Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions: A Systematic Review and Meta-Analysis

Abstract

Importance: Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but such evidence has not been fully systematically synthesized.

Objective: To evaluate the associations of PSST with parental, pediatric, and family psychosocial outcomes.

Data sources: Six English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library), 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang), gray literature, and references were searched from inception to April 30, 2023.

Study selection: Randomized clinical trials (RCTs) that performed PSST for parents of children with CHCs and reported at least 1 parental, pediatric, or family psychosocial outcome were included.

Data extraction and synthesis: Study selection, data extraction, and quality assessment were conducted independently by 2 reviewers. Data were pooled for meta-analysis using the standardized mean difference (SMD) by the inverse variance method or a random-effects model. Subgroup analyses of children- and intervention-level characteristics were conducted.

Main outcomes and measures: The psychosocial outcomes of the parents, their children, and their families, such as problem-solving skills, negative affectivity, quality of life (QOL), and family adaptation.

Results: The systematic review included 23 RCTs involving 3141 parents, and 21 of these trials were eligible for meta-analysis. There was a significant association between PSST and improvements in parental outcomes, including problem-solving skills (SMD, 0.43; 95% CI, 0.27-0.58), depression (SMD, -0.45; 95% CI, -0.66 to -0.23), distress (SMD, -0.61; 95% CI, -0.81 to -0.40), posttraumatic stress (SMD -0.39; 95% CI, -0.48 to -0.31), parenting stress (SMD, -0.62; 95% CI, -1.05 to -0.19), and QOL (SMD, 0.45; 95% CI, 0.15-0.74). For children, PSST was associated with better QOL (SMD, 0.76; 95% CI, 0.04-1.47) and fewer mental problems (SMD, -0.51; 95% CI, -0.68 to -0.34), as well as with less parent-child conflict (SMD, -0.38; 95% CI, -0.60 to -0.16). Subgroup analysis showed that PSST was more efficient for parents of children aged 10 years or younger or who were newly diagnosed with a CHC. Significant improvements in most outcomes were associated with PSST delivered online.

Conclusions and relevance: These findings suggest that PSST for parents of children with CHCs may improve the psychosocial well-being of the parents, their children, and their families. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence.

Figure 1.. Flowchart for Study Selection

Figure 2.. Risk-of-Bias Summary of the Included Studies

Figure 3.. Meta-Analysis Summary of the Included Psychosocial Outcomes

GRADE indicates Grading of Recommendations, Assessment, Development, and Evaluations; SMD, standardized mean difference. ^aFor meta-analysis of parental problem-solving skills, quality of life, pediatric quality of life, and social functioning, the problem-solving skills training (PSST) group was preferable when the effect size was greater than 0, while the value of effect size for other outcomes less than 0 indicated a favor of PSST. ^bFor meta-analysis of parental posttraumatic stress, quality of life, pediatric mental problems, and parent-child conflict, the values of I² were less than 50%, and the inverse variance method was therefore used. ^cDowngraded 1 level for serious inconsistency due to statistical heterogeneity. ^dDowngraded 1 level for serious risk of bias of included studies. ^eDowngraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 1 level for serious imprecision due to limited sample size. ^fDowngraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 2 levels for very serious imprecision due to limited sample size and wide CIs. ^gDowngraded 2 levels for very serious imprecision due to limited sample size and data from only 2 studies. ^hDowngraded 1 level for serious inconsistency due to statistical heterogeneity and downgraded 1 level for serious imprecision due to wide CIs. ⁱDowngraded 1 level for serious imprecision due to limited sample size. ^jDowngraded 1 level for serious risk of bias of included studies and downgraded 1 level for serious imprecision due to limited sample size.