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Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

BMJ 2008; 336 doi: (Published 07 February 2008) Cite this as: BMJ 2008;336:318
  1. Harriet Hiscock, postdoctoral research fellow and paediatrician 123,
  2. Jordana K Bayer, postdoctoral research fellow and clinical child psychologist 123,
  3. Anna Price, research assistant13,
  4. Obioha C Ukoumunne, postdoctoral research fellow and statistician234,
  5. Susan Rogers, clinical research fellow 5,
  6. Melissa Wake, paediatrician and senior research fellow123
  1. 1Centre for Community Child Health, Royal Children’s Hospital, Parkville VIC 3052, Australia
  2. 2Department of Paediatrics, University of Melbourne, Parkville
  3. 3Murdoch Children’s Research Institute, Parkville
  4. 4Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Parkville
  5. 5Parenting Research Centre, Carlton, VIC 3053
  1. Correspondence to: H Hiscock harriet.hiscock{at}
  • Accepted 21 November 2007


Objective To determine whether a parenting programme, offered universally in primary care, can prevent behavioural problems in children and improve parenting and maternal mental health.

Design Cluster randomised trial.

Setting 40 primary care nursing centres (clusters) in Victoria, Australia.

Participants 733 English speaking mothers of 8 month old children sequentially recruited from well child appointments; 656 retained at 24 months.

Intervention Structured three session programme at age 8-15 months, co-led by well child providers and a parenting expert. The programme covered normal development and behaviour, strategies to increase desired behaviour, and strategies to reduce unwanted behaviour.

Main outcome measures Maternal report of child externalising behaviour (child behavior checklist 1½-5 year old), parenting (parent behavior checklist), and maternal mental health (depression anxiety stress scales) at 18 and 24 months.

Results At 18 months, child behaviour and parenting scores were similar in the two groups. At 24 months, externalising scores in the intervention and control groups were similar (mean 11.9 (SD 7.2) v 12.9 (7.4)); however, on the parent behavior checklist subscale scores, intervention group parents were less likely to report harsh/abusive parenting (mean 38.9 (SD 7.7) v 40.5 (8.8); adjusted mean difference −1.83, 95% confidence interval −3.12 to −0.55) and unreasonable expectations of child development (40.9 (9.9) v 42.7 (9.6); −2.18, −3.74 to −0.62). Mean scores for nurturing parenting and maternal mental health were similar in the two groups at both times.

Conclusions A universal parenting programme resulted in modest improvement in parenting factors that predict behavioural problems in children but did not reduce externalising behavioural problems or affect maternal mental health at 2 years.

Trial registration ISRCTN 77531789.


  • We thank maternal and child health nurses and families of the Melbourne cities of Glen Eira, Greater Geelong, Kingston, Maribyrnong, Nillumbik, and Stonnington who took part in this research and the co-facilitators from the Parenting Research Centre.

  • Contributors: HH, JKB, and MW were involved in the conception and design of the study and obtained funding. HH, JKB, SR, and AP were involved with acquisition of study data and, together with OCU and MW, were responsible for analysis and interpretation of the data. OCU did the statistical analysis with assistance from AP. HH and JKB drafted the manuscript with critical revision from OCU, MW, AP, and SR. HH is the guarantor.

  • Funding: This project was funded by the Telstra Community Development Fund. The authors’ work was independent of the funders. HH’s and OCU’s postdoctoral positions are funded by Australian National Health and Medical Research Council (NHMRC) Population Health Capacity Building Grant 436914; MW is part funded by NHMRC Career Development Award 284556; and JB is part funded by an Australian Rotary Health Research Fund Postdoctoral Fellowship.

  • Competing interests: None declared.

  • Ethical approval: Ethics in Human Research Committee of the Royal Children’s Hospital, Melbourne, Australia (project approval 24020A).

  • Accepted 21 November 2007
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