Searches were conducted in a number of databases, including PubMed, Psycinfo, Cinhal, Web of Science, Eric, and the Cochrane Library. Search terms encompassed terms related to parental competence and intervention strategies. These included: parenting, parental competence, positive parenting, parenting practices, strategies, intervention, programme, program, treatment, and health promotion. All terms were combined with the Boolean operators AND and OR. The interventions considered in this review were those carried out more on an individual level than on a health policy level. No attempt was made to search for unpublished works, such as dissertations and theses, neither limits were established in relation to the year of publication. Articles in English and Spanish were reviewed.

This review focused on intervention studies that sought to increase the development of parental competence or any of the abilities that parents need in order to promote healthy lifestyles among their children.9 For this purpose, studies were included in the review if they met the inclusion criteria. These were established according to the different characteristics shown below.

Initial screening was undertaken to identify potential articles meeting the inclusion criteria from the titles and abstracts. Full texts were obtained for the relevant articles. Full texts were also obtained for any study whose inclusion was unclear. All articles were examined to ensure that they met all the inclusion criteria. Any uncertainties were resolved by discussion. PRISMA flow diagram procedure was used to ensure rigor in the selection process.17

In order to analyze and synthesize the data from the fifteen studies included,18–32 three tables were used. Table 1 provides general information of the studies including author, year of publication, country and name of the program, design, participants and context in which the program took place, the main characteristics of intervention, length, measurement tools, variables, and main results. Quality assessment was considered a key feature for this review and encompassed two components: the adequacy of the interventions in terms of the key components that a parental competence intervention should have and the methodological quality of the studies. Regarding the key components of interventions, the authors assessed whether the articles provided sufficient details about parental competence or skills and the theoretical framework used; included an objective and subjective evaluation of the competence; focused on health promotion and positive parenting; included both parents and childhood-relevant contexts; included group sessions with parents; and encouraged the development of family activities at home (Table 2). For methodological quality assessment, an adaptation of the CASPe guide33 was used (Table 3).

The bibliographic search yielded 2282 articles. After removing duplicates, a total of 2267 abstracts were screened. Out of these, 41 full-text articles were assessed for eligibility. In the end, a total of fifteen studies met the inclusion criteria for this review. A summary of the literature identified at each stage of the search process can be found in Fig. 1. Twenty-six full-texts were rejected following the exclusion criteria.

Figure 1.

PRISMA flow diagram.

(0.29MB).

Over half of the studies included were carried out within the last five years (Table 1). Nine studies were conducted in North America, four in Europe (Sweden, England, Spain, and the Netherlands), and two in Asia (Hong Kong and Pakistan).

Sample size was highly variable across studies, ranging from 49 to 840 participants. In most studies, the sample was composed by between 100 and 200 participants. While most focused on both parents (n=10),20,22–25,27–31 four studies18,21,26,32 only included mothers in their samples and the remaining study ended up excluding male parents from the analysis, as they only represented 6% of participants.19 Despite the inclusion of both parents, female representation was over 90% in all the studies.

One-third of the studies had a special focus on vulnerable situations: low-income families,25,28,31 disadvantaged families,30 or mothers at psychosocial risk.19

Interventions ranged in length from five weeks to eight months, although in general they were short-termed.

Intervention settings included day care centers23; family centers22,27,28,32; community health,24,31 primary care29 or social service centers19; as well as the home.18,20,21,30 In some studies, the interventions were conducted in children's centers, which were specific centers providing support for young families in disadvantaged areas of England (Table 2).27

Seven studies had a preventive focus,18–21,23,24,27 while the remaining eight studies had a positive health promotion approach.22,25,26,28–32 Only three studies explicitly referred to positive parenting.19,29,32 Some adopted a global perspective and helped parents to develop child*raising skills. However, most of the interventions (n=10) focused on specific lifestyles: four on diet, exercise, and screen time18,20,26,28; three on diet or exercise27,30,31; one on exercise and screen time22; and two on one specific lifestyle (Table 2).23,25 The majority (n=8) used group sessions as method to implement their programs.19,23,24,27–29,31,32 Four of the studies used family sessions,18,20,21,30 and the remaining (n=3)22,25,26 based their programs on sending information primarily by email (Table 1). All but five studies included an extension component, involving activities to perform at home18,23–25,27–32 in order to practice the recommendations offered in the program (Table 2).

Study designs included randomized controlled trials18–20,25–32 (n=11) and quasi-experimental studies21–24 (n=4). Ten studies divided the sample into two groups,18,19,21–24,26,30–32 while one divided it into four groups.20 Almost half were pilot studies (Table 1).18,22,24,28,29,32

Parental competence assessment methods varied across studies. Most of them included a subjective evaluation component of the outcome,18–25,27–32 using a variety of scales, and three considered an objective evaluation component through observations based on guidelines.19,21,23 Another three studies reported evaluations through focus groups and recordings to assess parental satisfaction with the program and how it helped them in their parenting (Table 2).24,25,29

Parental self-efficacy was the main variable measured in 12 studies.18–22,24,27–32 A variety of scales or questionnaires was used to evaluate this variable including Parenting Self-Efficacy Scale, General Self-Efficacy Scale, Tool to Measure Parenting Self-Efficacy, Parenting Efficacy Scale, Toddler Care Questionnaire, and Parenting Self-Agency Questionnaire (Table 1).

Studies’ follow-up ranged from eight weeks to 24 months, although generally they were short-termed.

Quality assessment of the studies had two dimensions: conceptual adequacy of the intervention and the methodological approach of the study. In terms of the former, as it can be seen in Table 2, only three studies referred to some theoretical grounding specifically regarding parental competence.19,21,29 Ten studies made explicit reference to parenting skills,18–21,24,27–30,32 and seven studies developed aspects such as self-efficacy, self-regulation, or parents as role model, using theories based on parenting skills or competence.19,21–23,26,27,29 Five of the included studies referred to parenting styles providing significant value to the development of an authoritative or democratic style for raising children.20,21,26,27,32 Only one study considered schools as a key setting.20 Two studies encompassed strategies to ensure the fidelity of the intervention delivered. More specifically, this was done by recording some of the group sessions in order to evaluate facilitator's adherence to the program content, or using a guide to assess whether the delivery of the sessions was correct.19,29

In terms of methodological quality (Table 3), four studies were regarded as having high quality.20,26,30,31 Eight studies were considered to have a moderate quality,18,19,23,25,27–29,32 and half of them (n=4) lacked a comparison group.25,27–29 Finally, three of them had low methodological quality.21,22,24 Both the lack of a comparison group and non-randomization of the sample were considered important limitations.

The primary endpoint was parental self-efficacy in most of the studies. As suggested by Table 1, although parental self-efficacy was targeted in 12 studies, only four considered it as outcome variables, and they all used different outcome measures.19,24,27,29 Only the study by Martín et al.19 reported a higher parental self-efficacy in the post measurement in the intervention group (5.34±0.64) compared to the baseline measurement of the control group (4.49±0.54). Seemingly, Kennett and Chislett24 reported a significant increase in the variable scores of parents who earned the certificate after intervention (post: 37.30±4.63, follow-up: 37.00±4.39). Enebrink et al.29 achieved a significant increase in the components of parental self-efficacy scores as rules and discipline (pre: 42.20±9.97; post: 45.94±8.58; and follow-up: 46.80±9.36) or empathy and understanding (pre: 49.85±7.18; post: 53.69±5.40; and follow-up: 52.41±8.22). Finally, in the fourth study, parental self-efficacy scores increased over time (baseline: 12.55±4.26; post: 14.96±2.70; and follow-up: 15.34±2.72).27

Other three studies reported a higher parental self-efficacy only related to some specific components. Two of them were related to the control of TV viewing (intervention group pre: 3.93±0.81; post: 4.05±0.8228; difference between groups in post: 3.32).22 Another study was related to the parental feeding practices restriction (intervention group post: −0.32±0.61; control group post: −0.04±0.56).31 Three studies did not find changes in parental self-efficacy20,30,31 and two did not reflect the results.18,32

Four of the studies assessed parental sense of competence.21,24,26,29 Only two of them reported significant intervention effects, those who had low and moderate quality. Deković et al.21 reported higher scores in parental sense of competence in the intervention group (0.01±0.01) when compared with the control group (0.03±0.01). The study with only one group found higher scores in parental self-competence (pre: 47.29±7.76; post: 51.02±7.11; and follow-up: 49.86±8.93).29 The other two studies did not report changes in parental self-perception of competency.24,26