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Family wellbeing in general practice: a study protocol for a cluster-randomised trial of the web-based resilience
Gritt Overbeck1, Jakob Kragstrup2, Mette Gørtz3
1University of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark. grio@sund.ku.dk.
Insights
This study investigated an intervention to boost maternal mentalisation skills, aiming to improve child socio-emotional and language development. Early intervention in primary care can prevent developmental issues and support the mother-infant relationship.
Area of Science:
- Child development
- Maternal mental health
- Primary care interventions
Background:
- Early childhood social, emotional, and behavioral problems have long-term negative outcomes.
- These issues can stem from the early mother-infant relationship and may be preventable.
- Danish primary healthcare plays a key role in preventive care for pregnant women and young children.
Purpose of the Study:
- To examine the impact of a complex intervention on maternal mentalisation skills.
- The intervention involved training general practice clinicians and providing a web-based resource.
- To assess the effect on child socio-emotional and language development at 30 months.
Main Methods:
- Cluster-randomised controlled trial in 70 Danish general practices.
- Intervention group clinicians received training and signposted a web resource.
- Control group received standard training; outcomes measured by parent-reported questionnaires.
Main Results:
- The study hypothesizes improved maternal sensitivity to infant mental states.
- This is expected to lead to better child language and mental state outcomes at 30 months.
- Outcomes measured using the Communicative Development Inventory and Strengths and Difficulties Questionnaire.
Conclusions:
- The intervention aims to enhance maternal mentalisation skills.
- Improved mentalisation is hypothesized to positively impact child development.
- This approach leverages primary care for early intervention in mother-infant relationships.
Background:
Social, emotional and behavioural problems in early childhood are associated with increased risk for a wide range of poor outcomes associated with substantial cost and impact on society as a whole. Some of these problems are rooted in the early mother-infant relationship and might be prevented. In Denmark, primary health care has a central role in preventive care during pregnancy and the first years of the child's life and general practice provides opportunities to promote a healthy mother-infant relationship in early parenthood.
Objective:
In the context of standardised antenatal and child development assessments focused on psychosocial wellbeing, we examine the impact of a complex intervention designed to improve maternal mentalisation skills, involving training of general practice clinicians and signposting towards a web-based resource. Joint main outcomes are child socio-emotional and language development at age 30 months measured by parentally reported questionnaires (Communicative Development Inventory and Strengths and Difficulties Questionnaire).
Methods:
The study is a cluster-randomised controlled trial based in general practices in the Capital Region and the Zealand Region of Denmark. Seventy practices were included. Practices were randomised by a computer algorithm in a ratio of 1:1 to intervention or control groups. Each practice was asked to recruit up to 30 women consecutively at their first scheduled antenatal assessment. Clinicians in both groups received one day of training in preventive antenatal and child development consultations with added focus on parental psychosocial well-being, social support, and parent-child interaction. These preventive consultations delivered in both trial arms require enhanced data recording about psychosocial factors. In intervention clinics, clinicians were asked to signpost a web page at three scheduled antenatal consultations and at four scheduled consultations when the child is 5 weeks, 5 months, 1 and 2 years.
Discussion:
We hypothesise that the intervention will increase mothers' ability to be sensitive to their child's mental state to an extent that improves the child's language and mental state at 30 months of age measured by parent-reported questionnaires.
Trial Registration:
ClinicalTrials.gov NCT04129359. Registered on Oct 16 2019.
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