Elsevier

Preventive Medicine

Volume 99, June 2017, Pages 236-250
Preventive Medicine

Review Article
Preventive healthcare for young children: A systematic review of interventions in primary care

https://doi.org/10.1016/j.ypmed.2017.02.024Get rights and content

Highlights

  • First systematic review of preventive interventions for young children, targeting primary care

  • This review only identified US research that focused on ‘Well Child Care’.

  • Found inconclusive evidence in favour of multi-component interventions

  • QI interventions supported by regulatory change enable more preventive healthcare.

  • Further research needs to include clinical end points.

Abstract

High rates of preventable health problems amongst children in economically developed countries have prompted governments to seek pathways for early intervention. We systematically reviewed the literature to discover what primary care-targeted interventions increased preventive healthcare (e.g. review child development, growth, vision screening, social-emotional health) for preschool children, excluding vaccinations. MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched for published intervention studies, between years 2000 and 2014, which reflected preventive health activities for preschool children, delivered by health practitioners. Analysis included an assessment of study quality and the primary outcome measures employed. Of the 743 titles retrieved, 29 individual studies were selected, all originating from the United States. Twenty-four studies employed complex, multifaceted interventions and only two were rated high quality. Twelve studies addressed childhood overweight and 11 targeted general health and development. Most interventions reported outcomes that increased rates of screening, recording and recognition of health risks. Only six studies followed up children post-intervention, noting low referral rates by health practitioners and poor follow-through by parents and no study demonstrated clear health benefits for children. Preliminary evidence suggests that multi-component interventions, that combine training of health practitioners and office staff with modification of the physical environment and/or practice support, may be more effective than single component interventions. Quality Improvement interventions have been extensively replicated but their success may have relied on factors beyond the confines of individual or practice-led behaviour. This research reinforces the need for high quality studies of pediatric health assessments with the inclusion of clinical end-points.

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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  • 1

    Present address: School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia.

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