title: Parent education interventions designed to support the transition to parenthood: A realist review.
abstract: BACKGROUND
  Public health nurses use parent education programmes to support individuals' transition to parenthood. A wide array of these programmes exists; however, the approach must be accommodated by resources available in a publicly funded system. For example, some new-parent education approaches use 1:1 home visiting (with a nurse or trained lay-home visitor) but the costs of this intensive approach can be prohibitive. Because of this limitation there is an interest in identifying effective and efficient new parent educational approaches that can realistically be provided at a universal level. Unfortunately, there is a lack of high-quality evaluation identifying programmes or educational processes that meet these criteria.
  
  
  OBJECTIVE
  To identify potentially effective new-parenting education interventions that could be implemented at a population level during the transition to parenthood period.
  
  
  METHODS
  Realist synthesis.
  
  
  METHODS
  Medline, CINAHL, ERIC, PsycINFO, Sociological Abstracts, grey literature.
  
  
  METHODS
  A realist review method generated a total of 72 papers that were used to inform the results. A three-pronged approach was used incorporating an initial search (6), a database search using applicable keywords and MeSH headings (58), and review of literature identified by advisory group (8 grey literature). An 'implementation chain' was developed to outline the overall logic and process behind parent education interventions and to guide the analysis.
  
  
  RESULTS
  Seventy-two papers informed this review: 13 systematic reviews/meta-analyses, 34 intervention studies, 9 opinion papers, 8 programme reviews, and 8 grey literature reports. There was no compelling evidence to suggest that a single educational programme or delivery format was effective at a universal level. Some inherent issues were identified. For example, adult learning principles were overlooked and theories of parent-child interaction were not in evidence. No direct links between universal new-parent education programmes and child development outcomes were established. Programme reach and attrition were key challenges. Programme evaluation criteria were inconsistent, with an over-reliance on parent satisfaction or self-reported intention to change behaviour. There was evidence that effective facilitators helped increase parents' perceived satisfaction with programmes.
  
  
  CONCLUSIONS
  It is unlikely that a single standardized format or programme will meet all the specific learning needs of parents. Multiple approaches that will allow people to access information or education at a time and in a format that suits them may be of value. The importance of the transition to parenthood and its impact on parent and child wellbeing warrant careful consideration of current programming and careful evaluation of future initiatives.
authors.affiliation: Trent-Fleming School of Nursing, Trent University, Canada. Electronic address: cyndigilmer@trentu.ca.
authors.forename: Cyndi
authors.initials: C
authors.lastname: Gilmer
authors.affiliation: Family Health Division, Peel Public Health, Canada.
authors.forename: Judy L
authors.initials: JL
authors.lastname: Buchan
authors.affiliation: Research Chair, Faculty of Nursing, University of Calgary, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Letourneau
authors.affiliation: Strategic Policy, Planning and Programs, Health Services, Region of Peel, Canada.
authors.forename: Claudine T
authors.initials: CT
authors.lastname: Bennett
authors.affiliation: Milton and Ethel Harris Research Initiative, York University, Toronto, Canada.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Shanker
authors.affiliation: Family Health Division, Peel Public Health, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Fenwick
authors.affiliation: Department of Psychology, Trent University, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Smith-Chant
mesh_terms: D006801:Humans; D010290:Parents / Q000193:education*
keywords: Nurse; Parent Education; Parenting; Post natal care; Prenatal care; Realist; Realist synthesis; Review; Social environment