This rapid review was conducted by Cordis Bright to supplement an earlier review by the Early Intervention Foundation (EIF; now Foundations) and to help local authorities consider evidence-based options for their Family Hubs digital offer within the 2023 – 2025 time period.
The EIF review on virtual and digital interventions for children and young people was conducted as a response to the COVID-19 pandemic. Despite outlining potential to support children’s development, the review found little evidence that virtual and digital interventions are superior to face-to-face support and no study had revealed improvements in long term outcomes.
The purpose of this review was to identify specific virtual and digital interventions for children aged 0-5 and their families that local authorities might include as part of their Family Hubs offer within four priority areas:
- Parenting support
- Parent–infant relationships and perinatal mental health
- Support for children’s early language and the home learning environment
- Infant feeding
This rapid review was conducted under a limited timeframe through desk-based synthesis, and collated available research evidence using the following criteria:
- Studies that provide data for both child and parent outcomes
- Primary research only
- Countries with contexts that are highly relevant to the UK only
- Studies that meet Foundations Level 3 Study Quality Criteria.
The study design and search only included randomised controlled trial and quasi-experimental design studies in order to increase the likelihood of the studies examined having Level 3 evidence.
This review aimed to address the gap in knowledge about virtual and digital interventions for families with a child aged 0-5 that could be offered by Family Hubs within the four priority areas.
This review primarily answered the following research questions:
- To what extent do effective virtual and digital interventions corresponding with the four Family Hubs funded service areas exist?
- What is the impact of these interventions on important child parent and child behaviours outcomes known to support children’s healthy development?
The review also considers the following three questions where enough effective interventions were identified:
- What is known about their differential impacts on different groups of families on the basis of socio-demographic factors such as age, race, gender, socio-economic status?
- What are the conditions for success, or failure, of these interventions in practice?
- What is the acceptability / feasibility of these interventions for families in practice?
Given the limited timeframe, this rapid review does not provide sufficient evidence to suggest that virtual interventions are superior to face-to-face interventions in supporting families with children under the age of five years.
Of the seven studies which were deemed to meet the inclusion criteria, only two articles showed statistically significant evidence of impact. Both studies aligned with the Family Hub priority area on parenting support, demonstrating positive impacts on parenting practice:
- Van Leishout et al., 2021 highlighted positive impacts on parent-infant relationships through a one-day interactive workshop that led to significant mean reductions in Edinburgh Postnatal Depression Scale scores for mothers. Despite more research being needed to compare this brief intervention with longer programmes, the article showed potential for virtual and digital delivery interventions to perhaps complement face-to-face support for parents with depression.
- Helle et al., 2019 ‘Early Food for Future Health’ intervention demonstrated that 80% of mothers preferred accessing information on infant nutrition online. The intervention showed positive outcomes in children’s diet and eating habits by for example children being served more fruit and vegetables and having beneficial mealtime routines such as not watching TV/playing on tables during mealtimes.
Whilst two of the interventions did have rigorous evidence of positive impact, the evidence base is small, and as they were not based in the UK it is not possible to examine differences amongst participants across socio-economic groups or a range of protected characteristics such as ethnicity. It is also important to mention that the interventions identified in the review were compared to ‘usual care’ within the country, which varied markedly between studies making it hard to measure value-added.
Many of the included studies that did not show any statistically significant improvements in outcomes often discussed virtual and digital delivery of interventions as cost-effective and could increase reach to populations if used as accompanying tools to business-as-usual interventions. It is however worth mentioning that there was no evidence presented in this rapid review to support these claims.
Despite limited impacts on outcome measures, the review gathered that parents seem to enjoy the virtual and digital interventions as the acceptability, feasibility, and engagement were reported high and parents noted that they found them relatively easy to use.
Implications for policy
This review found limited evidence to support the use of virtual and digital interventions for families of children under the age of five, nor did it find evidence to support the suggestion that they are superior to face-to-face interventions. However, the review did find some promising findings that a virtual or digital component can increase the efficacy of face-to-face support. This may suggest that services and interventions can be strengthened by including both face-to-face and virtual components to serve different community needs.
However, these findings are preliminary and further rigorous research is required before clear policy implications can be identified. Further reviews are necessary to establish ‘what works for whom’ and in what circumstances, especially as the current findings do not reflect the demographic in the UK.
Implications for future research
Despite the mixed evidence findings in this rapid review, there are some important lessons to be learnt about virtual and digital interventions:
- Mental health considerations: Future research should be conscious of parent stress levels in terms of how stress might affect parents’ learning and consider remote access to brief interventions as a useful design/delivery approach to replicate. The one-day workshop could in this regard be considered a useful takeaway allowing mothers to remotely access the intervention with ease.
- Mother’s experience: Whilst there were no analyses comparing differences between first-time mothers and mothers with older children, a number of the studies considered parents with older children having ‘set’ practices that may impact the effects of interventions.
- Disengagement: Further understanding about reasons for disengagement will be necessary to better support and encourage users to use the virtual and digital interventions as intended.
- Sustaining engagement: Further understanding of user preferences with digital and virtual interventions to ensure sustainable engagement over a longer period of time will also be necessary to better support and encourage users to use the virtual and digital interventions as intended.
- Group-based and peer support interventions: The Family Hub guidance notes the importance of parenting support including the ability for parent networking and peer-to-peer learning.