Review ArticlePreventive healthcare for young children: A systematic review of interventions in primary care
Section snippets
Background
In economically developed countries, like Australia, developmental disabilities, mental health disorders and overweight affect between 10 and 20% of preschool children, (Australian Government, 2013, Boyle et al., 2011, Glascoe, 2000, Hazel et al., 2005, Houtrow et al., 2014, Lawrence et al., 2015, OECD Directorate for Employment Labour and Social Affairs, 2014, Wake et al., 2007) and higher proportions are burdened with chronic diseases and dental caries (Australian Institute of Health and
Key questions
The research question (applied “PICO”) we sought to address was: What interventions, applied at the level of the primary care team or environment, increase the delivery of preventive healthcare to preschool children?
Search strategy
Following PRISMA guidelines (Moher et al., 2009), we established a uniform strategy for searching MEDLINE, EMBASE, CINAHL, and Cochrane databases. We systematically searched terms relevant to the evidence based components of the HKC (Alexander and Mazza, 2010), matching terms
Study characteristics
The database search identified 743 titles from which 22 studies and two systematic reviews, furnishing an additional seven studies, were selected (Fig. 1). All of the studies identified by this search strategy were conducted in the United States (US).
Participants
Interventions were delivered by both health practitioners and office staff in primary care settings (e.g. community health centres, pediatric primary care centres, family practices). The number of sites ranged from less than five (n = 8) to > 100
Discussion
In this systematic review we sought to identify primary care-delivered interventions aimed at preventive healthcare for preschool-aged children and analyse them according to their type, context, quality and primary outcome measure, to evaluate our own theoretically derived intervention. Twenty-nine studies relevant to the HKC (all of which were conducted in the US) were analysed in this review. We were unable to delineate the factors that clearly promoted preventive healthcare, finding that
Conclusions
This is the first systematic review of interventions targeting health practitioners working to improve preventive health for preschool children. We encountered many of the problems experienced by other researchers when reviewing complex interventions and found that the diversity of targets and primary outcomes and overall low study quality precluded meta-analysis. However, preliminary evidence from step-wise interventions and QI studies suggest that multi-component interventions and
Conflict of interest statement
The authors declare that they have none.
Authors' contributions
KA conceptualised the study, with guidance from DM and BB. KA conducted the systematic review and analysed the data with RB and KH. BB and DM critically revised the manuscript and all authors read and approved the final manuscript.
Sources of support
KA was supported by the Royal Australian College of General Practitioner's Chris Silagy Research Scholarship. BB received an Early Career Fellowship from the Australian National Health and Medical Research Council (NHMRC) and RB a Postgraduate scholarship, also from NHMRC.
Acknowledgments
Not applicable.
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Present address: School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia.