Home-visiting Parenting Programs to Improve Mother-Infant Interactions at Early Ages: A Systematic Review.

Objective: To systematically review studies examining the effects of home-visiting preventive parenting programs (HV-PPs) on improving the quality of mother-child interactions in early childhood. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we identified 3,586 studies published between 2018 and 2022 by searching the following databases: PubMed, Web of Science, BVS/LILACS, SciELO, and PsycNET/PsycINFO. After applying the eligibility criteria, 17 articles were selected for review. Results: Most studies were conducted in high-income countries (53%) and the remainder were conducted in upper-middle-income countries, predominantly using a randomized controlled trial design and with strong methodological quality. The 17 studies applied 13 different HV-PPs, predominantly using video feedback, based on various dosages and schedules. Most studies (77%) showed significant positive effects on mother-child interactions by improving mainly positive maternal behaviors (e.g., sensitivity and responsiveness). Positive effects occurred independent of the study design, sample characteristics, measures, and constructs assessed. However, the findings suggest that the combination of fewer than six sessions, durations shorter than three months, and a very early start did not impact mother-child interactions, as expected. Few studies have explored negative maternal behaviors, children's behaviors, and dyadic interactions such as mutuality and synchrony. Conclusions: HV-PPs positively impacted mother-child interactions in early childhood despite the large heterogeneity across program designs, outcome measures, and overlapping constructs. Based on the results, we discuss the practical and economic implications of using parenting programs as a preventive approach.

A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial.

The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.

El ensayo controlado aleatorizado analizó la eficacia de un un programa personalizado de parentalidad a distancia mediante feedback por vídeo dirigido a mejorar la parentalidad y el comportamiento de los niños. Se distribuyó aleatoriamente a 92 madres de niños de entre 2 y 6 años de edad en el grupo de intervención (n = 50) y un grupo control de lista de espera (n = 42). Para mejorar la parentalidad positiva se utilizó el programa preventivo Strengthening Bonds, en el que las madres participaron en una sesión de grupo presencial. Durante seis semanas recibieron por teléfono móvil feedback en vídeo personalizado sobre su interacción madre-hijo durante el juego. El resultado primario fue la conducta parental, y el resultado secundario la conducta del niño. Se llevaron a cabo mediciones preintervención y posintervención. El análisis de ecuaciones de estimación general no tuvo resultados significativos en los análisis por intención de tratar (AIT). En los análisis por protocolo (APP) hubo efectos significativos, reduciendo las prácticas parentales coercitivas de las madres y los problemas de conducta de los niños. El análisis de modelos de ecuaciones estructurales reveló que la disminución de los problemas de conducta de los niños producida por la intervención era mediada por la mejora en las prácticas coercitivas. La intervención tenía un efecto directo en la mejora del sentimiento de competencia parental. A pesar de la falta de resultados del AIT, el APP dio resultados prometedores en cuanto a la mejora de las conductas y creencias parentales positivas y en la reducción de los problemas de conducta de los niños.