Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev. 2013 Mar 28;3:CD006020. doi: 10.1002/14651858.CD006020.pub3. (Review) PMID: 23543542
BACKGROUND: Parent education and training programmes can improve
maternal psychosocial health, child behavioural problems and parenting
practices. This review assesses the effects of parenting interventions
for reducing child injury.
OBJECTIVES: To assess the effects of
parenting interventions for preventing unintentional injury in children
aged under 18 years and for increasing possession and use of safety
equipment and safety practices by parents.
SEARCH METHODS: We
searched CENTRAL, MEDLINE, EMBASE, BIOSIS Preview, PsycINFO,
Sociological Abstracts, Social Science Citation Index, CINAHL, ProQuest
Dissertations and Theses, ERIC, DARE, ASSIA, Web of Science, SIGLE and
ZETOC. We also handsearched abstracts from the World Conferences on
Injury Prevention & Control and the journal Injury Prevention. The
searches were conducted in January 2011.
SELECTION CRITERIA: We
included randomised controlled trials (RCTs), non-randomised controlled
trials (non-RCTs) and controlled before and after studies (CBAs), which
evaluated parenting interventions administered to parents of children
aged 18 years and under, and reported outcome data on injuries for
children (unintentional or unspecified intent), possession and use of
safety equipment or safety practices (including the Home Observation for
Measurement of the Environment (HOME) scale which contained an
assessment of home safety) by parents. Parenting interventions were
defined as those with a specified protocol, manual or curriculum aimed
at changing knowledge, attitudes or skills covering a range of
parenting topics.
DATA COLLECTION AND ANALYSIS: Studies were
selected, data were extracted and quality appraised independently by two
authors. Pooled relative risks (RR) were estimated using random effect
models.
MAIN RESULTS: Twenty two studies were included in the review:
16 RCTs, two non-RCTs, one partially randomised trial which contained
two randomised intervention arms and one non-randomised control arm, two
CBA studies and one quasi randomised controlled trial. Seventeen
studies provided interventions comprising parenting education and other
support services; 15 of which were home visiting programmes and two of
which were paediatric practice-based interventions. Two provided solely
educational interventions. Nineteen studies recruited families who were
from socio-economically disadvantaged populations, were at risk of
adverse child outcomes or people who may benefit from extra support,
such as single mothers, teenage mothers, first time mothers and mothers
with learning difficulties. Ten RCTs involving 5074 participants were
included in the meta-analysis, which indicated that intervention
families had a statistically significant lower risk of injury than
control families (RR 0.83, 95% CI 0.73 to 0.94). Sensitivity analyses
undertaken including only RCTs at low risk of various sources of bias
found the findings to be robust to including only those studies at low
risk of detection bias in terms of blinded outcome assessment and
attrition bias in terms of follow up of fewer than 80% of participants
in each arm. When analyses were restricted to studies at low risk of
selection bias in terms of inadequate allocation concealment the effect
size was no longer statistically significant. Several studies found
statistically significant fewer home hazards or a greater number of
safety practices in intervention families. Of ten studies reporting
scores on the HOME scale, data from three RCTs were included in a
meta-analysis which found no evidence of a difference in quality of the
home environment between treatment arms (mean difference 0.57, 95% CI
-0.59 to 1.72). Most of the studies reporting home safety practices,
home hazards or composite home safety scores found statistically
significant effects favouring intervention arm families. Overall, using
GRADE, the quality of the evidence was rated as moderate.
AUTHORS'
CONCLUSIONS: Parenting interventions, most commonly provided within the
home using multi-faceted interventions are effective in reducing child
injury. There is fairly consistent evidence that they also improve home
safety. The evidence relates mainly to interventions provided to
families from disadvantaged populations, who are at risk of adverse
child health outcomes or whose families may benefit from extra support.
Further research is required to explore mechanisms by which these
interventions may reduce injury, the features of parenting interventions
that are necessary or sufficient to reduce injury and the
generalisability to different population groups.