The power of the group - Group-based parenting programmes for disadvantaged parents and their infants: a realist review.

Purpose: Despite growing evidence of the importance of supporting disadvantaged parents during the first phase of parenthood, most existing parenting programmes targeted at this population are individually delivered, even though group-based programmes are cost-efficient, require fewer personnel (i.e. specialised nurses), and are appreciated by parents, particularly those experiencing social isolation. Given the potential benefits, the aim of this study is to understand how and under what circumstances group-based programmes can work effectively for disadvantaged populations. Methods: We conducted a five-stage realist review to identify the contexts and mechanisms underpinning the delivery of parenting programmes for disadvantaged parents of infants. An initial programme theory was developed. A formal literature search was conducted across five bibliographic databases, supplemented by a Google search and expert advice to identify programmes. Three expert advisory groups comprising parents and professionals played a key role in shaping the review's direction and refining the programme theories. Results: We identified five group-based parenting programmes specifically designed for disadvantaged parents of infants. Twenty-eight documents (scientific and grey literature) were analysed, leading to the development of sixteen context-mechanism-outcome configurations, which were synthesised within six programme theories. These theories were presented within an overarching diagram highlighting the contextual factors and mechanisms which influence parental learning and development. The results were that a non-judgmental, supportive approach and the creation of a safe group space helped parents relax and engage. Parents reported being able to reflect and reframe past experiences, learn from peers and facilitators, strengthen multiple relationships, feel less isolated and feel closer to their infant. Reported outcomes extended beyond improved parent-child interaction and included the development of new support networks, engagement with education and employment, and social participation. Conclusion: Group-based parenting programmes can support disadvantaged parents of infants when they are delivered in ways that align with parents' lived circumstances and social histories. Supportive and non-judgmental group environments appear to trigger mechanisms of trust, emotional safety, and the normalising of shared experiences, enabling parents to engage, reflect on past experiences and learn from peers and facilitators. These mechanisms are more likely to operate when practical and relational barriers to participation (such as mistrust of services, transport difficulties) are addressed. Outcomes extended beyond parenting confidence and parent-infant interaction to include reduced isolation and wider social participation. Future research should focus on how these mechanisms are sustained over time and how they shape longer-term outcomes for parents and children across differing service contexts.