Abstract
BackgroundTo reduce social inequities in health, the World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever.The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period.MethodsTo meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires.ResultsThe main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented.While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents’ behavior, aiming to empower them but without giving them the means to do so.ConclusionsThis research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents’ needs.
Highlights
To reduce social inequities in health, the World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins
We recently conducted a synthesis of literature reviews on effective parenting support interventions in the perinatal period and how they contribute to reducing social inequalities in health [1]
Because parenting is not just the individual responsibility of parents [5, 16], parenting support interventions present the characteristics of complex interventions as defined by the Medical Research Council (MRC): “[complex interventions are those] comprising several interacting components, though the complexity of their implementation may add additional complexity, as does the number of organizational levels targeted” [8]
Summary
To reduce social inequities in health, the World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins In this context, parenting support is promoted as a major lever. Social inequalities in health are defined as significant and unfair health differences between social groups or geographic areas These differences are due to the conditions in which people are born, live, grow up, learn, work, and age. To reduce these inequities, the World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins. The World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins In this context, parenting support is promoted as a major lever [1]. Parenting programs, most often offered to mothers, and especially the most disadvantaged, rarely take social gradients of health into account [1]
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