy (BCTTv1) provides a methodology for identifying content of complex BCIs and a foundation for international cross-disciplinary collaboration for developing more effective interventions to improve health. Further work is needed to examine its usefulness for reporting interventions. FUNDING This project was funded by the Medical Research Council Ref: G0901474/1. Funding also came from the Peninsula Collaboration for Leadership in Applied Health Research and Care.
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Affiliation(s)
- Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Caroline E Wood
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marie Johnston
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Institute of Applied Health Sciences, College of Life Science and Medicine, University of Aberdeen, Health Sciences Building, Aberdeen, UK
| | - Charles Abraham
- University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, UK
| | - Jill J Francis
- School of Health Sciences, City University London, London, UK
| | - Wendy Hardeman
- Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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Winders Davis D, Myers J, Logsdon MC, Bauer NS. The Relationship Among Caregiver Depressive Symptoms, Parenting Behavior, and Family-Centered Care. J Pediatr Health Care 2016; 30:121-32. [PMID: 26189603 DOI: 10.1016/j.pedhc.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Parental depression has been associated with adverse child outcomes. However, the specific parenting behaviors that may result in such child outcomes and the effect of family-centered care (FCC) on positive parenting behavior of depressed parents has not previously been examined. METHODS Data from the National Survey of Early Childhood Health was used (n = 2,068). Groups were stratified by the presence of parental depression and compared with regard to demographics and the mean number of specific positive parenting behaviors. Generalized linear models were developed based on testing whether individuals performed more or less than the median number of positive behaviors. Lastly, we tested whether depression independently predicted each outcome after adjustment for FCC, coping, social support, and ethnicity to evaluate if depression independently predicted each outcome after adjustment. RESULTS No difference was found in demographic variables between parents who were depressed and not depressed. Parents who were not depressed performed significantly more routines (p = .036); reported coping better with parenting (p < .001); performed significantly less punitive behaviors (p = .022); and needed/had less social support (p = .002) compared with parents who were depressed. Individual items and scale scores were associated in the expected directions. FCC was independently associated with study variables but did not moderate the effect of depression. CONCLUSIONS These data identify specific parenting behaviors that differ between parents who report depressive symptoms compared with parents who do not have depressive symptoms. More targeted interventions coordinated through a medical home are needed for parents with depressive symptoms to reduce the child health disparities often associated with parental depression.
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7
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Fabrizio CS, Lam TH, Hirschmann MR, Pang I, Yu NX, Wang X, Stewart SM. Parental emotional management benefits family relationships: A randomized controlled trial in Hong Kong, China. Behav Res Ther 2015; 71:115-24. [PMID: 26112397 DOI: 10.1016/j.brat.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/29/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED There is a shortage of culturally appropriate, brief, preventive interventions designed to be sustainable and acceptable for community participants in nonwestern cultures. Parents' ability to regulate their emotions is an important factor for psychological well-being of the family. In Chinese societies, emotional regulation may be more important in light of the cultural desirability of maintaining harmonious family relationships. The objectives of our randomized controlled trial were to test the effectiveness of our Effective Parenting Programme (EPP) to increase the use of emotional management strategies (primary outcome) and enhance the parent-child relationship (secondary outcome). We utilized design characteristics that promoted recruitment, retention, and intervention sustainability. We randomized a community sample of 412 Hong Kong middle- and low-income mothers of children aged 6-8 years to the EPP or attention control group. At 3, 6 and 12- month follow up, the Effective Parent Program group reported greater increases in the use of emotion management strategies during parent-child interactions, with small to medium effect size, and lower negative affect and greater positive affect, subjective happiness, satisfaction with the parent-child relationship, and family harmony, compared to the control group, with small to medium effect size. Our results provided evidence of effectiveness for a sustainable, preventive, culturally appropriate, cognitive behaviorally-based emotion management program, in a non-clinical setting for Chinese mothers. TRIAL REGISTRATION HKCTR-1190.
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Affiliation(s)
- Cecilia S Fabrizio
- The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Tai Hing Lam
- The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Malia R Hirschmann
- The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Irene Pang
- Caritas-Hong Kong, 2 Caine Road, Hong Kong
| | - Nancy Xiaonan Yu
- The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Xin Wang
- The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Sunita M Stewart
- The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong
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Reijneveld SA, Kleefman M, Jansen DEMC. Stepping Stones Triple P: the importance of putting the findings into context--a response to Tellegen and Sofronoff. BMC Med 2015; 13:36. [PMID: 25877781 PMCID: PMC4350302 DOI: 10.1186/s12916-015-0289-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 02/07/2015] [Indexed: 11/10/2022] Open
Abstract
Recently, we reported the findings of a randomized controlled trial on the effectiveness of Stepping Stones Triple P (SSTP) compared to Care as Usual (CAU), in BMC Medicine. The study involved parents of 209 children with Borderline to Mild Intellectual Disability (BMID), included following a school-based assessment of psychosocial problems. We found that SSTP had some short-term advantages over CAU, i.e., a reduction of parenting stress and of teacher-reported psychosocial problems, but no long-term advantages, at 6 months after the intervention. Tellegen and Sofronoff criticized that we included a limited amount of studies on the effectiveness of SSTP, and that the interpretation of our findings was inadequate. Regarding available evidence, we confined our summary to published high-quality RCTs regarding individual SSTP on level 4--our RCT concerned that type of SSTP. Consequently, many studies were excluded but in a very adequate way. Regarding interpretation, Tellegen and Sofronoff criticized that we compared SSTP with CAU, but seem to be unware that this is consonant with current guidelines. Moreover, they noted that 49% of the parents who started SSTP followed less than half of the intended number of sessions. However, our findings on those who completed SSTP showed no more advantages of SSTP in the long term than CAU. We therefore stick to our conclusion that SSTP has some advantages in the short term compared to CAU, but not in the long term. The major burden of psychosocial problems in children with BMID prompts for further improvements. Please see related articles: http://www.biomedcentral.com/1741-7015/12/191 and http://www.biomedcentral.com/1741-7015/13/25.
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Barlow J, Smailagic N, Huband N, Roloff V, Bennett C. Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev 2014; 2014:CD002020. [PMID: 24838729 PMCID: PMC10898322 DOI: 10.1002/14651858.cd002020.pub4] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parental psychosocial health can have a significant effect on the parent-child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing. OBJECTIVES To address whether group-based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence). SEARCH METHODS We searched the following databases on 5 December 2011: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005. SELECTION CRITERIA We included randomised controlled trials that compared a group-based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting-list, no treatment, treatment as usual or a placebo. DATA COLLECTION AND ANALYSIS At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. MAIN RESULTS We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive-behavioural and multimodal. Overall, we found that group-based parenting programmes led to statistically significant short-term improvements in depression (standardised mean difference (SMD) -0.17, 95% confidence interval (CI) -0.28 to -0.07), anxiety (SMD -0.22, 95% CI -0.43 to -0.01), stress (SMD -0.29, 95% CI -0.42 to -0.15), anger (SMD -0.60, 95% CI -1.00 to -0.20), guilt (SMD -0.79, 95% CI -1.18 to -0.41), confidence (SMD -0.34, 95% CI -0.51 to -0.17) and satisfaction with the partner relationship (SMD -0.28, 95% CI -0.47 to -0.09). However, only stress and confidence continued to be statistically significant at six month follow-up, and none were significant at one year. There was no evidence of any effect on self-esteem (SMD -0.01, 95% CI -0.45 to 0.42). None of the trials reported on aggression or adverse effects.The limited data that explicitly focused on outcomes for fathers showed a statistically significant short-term improvement in paternal stress (SMD -0.43, 95% CI -0.79 to -0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction. AUTHORS' CONCLUSIONS The findings of this review support the use of parenting programmes to improve the short-term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning.
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Affiliation(s)
- Jane Barlow
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry, UK, CV4 7LF
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Spijkers W, Jansen DE, Reijneveld SA. Effectiveness of Primary Care Triple P on child psychosocial problems in preventive child healthcare: a randomized controlled trial. BMC Med 2013; 11:240. [PMID: 24207163 PMCID: PMC4226010 DOI: 10.1186/1741-7015-11-240] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Psychosocial problems in children have adverse effects on the children, their families, and society, thus early intervention is important. Community pediatric services offer an ideal setting to detect problem behaviour in children and provide support to parents. The objective of this study was to assess the effectiveness of a Primary Care Triple P (PCTP) program compared with care as usual (UC) for parents of children with mild psychosocial problems after an initial, evidence-based screening in routine community pediatric care. METHODS We conducted a multicenter, randomized, controlled trial in community pediatric services in the Netherlands, enrolling parents of children with mild psychosocial problems. The population was identified by screening using the Strengths and Difficulties Questionnaire (SDQ) with a cut-off point of 11 or higher (that is, a subclinical score). We compared PCTP with UC, and measured the effects immediately after treatment and after 6 and 12 months. PCTP comprised four individual counseling sessions with the parent of 20 to 30 minutes each. The primary outcome measures were the child psychosocial problems as measured by the SDQ and the Eyberg Child Behaviour Inventory (ECBI). RESULTS In total, 81 families were recruited and randomized, and 67 provided post-intervention data. Both treatment groups improved after treatment, with the PCTP group improving only slightly more than the UC group on most measures. The maximum difference on the SDQ was 1.94 (95% CI = -0.30 to 4.19, P = 0.09) and 5.81 (95% CI = -3.37 to 14.99, P = 0.21) on the ECBI (n = 67). None of the differences between PCTP and UC was significant. In the subsidiary analyses, only one of the twenty outcomes (that is, SDQ conduct problems) was significant. CONCLUSIONS PCTP did produce a reduction in psychosocial problems in children but had no statistically significant advantage over UC. In general, a few outcomes improved in both groups. Based on this admittedly underpowered study, we cannot conclude that PCTP is more effective than UC in preventive child healthcare.
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Affiliation(s)
- Willem Spijkers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, A, Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
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Fabrizio CS, Lam TH, Hirschmann MR, Stewart SM. A Brief Parenting Intervention to Enhance the Parent-Child Relationship in Hong Kong: Harmony@Home. JOURNAL OF CHILD AND FAMILY STUDIES 2013; 22:603-613. [PMID: 23772172 PMCID: PMC3679413 DOI: 10.1007/s10826-012-9614-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is a dearth of high-level evidence for brief programs designed to promote positive parent-child relationships in nonwestern cultures. We present a pilot randomized controlled trial of a four-session intervention to enhance the parenting skills that promote a positive relationship with pre-adolescent children in Hong Kong. Our intervention, Harmony@Home, utilized Cunningham's culturally appropriate coping modeling, problem-solving approach to change parental behavior. Our objective was to evaluate the feasibility, acceptability and initial evidence of benefit of the intervention. We blindly randomized 150 Hong Kong parents of children 10-13 years of age to (a) a Harmony@Home intervention group, (b) a waitlist control group, or (c) a third active intervention which shared the control group. Immediately following the intervention, we report increases in satisfaction with the parent-child relationship, one of the targeted parenting behaviors and family harmony, for the Harmony@Home group versus control group. However, only the results from satisfaction with the parent-child relationship were significant at 3-months post intervention. Most respondents reported high levels of program satisfaction. The results provide preliminary evidence that this parenting intervention is culturally acceptable for a nonwestern general population, is feasible for implementation in a community setting and shows evidence of benefit. This intervention is concordant with public health priorities because of the global importance of the parent-child relationship as a protective factor for adolescent outcomes, the need for culturally-appropriate interventions for nonwestern populations, and design characteristics that promote dissemination.
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Affiliation(s)
- Cecilia S. Fabrizio
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, Room 5-05, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, Room 5-05, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Malia R. Hirschmann
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, Room 5-05, 21 Sassoon Road, Pokfulam, Hong Kong
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Barlow J, Smailagic N, Huband N, Roloff V, Bennett C. Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev 2012:CD002020. [PMID: 22696327 DOI: 10.1002/14651858.cd002020.pub3] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Parental psychosocial health can have a significant effect on the parent-child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing. OBJECTIVES To address whether group-based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence). SEARCH METHODS We searched the following databases on 5 December 2012: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005. SELECTION CRITERIA We included randomised controlled trials that compared a group-based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting-list, no treatment, treatment as usual or a placebo. DATA COLLECTION AND ANALYSIS At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. MAIN RESULTS We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive-behavioural and multimodal. Overall, we found that group-based parenting programmes led to statistically significant short-term improvements in depression (standardised mean difference (SMD) -0.17, 95% confidence interval (CI) -0.28 to -0.07), anxiety (SMD -0.22, 95% CI -0.43 to -0.01), stress (SMD -0.29, 95% CI -0.42 to -0.15), anger (SMD -0.60, 95% CI -1.00 to -0.20), guilt (SMD -0.79, 95% CI -1.18 to -0.41), confidence (SMD -0.34, 95% CI -0.51 to -0.17) and satisfaction with the partner relationship (SMD -0.28, 95% CI -0.47 to -0.09). However, only stress and confidence continued to be statistically significant at six month follow-up, and none were significant at one year. There was no evidence of any effect on self-esteem (SMD -0.01, 95% CI -0.45 to 0.42). None of the trials reported on aggression or adverse effects.The limited data that explicitly focused on outcomes for fathers showed a statistically significant short-term improvement in paternal stress (SMD -0.43, 95% CI -0.79 to -0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction. AUTHORS' CONCLUSIONS The findings of this review support the use of parenting programmes to improve the short-term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning.
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Affiliation(s)
- Jane Barlow
- Health Sciences Research Unit, Warwick Medical School, Coventry, UK.
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Stewart SM, Fabrizio CS, Hirschmann MR, Lam TH. Developing community-based preventive interventions in Hong Kong: a description of the first phase of the family project. BMC Public Health 2012; 12:106. [PMID: 22309796 PMCID: PMC3297497 DOI: 10.1186/1471-2458-12-106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 02/07/2012] [Indexed: 11/12/2022] Open
Abstract
Background This paper describes the development of culturally-appropriate family-based interventions and their relevant measures, to promote family health, happiness and harmony in Hong Kong. Programs were developed in the community, using a collaborative approach with community partners. The development process, challenges, and the lessons learned are described. This experience may be of interest to the scientific community as there is little information currently available about community-based development of brief interventions with local validity in cultures outside the West. Methods The academic-community collaborative team each brought strengths to the development process and determined the targets for intervention (parent-child relationships). Information from expert advisors and stakeholder discussion groups was collected and utilized to define the sources of stress in parent-child relationships. Results Themes emerged from the literature and discussion groups that guided the content of the intervention. Projects emphasized features that were appropriate for this cultural group and promoted potential for sustainability, so that the programs might eventually be implemented at a population-wide level. Challenges included ensuring local direction, relevance and acceptability for the intervention content, engaging participants and enhancing motivation to make behavior changes after a brief program, measurement of behavior changes, and developing an equal partner relationship between academic and community staff. Conclusions This work has public health significance because of the global importance of parent-child relationships as a risk-factor for many outcomes in adulthood, the need to develop interventions with strong evidence of effectiveness to populations outside the West, the potential application of our interventions to universal populations, and characteristics of the interventions that promote dissemination, including minimal additional costs for delivery by community agencies, and high acceptability to participants.
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Affiliation(s)
- Sunita M Stewart
- University of Texas Southwestern Medical Center at Dallas, Texas, USA
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Spijkers W, Jansen DEMC, Reijneveld SA. The impact of area deprivation on parenting stress. Eur J Public Health 2011; 22:760-5. [PMID: 22021375 DOI: 10.1093/eurpub/ckr146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Willem Spijkers
- Department of Health Sciences, University of Groningen, Groningen, The Netherlands.
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