Short-term, medium-term and long-term effects of early parenting interventions in low- and middle-income countries: a systematic review

Abstract

Introduction: Parenting interventions during early childhood are known to improve various child development outcomes immediately following programme implementation. However, less is known about whether these initial benefits are sustained over time.

Methods: We conducted a systematic literature review of parenting interventions in low- and middle-income countries (LMICs) that were delivered during the first 3 years of life and had completed a follow-up evaluation of the intervention cohort at least 1 year after the primary postintervention endpoint. We summarized intervention effects over time by child-level and parent-level outcomes as well as by timing of follow-up rounds in the short-term (1-3 years after programme completion), medium-term (4-9 years), and long-term (10+ years). We also conducted exploratory meta-analyses to compare effects on children's cognitive and behavioral development by these subgroups of follow-up rounds.

Results: We identified 24 articles reporting on seven randomised controlled trials of parenting interventions delivered during early childhood that had at least one follow-up study in seven LMICs. The majority of follow-up studies were in the short-term. Three trials conducted a medium-term follow-up evaluation, and only two trials conducted a long-term follow-up evaluation. Although trials consistently supported wide-ranging benefits on early child development outcomes immediately after programme completion, results revealed a general fading of effects on children's outcomes over time. Short-term effects were mixed, and medium-term and long-term effects were largely inconclusive. The exploratory meta-analysis on cognitive development found that pooled effects were significant at postintervention and in the short-term (albeit smaller in magnitude), but the effects were not significant in the medium-term and long-term. For behavioural development, the effects were consistently null over time.

Conclusions: There have been few longer-term follow-up studies of early parenting interventions in LMICs. Greater investments in longitudinal intervention cohorts are needed in order to gain a more comprehensive understanding of the effectiveness of parenting interventions over the life course and to improve the design of future interventions so they can have greater potential for achieving and sustaining programme benefits over time.

Keywords: child health; prevention strategies.

Figure 1

Evaluation rounds of included parenting interventions. Note: Arrows represent intervention timing and duration. Black stars represent postintervention evaluation. Blue stars represent follow-up evaluations.

Figure 2

Parenting intervention effects on cognitive development outcomes for each trial across follow-up studies. Note: markers with black dots represent immediate postintervention trial results. For Cooper et al, there was no postintervention assessment of cognitive development.

Figure 3

Short-term, medium-term and long-term pooled effects of parenting interventions on cognitive development outcomes. Note: REML, random-effects meta-analysis.

Figure 4

Short-term, medium-term and long-term pooled effects of parenting interventions on behavioural outcomes. REML, random-effects meta-analysis.