Research question(s)
- How do interventions which affect access, engagement and retention of disadvantaged parents in parenting interventions impact health and health inequalities?
Evidence shows that parenting interventions are effective and cost-effective at improving a range of wellbeing, behavioural and educational outcomes for children, irrespective of parents’ ethnicity or levels of deprivation. Evidence also suggests that ethnic minority and low-income parents have lower uptake and engagement with preventative interventions. The Public Health Research (PHR) Programme recognises the overall efficacy of parenting interventions, and the focus of this call is not about efficacy. The gap in the research on parenting interventions relates to issues of inequalities in access, engagement, retention and outcomes. The term ‘parent’ in this brief refers to primary caregivers who nurture or raise children, including biological, non-birthing, foster and kinship parents.
A large portion of literature is dedicated to the impact of parenting on child development outcomes. It highlights a strong relationship between parent-child interactions and a nurturing environment with children’s mental health outcomes, socio-emotional and cognitive development as well as lifelong health outcomes. However, there is substantial inequality in early child development in the UK. Recent reports suggest the important role of parents’ socio-economic status in explaining early development gaps between children from different backgrounds. Building a safe, encouraging, and nurturing environment is harder for parents living in poverty. There is also an interrelation between deprivation and the social exclusion and intersectionality associated with ethnicity. Engagement with high-quality additional support is therefore particularly important for these families. Parents’ experiences of interventions and services is also important. There is a need to ensure that interventions are culturally sensitive and appropriate, and that the workforce is reflective of diverse communities.
Parenting interventions offer guidance, advice, and treatment for parents to support children’s social, emotional, and intellectual wellbeing. This support is largely provided in the form of ‘parenting programmes’ although it can include generic support provided by health visitors, specialised parent-infant relationship teams, or formal therapeutic interventions delivered by clinical health psychology or psychiatric services.
Research has been undertaken to determine whether specifically tailored parenting interventions are more effective than universal interventions. A recent NIHR-funded report indicated that the evidence base supports the effectiveness and cost-effectiveness of universal parenting interventions with parents belonging to ethnic minority or low-income populations and that universal interventions can be equally acceptable and effective for different communities. The report highlighted that it is more important for programme providers to be sensitive to different groups’ needs and the reasons for, or barriers to, engagement and retention with a programme than to provide separate or specifically tailored programmes.
Research suggests that low socioeconomic status is associated with an 8-19% reduction in attendance at parenting programmes. With the cost-of-living crisis and rising inflation, the number of families in poverty is increasing. A recent report forecast that by 2027 child poverty in the UK will be at its highest since 1999. However, there is a gap in the literature concerning how best to identify, recruit, and retain low-income parents to universal parenting interventions. Research is also lacking on how to best identify, engage and retain ethnic minority parents and other disadvantaged parents who would benefit most from universal parenting interventions (see this review by the Early Intervention Foundation).
The PHR Programme wishes to commission research on the health impacts of interventions which affect access, engagement, and retention of disadvantaged parents to parenting interventions. The Programme is predominantly interested in the evaluation of interventions operating at a population level rather than at an individual level and their impact on health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways. Applicants should explain and justify their choice of (sub)population. While the Programme recognises the importance of the first 1,001 days of child development, this call covers parenting interventions across childhood. Applicants should justify the age range of their intervention.
Of particular importance to the PHR Programme is an understanding of inequalities in impact of policy and access to services, and health inequalities experienced, by people from ethnic minority backgrounds in the UK.
Research areas of interest include, but are not limited to:
- Evaluating strategies to identify parents who would most benefit from parenting interventions, including the feasibility, acceptability, and effectiveness of assessment tools.
- Evaluating strategies to recruit and retain parents from socially deprived/ethnic minority backgrounds to parenting interventions. The Early Intervention Foundation include a list of potential strategies and considerations for intervention design in their review.
- Evaluating strategies to maximise engagement of parents from socially deprived/ethnic minority backgrounds in parenting interventions.
- Evaluations of interventions which lead to an increased understanding of the practical, organisational, social, economic, and cultural barriers.
- Evaluating interventions in the antenatal period and 0-2 years age range
- Evaluating interventions aimed at under-researched groups such as non-birthing parents, fathers, kinship and foster parents.
- Evaluating interventions delivered by the non-statutory sector.
- Evaluating interventions operating in a child protection context.
The PHR Programme recognises that for some proposals, underpinning or development work to understand epidemiology and inform the evaluation of interventions might be beneficial. This could include the forms of support, content, or aspects of parenting interventions that parents want, value, and need most. The Programme is willing to consider applications that include a period of underpinning or development work. Please contact the PHR Programme before applying to discuss further.
A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of health outcomes, target population group, as well as the rationale for their methodological approach. Researchers are encouraged to consider additional outcome measures including those relating to the broader determinants of health and health inequalities, which should be specified and justified. Researchers will also need to specify key outcomes and how these will be measured in the short, medium, and long term.
Understanding the value of public health interventions - whether the outcomes justify their use of resources - is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Researchers are strongly encouraged to ensure that people with lived experience from the target audience are involved in the design and planning of the intervention and/or as potential, suitably rewarded, members of the research team. This could include the subgroup of focus, current or previous parenting intervention attendees, and/or organisations working in the parenting support field. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences and they might do this through involving them as costed/rewarded members of the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences, and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practice, and ensure their proposed research is complementary.
For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information. These can be found by clicking on the relevant commissioned call on the main funding opportunities page. This also includes closing dates and details about how to apply.