The Chiba University Centre for Evidence Based Practice: A JBI Affiliated Group, Chiba, Japan.
Faculty of Nursing, Toho University, Chiba, Japan.
JBI Evid Synth. 2021 Mar;19(3):523-555. doi: 10.11124/JBISRIR-D-19-00327.
This review evaluated the effectiveness of antenatal parenting education versus usual care for maternal confidence, maternal depressive symptoms, and parenting stress among expectant primiparous women in Asia.
Previous reviews on parenting education have mostly examined practices in non-Asian countries and found that no single parenting education program met the needs of all parents. Given that there may be some common characteristics in Asian cultures, such as grandparents' involvement with child care, this review focused on specific interventions in determining the effects of practices on particular outcomes in these populations, so that providers of antenatal education can tailor interventions that are more culturally appropriate for Asian women.
Studies published in English or Japanese that included expectant primiparous women and couples in Asia who received antenatal parenting education were considered. The outcomes were maternal confidence, maternal depressive symptoms, and parenting stress.
The authors searched for English-language articles up to February 2019 using MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and PsycINFO. They also searched Ichushi-Web for Japanese articles. A gray literature search was conducted using Google Scholar and ProQuest Health and Medical Collection. Two independent reviewers selected studies, and a critical appraisal was undertaken using appropriate JBI tools. Data were presented in narrative form owing to the heterogeneity of the included studies.
Four studies involving 652 pregnant women were included: three were randomized controlled trials, and one was a quasi-experimental study. The studies were conducted in China, Hong Kong, and Taiwan, and included the following antenatal parenting education interventions: interpersonal, psychotherapy-oriented childbirth education; childbirth psychoeducation based on the concept of learned resourcefulness; and Internet newborn-care education based on self-efficacy theory. Overall, the methodological quality of the included studies was moderate. Meta-analysis was not possible owing to the heterogeneity, including small sample sizes and differences in intervention content, populations, and follow-up times. A subsequent narrative synthesis was undertaken for each outcome. Of three studies with maternal confidence as an outcome (n = 496), two showed significantly higher maternal confidence at six weeks' (P = 0.000, Cohen's d = 1.41) and three months' postpartum (P = 0.016, Cohen's d = 0.35) in the intervention groups; however, one study showed no significant group differences. Of three studies with maternal depressive symptoms as an outcome (n = 534), two found significantly fewer depressive symptoms at three months' (P = 0.018, Cohen's d = -0.34) and six months' postpartum (P = 0.005, Cohen's d = -0.42) in the intervention groups; however, one study revealed no significant group differences. Parenting stress was examined in one study (n = 156); it showed significantly lower parenting stress (P = 0.017, Cohen's d = 0.38) immediately after the intervention.
There is insufficient evidence to support the effectiveness of a specific type of antenatal parenting education for maternal confidence, maternal depressive symptoms, and parenting stress for expectant primiparous women in Asia. However, the findings suggest that specific theory-oriented antenatal parenting education is potentially effective for those women. Further high-quality studies are needed for antenatal parenting education among expectant primiparous women, especially in Asia.
本综述评估了亚洲初产妇接受产前父母教育与常规护理相比，在母亲信心、母亲抑郁症状和育儿压力方面的效果。
以往关于育儿教育的综述大多考察了非亚洲国家的实践，发现没有单一的育儿教育项目能满足所有父母的需求。鉴于亚洲文化中可能存在一些共同特征，例如祖辈参与育儿，因此本综述重点关注特定干预措施，以确定这些人群中实践对特定结果的影响，以便产前教育提供者能够针对亚洲女性量身定制更具文化适应性的干预措施。
纳入了发表在英文或日文的研究，纳入了亚洲的初产妇和夫妇，他们接受了产前育儿教育。结局是母亲信心、母亲抑郁症状和育儿压力。
作者使用 MEDLINE、CINAHL、Cochrane 对照试验中心注册库和 PsycINFO 搜索了截至 2019 年 2 月的英文文章。他们还使用 Ichushi-Web 搜索了日文文章。通过 Google Scholar 和 ProQuest Health and Medical Collection 进行了灰色文献搜索。两名独立评审员选择研究，并使用适当的 JBI 工具进行了批判性评价。由于纳入研究的异质性，数据以叙述形式呈现。
纳入了四项涉及 652 名孕妇的研究：三项为随机对照试验，一项为准实验研究。这些研究在中国、中国香港和中国台湾进行，包括以下产前育儿教育干预措施：人际、以心理为导向的生育教育；基于习得资源概念的生育心理教育；以及基于自我效能理论的互联网新生儿护理教育。总体而言，纳入研究的方法学质量为中等。由于包括样本量小、干预内容、人群和随访时间的差异在内的异质性，无法进行荟萃分析。随后对每个结局进行了叙述性综合。在以母亲信心为结局的三项研究（n=496）中，有两项研究在六周（P=0.000，Cohen's d=1.41）和三个月（P=0.016，Cohen's d=0.35）时显示出母亲信心明显更高；然而，一项研究显示组间无显著差异。在以母亲抑郁症状为结局的三项研究（n=534）中，有两项研究在三个月（P=0.018，Cohen's d=-0.34）和六个月（P=0.005，Cohen's d=-0.42）时显示出母亲抑郁症状明显减少；然而，一项研究显示组间无显著差异。一项研究（n=156）检查了育儿压力；干预后立即显示出育儿压力明显降低（P=0.017，Cohen's d=0.38）。
目前尚无足够证据支持亚洲初产妇接受特定类型的产前育儿教育对母亲信心、母亲抑郁症状和育儿压力的有效性。然而，研究结果表明，特定理论导向的产前育儿教育对这些女性可能是有效的。需要进一步开展高质量的研究，以了解亚洲初产妇的产前育儿教育。
