Are interventions delivered by healthcare professionals effective for weight management? A systematic review of systematic reviews.

OBJECTIVE: There are many systematic reviews of weight management interventions delivered by healthcare professionals (HCP), but it is not clear under what circumstances interventions are effective due to differences in review methodology. This review of systematic reviews synthesises the evidence about: (a) the effectiveness of HCP-delivered weight management interventions and (b) intervention and sample characteristics related to their effectiveness. DESIGN: The review of reviews involved searching six databases (inception - October 2020). Reviews were included if they were (a) systematic, (b) weight management interventions delivered, at least partially, by HCP, (c) of randomised controlled trials and (d) written in English. Data regarding weight management outcomes (e.g. weight) and moderating factors were extracted. Secondary analyses were conducted using study-level data reported in each of the reviews. SETTING: The review included studies that were delivered by HCP in any clinical or non-clinical setting. PARTICIPANTS: Not applicable. RESULTS: Six systematic reviews were included (forty-six unique studies). First-level synthesis showed that weight management interventions delivered by HCP are effective. The second-level synthesis found that interventions are only successful for up to 6 months, are most effective for women, non-Caucasians and adults and are most effective if they have at least six sessions. CONCLUSIONS: As interventions are only successful for up to 6 months, they are not sufficient for achieving and maintaining a healthy weight.

Editorial Perspective: How can we help the children of Ukraine and others affected by military conflict?

Parents and caregivers play a key role in protecting children from the stresses of war. Their own experiences, changes they see in children in their care and the nature of the parenting they provide can have a profound effect on childrens' reactions. The adoption of a pyramid of resources from universally available psychoeducational materials to specialised forms of trauma-informed interventions allows for screening and provision of appropriate levels of assistance. The importance of consideration of the family's context, the evidence base and the capacity of informal and professional networks to support caregiving is discussed. Resources available through the United Nations Office on Drugs and Crime are provided to share experiences of building a pyramid of interlinked, evidence-based, trauma-informed interventions which have been developed in collaboration with families and practitioners experiencing life through the contexts of military conflict, displacement and resettlement.

Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey.

BACKGROUND: Consistent with the 'Making Every Contact Count' UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions. METHODS: Cross-sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression. RESULTS: 94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%-87.4% across behaviours) and helpful (range 82.8%-85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long-term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions. CONCLUSIONS: Patients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients. PATIENT OR PUBLIC CONTRIBUTION: The questionnaire was piloted among a convenience sample prior to distribution.

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities.

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews.

Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals' (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals' own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals' delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.

Web-based integrated bipolar parenting intervention for parents with bipolar disorder: a randomised controlled pilot trial.

BACKGROUND: People with bipolar disorder (BD) experience additional parenting challenges associated with mood driven fluctuations in communication, impulse control and motivation. This paper describes a novel web-based self-management approach (Integrated Bipolar Parenting Intervention; IBPI) to support parents with BD. METHOD: Parents with BD with children aged 3-10 years randomised to IBPI plus treatment as usual (TAU) or waitlist control (WL). IBPI offered 16 weeks access to interactive self-management information concerning BD and parenting issues. Feasibility was through recruitment, retention and web usage. Clinical outcomes were assessed at baseline, 16, 24, 36 and 48 weeks. TRIAL REGISTRATION NUMBER: ISRCTN75279027. RESULTS: Ninety seven participants were recruited with 98% retention to end of intervention and 90% to final follow-up (56%-94% data analysed of retained participants; higher rates for observer measures). 77% of IBPI participants accessed the website (53% accessed parenting modules). Child behaviour, parenting sense of competence and parenting stress improved significantly in IBPI compared to WL to end of intervention, sustained to 48 weeks. Impacts of IBPI on family functioning, parent mood and time to mood relapse were not significant. CONCLUSIONS: Online self-management support for parents with BD is feasible, with promising improvements in parenting and child behaviour outcomes. A definitive clinical and cost-effectiveness trial is required to confirm and extend these findings.

Public health implications and risks for children and families resettled after exposure to armed conflict and displacement.

Early adverse experiences can precede long-term negative effects on physical health. Children experiencing armed conflict, flight and displacement, and refugee life may be at enhanced risk. Recent psychobiological models integrating knowledge about perinatal and childhood stress with susceptibility to chronic illnesses in later life make clear the pressing need for protective provision for war-affected children, who experience multiple traumas and continuing stressors. There is increasing recognition of the mechanisms linking physical and mental health with adult diseases seen as developmental disorders with origins early in life. Biological embedding models propose links between early adversity and increased vulnerability to later disease and premature death. Threat is central for children and families whose lives are changed by war and displacement, and may activate biological and behavioural systems that could increase the risk of long-term ill-health. Applying these models to understanding the experiences of refugees and the translation of these into the care provided and ways of monitoring and protecting long-term population health could potentially promote interventions to reduce longer term and secondary harms.

Exploration of Mechanisms behind Changes after Participation in a Parenting Intervention: A Qualitative Study in a Low-Resource Setting.

Parenting interventions are effective for preventing psychological difficulties in children. However, their active ingredients have not been comprehensively explored. How do they work? What are the mechanisms operating behind changes? In 2012, a randomized controlled trial of a parenting intervention was conducted in low-resource communities of Panama. Effects on child behavioral difficulties, parental stress, and parenting practices were large in the short and long term. This was an ideal opportunity to explore potential mechanisms operating behind effects found in this low-resource setting. Twenty-five parents were interviewed. Data were analyzed through an inductive semantic thematic analysis. Three themes emerged from the data: (a) psychological mechanisms behind changes, (b) behavioral changes in parent, and (c) changes in the children. Parents described that the intervention triggered changes in emotion regulation, self-efficacy, and problem solving. Parents also reported behavioral changes such as praising their children more often, who in turn seemed more responsible and better at following instructions. The study offers participant-driven insight into potential pathways of change after participation in this parenting intervention, pathways that are often overlooked in quantitative studies. Future studies should further explore these pathways, through mediator and moderator analyses, and determine how much is shared across interventions and across different cultural settings.

An exploratory randomised controlled trial of a web-based integrated bipolar parenting intervention (IBPI) for bipolar parents of young children (aged 3-10).

BACKGROUND: Communication, impulse control and motivation can all be affected by Bipolar Disorder (BD) making consistent parenting more difficult than for parents without mental health problems. Children of parents with BD (CPB) are at significantly increased risk of a range of mental health issues including Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depression, substance use, and sleep disorders. Furthermore, CPB are also at elevated risk for BD compared to the general population. This paper describes the rationale and protocol for a pilot randomised controlled trial (RCT) designed to assess the feasibility and acceptability of a new online intervention providing interactive psychoeducational information and parenting support for parents with BD. METHODS AND DESIGN: This article describes a single-blind randomised controlled trial comparing an Integrated Bipolar Parenting Intervention (IBPI) in addition to treatment as usual (TAU) with TAU alone. Participants will be recruited from across the UK from mental health services and through self-referral. The primary outcome of the study is the feasibility and acceptability of IBPI as indicated by recruitment to target, use of the intervention site, and retention to follow-up. Parents with BD allocated to the IBPI condition will have access to the intervention for 16 weeks. Effect size estimates will be obtained with respect to child behaviour, parenting skills and measures of parental mental health using measures taken at baseline (0), and at 16, 24, 36, and 48 weeks post randomization. DISCUSSION: This is the first randomised controlled trial of an integrated bipolar disorder parenting intervention. The benefits and challenges of delivering this online intervention, and evaluation using online RCT methodology are discussed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN75279027 Registered 12 August 2013.

An exploration of parents' perceptions and beliefs about changes following participation in a family skill training program: a qualitative study in a developing country.

Family skill training programs have been recognized as effective strategies for preventing substance use. However, they have been evaluated mainly in high-income countries. Families in developing countries also face difficulties; therefore, it is important to explore the fit of existing programs in this context. The present study explores parents' perceptions and beliefs about changes following participation in the Strengthening Families Program 10-14, which was implemented in Panama by the United Nations Office on Drugs and Crime. Thirty parents who had taken part in the program between 2010 and 2011 were interviewed. Thematic analysis was conducted taking a participant-driven inductive stand. An exploration of parents' narratives suggested that, after the program, they observed changes in themselves as parents, in their children, in the interaction between the two of them, and in their functioning as a couple. Perceived changes centered on communication, limits, obedience, relationship roles, emotional regulation, and social development. For example, parents reported being able to control their emotions in a healthier manner, reducing the use of shouting and setting limits in a more effective way. All these factors have been recognized in previous research as strategies for preventing substance use. It is important to assess participants' perceptions of programs brought from elsewhere before dissemination efforts can take place. Parents interviewed for this study appeared to hold positive views about this program. This methodology is discussed as a means of evaluating evidence-based interventions in different cultural settings.

A pilot randomized controlled trial of a brief parenting intervention in low-resource settings in Panama.

The aim of this study was to determine whether an intervention from the Triple P Positive Parenting Program system was effective in reducing parental reports of child behavioral difficulties in urban low-income settings in Panama City. A pilot parallel-group randomized controlled trial was carried out. A total of 108 parents of children 3 to 12 years old with some level of parent-rated behavioral difficulties were randomly assigned to a discussion group on "dealing with disobedience" or to a no intervention control. Blinded assessments were carried out prior to the intervention, 2 weeks, 3 months, and 6 months later. Results indicated that parental reports of child behavioral difficulties changed over time and decreased more steeply in the intervention than in the control group. The effects of the intervention on parental reports of behavioral difficulties were moderate at post-intervention and 3-month follow-up, and large at 6-month follow-up. Parents who participated in the discussion group reported fewer behavioral difficulties in their children after the intervention than those in the control condition. They also reported reduced parental stress and less use of dysfunctional parenting practices. There is a limited amount of evidence on the efficacy of parenting interventions in low-resource settings. This pilot trial was carried out using a small convenience sample living in low-income urban communities in Panama City, and therefore, the findings are of reduced generalizability to other settings. However, the methodology employed in this trial represents an example for future work in other low-resource settings.

Measuring parenting practices and family functioning with brief and simple instruments: validation of the Spanish version of the PAFAS.

A set of instruments with different response formats is usually used to assess parenting practices in clinical settings and in research studies. These complex protocols can be problematic for parents with low-literacy levels. The Parenting and Family Adjustment Scales (PAFAS) is a brief, easy to read instrument that has been developed to address these concerns. The English version of this instrument suggested that it has good internal consistency (range from .70 to .96), as well as satisfactory construct and predictive validity. The aim of the present study was to explore the validity and reliability of the Spanish version of the PAFAS. A sample of 174 Spanish-speaking parents (85% mothers; M = 37 years old; SD = 9.1) from Panama in Central America completed the instrument alongside the Parenting Scale and the Depression Anxiety Stress Scale (DASS-21). Psychometric evaluations revealed that the measure had satisfactory construct and concurrent validity as well as good internal consistency (values >.60 for all subscales) and test-retest reliability (ICC >.60 for all subscales). The PAFAS shows promise as a brief outcome measure to assess parenting practices and family functioning with Spanish-speaking parents. Potential uses of the measure and implications for further validation with diverse samples are discussed.

A pilot Web based positive parenting intervention to help bipolar parents to improve perceived parenting skills and child outcomes.

BACKGROUND: Children of bipolar parents are at elevated risk for psychiatric disorders including bipolar disorder. Helping bipolar parents to optimize parenting skills may improve their children's mental health outcomes. Clear evidence exists for benefits of behavioural parenting programmes, including those for depressed mothers. However, no studies have explored web-based self-directed parenting interventions for bipolar parents. AIMS: The aim of this research was to conduct a pilot study of a web-based parenting intervention based on the Triple P-Positive Parenting Programme. METHOD: Thirty-nine self-diagnosed bipolar parents were randomly allocated to the web-based intervention or a waiting list control condition. Parents reported on their index child (entry criterion age 4-10 years old). Perceived parenting behaviour and child behaviour problems (internalizing and externalizing) were assessed at inception and 10 weeks later (at course completion). Fifteen participants (4 control group and 11 intervention group) did not provide follow-up data. RESULTS: Levels of child behaviour problems (parent rated; Strengths and Difficulties Questionnaire) were above clinical thresholds at baseline, and problematic perceived parenting (self-rated; Parenting Scale) was at similar levels to those in previous studies of children with clinically significant emotional and behavioural problems. Parents in the intervention group reported improvements in child behaviour problems and problematic perceived parenting compared to controls. CONCLUSIONS: A web-based positive parenting intervention may have benefits for bipolar parents and their children. Initial results support improvement in child behaviour and perceived parenting. A more definitive study addressing the limitations of the current work is now called for.

Life Satisfaction among Unaccompanied Refugee Minors: Associations with Traumatic Events and Daily Hassles.

While there is a growing literature about mental health problems among unaccompanied asylum-seeking and refugee minors (URMs), far less is known about their wellbeing. Such information is important as a subjective sense of wellbeing is associated with a variety of positive health and psychosocial outcomes. The aim of this study was to examine life satisfaction and the association with traumatic events, daily hassles, and asylum status among URMs in Norway. We collected self-report questionnaire data from URMs living in Norway (n = 173, 90.80% male, 71.1% from Afghanistan). Mean age was 16.62 (SD = 1.74) years, and they reported clinically relevant post-traumatic stress symptoms. We explored variation in life satisfaction, URM-specific daily hassles and traumatic events. We also investigated a mediation model, in which we assumed that daily hassles mediated the association between traumatic events and life satisfaction. The participants reported low life satisfaction (M = 4.28, SD = 2.90, 0-10 scale). A negative outcome of the asylum process and URM-specific daily hassles were associated with reduced life satisfaction. URM-specific daily hassles accounted for the relation between traumatic events and life satisfaction. The youth had been exposed to several traumatic events yet the effect of these on life satisfaction appeared indirect, via an increase in URM-specific daily hassles. Reducing the number of, or help URM cope with, URM-specific daily hassles may increase their life satisfaction.

Nurturing families: A feasibility randomised controlled trial of a whole-family intervention with vulnerable families in Jordan.

Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War.

OBJECTIVE: More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions. METHOD: Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network. RESULTS: The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear. CONCLUSION: There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions. DIVERSITY & INCLUSION STATEMENT: We actively worked to promote sex and gender balance in our author group. STUDY PREREGISTRATION INFORMATION: Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

Positive parenting program (triple P) for families of adolescents with type 1 diabetes: a randomized controlled trial of self-directed teen triple P.

OBJECTIVES: Adolescents with type 1 diabetes (T1D) have shown improvements in glycemic control and family relations, via clinic-based family interventions. However, reach and clinician availability may be limited. We evaluated a self-directed intervention for this purpose. METHODS: Recruitment for a randomized controlled trial (RCT) occurred through national advertising with diabetes charities and conducted with online data collection. Parents of 11-17-year-olds with diabetes were randomized to usual care (n = 37) or intervention (n = 42) using computerized block randomization. The 10-week intervention comprised the Self-directed Teen Triple P workbook (10 × 1 hr modules) plus chronic illness tip sheet. Primary outcomes of diabetes-related family conflict and parenting stress were assessed pre and post-intervention. RESULTS: Intention-to-treat analyses (n = 79) identified significantly improved diabetes-related conflict, but not parental stress, compared with usual care. CONCLUSIONS: The preliminary findings suggest that this could be a useful way to expand intervention reach for this population.

The role of faith in parenting; considerations when implementing family skills interventions with families affected by armed conflict or displacement.

Religious beliefs and practices are fundamental to shaping family functioning in many countries and cultures around the world. They are often associated with a strong influence on parenting, and a potential resource for parents. While nurturing caregiving can act as a protective shield, buffering against the negative effects on children's well-being, armed conflict and displacement often compromises parental well-being and positive parenting practices. Making interventions available to families affected by conflict and displacement that help to develop the quality of parenting is now seen as an important component in the care of war-affected children, causing a rise in family skills interventions for humanitarian contexts. Accordingly, there are certain considerations that need to be taken to achieve cultural sensitivity and acceptability, that account for the influence of religion. Here we share our United Nations Office on Drugs and Crime (UNODC) experience in the case of implementing "Strong Families," a UNODC family skills programme implemented in over 30 countries, providing key recommendations. (1) Appreciate and account for common religious beliefs and practices in your target populations; (2) ensure programme material acceptability and sensitivity; (3) avoid initiation of direct discussions, on religious beliefs or practices; and (4) facilitator need to be trained and prepared to respond to questions about faith. Though these considerations are presented considering the implementation of family skills programmes, they are also relevant to a range of other programming in which direct social (or other) contact is made with families in challenged contexts, aiming to reduce any perceived gaps between trainers and the families they are working with, and give families a sense that their religious beliefs, values, and priorities are understood.

Health and social care professionals' views and experiences of supporting parents with serious mental illness.

Introduction: A significant number of individuals with a serious mental illness (SMI) such as schizophrenia or bipolar disorder are also parents of dependent children. Despite the risk of adverse psychological, behavioral, and social outcomes their needs often go unmet. To better understand the needs of parents with SMI and their children it is necessary to gain insight into the perspectives and experiences of the professionals in adult mental health and children's services who work with them, and who, ultimately, are best placed to meet those needs. Aims: To explore the views and experiences of health and social care professionals working with parents with SMI to understand the needs of, and their role supporting, parents with SMI and their children. Methods: Semi-structured interviews were conducted with seventeen professionals from six NHS and Local Authority settings in England, UK. Participants were included if they were employed in adult mental health or local authority children's services and had experience of working with parents with SMI. Sampling was purposive, including a wide range of professions in these settings. Interview data were analyzed using template analysis taking a critical realist perspective. Results: Three top-level themes were generated: (1) Impact of parental SMI on the child, (2) Accessing support from services, (3) Role of professionals working with parents with SMI. Themes highlight diverse, wide-ranging effects of SMI on the child and a reluctance from parents to seek help due to stigma and fear. Available services are reported to be inaccessible and unacceptable to parents with SMI and practitioners experience conflict when balancing the needs of the parent and child. A whole-family approach facilitated by improved communication between services is advocated. Conclusion: Participants believed that parents with SMI experience complex parenting challenges over and above other parents, describing a largely detrimental impact on the child. Support services were deemed inadequate, and participants stressed the need to develop specialist services tailored toward the needs of parents with SMI and their children. Although participants endorsed joined up working across health and social care settings to facilitate a whole family approach, they required greater service knowledge and training in parental SMI.

The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review.

PURPOSE: Asthmatic children are at risk of compromised health-related quality of life (HRQOL) compared with their healthy peers. This systematic review reports the range and effectiveness of psychosocial interventions designed to improve HRQOL amongst asthmatic children, adolescents, and their families. METHOD: Data sources included The Cochrane Airways Group Trials Register of trials, PubMed database, and reference lists from review articles. RESULTS: Eighteen studies of psychosocial interventions were identified. Interventions were designed to improve HRQOL amongst a range of psychosocial, health care, school-related and clinical outcomes, and were delivered in numerous settings and formats. Four studies reported that interventions were effective for significant improvements in child overall HRQOL scores. These include asthma education (n = 2), asthma education plus problem solving (n = 1), and art therapy (n = 1). CONCLUSIONS: Most interventions focussed on the delivery of asthma education to children, with the purpose of improving knowledge about asthma and disease management. There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children, adolescents, and their families. Most interventions lacked a theoretical basis and did not focus on family functioning variables. Multi-component interventions that incorporate asthma education along with strategies to assist families with implementing behaviour change towards improved asthma management are required. Future interventions should also attempt to address the wider context of family functioning likely to contribute to the family's ability to engage in successful asthma management in order to improve HRQOL.