Digital interventions for parenting support: a systematic review of effects and experiences
The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) commissioned this systematic review of effects of and parental experiences with these digital interventions.
We conducted a systematic review and included 30 studies of effects (including >6000 participants) and 6 studies of experiences (in total 36 studies of 35 interventions). The studies were conducted in the USA, Australia, Canada, England, Finland, Sweden, Germany and Wales, and were published between 2007 and 2018. Thirty studies were online interventions, two were email interventions, and one each looked at telephone, app and podcast interventions. There was a large variety regarding the intensity, duration and degree of coaching included in the interventions. The majority of the interventions targeted vulnerable families or parents of children with behaviour problems.
This systematic review found that online interventions with 1-12 sessions (for families with babies, toddlers, schoolchildren or youth) with or without coaching, give primarily more appropriate parental behaviour, compared to no intervention. Compared to face-to-face interventions, online interventions possibly give similar effects, while the results of email, app and podcast interventions are uncertain. The qualitative studies of parental experiences with the interventions indicate that parents have positive experiences with flexibility, anonymity and coaching in digital interventions, and they prefer individual and cultural adjustments.
More research on other digital formats is needed, as well as research on use among fathers and among other societal subgroups, such as immigrants.
The Norwegian Government has developed a strategy for parenting support. The objective is to prevent development of problems in children, increase parental confidence and to support parents with special needs in order to reduce the risk for neglect or abuse. In the long run, this preventive effort will be socio-economically beneficial. The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) aspires to increasingly offer their services digitally, and in 2016 launched a parenting support web page. This web page is to be developed further and other interventions are under consideration. Due to this increased focus on digital services, Bufdir commissioned this systematic review on the effects of and parental experiences with digital interventions for parenting support.
We conducted a systematic review in accordance with the Methods Handbook of the Division of Health Services, Norwegian Institute of Public Health. We performed a literature search in relevant databases and for grey literature; last updated in October 2018. In order to address both questions of effect and experience, we planned to include systematic reviews and primary studies, as long as they examined digital interventions for parenting support, compared to face-to-face interventions or no interventions. Outcomes were parent-child interaction, communication, relations, use of physical punishment, and cost-effectiveness. In qualitative studies, the relevant topic was the participants’ experiences with digital interventions. Two researchers screened all titles and abstracts and then the relevant full texts in order to assess eligibility consistent with the inclusion criteria. Only primary studies met the criteria. Two researchers critically appraised the included studies for potential risk of bias (studies of effect) or methodological strength and weaknesses (studies of experiences). We grouped the studies, formulated findings and assessed the confidence in the findings by using GRADE (effect) and GRADE-CERQual (experience).
We included 36 unique studies of 35 interventions: 30 studies of effect (28 randomized controlled studies and 2 non-randomised controlled studies, with more than 6000 participants) and 6 studies of experience. Twenty-nine studies were from the USA, 9 were from Australia, and 1 study each from Canada, England, Finland, Sweden, Germany and Wales. The studies were published between 2007 and 2018 (the quantitative studies after 2010). Thirty of the 35 interventions were online, 2 were email, 1 telephone, 1 app and 1 podcast intervention. The interventions were varied, in addition to the digital format: the setting, the intensity, the theoretical approach, target group, and outcomes measured varied across studies. Because of all these differences, we have formulated general findings.
A majority of the interventions were selective, that is, directed towards families with identified risk factors (primarily vulnerable and poor families). Almost as many interventions were indicative, directed towards parents of children with signs of emerging problems (primarily conduct problems but also mental problems). A few of the interventions were universal, directed towards parents in general, regardless of risk.
We carried out six comparisons of effect based on digital format and intensity, and one thematic synthesis of parental experiences. The general outcome is referred to as parenting behaviour. Our confidence is included in the statement of findings.
Effect of online interventions 1-6 sessions compared to no intervention
Ten studies compared online interventions consisting of 1-6 sessions, to not receiving any intervention. The interventions varied in intensity and duration but were all relatively short. The shortest intervention consisted of one session of 10 minutes; the longest included six sessions of 20-30 minutes over eight weeks. In 8 interventions there was no professional coaching. Three interventions targeted parents of toddlers 1-5 y, four targeted parents of schoolchildren 5-12 y, and three targeted parents of youth 13-18 y. We found that online interventions with 1-6 sessions with limited coaching, give primarily more appropriate parental behaviour, compared to no intervention.
Effect of online interventions 7-12 sessions compared to no intervention
Fifteen studies compared online interventions consisting of 7-12 sessions, to no intervention. Most programmes offered weekly sessions over 8-10 weeks. Nine interventions included coaching, six of these used weekly telephone coaching. Two interventions targeted parents of babies 0-1 y, five interventions targeted parents of toddlers 1-5 y, three targeted parents of schoolchildren 5-12 y and five targeted parents of youth 13-18 y. We found that online interventions with 7-12 sessions, often with coaching, give primarily more appropriate parental behaviour, compared to no intervention.
Effect of online interventions compared to face-to-face interventions
Four studies compared online interventions to interventions that were offered face-to-face. In two studies the participants chose the intervention they wanted, online or face-to-face. The online interventions were of various lengths (1-10 sessions) and without coaching, whereas the controls were group meetings of similar duration with coaching. We found no clear differences between online and face-to-face interventions regarding effects on parental behaviour, but the results are somewhat uncertain.
Effect of email interventions compared to no intervention
Two studies examined interventions based on emails. One intervention lasted for four weeks; the other lasted for 12 and included weekly telephone coaching. Both studies compared email interventions with no intervention. We found that email interventions possibly give little or no effect on parent behaviour, compared to no intervention.
Effect of app interventions compared to no intervention
One study examined an application for smartphones. The control group received no intervention. We found that it is uncertain whether app interventions for parents of children 8-12 y have any effect on parental behaviour compared to no intervention.
Effect of podcast interventions compared to no intervention
One study examined a podcast intervention. The control group received no intervention. We found that it is uncertain whether podcast interventions for parents of children 2-10 y have any effect on parental behaviour, compared to no intervention.
Parental experiences with digital interventions for parenting support
Six studies of parents’ experiences with digital interventions for parenting support indicated that participants in online and telephone intervention appreciated the flexibility and anonymity of digital interventions. In online interventions, the example videos were highlighted as important for learning, especially when these mirrored the participants’ cultural and personal styles. Interventions that offered coaching were valued for professional support and individual adaption. The participants in several interventions emphasized recognition and confidence as prerequisites for trust and learning.
There was a large variation in the interventions’ intensity and duration, and based on our comparisons we cannot say that some types of interventions are more effective than others, but they are more effective than no intervention. The online interventions have the best documented effect, but they are also the most studied. Also regarding coaching there were many different variants, but we cannot draw any conclusions. Most of the programmes used a cognitive-behavioural approach and sought to teach the parents skills in communication, discipline, praise and conflict resolution. Some of the programmes intended to teach the right way of doing things, often via multiple choice testing. Other programmes encouraged reflection and trying out different strategies. The majority of the interventions were directed towards vulnerable families or parents of children with conduct problems. These differences may not have been important for the content of the programmes. However, the last category included fewer vulnerable families, which might imply that they could utilize the interventions better. Only one study measured cost-effectiveness.
In this systematic review, we found that 25 online interventions of shorter or longer duration, with or without coaching, probably give more appropriate parental behaviour, compared to no interventions. Qualitative studies indicate positive experiences with flexibility and anonymity of interventions, coaching and individual and cultural tailoring.
More research is needed on the effects of other digital formats, in addition to studies comparing digital and face-to-face interventions. There is also a need for more research on fathers and other societal groups, for example immigrants. More high-quality qualitative studies is crucial.