Facilitators and barriers to the sustainability of universally accessible parental training interventions: a systematic qualitative review using normalization process theory

Background: 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, selfefficacy,
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.
Methods: 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.
Results: 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.