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Systematic Review
To evaluate the benefits and harms of family‐centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families.
We included nine RCTs and two cluster‐RCTs that investigated the effect of family‐centred care interventions delivered by primary healthcare services for Indigenous early child well‐being. There were 1270 mother–child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family‐centred education was the most common type of intervention delivered. Three studies compared family‐centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family‐centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain.
There is some evidence to suggest that family‐centred care delivered by primary healthcare services improves the overall health and well‐being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family‐centred interventions. Seven of the 11 studies delivered family‐centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high‐quality trials are needed to provide robust evidence for the use of family‐centred care interventions for Indigenous children aged less than five years.