Peacock-Chambers Elizabeth, Ivy Kathryn, Bair-Merritt Megan
Institute for Healthcare Delivery and Population Science, Baystate Health, Springfield, Massachusetts;
Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
Pediatrics. 2017 Dec;140(6). doi: 10.1542/peds.2017-1661. Epub 2017 Nov 14.
The pediatric primary care setting offers a platform to promote positive parenting behaviors and the optimal development of young children. Many new interventions have been developed and tested in this setting over the past 2 decades.
To summarize the recent published evidence regarding the impact of primary care-based interventions on parenting behaviors and child development outcomes; to provide recommendations for incorporation of effective interventions into pediatric clinics.
A literature search of PubMed and PsycINFO was conducted from January 1, 1999, to February 14, 2017.
Publications in which primary care-based interventions and reported outcomes regarding the child's development or parenting behaviors associated with the promotion of optimal child development are described.
Forty-eight studies in which 24 interventions were described were included. Levels of evidence and specific outcome measures are reported.
Included interventions were categorized as general developmental support, general behavioral development, or topic-specific interventions. Two interventions resulted in reductions in developmental delay, 4 improved cognitive development scores, and 6 resulted in improved behavioral intensity or reduction in behavioral problems. Interventions used a variety of theory-based behavior change strategies such as modeling, group discussion, role play, homework assignment, coaching, and video-recorded interactions. Three interventions report the cost of the intervention.
Community or home-based interventions were excluded.
Although several interventions resulted in improved child development outcomes for children aged 0 to 3 years, comparison across studies and interventions is limited by use of different outcome measures, time of evaluation, and variability of results.
儿科初级保健环境为促进积极的育儿行为和幼儿的最佳发育提供了一个平台。在过去20年里，许多新的干预措施已在这一环境中得到开发和测试。
总结近期发表的关于基于初级保健的干预措施对育儿行为和儿童发育结果影响的证据；为将有效干预措施纳入儿科诊所提供建议。
对1999年1月1日至2017年2月14日期间的PubMed和PsycINFO进行文献检索。
描述基于初级保健的干预措施以及与促进儿童最佳发育相关的儿童发育或育儿行为报告结果的出版物。
纳入了48项描述24种干预措施的研究。报告了证据水平和具体结果指标。
纳入的干预措施分为一般发育支持、一般行为发育或特定主题干预。两项干预措施减少了发育迟缓，4项提高了认知发育得分，6项改善了行为强度或减少了行为问题。干预措施采用了多种基于理论的行为改变策略，如示范、小组讨论、角色扮演、家庭作业、指导和视频互动。三项干预措施报告了干预成本。
排除了社区或家庭干预措施。
尽管有几种干预措施改善了0至3岁儿童的发育结果，但由于使用了不同的结果指标、评估时间和结果的变异性，不同研究和干预措施之间的比较受到限制。
