Evaluation of a Swedish universal health-promoting parenting program : effectiveness, cost-effectiveness and predictors

Sammanfattning: Knowledge of universal parenting programs is not as comprehensive as knowledge of targeted parenting programs. Few evaluations of universal programs have to date included a measure of child health and well-being; the focus has rather been on measuring improvement in child behavior problems. Still, many of the existing evaluations of these programs do not show effects in terms of reduced behavior problems in children. Knowledge of potential cost-effectiveness, predictors and moderators of universal programs is also scarce. The present thesis comprises studies of a newly developed universal health-promoting parenting program, with the overall aim of evaluating the effectiveness, cost-effectiveness, and predictors and moderators of the program’s effects. Study I aimed to describe the trial of All Children in Focus (the ABC program) in a study protocol. A randomized controlled trial was conducted, including 613 parents recruited within the County of Stockholm. Parents were randomized to either an intervention group (N = 317) receiving the program directly, or to a control group (N = 296) where parents were put on a waiting-list to receive the intervention after approximately six months. Study II aimed to evaluate the program’s effects on parental self-efficacy and parents’ perceptions of child health and development six months post baseline, as well as to test potential moderators. The results showed that the intervention group reported significant improvements in parental-self-efficacy and in parents’ perceptions of child health and development compared to the control group. Parents’ mental health, educational level, and number of children in the family moderated parental self-efficacy, while parents’ mental health and child age moderated child health and development. Study III aimed to estimate the costs, investigate the effects, and conduct a cost-effectiveness analysis alongside a randomized controlled trial. The study resulted in a base case incremental cost-effectiveness ratio of €47,290/QALY and sensitivity analyses resulted in ratios between €19,957−145,022 per gained QALY. The probability analysis resulted in a 51 percent probability that the program was cost-effective. Study IV concerned the intervention group only. The study aimed to evaluate whether the effect found at six months in child health and development was maintained at the 12-month follow-up, to investigate whether there were changes over time in the secondary outcome measures, and to examine whether changes in the secondary outcome measures predicted change in children’s health and development. The results showed significant changes over time (T1-T4) in parents’ perceptions of child health and development, parental self-efficacy, harsh and inconsistent parenting, and parents’ emotion regulation (the reappraisal scale). Parental self-efficacy was the only variable found to predict child health and development at 12 months. In sum, the current thesis provides support for short-term effects of a universal health-promoting parenting program, as well as for effects being maintained over a longer time perspective. The findings also highlights that families may benefit differently from the program and that further research is needed to establish predictors of the outcomes of universal parenting programs. Finally, the thesis also provides support for the cost-effectiveness of the program, even though further research is encouraged due to the rather low probability of cost-effectiveness found in the current work.