Review
Internet-based peer support for parents: A systematic integrative review

https://doi.org/10.1016/j.ijnurstu.2014.06.009Get rights and content

Abstract

Objectives

The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents.

Design

A systematic integrative review.

Data sources

The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases.

Review methods

Two reviewers independently screened the titles (n = 1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies that focused on mothers, fathers or both parents were separated.

Results

In total, 38 publications met the inclusion criteria. Most of the studies focused on Internet-based peer support between mothers (n = 16) or both parents (n = 15) and seven focused on fathers. In 16 studies, the Internet-based interventions had been developed by researchers and 22 studies used already existing Internet peer-support groups, in which any person using the Internet could participate. For mothers, Internet-based peer support provided emotional support, information and membership in a social community. For fathers, it provided support for the transition to fatherhood, information and humorous communication. Mothers were more active users of Internet-based peer-support groups than fathers. In general, parents were satisfied with Internet-based peer support. The evidence of the effectiveness of Internet-based peer support was inconclusive but no harmful effects were reported in these reviewed studies.

Conclusions

Internet-based peer support provided informational support for parents and was accessible despite geographical distance or time constraints. Internet-based peer support is a unique form of parental support, not replacing but supplementing support offered by professionals. Experimental studies in this area are needed.

Introduction

Parents want to share their experiences and receive information from other parents as much as they want to seek information and advice from professionals. Peer support between parents is an important source of emotional and informational support (Rossman, 2007) and it may help them to gain more positive perspectives on parenting (Ritchie et al., 2000). Peer support is defined as social emotional support (Solomon, 2004) which is voluntary, informal, flexible, non-hierarchical and non-medical (Mead and MacNeil, 2006). Peer support is giving and receiving help and understanding another's situation through shared experience (Mead et al., 2001). Professional support provided by nurses is an essential component of nursing practice and it contains informational, emotional, instrumental and esteem support (Miles et al., 1999). It partly overlaps with the idea of peer support but nurses are required to have certain skills, knowledge and competencies (Hobbs, 2009) and nurses do not belong to the social network of patients and do not share their experiences (Miles et al., 1999). Peer support is usually related to social support which is a multidimensional and broader concept including support also from, for example, family members and friends, not just peers. Social support is associated with well-being and there might be also a causal relationship (Cohen and Wills, 1985).

Today, in the era of social media, the Internet provides various possibilities for online peer support. Social media is here defined as a group of Internet-based applications that are based on the technological foundations of Web 2.0 and are publicly available (Kaplan and Haenlein, 2010). Nieuwboer et al. (2013a) showed in their review that the Internet provides multiple opportunities to provide peer and professional parenting support. Online parenting support utilises a wide range of online communication from one-to-one discussion to open group forums.

The transition to parenthood is one of the biggest life changes and parents need support during this time (Petch and Halford, 2008, Solmeyer and Feinberg, 2011). ‘Traditional’ peer support has been shown to be an efficient intervention. Successful mother-to-mother peer support associated with breastfeeding, for example, has been conducted within home visits and via the telephone (e.g. Ahmed and Sands, 2010, Kaunonen et al., 2012, Merewood et al., 2006). Breastfeeding rates in Texas also increased after the use of father-to-father peer support; indeed, the attitude of the father has a strong impact on a mother's decision over feeding methods (Stremler and Lovera, 2004). Parents of children with special health-care needs have received particular benefits, such as increased knowledge, skills and support, from peer-support groups (Kingsnorth et al., 2011). Telephone-based peer support has also been used by mothers suffering from postpartum depression, in which it was shown that it may be effective: at the very least, the mothers reported being satisfied with this peer-support experience (Dennis, 2010, Dennis et al., 2009).

Internet-based peer support is available for diverse groups of people, including parents and families, despite geographical distance or time constraints. Peer support for mothers, fathers or pregnant women can be provided in public groups open for all Internet users or in closed groups for a targeted group only. Peer-support groups can be either moderated or not and they can be synchronous or asynchronous. These groups in Internet-based social media are a constantly growing phenomenon. In Yahoo!Groups (www.yahoo.com) alone there are over 20,000 groups for parenting, and in the social media site Facebook (www.facebook.com) – which had over 1.2 billion monthly active users in December 2013 (Facebook, 2013) – there are thousands of groups for such peer support. On average, 77% of the European and 61% of the American population in 2013 use the Internet (ITU, 2013). Young adults are very active Internet users, for example in Finland 98% of people aged between 25 and 34 use the Internet every week and over 70% of this age group visit social media sites at least occasionally. Furthermore, families with children are very active users of the Internet and over 60% of Finnish families use various discussion forums (Taloustutkimus, 2010). Research on parenthood and the use of the Internet has strongly increased after the millennium (Plantin and Daneback, 2009). It has been suggested that new mothers particularly feel more connected with other people by using the Internet than without doing so (McDaniel et al., 2012). In a study by Bartholomew et al. (2012), 58% of new American mothers and 44% of fathers visited their Facebook accounts at least once a day, however, for various reasons, not only parenting issues.

In a systematic review on the effects of online peer-to-peer interactions, no evidence on the effects of online peer support was found, partly because in many studies included in the review, peer support was only one part of a complex intervention (Eysenbach et al., 2004). Results of the review by Shilling et al. (2013) on peer support for parents of children with chronic disabling conditions suggested that parents benefit from peer support, for example by sharing a social identity or learning practical information, but the evidence of this effectiveness was inconsistent. Nieuwboer et al. (2013b) concluded that online interventions can make a positive contribution to parents. All online programmes aiming to improve parenting, in addition to peer support, were included in their review.

Nieuwboer et al., 2013a, Nieuwboer et al., 2013b reviews approach this phenomenon but with different perspectives such as communication types and online programmes. Indeed, no previous systematic review has purely focused on the outcomes of Internet-based peer support for parents. Our integrative review strives to fill this gap because Internet-based peer support is an easy and accessible channel for almost all parents, and it may be an efficient intervention to promote parents’ well-being. Furthermore, by combining professional nursing support and Internet-based peer support it could be possible to create a cost-effective method of providing additional support for parents. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents.

The research questions were as follows:

  • 1.

    What Internet-based peer-support groups/interventions have been provided for parents?

  • 2.

    What outcomes have been achieved by using these Internet-based peer-support groups/interventions for parents?

Section snippets

Inclusion and exclusion criteria

This integrative review has been conducted based on the framework of Whittemore and Knafl (2005). We searched for papers with diverse methodologies concerning Internet-based peer support for parents. We included studies published in peer-reviewed journals written in English. The inclusion criteria were as follows: first, there had to be an Internet-based community as an intervention or at least as a component of an intervention; second, the participants in the Internet-based community had to be

Included studies

In total, 38 publications met our inclusion criteria and were chosen for the review. Most of the studies (n = 16) were focused on Internet-based peer support between mothers. Seven studies were focused on fathers and 15 on both parents. Although the publication years were not limited, almost all of the papers were published after the year 2000. The oldest included study (Dunham et al., 1998) was published in 1998. Most of the studies were from North America, with 13 from the USA and seven from

Discussion

Internet-based peer groups and interventions have been conducted to support the transition into parenthood or coping during stressful events in parenthood. These interventions have been mainly aimed at mothers or both parents, with a few for fathers only. Mothers and fathers appreciated up-to-date informational support from their peers. Characteristic outcomes for mothers were emotional support and a membership in a virtual community; for fathers these were support for the transition to

Conclusions

Internet-based peer support provided informational support for both parents, despite geographic distance or time constraints. Mothers mostly gained emotional support and fathers found affirmation of their fatherhood. Both parents appreciated being a member of a group with other parents in similar situations, but mothers were more active users of Internet-based peer support than fathers. These above-mentioned elements seemed to be key factors in Internet-based peer support for parents.

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