Background
Primary healthcare, particularly Indigenous‐led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child‐rearing practices, and Indigenous ways of knowing and doing business. Indigenous family‐centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family‐centred interventions can be through environmental, communication, educational, counselling, and family support approaches.
Objectives
To evaluate the benefits and harms of family‐centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families.Search methodsWe used standard, extensive Cochrane search methods. The latest search date was 22 September 2021.Selection criteriaWe included randomised controlled trials (RCTs), cluster RCTs, quasi‐RCTs, controlled before‐after studies, and interrupted time series of family‐centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family‐centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family‐centred intervention versus another.
Data collection and analysis
We used standard Cochrane methods. Our primary outcomes were 1. overall health and well‐being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health‐enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family‐centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes.Main resultsWe included nine RCTs and two cluster‐RCTs that investigated the effect of family‐centred care interventions delivered by primary healthcare services for Indigenous early child well‐being. There were 1270 mother–child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family‐centred education was the most common type of intervention delivered. Three studies compared family‐centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family‐centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain.
Family‐centred care may improve overall health and well‐being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family‐centred care improved the overall health and well‐being of Indigenous children and their families compared no family‐centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants).We are very uncertain whether family‐centred care compared to no family‐centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI
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