Understanding parenting programmes: parents’ views

Understanding Knowledge Mobilisation between Community Champions and Parents: Evidence from a Community-Based Programme to Support Parents with Young Children

BACKGROUND

Community champions have been employed across various settings to disseminate evidence-based public health information. The Building Babies' Brains programme trains champions to work with parents in communities, equipping them with child development knowledge and parental engagement strategies. We explored what makes community champions effective in distributing information to parents, including how the champion-parent relationship and champions' personal characteristics affect information dissemination.

METHODS

Champions included both peers and professionals working with parents in target communities. We administered an online survey (n = 53) and follow-up interviews (n = 14) with champions, with representation from across all training cohorts. We conducted a realist-informed reflexive thematic analysis to generate themes in the data and highlight the contexts, mechanisms, and outcome patterns identified.

RESULTS

We observed 15 Context-Mechanism-Outcome configurations across five themes: information sharing opportunities, information relevance, the nature of the champion-parent relationship, interaction expectations, and champion confidence. Our programme theory for how the community champion approach works identified that peer champions focused more on building rapport, modelling behaviours, and being a trusted community resource than direct information transfer. Professional champions, in contrast, showed greater expertise and confidence in discussing parenting practices directly. For both groups, traits such as friendliness and the ability to establish a trusting relationship enhanced effectiveness.

CONCLUSIONS

This research identifies the impacts of champion role, characteristics, and the champion-parent relationship on the effectiveness of knowledge mobilisation in this context, with implications for training and recruitment of champions. Those using a champion model in comparable settings should ensure that champions have the necessary knowledge, skills, and confidence to engage parents and share information effectively.

Exploring Staff Implementation of a Self-directed Parenting Intervention for Parents with Mental Health Difficulties

Parents with mental health difficulties face significant barriers in accessing evidence-based parenting interventions. Self-directed approaches may be a destigmatising, accessible alternative. Evidence has suggested that Triple P Positive Parenting Programme's self-directed format is as effective as more time- and cost-intensive delivery methods. The aim of the current study was to establish whether staff were able to use this intervention with parents with mental health difficulties and to explore staff experiences of implementation. Triple P self-help workbooks were provided to practitioners across three teams. Data were collected regarding workbook uptake and use. Interviews with staff exploring their experiences of implementation were analysed using thematic analysis. Overall, 41 participants were recruited, of which 12 (29.27%) also consented to interviews. Overall, six practitioners (14.63%) reported that they utilised the workbook. Uptake and utilisation were varied, but practitioners who used the workbook reported positive outcomes. Interviews revealed themes regarding practitioner concerns, views of the intervention and implementation issues. Self-directed Triple remains a promising intervention but its feasibility is dependent on addressing barriers to implementation and facilitating a family-focused approach to meet the needs of these parents and their children.

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.

Parent and facilitator experiences of an intensive parent and infant programme delivered in routine community settings

AIM

The aims of this study were to (1) assess the initial experiences of parenthood amongst mainly disadvantaged mothers; (2) explore their views on the extent to which they felt they had benefitted (or not) from participating in a newly developed, intensive mother and baby support programme in the community; and (3) explore the perspectives of those who delivered the programme (i.e., facilitators), most of whom were Public Health Nurses (PHNs).

BACKGROUND

Positive parent-child interactions and appropriate levels of infant stimulation are essential to promoting a child's well-being and laying a foundation in the early years for positive developmental outcomes. It is important, therefore, to examine participants' experiences of community-based, family-focused, early prevention and intervention programmes.

METHODS

This study was undertaken as part of a larger evaluation of a newly developed parent and infant (PIN) programme which was delivered in two disadvantaged areas in Ireland. One-to-one interviews were conducted with both mothers (n = 22) and facilitators (n = 8) (including three PHNs) plus six focus groups with an additional sub-group of facilitators (n = 17).

FINDINGS

The collective findings suggest that mothers found the programme helpful in promoting a greater understanding of their infants' behaviour and needs, and in alleviating stress and concerns associated with motherhood. Mothers described feeling more knowledgeable about the importance of regular and appropriate infant interaction to encourage learning and development. Facilitators, specifically PHNs, also reported a greater awareness of the value of infant socioemotional development for their clinical practice and observed greater positive communication between mothers and infants.

CONCLUSION

These findings suggest that a community-based, intensive mother and baby programme can help to promote parental competence and enhance infant learning and development. Additional benefits in terms of early intervention and positive changes to public health nursing practice are also discussed.

Changing Relationships through Interactions: Preliminary Accounts of Parent-Child Interactions after Undertaking Individual Parent Training

Parent and child interaction training has been increasingly investigated over recent years. However, the mechanisms of change within individual training programmes are not well understood. To explore the factors that can facilitate or inhibit meaningful changes in interactions and ultimately relationships, the current study employed semi-structured interviews to obtain first person accounts from parents who had undertaken an individualised parent-training programme. Three participants provided accounts of the training programme and their perceived impact upon interactions with their children were analysed using inductive thematic analysis. The analysis resulted in three themes, which illustrate how participants adjusted their interactional style with their child to varying degrees through enhanced personal awareness, increased understanding of their child's emotional and interactional needs, and accepting the reciprocity of interactional accountability. Changes in interactional style enabled participants to alter their perceptions of their own behaviours, their child's behaviours, and how they influenced one another through interactions. Recommendations for future research and therapeutic practice are discussed in the context of the findings and the existing evidence base.

Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review)

BACKGROUND

Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear.

OBJECTIVES

To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills.

SEARCH METHODS

We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews.

SELECTION CRITERIA

We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.

MAIN RESULTS

This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems.

AUTHORS' CONCLUSIONS

Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.

The Efficacy and Acceptability of the Triple P-Positive Parenting Program With Japanese Parents

This study examined the efficacy of the Group Triple P-Positive Parenting Program with a Japanese population to evaluate the feasibility and acceptability of the program and the parenting skills taught in a crosscultural context. The study involved 50 Japanese parents living in Australia and used a randomised group comparison design with two conditions, Triple P group and a waitlist control group. The results revealed significant reductions in parent reported child behaviour problems, parental overreactivity and laxness, and parental conflict as well as increasing parental competence. The acceptability of the program was found to be high. Intervention effects and program acceptability in a Japanese context as well as limitations and future research are discussed.

Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years

BACKGROUND

Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear.

OBJECTIVES

To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills.

SEARCH METHODS

We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews.

SELECTION CRITERIA

We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.

MAIN RESULTS

This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems.

AUTHORS' CONCLUSIONS

Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.

Interventions addressing general parenting to prevent or treat childhood obesity

Observational studies increasingly emphasize the impact of general parenting on the development of childhood overweight and obesity. The aim of the current literature review was to provide an overview of interventions addressing general parenting in order to prevent or treat childhood obesity. Electronic literature databases were systematically searched for relevant studies. Seven studies were eligible for inclusion. The studies described four different general parenting programs, which were supplemented with lifestyle components (i.e., physical activity and nutrition). All studies showed significant small to moderate intervention effects on at least one weight-related outcome measure. The current review shows that despite the emerging observational evidence for the role of parenting in children's weight-related outcomes, few interventions have been developed that address general parenting in the prevention of childhood obesity. These interventions provide evidence that the promotion of authoritative parenting is an effective strategy for the prevention and management of childhood obesity.

Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children

BACKGROUND

Parenting programmes are a potentially important means of supporting teenage parents and improving outcomes for their children, and parenting support is a priority across most Western countries. This review updates the previous version published in 2001.

OBJECTIVES

To examine the effectiveness of parenting programmes in improving psychosocial outcomes for teenage parents and developmental outcomes in their children.

SEARCH STRATEGY

We searched to find new studies for this updated review in January 2008 and May 2010 in CENTRAL, MEDLINE, EMBASE, ASSIA, CINAHL, DARE, ERIC, PsycINFO, Sociological Abstracts and Social Science Citation Index. The National Research Register (NRR) was last searched in May 2005 and UK Clinical Research Network Portfolio Database in May 2010.

SELECTION CRITERIA

Randomised controlled trials assessing short-term parenting interventions aimed specifically at teenage parents and a control group (no-treatment, waiting list or treatment-as-usual).

DATA COLLECTION AND ANALYSIS

We assessed the risk of bias in each study. 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 eight studies with 513 participants, providing a total of 47 comparisons of outcome between intervention and control conditions. Nineteen comparisons were statistically significant, all favouring the intervention group. We conducted nine meta-analyses using data from four studies in total (each meta-analysis included data from two studies). Four meta-analyses showed statistically significant findings favouring the intervention group for the following outcomes: parent responsiveness to the child post-intervention (SMD -0.91, 95% CI -1.52 to -0.30, P = 0.04); infant responsiveness to mother at follow-up (SMD -0.65, 95% CI -1.25 to -0.06, P = 0.03); and an overall measure of parent-child interactions post-intervention (SMD -0.71, 95% CI -1.31 to -0.11, P = 0.02), and at follow-up (SMD -0.90, 95% CI -1.51 to -0.30, P = 0.004). The results of the remaining five meta-analyses were inconclusive.

AUTHORS' CONCLUSIONS

Variation in the measures used, the included populations and interventions, and the risk of bias within the included studies limit the conclusions that can be reached. The findings provide some evidence to suggest that parenting programmes may be effective in improving a number of aspects of parent-child interaction both in the short- and long-term, but further research is now needed.

Measuring the impact and costs of a universal group based parenting programme: protocol and implementation of a trial

Background

Sub-optimal parenting is a common risk factor for a wide range of negative health, social and educational outcomes. Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management. The Family Links Nurturing Programme (FLNP) focuses on family relationships as well as behaviour management and is offered on a universal basis. As a result it may be better placed to improve health and educational outcomes. Developed in the UK voluntary sector, FLNP is popular with practitioners, has impressed policy makers throughout the UK, has been found to be effective in before/after and qualitative studies, but lacks a randomised controlled trial (RCT) evidence base.

Methods/Design

A multi-centre, investigator blind, randomised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2-4 yrs living in or near to Flying Start/Sure Start areas. Changes in parenting, parent child relations and parent and child wellbeing are assessed with validated measures immediately and at 6 months post intervention. Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life. Attendance and completion rates and fidelity to the FLNP course delivery are assessed. A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families. By the end of May 2010, 287 families have been recruited into the trial across four areas of south Wales. Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial, family concern about video and audio recording, programme facilitator concern about the recording of FLNP sessions for fidelity purposes and delays due to the new UK research governance procedures.

Discussion

Whilst there are strong theoretical arguments to support universal provision of parenting programmes, few universal programmes have been subjected to randomised controlled trials. In this paper we describe a RCT protocol with quantitative and qualitative outcome measures and an economic evaluation designed to provide clear evidence with regard to effectiveness and costs. We describe challenges implementing the protocol and how we are addressing these.

Trial Registration

Current Controlled Trials ISRCTN13919732

Parenting programmes: a systematic review and synthesis of qualitative research

BACKGROUND

Parenting programmes are at the heart of intervention strategies for parents of children with emotional and behaviour problems. Systematic reviews and meta-analyses of randomized controlled trials have indicated that such programmes can improve many aspects of family life. However, there is currently a dearth of information concerning what it is that makes parenting programmes meaningful and helpful to parents. The aim of this paper was to examine parents' experience and perceptions of parenting programmes using the meta-ethnographic method, in order to sensitize policymakers and practitioners to the key factors that parents perceive to be of value.

METHODS

Systematic searches of a number of electronic databases were undertaken using key search terms. Critical appraisal of included studies was conducted using standardized criteria, and the reports were synthesized using meta-ethnographic methods.

RESULTS

Six reports were purposefully selected and critically appraised independently by two reviewers. Two were excluded. Based on the remaining four papers, five key concepts were identified as important when planning and delivering parenting programmes. A lines-of-argument synthesis was developed which suggests that the acquisition of knowledge, skills and understanding, together with feelings of acceptance and support from other parents in the parenting group, enabled parents to regain control and feel more able to cope. This led to a reduction in feelings of guilt and social isolation, increased empathy with their children and confidence in dealing with their behaviour.

CONCLUSION

This evaluation provides an indication of the components that parents perceive to be necessary in the provision of parenting programmes, independent of the particular type of programme being provided. It may therefore aid policymakers in decisions about which programmes to provide.

Preventing emotional and behavioural problems: the effectiveness of parenting programmes with children less than 3 years of age

BACKGROUND

Emotional and behavioural problems in children under 3 years of age have a high prevalence, and parenting practices have been shown to be strongly associated with their development. A number of recent systematic reviews have shown that group-based parenting programmes can be effective in improving the emotional and behavioural adjustment of older children (aged 3-10 years). The aim of this review was to establish whether there is evidence from controlled trials that group-based parenting programmes are effective in improving the emotional and behavioural adjustment of children less than 3 years of age, and their role in the primary prevention of emotional and behavioural problems.

METHODS

English and non-English language articles published between January 1970 and July 2001 were retrieved using a keyword search of a number of electronic databases.

RESULTS

Five studies were included and two meta-analyses were conducted, the first combining data from parent reports and the second combining data from independent observations of children's behaviour. The combined parent reports showed a non-significant difference favouring the intervention group, while the combined independent observations showed a significant difference favouring the intervention group.

CONCLUSION

It is concluded that this review points to the potential of parenting programmes to improve the emotional and behavioural adjustment of children less than 3 years of age, but that there is insufficient evidence from controlled trials to assess whether the short-term benefit is maintained over time, or the role that such programmes might play in the primary prevention of emotional and behavioural problems. This review points to the need for further primary preventive research on this important public health issue.

Parents' perceptions of the value of the Webster-Stratton Parenting Programme: a qualitative study of a general practice based initiative

BACKGROUND

Parenting styles and parent-child relationships are a determinant of emotional and behavioural problems in children. Controlled trials of parenting programmes have been shown to be effective in helping parents of children with clinical levels of behaviour problems, but there is little research on the impact of such programmes in families where children's development falls in the 'normal' range. Also, such trials do not shed light on why or how programmes do, or do not, work, or how they might be improved.

METHODS

A qualitative study of the impact of the Webster-Stratton 'Parents and Children Series' programme on participants in a controlled trial of this programme, whose children's behaviour was below average, but, for the majority, in the normal range. Data were gathered in interviews, open-ended questions on a questionnaire and tape recordings of group leader supervision sessions.

RESULTS

Parents reported increased confidence, better relationships with their children, successful use of new behaviour management techniques and improvements in their children's behaviour as a result of the programme. One parent found the programme unsuitable because she was already using the techniques that were taught, and another parent felt the programme was designed for parents of younger children. Many parents reported that additional sessions would have been useful to consolidate what they had learnt, and some parents felt the course would have been more effective if their partners had attended.

CONCLUSIONS

The Webster-Stratton Parenting Programme is useful for parents of 'normal' children as well as for parents of children whose behaviour is in the clinical range. Follow-up sessions and attendance by both parents might increase effectiveness. The findings of this study suggest greater benefits to parents and children than were apparent in the controlled trial.

A qualitative study exploring the experiences and views of mothers, health visitors and family support centre workers on the challenges and difficulties of parenting

Successive policy documents have referred to the need to support parents as an approach to reducing social exclusion, behaviour problems among young people and crime rates. Much of the rhetoric focuses on professional intervention, and there is less attention paid to the views and experiences of parents themselves. The present study explores the experiences and views of mothers, health visitors and family support centre workers who work with parents on the challenges and difficulties of parenting children under the age of 6 years. It provides an appreciation of their views on effective parenting and how parents can be helped to feel more effective in the parenting role. Focus groups, which were exploratory and interactive in form, were conducted across three primary care trusts in Hertfordshire, UK. Three samples were purposively selected in order to examine the range and diversity of experiences and views about parenting, and included the parents of children up to the age of 6 years, health visitors and family support centre workers. The mothers were those waiting to attend a parenting programme, and included first-time mothers and those with more than one child. The health visitors and family support workers had a range of experience in working with parents and children, and included those who were facilitating parenting programmes and those who were not. A number of themes emerged surrounding the challenges and difficulties of parenting and effective parenting, including expectations of others, establishing routines, play, behavioural issues and discipline, empathy, and communication. Similar themes emerged from all groups; however, there were qualitative differences between parents and professionals in the way in which these issues were expressed. Key statements from the parent focus groups have been developed into self-efficacy statements, which will be used as input to the development of a tool to measure the effectiveness of parenting programmes.

Promoting and protecting the health of children and young people

BACKGROUND

The health-related behaviours adopted by children and young people can have both immediate and long-term health effects. Health promotion interventions that target children and young people can lay the foundations of a healthy lifestyle that may be sustained into adulthood. This paper is based on a selective review of evidence relating to health promotion in childhood, carried out to support the external working group on the 'Healthy Child' module of the Children's National Service Framework.

METHODS

This is a selective review of mainly secondary research. It focuses on injury prevention, support for parenting and the promotion of good mental health, and promoting a healthy diet and physical activity amongst children and young people.

FINDINGS

In many areas, the quality of primary research into health promotion interventions aimed at children and young people is poor. Interventions are heterogeneous and not described in sufficient detail. Sample sizes tend to be small, and there are commonly problems of bias. Despite these difficulties, there is good evidence for a range of interventions, including (1) area road safety schemes; (2) combining a variety of approaches to the promotion of the use of safety equipment, including legislation and enforcement, loan/assisted purchase/giveaway schemes, education, fitting and maintenance of safety equipment; (3) school-based mental health promotion; (4) parenting support; (5) interventions that promote and facilitate 'lifestyle' activity for children, such as walking and cycling to school, and those that aim to reduce sedentary behaviours such as parent education to reduce the time children spend watching TV and using computers; and (6) controlling advertising of unhealthy food that is aimed at children.

CONCLUSIONS

There are effective interventions to promote and protect the health of children and young people that require action across the five areas described in the Ottawa Charter. Health, social care and education services have a direct role in the delivery of many of these interventions and, in other areas, a role in collaborative work with other agencies, in lobbying for policy change and in raising the profile of child health promotion. Further research is needed using larger study populations, and closely defined interventions, both targeted and universal, in order to fill some of the current gaps in the evidence base for health promotion in children and young people.