The portfolio of reviews from the Cochrane Consumers and Communication Group was added to in December 2022 with a new review of the effects of family‐centred interventions for Indigenous early childhood well‐being delivered by primary healthcare services. We asked lead author, Natalie Strobel from Edith Cowan University in Mount Lawley Australia, to tell us about these interventions and their effects in this podcast.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The portfolio of reviews from the Cochrane Consumers and Communication Group was added to in December 2022 with a new review of the effects of family‐centred interventions for Indigenous early childhood well‐being delivered by primary healthcare services. We asked lead author, Natalie Strobel from Edith Cowan University in Mount Lawley Australia, to tell us about these interventions and their effects in this podcast.
Natalie: Family-centred interventions are a way of providing care that focuses on the needs of children while providing planned care around the entire family unit. It recognises that all family members are care recipients and aims to involve families in partnership with primary healthcare services. Family-centred care can be delivered in a variety of ways including through environmental, communication, educational, counselling and family support approaches.
For our Cochrane review, we searched for studies that looked at family‐centred care interventions delivered in Canada, Australia, New Zealand and the USA led by primary healthcare services to Indigenous children aged under five. We found 11 studies that enrolled 1270 mother-child pairs and nearly 2000 children. Most of the family‐centred interventions delivered to children focussed on different aspects of care such as childhood obesity, behavioural problems, negative parenting patterns and acute respiratory illness. Seven studies used education as a way of delivering family‐centred care. All studies compared family‐centred care interventions to usual care or a minimal control comparison. Seven studies were from the USA, and there were two from New Zealand, one from Canada and one that was completed in both Australia and New Zealand.
Our results show that family‐centred care may improve overall health and well‐being of Indigenous children and their families. We also found a small improvement in parenting knowledge and awareness for families who participated in family‐centred care. However, because people in the studies were aware of what intervention they were getting, and many people did not come back to report their results, we can't come to firm conclusions about the effects.
We were also interested in some other outcomes: the psychological health and emotional behaviour of children, their physical health and developmental outcomes, family health‐enhancing lifestyle and behaviours, and psychological health of parents and carers. We did not find any improvements in these outcomes for children and families who participated in family-centred care. We were also interested in the health service providers' perspective, the family's evaluation of care and family‐centredness of consultation processes, but no studies reported these outcomes.
It is important to understand that studies included in our review required the child to be the main focus for the delivery of family‐centred care. As a result, many of our outcomes were child related. However, it's important to recognise that family‐centred care, particularly in the context of Indigenous health, includes care not only for child health, antenatal care, family support and early childhood care, but also for adults including mental health and chronic disease care. These latter aspects of care aim to improve adult health outcomes. Family‐centred care also aims to prevent, reduce and intervene in adverse childhood events and to reduce the long‐term impacts that chronic disease, depression and suicidal ideation have on families. Indeed, Indigenous governed health services have greater capacity than other non‐health programmes to influence portfolios outside primary health care. As such, this review does not capture this wider context of family‐centred care programmes that are delivered in communities.
Despite this, we found some evidence that family centred care delivered by primary healthcare services may benefit the overall health and wellbeing of children and their families. The evidence from this review will help primary care services base their decisions on optimal interventions to improve the health and well‐being of children and their families from Indigenous populations, using the most current and reliable evidence.
Mike: If you would like to find out more about this evidence, the full review is available online. If you go to Cochrane Library dot com and search 'family‐centred interventions for Indigenous families' you'll find it.