Twenty-eight studies (n=1,622) were included: 21 RCTs (n=1,436), 3 non-randomised controlled studies (CTs; n=166) and one pre-test post-test study (n=20).
Education on infant care giving education (5 RCTs, n=421).
Audiotaped and videotaped instruction (3 RCTS, n=286) was not associated with increased maternal knowledge of infant care, and in one RCT (n=25) telephone audiotapes appeared to increase difficulty in adjusting to the maternal role. Individualised self-instruction (using booklets and slides) and individualised nursing help with breast-feeding were associated with significantly greater infant care knowledge and higher breast-feeding rates, respectively (2 RCTs, n=135).
Education on infant interactive capabilities (10 RCTs, n=575; 1 CT, n=31).
Improved maternal interactive behaviour and/or improved perception and knowledge about the infant were reported in the intervention group in 7 RCTs (n=363), some conducted on all or partially among at-risk populations (3 RCTs, n=190). However, a larger RCT of pregnant adolescents (n=121) reported no such benefit. Moreover, the intervention did not improve maternal confidence (2 RCTs, n=66), competence (1 RCT, n=61) or ease of transition into the maternal role (1 CT, n=31) . Nursing demonstration of interactive behaviour and/or maternal stimulation of the infant were more effective than information alone or other control conditions (4 RCTS, n=139).
Interventions focused on fostering maternal-infant attachment (6 RCTs, n=171).
Two RCTs (n=30) reported improved maternal-foetal attachment as a result of guided maternal-foetal activities, but 2 larger RCTs (n=91) reported no statistically significant effect. An RCT (n=20) of extended skin-to-skin contact after childbirth also reported no statistically significant effect from the intervention. An RCT (n=30) of an in-home teaching intervention 2 to 4 days after discharge reported improved maternal perceptions of the infant at 1 month in the intervention group.
Interventions focused on maternal/social role responsibilities (1 RCT, n=91; 2 CTs, n=135).
Two studies reported that the intervention group had improved maternal adaptation (1 RCT, n=91) and more favourable interaction with the infant (1 CT, n=77) 10.5 months later. However, the intervention was not associated with self-reported improvement in confidence or resilience (1 RCT, n=91; 1 CT, n=58). The RCT (n=91) found that better-educated mothers benefited less from the intervention than those less well educated.
Interactive therapeutic nurse/client relationship (2 RCTs, n=178; 1 pre-test post-post study, n=20).
Improvement in maternal competence was reported in at-risk populations receiving this intervention, which was delivered by specially trained professional nurses. No statistically significant effect on maternal role attitudes was found (1 RCT, n=31).
Other results were reported in the review.