Komro
KA(1), Tobler AL, Delisle AL, O'Mara RJ, Wagenaar AC.
BACKGROUND:
Promoting child wellbeing necessarily goes beyond the clinic as risks to child
health and development are embedded in the social and physical environmental
conditions in which children live. Pediatricians play a vital role in promoting
the health of children in the communities they serve and can maximize their
impact by advocating for and supporting efficacious, evidence-based strategies
in their communities.
METHODS:
To provide a succinct guide for community pediatric efforts to advance the
wellbeing of all children and particularly disadvantaged children in a community,
we conducted a theory-driven and structured narrative review to synthesize
published systematic and meta-analytic reviews of policy-relevant, local-level
strategies addressing potent and malleable influences on child health and
development. An exhaustive list of policy-relevant, local-level strategies for
improving child health was used to conduct a comprehensive search of recent (1990-2012),
English language peer-reviewed published meta-analyses and systematic reviews
in the 10 core databases of scientific literature. Our review of the literature
encompassed six key conceptual domains of intervention foci, including distal
influences of child health (i.e., income and resources, social cohesion, and
physical environment) and proximal influences (i.e., family, school and peer).
We examined intervention effects on four key domains of child health and
development: cognitive development, social and emotional competence, psychological
and behavioral wellbeing, and physical health.
RESULTS:
Published reviews were identified for 98 distinct policy-relevant community
interventions, evaluated across 288 outcomes. We classified 46 strategies as
meeting scientific criteria for efficacy by having consistent, positive
outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood
watch programs, urban design and land use policies, access to quality childcare
services, class size reductions, after-school programs that promote
personal/social skills). Another 21 strategies were classified as having consistent
evidence of positive outcomes from high-quality observational studies only,
while 28 strategies had insufficient evidence available to assess their effectiveness
based on published reviews. We did not limit the review to studies conducted in the United States, but the vast
majority of them were U.S.-based,
and
the results therefore are most applicable to the U.S. context.
CONCLUSIONS:
Based on our synthesis of published literature on community development
strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child
health and development across a wide-range of child health outcomes.
