Equity effects of parenting interventions for child conduct problems: a pan-European individual participant data meta-analysis

Abstract

Background Childhood conduct problems are a costly public health problem and are five times more common in socially disadvantaged groups than they are in advantaged groups. Untreated, conduct problems have a poor prognosis, with increasing gaps between socioeconomic groups, and high rates of subsequent criminality. Incredible Years is a high quality parenting programme for reducing conduct problems and is widely disseminated in Europe. Many trials have shown Incredible Years to be effective but the potential effects of parenting interventions on social inequality are unknown. Some behavioural interventions (eg, smoking cessation programmes), although beneficial overall, can widen inequality gaps. Because single trials and aggregate-level meta-analyses are ill equipped for examining differential intervention (moderator) effects, we pooled individual-level trial data to assess the effects of Incredible Years on social equity. Methods We did a systematic review and individual participant data meta-analysis by searching CINAHL, Embase, Global Health, Medline, and PsycINFO, for studies published from inception to March 15, 2019. We also searched the Incredible Years website library and consulted with experts, including the European Incredible Years mentors' network. We included data from all completed randomised trials of the Incredible Years parenting intervention in Europe that included children aged 1-12 years, including unpublished trials, without restriction on publication year or outcome measures. We included prevention (selective or universal) and treatment or indicated prevention trials (for children diagnosed or above the clinical cutoff for conduct problems). We excluded trials or conditions within trials that were not randomised, included additional non-parenting material (eg, child-focused interventions), or were abbreviated, non-standard versions of the usual Incredible Years intervention of 12-14 weekly sessions. We requested individual participant data from the study authors. The primary outcome was child conduct problems, assessed using the Eyberg Child Behavior Inventory Intensity (ECBI-I) scale. Moderators were analysed using multilevel modelling with multiple imputation. Findings Of 15 European trials of Incredible Years parenting programmes (n=1696 children), individual participant data were unavailable for one trial and one trial did not assess the primary outcome. Children were aged 2-10 years (median 5•1), 492 (30%) of 1651 children were from an ethnic minority and 931 (58%) of 1614 were from low-income families. Families who received the Incredible Years intervention reported an overall reduction in child conduct problems (13•5 points on the ECBI-I scale, 95% CI 10•9-16•1). There were no differential effects by family disadvantage (indicated by poverty, lone parenthood, teenage parenthood, household joblessness, or low education), or ethnic minority status. Interpretation We found no evidence for differential effects by social disadvantage, suggesting that Incredible Years is unlikely to widen ...

The Earlier the Better? Individual Participant Data and Traditional Meta‐analysis of Age Effects of Parenting Interventions

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One-year follow-up of The Incredible Years Parents and Babies Program: A pilot randomized controlled trial

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Combining parenting and economic strengthening programmes to reduce violence against children: a cluster randomised controlled trial with predominantly male caregivers in rural Tanzania

“…A recent individual participant data meta-analysis of parenting programme effectiveness in HICs found no differential effects by family socioeconomic status. 18 The Skilful Parenting and Agribusiness Child Abuse Prevention Study aimed to investigate the inter-relationship between economic strengthening programmes and parent management training in reducing child maltreatment. This is of particular importance given the need for combined interventions that address multiple Sustainable Development Goals (SDGs) across economic, social and environmental domains.…”

“…A recent individual participant data meta-analysis of parenting programme effectiveness in HICs found no differential effects by family socioeconomic status. 18 …”