Hannah Kuper, Sara Rotenberg, Luthfi Azizatunnisa', Lena Morgon Banks, Tracey Smythe
The association between disability and mortality: a mixed-methods study
The Lancet. Public health
background parents primary caregivers young children responsive parentchild relationships parental support learning earliest years life crucial promoting early child development ecd conducted global systematic review metaanalysis evaluate effectiveness parenting interventions ecd parenting outcomes methods findings searched medline embase psycinfo cinahl web science global health library peerreviewed published articles database inception november 15 2020 included randomized controlled trials rcts parenting interventions delivered first 3 years life evaluated least 1 ecd outcome least 2 reviewers independently screened extracted data assessed study quality eligible studies ecd outcomes included cognitive language motor socioemotional development behavior problems attachment parenting outcomes included parenting knowledge parenting practices parentchild interactions parental depressive symptoms calculated intervention effect sizes standardized mean difference smd estimated pooled effect sizes outcome separately using robust variance estimation metaanalytic approaches used randomeffects metaregression models assess potential effect modification countryincome level child age intervention content duration delivery setting study quality review registered prospero crd42018092458 crd42018092461 11920 articles identified included 111 articles representing 102 unique rcts pooled effect sizes indicated positive benefits parenting interventions child cognitive development smd 032 95 ci confidence interval 023 040 p lt 0001 language development smd 028 95 ci 018 037 p lt 0001 motor development smd 024 95 ci 015 032 p lt 0001 socioemotional development smd 019 95 ci 010 028 p lt 0001 attachment smd 029 95 ci 018 040 p lt 0001 reductions behavior problems smd 013 95 ci 018 008 p lt 0001 positive benefits also found parenting knowledge smd 056 95 ci 033 079 p lt 0001 parenting practices smd 033 95 ci 022 044 p lt 0001 parentchild interactions smd 039 95 ci 024 053 p lt 0001 however significant reduction parental depressive symptoms smd 007 95 ci 016 002 p 008 subgroup analyses revealed significantly greater effects child cognitive language motor development parenting practices low middleincome countries compared highincome countries significantly greater effects child cognitive development parenting knowledge parenting practices parentchild interactions programs focused responsive caregiving compared hand clear evidence effect modification child age intervention duration delivery setting study risk bias study limitations include considerable unexplained heterogeneity inadequate reporting intervention content implementation varying quality evidence terms conduct trials robustness outcome measures used across studies conclusions parenting interventions children first 3 years life effective improving ecd outcomes enhancing parenting outcomes across low middle highincome countries increasing implementation effective highquality parenting interventions needed globally scale order support parents enable young children achieve full developmental potential