Review question
Are group-based parenting programmes effective in improving parental psychosocial health?
Relevance to primary care and nursing
Primary health-care and social-care professionals including nurses are involved in a number of parenting programmes to improve outcomes for both children and parents (National Institute for Health and Clinical Excellence, Social Care Institute for Excellence, 2006; Department for Education, Reference Barlow, Smailagic, Huband, Roloff and Bennett2014).
Characteristics of the evidence
This Cochrane review contained 48 randomised-controlled trials of which five were cluster randomised targeting adult parents with or without child behavioural problems (Barlow et al., 2014). They included both mothers and fathers (n=19), mothers only (n=13), single parent (n=12), parents, grandparents, step and foster parents, and relatives (n=4), although results were mainly reported from the mothers. Studies were conducted in the United States (n=22), Australia (n=10), Canada (n=7), United Kingdom (n=3) and the rest in China, Germany, Japan, the Netherlands and New Zealand. Interventions included group-based parenting programmes (behavioural n=22; cognitive behavioural n=19; multi modal n=8) compared with a control condition (wait list, no treatment, treatment as usual or placebo). Most interventions were delivered in a community setting. Studies were excluded if parents had a clinical psychiatric condition, interventions were individual or self-administered or did not include at least one standardised measure of parental psychosocial health.
Summary of key evidence
Included studies had 4937 participants in total ranging from 22 to 733. Duration of intervention varied and was categorised as ‘standard’ (8–14 sessions, n=36), ‘brief’ (one to six sessions, n=10) and ‘long’ (⩾16 weeks, n=2). Many studies reported an unclear risk of bias on key quality criteria, including allocation concealment, sequence generation and blinding.
Meta-analysis was conducted where appropriate, although results were heterogeneous. Evidence is summarised according to outcomes. Effect sizes as standardised mean difference (SMD) are given with 95% confidence intervals (CI) for outcomes at post-intervention (⩽4 weeks after intervention), short-term (two to six months post-intervention) and long-term follow-up (greater than six months post-intervention). The number of studies and participants are shown in parentheses.
Primary outcomes
Group-based parenting programmes were effective in the short term: depression (post-intervention, SMD −0.17, 95% CI −0.28 to −0.07, n=1591, 22 studies), anxiety (post-intervention, SMD −0.22, 95% CI −0.43 to −0.01, n=464, nine studies), stress (post-intervention, SMD −0.29, 95% CI −0.42 to −0.15, n=1567, 25 studies), anger (post-intervention, SMD −0.60, 95% CI −1.00 to −0.20, n=107, three studies) and guilt (SMD −0.79, 95% CI −1.18 to −0.41, n=119, three studies). Stress and confidence continued to be statistically significant at six-month follow-up, but not at long term. There was no evidence of any effect on self-esteem and no studies reported on aggression.
Secondary outcomes
Significant effects were reported for confidence (SMD −0.34, 95% CI −0.51 to −0.17, n=1001, 14 studies) and satisfaction with the partner relationship (SMD −0.28, 95% CI −0.47 to −0.09, n=432, nine studies). No study reported this outcome at short- or long-term follow-up. There was a significant effect on paternal stress at post-intervention (SMD −0.43, 95% CI −0.79 to −0.06, n=123, four studies). No study reported adverse effects.
Implications for practice
Group parenting programmes can be used to improve parental psychosocial functioning, but only in the short term. Additional support may be required to maintain this in the long term. Parenting programmes for fathers have the potential to improve short-term psychosocial well-being, and whilst there is a need to support fathers, their effectiveness needs to be established.
Implications for research
Future research should evaluate longer and more intensive programmes and their benefits on both mothers and fathers. It needs to examine the comparative effectiveness of different types of programmes as well as mechanisms (eg family functioning) that contribute to improved psychosocial functioning in parents.
Acknowledgements
The author is a member of the Cochrane Nursing Care Field (CNCF).
Financial Support
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Conflicts of Interest
None.
