Nurture and Play

Summary

Introduction

Nurture and Play is a group intervention for expectant parents and parents of infants aged two to six months. It is particularly suitable for mothers with mild to moderate depressive symptoms and mothers at risk of depression. It can be used in healthcare and social welfare, especially in maternity and child health clinics. It aims to increase the parent’s emotional availability and mentalisation capacity in relation to the child, so that the early attachment and the child’s development progress favourably. Parents are referred to the intervention by maternity and child health clinics and family centre services. The intervention is focused on the key factors related to early interaction, including the parent’s stress, emotional regulation and interaction skills, which influence the infant’s sense of security and development. The intervention involves working in a group led by two instructors, based on a handbook, progressing from pregnancy to the infant stage. The key elements are peer support, experience orientation and playfulness, which support the parent’s positive emotional experiences and strengthen natural nurturing behaviour.

Objective and research question

This systematic literature review assesses the effectiveness of the Nurture and Play intervention on the basis of research literature. The review answers the following questions: 1) In how much detail has the Nurture and Play psychosocial intervention been described? 2) Does the Nurture and Play intervention used in Finland have evidence-based effectiveness in strengthening the emotional availability, sensitivity and ability to reflect of parents with depression symptoms and, consequently, the positive development of the early attachment relationship?

Data and research methods

A systematic literature search was carried out using the PCC search strategy (Population, Concept, Context), which focused on the question: What research has been done on the Nurture and Play intervention? The following keywords were used: P = infants, parents, C = “Hoivaa ja leiki” OR “Nurture and Play”. Context (C) was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the intervention. A systematic literature search was carried out for the following six reference databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for publications in Finnish was performed on the Finna.fi service, and the search was supplemented by a manual search. The accuracy of the method description in the manuals and other written materials maintained by the home base was evaluated.

Results

One impact study was found in the literature search. A randomised controlled trial by Salo et al. (2019) demonstrated that Nurture and Play is an effective prenatal intervention for mothers with depression symptoms. In the study, 45 pregnant women were allocated into an intervention group (n = 24) and a control group, and the effects of the intervention on the mother’s sensitivity and emotional availability, ability to reflect and depression symptoms were assessed. The intervention group participated in Nurture and Play group activities from pregnancy until the infant reached seven months of age, while the control group received standard care. The results at 12 months showed improved sensitivity and emotional availability (η²_p = 0.24, p = 0.003), greater ability to reflect(η²_p = 0.18, p = 0.004) and greater reduction in depression symptoms (η²_p = 0.11, p = 0.025) in the intervention group when compared to the control group, although alleviation of symptoms was also observed in the control group. The NNT figures corresponding to the effect sizes ranged from 1.75 to 2.63, i.e. at least three participants should receive support from the intervention in order for one of them to benefit. The findings provide support for the ability of the Nurture and Play intervention to strengthen key protective factors of early interaction, such as emotional availability, sensitivity and the ability to reflect, which are associated with the development of the child’s secure attachment relationship. The advantages of the intervention also include its suitability for maternity and child health clinic services, brief duration and cost-effectiveness, but the generalisability of the results is limited by the small sample size and the lack of long-term follow-up. In the future, it would be beneficial to study the effectiveness of the intervention using larger data sets.

Methodology evaluation

Evidence of the intervention’s effectiveness has been demonstrated for pregnant mothers and mothers of infants with depression symptoms. Compared to regular maternity and child health clinic visits, the intervention has improved the interaction between the mother and the infant, strengthened the mother’s ability to reflect, and reduced depression symptoms. The intervention has been studied in the Finnish maternity and child health clinic context, and the evidence of its effectiveness applies to the target group of mothers with depression symptoms and mothers at risk of depression. The research evidence is based on one randomised controlled trial conducted in the maternity and child health clinic context.