Title: Parent-to-parent support interventions for parents of babies cared for in a neonatal unit - a systematic review of qualitative and quantitative evidence
Funder: Department of Health and Social Care

Abstract: Background: Perinatal mental health problems carry a total economic and social long-term cost to society of about &pound;8.1 billion for each one-year cohort of births in the UK and existing services are continually being reduced through increasingly limited financial resources. There are higher levels of anxiety, depression and post-traumatic stress in mothers of pre-term babies than those whose children are born at term which may persist long after discharge from the unit. Many parents experience practical difficulties associated with visiting their babies and looking after older siblings at home. Fathers are often the sole source of support and this can place additional stress on relationships. This combined with high levels of parental stress can affect the quality of the early parent-child relationship with long term implications for the health of both the parent and child. Using peer to peer support may reduce parent stress and improve parental self-esteem on the unit and on returning home may improve outcomes for parents and children. Aims: The aim of this research is to determine the key components of peer to peer (in this case parent to parent) support in the neonatal setting and to understand the experience of peer to peer support from the perspectives of both the peer supporter and the parent. Where adequate data are available we also aim to determine the effectiveness of peer to peer support on the health and wellbeing of parents and children in this setting. Method/plan: We will conduct a systematic review of the quantitative and qualitative evidence of peer to peer support interventions for families with a baby in neonatal care. Systematic searches will be designed and conducted designed by an information specialist using a combination of subject headings and free text terms. No language, date or study type limits will be applied. The databases will include Medline, Medline In Process, EMBASE, PsycINFO, CINAHL, Social Policy and Practice (SPP), The Cochrane Library (CDSR, CENTRAL and DARE), Applied Social Sciences Index and Abstracts (ASSIA), British Nursing Index (BNI), Social Science Citation Index (SSCI), NHS EED, Health Management Information Consortium (HMIC) and Midwives Information and Resource Service. In order to identify unpublished literature, we will search resources such as CINAHL, Social Policy and Practice (SPP), and Health Management Information Consortium (HMIC) Benefits as well as searching numerous relevant organisations websites. Studies will be selected based on pre specified inclusion criteria. Two reviewers will independently screen the abstracts and full texts, one reviewer will conduct data extraction and quality assessment which will be checked by a second reviewer. The findings will be brought together in a narrative synthesis. Benefits: Our research will understand the current context of services provided and inform practice by identifying helpful components of peer to peer support and the best ways to organise and deliver these interventions. This will directly impact on parents (and their children) as recipients (and providers) of these services. Our findings will also identify and offer solutions to barriers to the successful implementation of peer to peer support, improve efficiency, highlight areas for future research and encourage service providers to evaluate their work.

Lay abstract: Parents of babies admitted to neonatal units experience an emotional journey for which they are ill-prepared. Feelings of helplessness, fear, sadness, guilt, grief and anger are common. These feelings can lead to anxiety, depression and post-traumatic stress which may persist long after discharge from the unit. The experience can have detrimental effects on family bonding with problematic long-term outcomes. Support from a peer with first-hand experience able to empathise with problems and challenges has been shown to be beneficial in other settings. The contribution of parent-to-parent support within the neonatal context has not been fully explored. We will conduct a thorough and systematic search for published and unpublished research studies using academic databases, speaking to clinicians, researchers and parents and by looking at websites of relevant organisations. This broad and comprehensive approach to identifying research literature is necessary since we anticipate that much of the information will not be located in typical academic sources. We expect to identify studies in which researchers have interviewed parents that have given/received support about their experiences (qualitative research) and studies in which the effects of the support on health outcomes for babies and their parents have been measured (quantitative research). Using predefined criteria, researchers will independently select papers that best address our research objectives. We will look at the method of provision of support, how it is organised and delivered, and with what resources. We will look for similarities and differences in the results from included studies and will draw conclusions that link the effectiveness of interventions with the experience of parents. We will bring together local and national neonatal representatives to discuss the findings of the review and how they can be used to ensure this work has an impact on services, parent and child health outcomes and guide future research.

Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES);8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;MENTAL HEALTH