Never too old to learn - Parenting interventions for grandparents – A systematic review

Figures & data

Figure 1. Flow chart: Parenting interventions for grandparents systematic review—paper inclusion

Figure 2. Quality of data summary

Figure 3. Risk of bias summary table of studies included within the review

Table 1. Summary of inclusiveness of generational outcomes within the studies included within this review

Study	Grandmothers	Grandfathers	Grandparent outcomes	Parental outcomes	Child outcomes
Zauszniewski et al. (2014)	Yes	No	Yes	No	No
Boon et al. (2009)	Yes	Yes	Yes	No	No
Kirby & Sanders (2014)	Yes	Yes	Yes	Yes	Yes
Kelley et al. (2001)	Yes	Yes	No	Yes	Yes
N’zi et al. (2016)	Yes	No	No	Yes	Yes
Littlewood et al. (2014)	Yes	No	Yes	Yes	Yes
Kelley et al. (2007)	Yes	No	Yes	No	No
McCallion et al. (2004)	Yes	Yes	Yes	No	No

Table 2. Summary of 8 Grandparenting intervention studies, evaluation and outcomes

Study	Country Design		Sample	Measures	Intervention	Results	Positive outcomes
1.Zauszniewski et al. (2014)	USA	Clinical trial—pilot	Grandparents: N = 102 (R = 40–82, M = 58). 100% Female Grandchild info not provided	1) 4 structured face to face interviews. 2) Demographic questionnaire baseline, 2, 6 & 12 weeks post intervention 3) Perceived Stress (PSS; (Cohen, Kamarck, & Mermelstein, 1983)). 4) Depression scale (CES-D; Radloff, 1977). 5) Quality of life (SF-12; (Ware, Kosinski, & Keller, 1996)	4 weeks intervention: RT = personal R skills (self-help strategies, expressive writing), Social R skills (verbal disclosure).	Differences in the 3 groups (RT & reinforcement(EW/VD), comparison conditions(EW/VD ONLY) and attention control) over time (n = 120): Perceived Stress: lower stress (F(1, 119) = 7.84, p < .001) Depression: symptoms did not change. (F(1, 119) = 2.32, p < .05) Quality of life: increased trend (F(1, 119) = 3.80, p < .01) -Differences in EW & VD as reinforcement over time (n = 40): PS: lower stress (F(1, 39) = 0.15)D: symptoms did not change. (F(1,39) = 0.2) QoL: increased trend (F(1,39) = 0.05)	Yes
2. Boon et al. (2009)	South Africa	Pilot—longitudinal quasi	Grandparents: N = 202 (Male: 34, female: 165, n = 3 unknown). Children: N = 151	1) Depression scale(Derogatis & Spencer, 1993) 2) Ways of coping (Folkman & Lazarus, 1985) 3) Demographic details also collected.	Workshop including 4 modules: 1)HIV/AIDS 2)parenting skills 3)skills in home nursing for caring for children with HIV/AIDS 4)social assistance	Comparisons made between those who completed all 4 workshops and those who completed part/0 (T1 = Immediate post-test & T2 = 3 Month follow up): Depression: reduced at post-test & follow up in both groups. Capacity to provide care: those who attended all 4 were more likely to perceive themselves as being better better able (F(1,161) = 19.03, p < .003 at T1 & F(1,177) = 13.51, p < .003). Perceived ability to provide care: Higher for those who attended all 4. Significant at T1 & T2. Ability to cope with psychosocial needs: Those who attended all 4 were more likely to have positive attitude towards sufferers of HIV/AIDS F(1,167) = 17.12, p < .003 at T1 & had improved knowledge of HIV/AIDS (1,157) = 38.29, p < .003 at T1 and T2 F(1,166) = 34.37, p < .003. Passive & Proactive coping: reduced at post-test but increased after follow-up for both groups at T1 & T2. Facilitate dissemination of information: Subjective norms towards providing care: higher than those who attended part/0 at T1 F(1,165) = 26.48, p < .003	Yes
3. Kirby & Sanders (2013)	Aust-ralia	RCT	Grandparents: N = 54 (N = 51F, N = 3M) Children: N = 54 (N = 21F, N = 33M) Parents: N = 48 (N = 43F, N = 11M)	1) Family Background Questionnaire (FBQ; (Zubrick et al., 2005)) 2) Eyberg child behaviour inventory (ECBI; Eyberg & Pincus, 1999), 3) Parenting Scale (PS; (Arnold, O’leary, Wolff, & Acker, 1993) 4) Parenting tasks checklist (Sanders & Woolley, 2005) 5) Depression Anxiety Stress Scale-21 (DASS; Lovibond & Lovibond, 1995) 6) The quality of relationships inventory (QRI; (Pierce, Sarason, & Sarason, 1991) 7) Grandparent Communication checklist 8)Client Satisfaction Questionnaire (CSQ) Pre, post & 6-month follow-up	Triple P Parenting Program: 9 weeks with 6 group sessions lasting 2 h and 3, 30 min telephone consultations. Given workbook that includes homework. (a) use of positive parenting strategies, (b) building a positive-parenting team with the parent, and (c) coping strategies to manage unhelpful emotions.	Results for time x condition interaction effect between Intervention and GCAU condition: Grandparent & Parent Short Term multi & univariate effects (Pre to Post): Child Behaviour (CB): Grandparent (GP): Significant interaction effect (F(2,51) = 10.11, p < .001). Parent (P): Significant effect found (F(2, 45) = 10.65, p < .001) Dysfunctional parenting style (DPS): GP: no significant effect. Parenting Confidence (PC): significant effect (F(2,51) = 4.99, p = .01) Grandparent Adjustment (GA): GP: significant effect (F(3,50) = 5.75, p = .002). Significant univariate effect in depression (F(1,52) = 12.43, p = 0.001), anxiety (F(1,52) = 10.98, p = .002)and stress (F(1,52) = 11.92, p = .007). Grandparent-Parent relationship adjustment (G-P RA): GP: Significant effect when related biologically (F(3,49) = 2.84,p = .047). P: no significant effect. Grandparent-Parent Communication (G-P C): GP: Significant univariate interaction effect when related biologically (F(1,50) = 5.14, p = .028). Grandparent & Parent Long Term effects (Pre to 6 month Follow up): CB: GP: approached significance (F(3, 50) = 2.69, p = .056. P: improvements maintained over time with non-significant effects found. PC: GP: Differential improvement maintained but no significant effect found. GA: GP: Significant effect (F(3,50) = 3.11, p = .035). Univariate effect significant with Stress (F(1,52) = 8.37, p = .006)& Depression (F(1,52) = 4.22, p = .045) but not Anxiety (F(1,52) = 0.07, p = .797). G-P RA: GP: No significant effect when biologically related (F(3,49) = 2.19, p = .454). P: non-significant effect. G-P C: Significant univariate effect found when biologically related (F(1,50) = 9.79, p = .003)	Yes
4. Kelley et al. (2001)	USA	Pilot pre and post	Grandparents: N = 24 (M = 55.7, SD = 10.46, R = 39–78). Of which: N = 1 M & N = 23 F Children: N = 63 (M = 6.8, SD = 3.91, R = 58–17).	1) Brief Symptom Inventory (Derogatis & Spencer, 1993) 2) Family resource scale (C. J. Dunst & Leet, 1985) 3) Family support Scale (C. Dunst, Jenkins, & Trivette, 1984) 4) Grandparent Interview Form (Kelley et al., 2001) 5) Short Form 36 General Health Survey (Ware et al., 1996)	6 month intervention aiming to reduce psychological stress and improve physical and mental health with home visits by registered nurses, social workers and legal assistants. Aspects: Social work: aimed to empower grandparents by using strengths-based case management practices. Nursing: regular health assessments, referrals made if necessary. Legal: were provided with legal assistance if needed.	Comparisons between pre and post-test mean scores (t-test): Psychological distress (BSI): statistical significance found between scores on scales for hostility (t = 2.56, p = .011) and interpersonal sensitivity (t = 2.25, p = .017). Differences between anxiety scores approached significance (t = 1.49, p = .075). No change in scores of depression. Physical and Mental Health (SF-36): no statistically significant difference found with physical functioning scores (p = .140). Social Support (FSS): significant difference found between scores (p = .011). Family Resources (FRS): approached significance (p = .066).	Yes
5. N’zi et al. (2016)	USA	Pilot- Randomized control trial	Grandparents: N = 14F of which N = 2 great grandmothers.	1) Eyberg Child Behaviour Inventory (Eyberg & Pincus, 1999). 2)Child Behaviour Checklist (CBCL 1.5–5 years, (Achenbach & Rescorla, 2001); CBCL 6–18 years, (Achenbach & Rescorla, 2000) 3)Child-Parent Relationship Scale (Pianta, 1992) 4)Dyadic Parent-Child Interaction Coding System 4th edition (Pianta, 1992) 5)Parent Daily Report & Daily Discipline Inventory (Chamberlain & Reid, 1987) 6)Beck Depression Inventory II (BDI-II; (Beck et al., 1996) 7)Parenting Stress Index Short Form (Abidin, 1995)	Child Directed Interaction Training (CDIT): Coaching sessions where caregivers are taught relationship enhancing skills and to avoid intrusive negative leading behaviours. 7 sessions where caregiver practiced new skills with child whilst being coached by trainer.	ANCOVA used between CDIT & Waitlisted Control Condition (WLC): Caregiver report of child behaviour: CDIT reported significantly fewer child externalising behaviour problems than WLC (F(1,11) = 5.94, p = .03). No difference detected in caregiver report of child internalising symptoms (F(1,11) = 0.00, p = .97). Caregiver report of relationship quality: CDIT reported significantly more positive interactions with child than WLC caregivers (F(1,11) = 4.80, p = .05). Caregiver self-report of parenting stress & depression: CDIT reported lower total caregiver stress on PSI-SF than WLC (F(1,11) = 12.59, P = .005). CDIT also reported fewer depressive symptoms on BDI-II (F(1,11) = 6.97, p = .02). Caregiver daily discipline report: CDIT reported a significantly lower percentage of critical verbal force (F(1,11) = 6.31, p = .03). Also a significantly greater use of limit setting in response to different child behaviours than WLC caregivers (F(1,11) = 4.87, p = .05). Observed Parenting Skills: CDIT used significantly more positive following skills (F(1,8) = 31.02, p = 0.001). Also significantly fewer negative leading behaviours (F(1,8) = 26.42, p = .001).	Yes
6. Littlewood et al. (2014)	USA	Pre and post	Grandparents: N = 83 (M = 56.5, R = 45.9–73). Children: N = 162 (M = 3.35)	1)The Home Observation for Measurement of the Environment (HOME) Inventory (Caldwell & Bradley, 2003) 2)The Kin Knowledge Questionnaire (Wagner, Iida, & Spiker, 2001)(KKQ) 3) The Florida Kinship Centre Demographic Survey (Strozier & Krisman, 2007) 4) support groups 5) Ages & stages questionnaire (Squires & Potter, 1999)	1) Kin As Teachers: two year programme that focuses on parent knowledge and parenting practices, detection of developmental delays and health issues, prevention of child abuse and neglect, and promotion of school readiness and success. 2) Referral to specialists for children with delayed development.	Paired t-test conducted to determine the significant difference between pre and post test scores on HOME inventory and KKQ: HOME: significant difference exists between participants overall pre and post test score (t(30) = -7.71, p < .000 (each scale yielded a significant difference: Infant toddler & Early Childhood). KKQ: results indicate positive significant difference in total scores (p = .000).	Yes
7. Kelley et al. (2007)	USA	Case series, pre and post	Grandparents: N = 120, M = 56.2 years, SD = 8.9, R = 38–78. N = 110F & N = 10 great grandmothers. Grandchildren: M = 8.7 years, SD = 4.7, R = 1 month-18 years	1) Grandparent Demographic Form 2) Brief Symptom Inventory (Derogatis & Spencer, 1993) 3) Family resource scale (Dunst & Leet, 1987; (Deal, Trivette, & Dunst, 1988) 4) Family support scale (Dunst & Trivette, 1989) 5) Short form-26 General Health Survey (Ware et al., 1996) 6) Family Crisis Oriented Personal Evaluation Scales (McCubbin, Olson, & Larsen, 1981)	Project healthy grandparents Strengthen social, physical and emotional state of grandparents. One year intervention to develop/enhance adaptive abilities and increase competency regarding parenting ability.	Results indicate a significant effect from pre- to post-intervention for the variables of psychological distress, physical health, family resources, social support, and family coping Repeated Measures MANOVA performed on 5 dependent variables: Results indicate a significant effect from pre to post intervention for all 5 variables (F = 76.31, p = .0000). 5 variables being: psychological distress (p < .027), family resources (p < .0000), social support (p < .028*) but physical health did not demonstrate an effect (p < .069).
8. McCallion et al. (2004)	USA	Intervention x Partial cross over design, pre and post	Grandparents: N = 97 (M = 60) (94% Female, 6% Male) Grandchildren: N = 171 (57% Male M = 11 (5 Children over 21)	1) Demographics and care-related questions 2) The centre of Epidemiological Studies Depression Scale 3) Family empowerment scale 4) Caregiving Mastery Scale	2 part intervention, active case management including housing services, social health agencies, counselling, education and summer camps for children. Secondly, support groups focusing on children (disability, problem behaviours, education). Segment focusing on psychological health of caregiver.	Condition x Time interaction with Intervention and wait list control group from baseline to 3 month observation: Significant effects were found for all outcome measures: CES-D (F = 3.24), Empowerment (F = 6.96), Services (F = 5.6), Community (F = 9.21) and Mastery (F = 8.57).	Yes

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