Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and
Department of Epidemiology, Berkeley School of Public Health, University of California Berkeley, Berkeley, California.
Pediatrics. 2018 Apr;141(4). doi: 10.1542/peds.2017-3510. Epub 2018 Mar 2.
Early childhood stimulation interventions positively impact early child development (ECD) outcomes in low- and middle-income countries. However, trials have less comprehensively evaluated the effects of such parenting programs on caregivers' skills and capacities.
We conducted a systematic review and meta-analysis to assess the effectiveness of stimulation interventions on improving parenting outcomes.
Six electronic bibliographic databases.
Inclusion criteria included randomized controlled trials of stimulation interventions designed to improve ECD outcomes during the first 2 years of life that measured any maternal or parenting-related outcome after the start of the intervention.
Two independent reviewers extracted data by using a structured form.
Fifteen studies representing 13 unique randomized controlled trials met the inclusion criteria. Pooled standardized mean differences (SMDs) based on random-effects models revealed medium-to-large benefits of stimulation interventions for improving the home caregiving environment ( = 10; SMD = 0.57; 95% confidence interval [CI], 0.37 to 0.77), mother-child interactions ( = 3; SMD = 0.44; 95% CI, 0.14 to 0.74), and maternal knowledge of ECD ( = 6; SMD = 0.91; 95% CI, 0.51 to 1.31). No significant difference was seen for maternal depressive symptoms ( = 9; SMD = -0.10; 95% CI, -0.23 to -0.03).
Limitations include heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies.
Early childhood stimulation interventions improve several distinct aspects of maternal parenting. Improvements in parenting capacities may serve as key mechanisms by which these programs benefit ECD outcomes.
儿童早期刺激干预措施对中低收入国家的儿童早期发展（ECD）结果有积极影响。然而，试验并没有更全面地评估这些育儿计划对照顾者技能和能力的影响。
我们进行了系统评价和荟萃分析，以评估刺激干预对改善育儿结果的有效性。
六个电子文献数据库。
纳入标准包括旨在改善生命头 2 年 ECD 结果的刺激干预的随机对照试验，这些试验在干预开始后测量任何与母亲或育儿相关的结果。
两名独立审查员使用结构化表格提取数据。
有 15 项研究代表 13 项独特的随机对照试验符合纳入标准。基于随机效应模型的汇总标准化均数差（SMD）显示，刺激干预在改善家庭护理环境（ = 10；SMD = 0.57；95%置信区间[CI]，0.37 至 0.77）、母婴互动（ = 3；SMD = 0.44；95%CI，0.14 至 0.74）和母亲对 ECD 的知识（ = 6；SMD = 0.91；95%CI，0.51 至 1.31）方面具有中到大的益处。在母亲抑郁症状方面（ = 9；SMD = -0.10；95%CI，-0.23 至 -0.03）没有显著差异。
限制包括干预措施之间的异质性、缺乏标准化措施以及研究之间评估的不同时间点。
儿童早期刺激干预措施改善了母亲育儿的几个不同方面。育儿能力的提高可能是这些计划对 ECD 结果有益的关键机制。
