Cochrane Database Syst Rev. 2021 Dec 20;12:CD010618. doi: 10.1002/14651858.CD010618.pub2.
Peer support interventions for parents and carers of children with complex needs.
The Cochrane database of systematic reviews
Gina-Maree Sartore, Anastasia Pourliakas, Vince Lagioia
Affiliations
Affiliations
- Parenting Research Centre, East Melbourne, Australia.
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia.
PMID: 34923624
PMCID: PMC8684823 DOI: 10.1002/14651858.CD010618.pub2
Abstract
BACKGROUND: Parents and family carers of children with complex needs experience a high level of pressure to meet children's needs while maintaining family functioning and, as a consequence, often experience reduced well-being and elevated psychological distress. Peer support interventions are intended to improve parent and carer well-being by enhancing the social support available to them. Support may be delivered via peer mentoring or through support groups (peer or facilitator led). Peer support interventions are widely available, but the potential benefits and risks of such interventions are not well established.
OBJECTIVES: To assess the effects of peer support interventions (compared to usual care or alternate interventions) on psychological and psychosocial outcomes, including adverse outcomes, for parents and other family carers of children with complex needs in any setting.
SEARCH METHODS: We searched the following resources. • Cochrane Central Register of Controlled Trials (CENTRAL; latest issue: April 2014), in the Cochrane Library. • MEDLINE (OvidSP) (1966 to 19 March 2014). • Embase (OvidSP) (1974 to 18 March 2014). • Journals@OVID (22 April 2014). • PsycINFO (OvidSP) (1887 to 19 March 2014). • BiblioMap (EPPI-Centre, Health Promotion Research database) (22 April 2014). • ProQuest Dissertations and Theses (26 May 2014). • metaRegister of Controlled Trials (13 May 2014). We conducted a search update of the following databases. • MEDLINE (OvidSP) (2013 to 20 February 2018) (search overlapped to 2013). • PsycINFO (ProQuest) (2013 to 20 February 2018). • Embase (Elsevier) (2013 to 21 February 2018). We handsearched the reference lists of included studies and four key journals (European Child and Adolescent Psychiatry: 31 March 2015; Journal of Autism and Developmental Disorders: 30 March 2015; Diabetes Educator: 7 April 2015; Journal of Intellectual Disability Research: 13 April 2015). We contacted key investigators and consulted key advocacy groups for advice on identifying unpublished data. We ran updated searches on 14 August 2019 and on 25 May 2021. Studies identified in these searches as eligible for full-text review are listed as "Studies awaiting classification" and will be assessed in a future update.
SELECTION CRITERIA: Randomised and cluster randomised controlled trials (RCTs and cluster RCTs) and quasi-RCTs were eligible for inclusion. Controlled before-and-after and interrupted time series studies were eligible for inclusion if they met criteria set by the Cochrane Effective Practice and Organisation of Care Review Group. The comparator could be usual care or an alternative intervention. The population eligible for inclusion consisted of parents and other family carers of children with any complex needs. We applied no restriction on setting.
DATA COLLECTION AND ANALYSIS: Inclusion decisions were made independently by two authors, with differences resolved by a third author. Extraction to data extraction templates was conducted independently by two authors and cross-checked. Risk of bias assessments were made independently by two authors and were reported according to Cochrane guidelines. All measures of treatment effect were continuous and were analysed in Review Manager version 5.3. GRADE assessments were undertaken independently by two review authors, with differences resolved by discussion.
MAIN RESULTS: We included 22 studies (21 RCTs, 1 quasi-RCT) of 2404 participants. Sixteen studies compared peer support to usual care; three studies compared peer support to an alternative intervention and to usual care but only data from the usual care arm contributed to results; and three studies compared peer support to an alternative intervention only. We judged risk of bias as moderate to high across all studies, particularly for selection, performance, and detection bias. Included studies contributed data to seven effect estimates compared to usual care: psychological distress (standardised mean difference (SMD) -0.10, 95% confidence interval (CI) -0.32 to 0.11; 8 studies, 864 participants), confidence and self-efficacy (SMD 0.04, 95% CI -0.14 to 0.21; 8 studies, 542 participants), perception of coping (SMD -0.08, 95% CI -0.38 to 0.21; 3 studies, 293 participants), quality of life and life satisfaction (SMD 0.03, 95% CI -0.32 to 0.38; 2 studies, 143 participants), family functioning (SMD 0.15, 95% CI -0.09 to 0.38; 4 studies, 272 participants), perceived social support (SMD 0.31, 95% CI -0.15 to 0.77; 4 studies, 191 participants), and confidence and skill in navigating medical services (SMD 0.05, 95% CI -0.17 to 0.28; 4 studies, 304 participants). In comparisons to alternative interventions, one pooled effect estimate was possible: psychological distress (SMD 0.2, 95% CI -0.38 to 0.79; 2 studies, 95 participants). No studies reported on adverse outcomes. All narratively synthesised data for psychological distress (compared to usual care - 2 studies), family functioning (compared to usual care - 1 study; compared to an alternative intervention - 1 study), perceived social support (compared to usual care - 2 studies), and self-efficacy (compared to alternative interventions - 1 study) were equivocal. Comparisons with usual care showed no difference between intervention and control groups (perceived social support), some effect over time for both groups but more effect for intervention (distress), or mixed effects for intervention (family function). Comparisons with alternative interventions showed no difference between the intervention of interest and the alternative. This may indicate similar effects to the intervention of interest or lack of effect of both, and we are uncertain which option is likely. We found no clear evidence of effects of peer support interventions on any parent outcome, for any comparator; however, the certainty of evidence for each outcome was low to very low, and true effects may differ substantially from those reported here. We found no evidence of adverse events such as mood contagion, negative group interactions, or worsened psychological health. Qualitative data suggest that parents and carers value peer support interventions and appreciate emotional support.
AUTHORS' CONCLUSIONS: Parents and carers of children with complex needs perceive peer support interventions as valuable, but this review found no evidence of either benefit or harm. Currently, there is uncertainty about the effects of peer support interventions for parents and carers of children with complex needs. However, given the overall low to very low certainty of available evidence, our estimates showing no effects of interventions may very well change with further research of higher quality.
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
References
- Rehabil Psychol. 2010 May;55(2):139-50 - PubMed
- Cochrane Database Syst Rev. 2013 Jul 18;(7):CD009338 - PubMed
- Health Commun. 2008 Sep;23(5):413-26 - PubMed
- Child Care Health Dev. 2015 Mar;41(2):303-13 - PubMed
- Br J Clin Psychol. 1983 Nov;22 (Pt 4):245-9 - PubMed
- Clin Psychol Rev. 2002 Apr;22(3):383-442 - PubMed
- Disabil Rehabil. 2010;32(20):1673-7 - PubMed
- J Matern Fetal Neonatal Med. 2013 Nov;26(17):1737-41 - PubMed
- Aust Occup Ther J. 2010 Apr;57(2):127-36 - PubMed
- Diabetes Educ. 2010 Jan-Feb;36(1):88-97 - PubMed
- Adm Policy Ment Health. 2011 Sep;38(5):412-27 - PubMed
- Arch Psychiatr Nurs. 2014 Oct;28(5):319-26 - PubMed
- Health Qual Life Outcomes. 2003 Nov 13;1:66 - PubMed
- Am J Ment Retard. 2004 Sep;109(5):352-61 - PubMed
- J Adv Nurs. 2012 Sep;68(9):2095-102 - PubMed
- Dev Med Child Neurol. 2013 Jul;55(7):602-9 - PubMed
- J Child Adolesc Psychiatr Nurs. 2009 May;22(2):86-98 - PubMed
- Cochrane Database Syst Rev. 2021 Jan 4;1:CD006440 - PubMed
- Behav Res Ther. 1995 Mar;33(3):335-43 - PubMed
- J Pediatr Psychol. 1996 Oct;21(5):633-41 - PubMed
- Cochrane Database Syst Rev. 2021 Dec 20;12:CD010618 - PubMed
- Res Dev Disabil. 2014 Apr;35(4):833-48 - PubMed
- J Soc Pediatr Nurs. 1996 Oct-Dec;1(3):103-9; quiz 111-2 - PubMed
- JMIR Res Protoc. 2014 Dec 03;3(4):e69 - PubMed
- Autism. 2005 Oct;9(4):416-27 - PubMed
- Eur Child Adolesc Psychiatry. 2014 Aug;23(8):637-47 - PubMed
- CMAJ. 2003 Apr 15;168(8):969-73 - PubMed
- J Adv Nurs. 2002 Jul;39(2):190-8 - PubMed
- Qual Health Res. 2000 Mar;10(2):225-41 - PubMed
- Am J Ment Retard. 2002 Nov;107(6):433-44 - PubMed
- Pediatrics. 2017 Mar;139(3): - PubMed
- Ment Retard. 1972 Dec;10(6):14-5 - PubMed
- Contemp Clin Trials. 2018 Jul;70:117-134 - PubMed
- Diabetes Educ. 2011 Jul-Aug;37(4):508-18 - PubMed
- Diabetes Educ. 2004 May-Jun;30(3):476-84 - PubMed
- Res Nurs Health. 1992 Jun;15(3):227-35 - PubMed
- Am J Ment Retard. 2007 Sep;112(5):330-48 - PubMed
- Soc Sci Med. 2007 Jan;64(1):150-63 - PubMed
- Behav Ther. 2008 Mar;39(1):33-46 - PubMed
- Br J Psychiatry. 2003 Oct;183:342-8 - PubMed
- Cochrane Database Syst Rev. 2017 Feb 14;2:CD001055 - PubMed
- J Pers Soc Psychol. 1987 Jul;53(1):71-80 - PubMed
- Phys Occup Ther Pediatr. 2001;21(2-3):29-48 - PubMed
- Cochrane Database Syst Rev. 2017 Apr 19;4:CD012331 - PubMed
- J Child Psychol Psychiatry. 2004 Nov;45(8):1338-49 - PubMed
- Asian Nurs Res (Korean Soc Nurs Sci). 2007 Sep;1(2):116-24 - PubMed
- J Spinal Cord Med. 2002 Summer;25(2):129-32 - PubMed
- Arch Dis Child. 2005 Oct;90(10):1053-7 - PubMed
- Int J Nurs Stud. 2014 Nov;51(11):1524-37 - PubMed
- J Clin Child Adolesc Psychol. 2002 Sep;31(3):384-92 - PubMed
- J Med Internet Res. 2017 Aug 22;19(8):e287 - PubMed
- Child Care Health Dev. 2011 Sep;37(5):679-91 - PubMed
- Soc Sci Med. 1999 Jun;48(11):1563-75 - PubMed
- Cochrane Database Syst Rev. 2008 Oct 08;(4):CD006903 - PubMed
- J Autism Dev Disord. 2017 May;47(5):1314-1322 - PubMed
- Iran J Cancer Prev. 2012 Fall;5(4):183-8 - PubMed
- BMC Pediatr. 2014 Jan 28;14:24 - PubMed
- Pediatrics. 2009 Dec;124(6):1522-32 - PubMed
- Am J Ment Retard. 2002 Mar;107(2):116-27 - PubMed
- Child Care Health Dev. 2000 Jul;26(4):309-22 - PubMed
- MCN Am J Matern Child Nurs. 2011 Jul-Aug;36(4):224-31 - PubMed
- Int J Methods Psychiatr Res. 2010 Jun;19 Suppl 1:4-22 - PubMed
- Codas. 2015 Sep-Oct;27(5):411-8 - PubMed
- Autism. 2013 Jan;17(1):27-43 - PubMed
- Child Care Health Dev. 2006 Jan;32(1):19-31 - PubMed
- Issues Compr Pediatr Nurs. 1992 Jan-Mar;15(1):55-67 - PubMed
- Med Care. 1980 Apr;18(4):465-72 - PubMed
- BMJ. 2004 May 15;328(7449):1166 - PubMed
- Front Psychiatry. 2018 Dec 18;9:710 - PubMed
- J Autism Dev Disord. 2013 Jul;43(7):1662-75 - PubMed
- Health Qual Life Outcomes. 2004 Sep 27;2:55 - PubMed
- Haemophilia. 2012 Nov;18(6):892-7 - PubMed
- J Am Acad Nurse Pract. 2007 May;19(5):251-60 - PubMed
- J Pediatr Psychol. 1998 Apr;23(2):99-109 - PubMed
- J Intellect Disabil Res. 2005 Jan;49(Pt 1):47-53 - PubMed
- Cochrane Database Syst Rev. 2019 Jun 17;6:CD009912 - PubMed
- Arch Pediatr Adolesc Med. 2001 Jul;155(7):771-7 - PubMed
- J Adv Nurs. 2006 Feb;53(4):392-402 - PubMed
- BMJ. 2011 Jul 22;343:d4002 - PubMed
Publication Types