Article Text

Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial
  1. D E Simkiss1,
  2. H A Snooks2,
  3. N Stallard1,
  4. P K Kimani1,
  5. B Sewell3,
  6. D Fitzsimmons3,
  7. R Anthony2,
  8. S Winstanley2,
  9. L Wilson2,
  10. C J Phillips3,
  11. S Stewart-Brown1
  1. 1Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
  2. 2Centre for Health Information, Research and Evaluation, Institute of Life Science, College of Medicine, Swansea University, Swansea, Wales, UK
  3. 3Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, SA2 8PP, Swansea University, Swansea, Wales, UK
  1. Correspondence to Dr D E Simkiss; d.e.simkiss{at}


Objective To evaluate the effectiveness and cost utility of a universally provided early years parenting programme.

Design Multicentre randomised controlled trial with cost-effectiveness analysis.

Setting Early years centres in four deprived areas of South Wales.

Participants Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control.

Intervention The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions.

Main outcome measures Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures.

Results There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With ‘+’ indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI −1.90 to 3.69); in supportive parenting, +0.17 (95%CI −0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485–46 578) over 5 years and £18 954 (range 11 664–25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up.

Conclusions Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains.

Trial registration The trial is registered with Current Controlled Trials ISRCTN13919732.

  • Public Health

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