Universal parenting support during a child's first years

<jats:p>&lt;p dir="ltr"&gt;Background: The first 1000 days constitute a sensitive developmental period in which early relational environments strongly influence later health and development. Universal parenting programs can strengthen parents during this stage, yet few have been developed or evaluated for families with 1-2-year-olds. Little ACF was therefore created as a toddler-adapted version of the established Swedish universal program ACF for parents of children aged 3-12 years.&lt;/p&gt;&lt;p dir="ltr"&gt;Aim: The overarching aim of this thesis is to deepen the understanding of how a universal structured group-based program for parents of 1-2-year-olds can enhance parents and promote children's mental health using the Child Health Services as its platform. This aim is addressed through four complementary studies: a study protocol outlining the program and the trial design (&lt;b&gt;Study 1&lt;/b&gt;), a psychometric evaluation of the child outcome measure ASQ:SE-2 used in the trial (&lt;b&gt;Study 2&lt;/b&gt;), an RCT assessing program effectiveness and feasibility (&lt;b&gt;Study 3&lt;/b&gt;), and a qualitative interview study exploring Child Health Services nurses' experiences of delivering the program, and if these experiences influence their general professional practice (&lt;b&gt;Study 4&lt;/b&gt;).&lt;/p&gt;&lt;p dir="ltr"&gt;Methods: For the empirical studies included in this thesis, the Swedish Child Health Services provided the platform for recruitment and data collection, in collaboration with municipal and civil society organizations. In &lt;b&gt;Study 2&lt;/b&gt; data were collected from 586 Swedish-speaking parents of 18-month-old children. Parents completed the ASQ:SE-2 and the SEAM, and nurses at the Child Health Services conducted an observational assessment of each child's socioemotional development. We examined the ASQ:SE-2 using exploratory factor analysis and Rasch modeling, and analyzed associations with the SEAM and the nurse assessment using Pearson and Spearman correlations. &lt;b&gt;Study 3&lt;/b&gt; evaluated Little ACF in a two-arm RCT with 832 parents, comparing four structured group sessions with an active control receiving digital lectures. Outcomes included parenting self-efficacy and stress, coparenting, emotion regulation in parents and children, and child socioemotional development. An intention-to-treat approach was applied using linear mixed models for analyzing the effectiveness of Little ACF. &lt;b&gt;Study 4&lt;/b&gt; explored CHS nurses' experiences through semi-structured interviews analyzed with reflexive thematic analysis.&lt;/p&gt;&lt;p dir="ltr"&gt;Results: In &lt;b&gt;Study 2&lt;/b&gt;, the findings indicate that the Swedish ASQ:SE-2 at 18 months primarily captures elevated social interaction difficulties rather than assessing social and emotional competencies in a general population. In &lt;b&gt;Study 3&lt;/b&gt;, parents in the intervention group reported a significantly larger increase in supportive strategies for managing their children's negative emotions (β = 3.0, CI 0.9-5.0). High engagement and retention indicated that the program is feasible in a universal context and may strengthen parents' capacity to support young children's emotional development. In &lt;b&gt;Study 4&lt;/b&gt;, the nurses described strengthened knowledge, confidence, and collaborative skills, and identified the group format as a key mechanism offering learning opportunities beyond individual visits. They reported a shift from an expert-driven stance toward a more guiding, collaborative approach and a movement from a parent-focused to a more child-centered perspective in everyday practice. The structured format also supported early identification of families needing additional support and facilitated collaboration with municipal and civil society partners.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions: The findings of the thesis show both the potential and the challenges of universal parenting support during the first years of life. Current tools for assessing socioemotional development at 18 months lack sufficient sensitivity for use in universal settings. At the same time, the studies demonstrate that a brief, structured group-based parenting program can strengthen supportive parenting practices and build professional competence within the Child Health Services. The studies also demonstrate how universal parenting support can be integrated into routine Child Health Services practice through collaboration across sectors. A broader challenge concerns the limited availability of measures that capture strengths and positive developmental changes, which are central targets of universal programs. This underscores the need for instruments that can detect early, health-promoting shifts in families who have not yet developed clear difficulties. A brief program may also limit the degree of change that can realistically be expected in universal settings. Overall, the results indicate that universal parenting support can benefit both parents and professionals, and that Child Health Services offers an accessible platform for reaching families. Continued efforts are needed to ensure accessibility for families with diverse languages and life circumstances and to secure the organizational conditions required for sustainable implementation.&lt;/p&gt;&lt;h3 dir="ltr"&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;I. Blom, L., &lt;b&gt;Edenius, A.&lt;/b&gt;, Enebrink, P., Hjern, A., Silfverdal, S. A., Åhlén, J., Bergström, M., &amp; Lindberg, L. (2023). Little All Children in Focus (Little ACF), evaluation of a parental support program for parents of children aged 1-2 years: study protocol for a randomized controlled trial. Trials, 24(1), Article 184. &lt;a href="https://doi.org/10.1186/s13063-023-07212-4"&gt;https://doi.org/10.1186/s13063-023-07212-4&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;II. &lt;b&gt;Edenius, A.&lt;/b&gt;, Bergström, M., Lindberg, L., Bergqvist, K., Fröjlinger, A., Enebrink, P., &amp; Åhlén, J. (2024). Psychometric evaluation of the Swedish version of ages and stages questionnaire social-emotional: second edition for parents of children 18 months of age. BMC Psychology, 12(1), Article 564. &lt;a href="https://doi.org/10.1186/s40359-024-01996-z"&gt;https://doi.org/10.1186/s40359-024-01996-z&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;III. &lt;b&gt;Edenius, A.&lt;/b&gt;, Lindberg, L., Åhlén, J., Enebrink, P., &amp; Bergström, M. (2026). Little All Children in Focus (Little ACF) - evaluation of a parenting support programme for parents of children aged 1-2 years in Sweden: a randomised controlled trial. BMC Public Health, 26(1), Article 1563. &lt;a href="https://doi.org/10.1186/s12889-026-27733-2"&gt;https://doi.org/10.1186/s12889-026-27733-2&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;IV. &lt;b&gt;Edenius, A.&lt;/b&gt;, Engström, M, Lindberg, L., Enebrink, P., Bergström, M. Child health nurses' experiences of working with a structured universal parenting program for parents of toddlers in Sweden: a qualitative study. Manuscript in preparation. [Manuscript]&lt;/p&gt;</jats:p>