{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:18:12Z","timestamp":1787811492139,"version":"build-2784847793"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Universal parenting programmes aim to strengthen parent-child relationships and support parental well-being during the transition to parenthood. While these programmes can improve parental confidence, self-efficacy, and child social-emotional development, achieving sustained delivery in routine practice remains a major challenge. Understanding the factors that facilitate or hinder their implementation is essential for optimizing their public health impact. This review synthesizes qualitative evidence on barriers and facilitators to the implementation and sustainability of universally accessible parental training interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic qualitative review following PRISMA guidelines. Ten databases (PubMed, PsycInfo, SocIndex, CINAHL, Embase, Medline, Sociological Abstracts, ERIC, Scopus, and Web of Science) were searched in May 2024, and updated in July 2025, for peer-reviewed qualitative studies published after 2003 in English. Studies were eligible if they evaluated universal parenting interventions in high-income countries and explored aspects of implementation or sustainability. Interventions targeting specific clinical populations were excluded. Data extraction was conducted by multiple authors, and reporting transparency was assessed using the Consolidated Criteria for Reporting Qualitative Research (COREQ). Findings were synthesized using Normalization Process Theory (NPT) to identify how interventions become embedded in practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight studies from six countries were included, covering interventions delivered in primary care, community health, and web-based settings. Across NPT constructs, key facilitators included strong stakeholder engagement, peer and managerial support among participants, and flexible delivery models that fit local contexts. Recurrent barriers were limited time and resources, insufficient training and weak managerial or policy support. Parent engagement was sometimes constrained by perceptions of limited programme relevance or logistical obstacles, highlighting the importance of clear communication and iterative adaptation to local needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Universal parenting interventions can contribute to improved parental and child outcomes when effectively integrated into routine practice. Sustainable implementation depends on early co-design with stakeholders, alignment with existing health services, and sustained managerial and policy support. Embedding feedback loops and mechanisms for adaptation can strengthen engagement and ensure that interventions remain feasible and relevant over time. Future research should focus on strategies to enhance reach and to assess long-term population-level effects on child well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024559474<\/jats:ext-link>\n                      , identifier CRD42024559474\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1802287","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:34:05Z","timestamp":1787808845000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Facilitators and barriers to the sustainability of universally accessible parental training interventions: a systematic qualitative review using normalization process theory"],"prefix":"10.3389","volume":"14","author":[{"given":"Mette Louise","family":"Petersen","sequence":"first","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedvig Ramnefjell","family":"Dolva","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Str\u00f8yer de Voss","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida Scheel","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiken","family":"Pontoppidan","sequence":"additional","affiliation":[{"name":"VIVE\u2014The Danish Center for Social Science Research","place":["K\u00f8benhavn K, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth Kirk","family":"Ertmann","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Wilson","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gritt","family":"Overbeck","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice & Section of General Practice, Department of Public Health, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1136\/ebmental-2021-300277","article-title":"Prevalence of childhood mental disorders in high-income countries: a systematic review and meta-analysis to inform policymaking","volume":"25","author":"Barican","year":"2022","journal-title":"Evid Based Ment Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/1471-2431-13-147","article-title":"Prediction of 7-year psychopathology from mother-infant joint attention behaviours: a nested case-control study","volume":"13","author":"Allely","year":"2013","journal-title":"BMC Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.ridd.2012.09.007","article-title":"Predictors of diagnosis of child psychiatric disorder in adult\u2013infant social-communicative interaction at 12 months","volume":"34","author":"Marwick","year":"2013","journal-title":"Res Dev Disabil"},{"key":"B4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/1471-2431-14-223","article-title":"Association between parent-infant interactions in infancy and disruptive behaviour disorders at age seven: a nested, case-control ALSPAC study","volume":"14","author":"Puckering","year":"2014","journal-title":"BMC Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1111\/cch.12061","article-title":"Early parental physical punishment and emotional and behavioural outcomes in preschool children","volume":"40","author":"Scott","year":"2014","journal-title":"Child: Care, Health Dev"},{"key":"B6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1136\/jech-2011-200856","article-title":"What predicts persistent early conduct problems? Evidence from the growing up in Scotland cohort","volume":"67","author":"Wilson","year":"2013","journal-title":"J Epidemiol Community Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1111\/1467-8624.00037","article-title":"Parental reactions to children\u2019s negative emotions: longitudinal relations to quality of children\u2019s social functioning","volume":"70","author":"Eisenberg","year":"1999","journal-title":"Child Dev"},{"key":"B8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1471-2393-8-16","article-title":"Maternal mental health predicts risk of developmental problems at 3 years of age: follow up of a community based trial","volume":"8","author":"Tough","year":"2008","journal-title":"BMC Pregnancy Childbirth"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1162\/0898929042304796","article-title":"Sensitive periods in the development of the brain and behavior","volume":"16","author":"Knudsen","year":"2004","journal-title":"J Cogn Neurosci"},{"key":"B10","first-page":"350","article-title":"The nature of the child\u2019s tie to his mother","volume":"39","author":"Bowlby","year":"1958","journal-title":"Int J Psychoanal"},{"key":"B11","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-04769-6","volume-title":"Early Interaction and Developmental Psychopathology: Volume I: Infancy","author":"Apter","year":"2019"},{"key":"B12","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1038\/npp.2014.140","article-title":"Early-life experience, epigenetics, and the developing brain","volume":"40","author":"Kundakovic","year":"2015","journal-title":"Neuropsychopharmacology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1037\/a0013030","article-title":"A responsive parenting intervention: the optimal timing across early childhood for impacting maternal behaviors and child outcomes","volume":"44","author":"Landry","year":"2008","journal-title":"Dev Psychol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1037\/0012-1649.41.6.885","article-title":"The effectiveness of early head start for 3-year-old children and their parents: lessons for policy and programs","volume":"41","author":"Love","year":"2005","journal-title":"Dev Psychol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1192\/bjp.bp.106.032789","article-title":"Effects of treating postnatal depression on mother infant interaction and child development: systematic review","volume":"191","author":"Poobalan","year":"2007","journal-title":"Br J Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e015707","DOI":"10.1136\/bmjopen-2016-015707","article-title":"Effects of parenting interventions for at-risk parents with infants: a systematic review and meta-analyses","volume":"7","author":"Rayce","year":"2017","journal-title":"BMJ open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1192\/bjo.2019.89","article-title":"Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis","volume":"6","author":"Rayce","year":"2020","journal-title":"BJPsych Open"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e011706","DOI":"10.1136\/bmjopen-2016-011706","article-title":"Effects of universally offered parenting interventions for parents with infants: a systematic review","volume":"6","author":"Pontoppidan","year":"2016","journal-title":"BMJ Open"},{"key":"B19","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.cpr.2014.04.003","article-title":"The triple P-positive parenting program: a systematic review and meta-analysis of a multi-level system of parenting support","volume":"34","author":"Sanders","year":"2014","journal-title":"Clin Psychol Rev"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1177\/15248380211013131","article-title":"Universal intervention to strengthen parenting and prevent child maltreatment: updated systematic review","volume":"23","author":"Branco","year":"2022","journal-title":"Trauma Violence Abuse"},{"key":"B21","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12887-023-03849-x","article-title":"Increasing the psychosocial focus in child developmental assessments: a qualitative study","volume":"23","author":"De Voss","year":"2023","journal-title":"BMC Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1007\/s10567-023-00465-0","article-title":"Implementation of parenting programs in real-world community settings: a scoping review","volume":"27","author":"Pinto","year":"2024","journal-title":"Clin Child Fam Psychol Rev"},{"key":"B23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13012-015-0242-0","article-title":"Making sense of implementation theories, models and frameworks","volume":"10","author":"Nilsen","year":"2015","journal-title":"Implement Sci"},{"key":"B24","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1111\/j.1471-1842.2009.00848.x","article-title":"A typology of reviews: an analysis of 14 review types and associated methodologies","volume":"26","author":"Grant","year":"2009","journal-title":"Health Info Libr J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/01.NAJ.0000445689.67800.86","article-title":"Developing the review question and inclusion criteria","volume":"114","author":"Stern","year":"2014","journal-title":"Am J Nurs"},{"key":"B26","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"B27","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/1748-5908-4-29","article-title":"Development of a theory of implementation and integration: normalization process theory","volume":"4","author":"May","year":"2009","journal-title":"Implement Sci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual Health Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1177\/17579139221118243","article-title":"A process evaluation of promotional guides used by health visitors to support men\u2019s transition to fatherhood: a qualitative study","volume":"144","author":"Baldwin","year":"2024","journal-title":"Perspect Public Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s10935-021-00664-x","article-title":"Introducing parenting support in primary care: professionals\u2019 perspectives on the implementation of a positive parenting program","volume":"43","author":"Callejas","year":"2022","journal-title":"J Prev"},{"key":"B31","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.acap.2017.09.011","article-title":"Feasibility of implementing group well baby\/well woman dyad care at federally qualified health centers","volume":"18","author":"Connor","year":"2018","journal-title":"Acad Pediatr"},{"key":"B32","doi-asserted-by":"publisher","first-page":"178","DOI":"10.3390\/educsci8040178","article-title":"A universal early parenting education intervention in community-based primary care settings: development and installation challenges","volume":"8","author":"Hickey","year":"2018","journal-title":"Educ Sci"},{"key":"B33","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s11121-020-01170-y","article-title":"Putting meat on the bones\u201d: understanding the implementation of a community-based early intervention and prevention programme\u2014contextual, person, and programme influences","volume":"22","author":"Hickey","year":"2021","journal-title":"Prev Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/j.1365-2214.2005.00479.x","article-title":"Parents\u2019 perceptions of the value of the Webster-Stratton parenting programme: a qualitative study of a general practice based initiative","volume":"31","author":"Patterson","year":"2005","journal-title":"Child: Care, Health Dev"},{"key":"B35","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1186\/s12884-023-05671-w","article-title":"Clinicians\u2019 experiences in signposting an online mental health resource to expectant mothers: a qualitative study","volume":"23","author":"Saxild","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"B36","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1111\/scs.12329","article-title":"Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care","volume":"31","author":"Westerlund","year":"2017","journal-title":"Scand J Caring Sci"},{"key":"B37","doi-asserted-by":"publisher","first-page":"108201","DOI":"10.1016\/j.childyouth.2025.108201","article-title":"Group-based parenting programs implementation and facilitators\u2019 perspectives: a systematic review and thematic synthesis","volume":"171","author":"J\u00fcrgensen","year":"2025","journal-title":"Child Youth Serv Rev"},{"key":"B38","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s10464-008-9165-0","article-title":"Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation","volume":"41","author":"Durlak","year":"2008","journal-title":"Am J Community Psychol"},{"key":"B39","volume-title":"Implementation Research: A Synthesis of the Literature","author":"Fixsen","year":"2005"},{"key":"B40","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/j.cpr.2013.07.006","article-title":"Effectiveness of the incredible years parent training to modify disruptive and prosocial child behavior: a meta-analytic review","volume":"33","author":"Menting","year":"2013","journal-title":"Clin Psychol Rev"},{"key":"B41","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00787-013-0401-2","article-title":"Barriers to, and facilitators of, parenting programmes for childhood behaviour problems: a qualitative synthesis of studies of parents\u2019 and professionals\u2019 perceptions","volume":"22","author":"Koerting","year":"2013","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B42","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s10935-011-0238-8","article-title":"Stages of parental engagement in a universal parent training program","volume":"32","author":"Eisner","year":"2011","journal-title":"J Prim Prev"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1111\/famp.12658","article-title":"Cultural adaptation of group parenting programs: review of the literature and recommendations for best practices","volume":"60","author":"Schilling","year":"2021","journal-title":"Fam Process"},{"key":"B44","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1186\/s13012-016-0519-y","article-title":"Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review","volume":"11","author":"Overbeck","year":"2016","journal-title":"Implement Sci"},{"key":"B45","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1093\/ijpp\/riad001","article-title":"Barriers and facilitators of implementing proactive deprescribing within primary care: a systematic review","volume":"31","author":"Okeowo","year":"2023","journal-title":"Int J Pharm Pract"},{"key":"B46","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1186\/s12874-021-01363-1","article-title":"A meta-review demonstrates improved reporting quality of qualitative reviews following the publication of COREQ- and ENTREQ-checklists, regardless of modest uptake","volume":"21","author":"de Jong","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1748-5908-9-2","article-title":"A qualitative systematic review of studies using the normalization process theory to research implementation processes","volume":"9","author":"McEvoy","year":"2014","journal-title":"Implement Sci"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1802287\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:34:07Z","timestamp":1787808847000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1802287\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":47,"alternative-id":["10.3389\/fped.2026.1802287"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1802287","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"1802287"}}