JMIR Publications

ABSTRACT

Background:

Parents of children living with chronic health conditions experience elevated levels of stress, which can negatively impact both parental wellbeing and child outcomes. Evidence indicates that group-based stress management interventions can improve stress outcomes and family functioning; however, little is known about how and why these interventions work, for whom, and under what contextual conditions. This realist review aimed to explore the mechanisms and contexts that underpin the effectiveness of group stress management interventions for parents of school-aged children living with chronic health conditions.

Objective:

To identify and synthesise evidence on the underlying mechanisms and contextual factors of group stress management interventions for parents of school-aged children living with chronic health conditions.

Methods:

A realist synthesis was conducted in accordance with RAMESES II standards. Five electronic databases (CINAHL, EMBASE, Emcare, Medline, and Psychology and Behavioural Sciences Collection) were searched for studies published between 2015 and July 2025. Eligibility criteria were informed by SPIDER and Context–Mechanism–Outcome (CMO) frameworks. Screening followed PRISMA guidance, and methodological quality was assessed using CASP and MMAT tools. A theory-driven realist synthesis was conducted to synthesise data. A refined programme theory was developed to explain why interventions worked or failed, for whom, and under what contexts. Behaviour Change Techniques (BCTs) were also extracted and coded at synthesis to determine the use of behaviour change theory across interventions.

Results:

Three studies met inclusion criteria, encompassing interventions based on Integrative Body-Mind-Spirit, CBT-based hypnosis, and problem-solving approaches. Five key mechanisms were identified: peer support, psychoeducation, skills practice and modelling, mind–body techniques, and structured reflection. These mechanisms were associated with reduced perceived stress, improved emotional regulation, increased self-efficacy, and enhanced coping. However, intervention effectiveness was shaped by contextual factors, including caregiving burden, socioeconomic conditions, and participant characteristics. Evidence suggested that while behaviour change techniques were present, explicit theoretical integration was limited.

Conclusions:

Group stress management interventions can positively influence parental stress and wellbeing when key mechanisms are activated within supportive contexts. However, current evidence is limited and may not fully reflect complex real-world settings, particularly within NHS populations experiencing higher levels of adversity. Future research should prioritise theory-driven intervention design and explore adaptation for diverse and under-represented populations. Clinical Trial: The review protocol was registered in PROSPERO (registration number: CRD420251012583).