Teaching Parents to Be Responsive: A Network Meta-analysis

CONTEXT: Children who receive more responsive care during their early childhood tend to exhibit abstract stronger cognitive development, mental well-being, and physical health across their life course. OBJECTIVE: Determine how to design effective responsivity training programs for caregivers. DATA SOURCES: We searched seven electronic databases through October 2020. STUDY SELECTION: Randomized trials (k = 120) of programs training parents of children ages 0 to 6 to be more responsive. DATA EXTRACTION: Two reviewers independently extracted data. Data were pooled by using random-effects pairwise and network meta-analyses. RESULTS: Programs had, on average, a medium effect (d = 0.56; 95% confidence interval [CI]: 0.47 to 0.65). The most effective programs included didactic teaching and opportunities for parents to observe models, practice skills, and receive feedback (d = 1.07; 95% CI: 0.37 to 1.77), or all these instructional methods in addition to reflection (d = 0.86; 95% CI: 0.64 to 1.09). Programs that had participants observe examples of responsivity (d = 0.70; 95% CI: 0.57 to 0.83), used researchers as facilitators (d = 0.89; 95% CI: 0.66 to 1.12), assigned homework (d = 0.85; 95% CI: 0.66 to 1.02), and had a narrow scope (d = 0.72; 95% CI: 0.57 to 0.87) were more effective than those that did not. LIMITATIONS: Most samples included only mothers from Western countries and lacked follow-up data. CONCLUSIONS: Having parents observe examples of responsive caregiving and complete home-practice in short, focused programs may be an effective, scalable approach to enhancing responsivity in the general population and reducing inequalities in child development.