Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.
BMC Public Health. 2020 Jun 24;20(1):993. doi: 10.1186/s12889-020-09104-7.
Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS.
A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline.
Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable.
Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of "best bet" interventions.
普遍儿童健康服务（UCHS）为提供普遍和有针对性的干预措施提供了一个重要的实用平台，以支持家庭并优化儿童健康结果。我们旨在确定可潜在地在 UCHS 中实施的常见健康和发育问题的简短、基于证据的干预措施。
对 2006 年 1 月至 2019 年 8 月的电子数据库和灰色文献进行了受限证据评估（REA）。如果（i）研究结果与以下四个领域中的一个或多个相关：儿童社会和情感健康（SEWB）、婴儿睡眠、家庭学习环境或父母心理健康，（ii）使用了对照组，（iii）在非三级环境中提供了普遍或有针对性的干预措施，（iv）干预措施持续时间不超过 4 个疗程，以及（v）儿童在基线时年龄在 2 周到 5 岁之间，则研究符合纳入标准。
符合纳入标准的研究有 17 项。其中，有 3 种干预措施可能在 UCHS 平台上大规模实施：（1）一种普遍的儿童行为干预措施，该措施并未影响其婴儿睡眠的主要结果，但改善了父母的心理健康；（2）一种普遍的筛查计划，改善了母亲的心理健康；（3）一种有针对性的儿童行为干预措施，改善了父母报告的婴儿睡眠问题和父母的心理健康。主要经验教训包括：（1）干预措施应在初始会议中传达最大量的信息，后续会议则强化关键信息；（2）干预措施应将家庭视为一个整体单元，考虑到父母的需求，重点是识别、分诊和转介；（3）简短的干预措施可能更容易被人们接受，但仍然存在相当大的障碍，使最脆弱的人群望而却步。
从 UCHS 提供简短的基于证据的干预措施可能会通过更具响应性和公平性的服务来改善母婴健康结果。我们建议实施符合我们“最佳选择”干预措施标准的 3 种干预措施。
