Protective and Promotive Factors Identified Relating to Parent-Child relations

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Discussion

This systematic literature review aimed to identify protective and promotive factors for ethnic minority children living in relative poverty in regards to parent-child relations. There was a total of 12 studies which fit the criteria and were reviewed, and the results will be discussed and reflected on guided by the three theoretical frameworks described in the background.

Reflections on findings

Resilience

It was evident that there are parent-child related protective and promotive factors leading to resilience in ethnic minority youth in relative poverty. Despite negative circumstances, factors were identified which promoted wellbeing and the negative circumstances could be overcome, which supports the findings of Zimmerman et al. (2013) who highlighted the vital role adults can have in the development of resilience. For example, feeling supported by one’s parents decreased the negative effect of discrimination and hopelessness in Roma youth (Kolarcik et al., 2015). The findings from this review support Masten and Monn’s (2015) conclusion regarding the need to link child resilience with family resilience and shift to a strength-based approach. This was particularly evident in the fact that maternal life satisfaction was positively associated with life satisfaction in Roma youth (Dimitrova et al., 2015). It suggests that there is indeed a call to go beyond child resilience and seeing the family as a unit to a higher degree than previously, working with the family as a whole and planning interventions accordingly. The child’s individual competencies must how-ever not be forgotten and ought to be encouraged as protective factors (Werner, 2000). The amount of positive findings in this review is in accordance with Neblett, Rivas-Drake, and Umana-Taylor (2012) who encourages research to not only see ethnic minority as a disadvantage and risk factor.

Children’s rights

To uphold children’s rights, findings from this review can to be used to facilitate and inform childhood interventions. Using a family-centred approach building on family strengths (Guralnick, 2001; Trivette et al., 1997), the result from this review would suggest that interventions for ethnic minority youth living in relative poverty ought to be more inclusive of the parents to be more effective. Involving parents and enhancing their wellbeing can have a direct or indirect impact on the wellbeing of these children. The results indicate that different ethnic minority youth can re-spond differently to stimuli. For example, father acceptance had a protective effect on self-reported levels of anxiety and depression beyond the mother’s acceptance in Hispanic/Latino youth (Leidy et al., 2011). This was however contrasted with Carter et al. (2014) who found maternal effects to have beneficial impact on internalizing symptoms in Hispanic/Latino youth, and that maternal but not paternal attachment was associated with positive outcomes in African American youth. Simi-larly, Dimitrova et al. (2015) found that life satisfaction in Roma youth was related to maternal but not paternal life satisfaction.
If children are to develop into their full potential and rightfully access – and continue – their education as per the UNCRC (UN, 1989), parental involvement in education is important, and the message from parents to their child needs to be that education equals hope for the future, as shown by Wang et al. (2014). This requires understanding the cultural values of the ethnicity in question. Among Roma children, more than 75% do not finish secondary school (World Bank, 2012). This is not necessarily an indication that their parents are intentionally overturning the UNCRC, but it is an example of a situation where cultural mismatch has occurred between parents and a service provider – in this case the school (Garcia-Coll & Magnuson, 2000). Improved com-munication between parents and teachers and an increased understanding of the differences in culture and values are key to move forward. This demonstrates the need to encourage ethnic di-versity also on a societal level.
Poverty continues to provide obstacles for child wellbeing and undermine children’s rights. The inequalities caused by growing up in a low-SES family need to be persistently and actively resisted and counteracted. Identifying protective and promotive factors are a part of upholding children’s rights and must not be ignored.

The Bioecological Model

Returning to the Bioecological Model, it can be summarised that all the results from this review are related to the proximal processes there described and promoted. Enhancing these prox-imal processes nearest the child can facilitate positive child development, which these studies all confirmed through positive parent-child interactions leading to positive outcomes.
This was especially visible in the results regarding ethnic socialization and ethnic identity. These two highly interactive processes are built on and shaped by the relations between parent and child, and were shown as ingredients for wellbeing in Roma youth (Dimitrova et al., 2014; Dimitrova et al., 2015; Dimitrova et al., 2018; Smokowski et al., 2014). This links with the results from Cameron, Lau and Tapanya (2009) which states that secure relationships with those within closest proximity such as parents are key contributors for protective factors in the lives of children growing up in diverse communities. In addition, it confirms the findings of Vera et al. (2011) in regard to ethnic identity moderating the effect of discrimination on life satisfaction. Naturally, these nurturing parent-child relationships can be traced back to Bowlby and his attachment theory, and in this case perhaps most suitably to his work specifically on security (Bowlby, 1988). The results also sustain the theory in Guralnick’s Developmental Systems Model for Early Intervention (2001) which in line with the Bioecological Model promotes the quality of parent-child transactions as critical to a child’s development. Fiese and Winter (2010) also support the notion of focusing re-sources on the family environment and exchanges – in their case specifically to aid socioemotional wellbeing in chaotic families.
The results for African American youth regarding parental involvement and paternal warmth support the conclusions of Williams, Hewison, Wagstaff, and Randall (2012) saying authoritative parenting and affection are related to wellbeing outcomes in African and African-Caribbean youth. This is reiterated in a review of the influence of low-income fathers on their children by Carlson and Magnuson (2011). Their conclusions include the quality of interaction between father and child as a predictor of child wellbeing. However, they call for further studies on specifically low-income fathers as the amount of evidence is relatively small. This can also be said following this review, where paternal factors were only a small part of the data available.

Limitations and methodological issues

Methodological issues

There are advantages and disadvantages to a systematic literature review. If done correctly – systematically, critically, neutrally and transparently – it synthesizes findings within a specific field in order to promote it for practice as well as identifying gaps in that knowledge which need atten-tion in further studies (Jesson et al., 2011). It also means it is replicable and that another researcher should be able to reach the same conclusions. However, there are ways through which the system-atic literature review can be weakened. Despite being carried out with diligence as the concept requires, there are nevertheless limitations to this review, summarised in four main methodological issues.
Firstly, the search process. Three databases were used, PsycINFO, MEDLINE and CI-NAHL. This could be deemed sufficient, and the author believed this to be an appropriate amount for the task in relation to the time and resources available. Despite this, more databases could have been included if further resources had been available, or alternatively the databases used could have been challenged and potentially altered to cover a broader area. However, the three databases used are large and cover health from medical, sociological and psychological perspectives. No manual search was carried out, which could have detected articles that the database searches missed. In addition, ethnic minority groups are not always referred to as such, and there is the risk that some minorities were missed and thereby not represented in the research reviewed. A manual search could have prevented this to some extent.
Secondly, this systematic literature review was undertaken by a single researcher over a restricted amount of time. Generally, these reviews are a substantially larger project, which mini-mizes the risk of bias in the selection process and maximizes the number of articles which can be processed. To balance out this disadvantage and increase the reliability of this study, there was an element of peer-review in this paper, when a second researcher read a randomly chosen third of the articles (9 out of 25) selected for full-text review. Using the PICO and the inclusion and exclu-sion criteria, with guidance from the full-text extraction form, the peer-reviewer was able to mini-mize bias through assessing these articles independently.
Thirdly, the quality assessment carried out is a potential risk for methodological issues. Naturally, quality assessments are an important part of systematic literature reviews and can en-hance the credibility of its findings (Statens beredning för medicinsk och social utvärdering, 2017). They are also a risk for bias, as it is the reviewer’s judgment which leads the assessment and sub-sequently the scoring (Jesson et al., 2011). Therefore, it needs to be considered a potential meth-odological issue, even though the author took measures to maintain as objective as possible and create a quality assessment tool suitable for the review. However, creating a quality assessment tool specifically for this review also aids the reliability of it.
Lastly, some of the filters and exclusion criteria used may have impacted the outcomes of the articles which were screened. The author set a limit for when the data for each study had to be collected, which was that the last set of data should not have been collected earlier than 2004. This was a way to ensure that the articles were still relevant, as the review set out to investigate the last ten years of research. But this did also restrict the articles included for screening. Age of participants was also used as a filter, and even though the only limit set was for children to be over two and no older than 18, it may have inadvertently removed eligible articles before the screening process. Additionally, ethnic groups contain individuals of great variety who embrace their cultural identity to a greater or lesser extent. Hispanic/Latino youth were grouped together, creating one large group of rather many groups of different albeit similar origin and the results may not be applicable to all subgroups. Similarly, the Roma culture is a diverse ethnic minority. Signified by their ‘mosaic’ blend made up by clans and subgroups, they are a group which is difficult to generalize findings for.

Limitations

This section will highlight the four main limitations identified regarding the studies included in this review.
Variations in instruments and definitions
There were some inconsistencies in instruments and definitions between the studies re-viewed. The measurements and instruments used in the articles varied greatly and the instruments have not been scrutinised by the author, which can compromise the validity of the findings (Creswell, 2009). Additionally, SES was measured and defined in different ways in each study, and were in some cases quite poorly defined. Although this review uses the concept of relative poverty, it can be considered as a weakening factor for the review. Despite the varied measurements and definitions in the studies, the aim was not to compare interventions but rather to find factors which improved the wellbeing of ethnic minority children living in relative poverty, which then allows for a slightly broader use of measurements and definitions, and the aim was still achieved.
Ensuring a child’s perspective
Although the aim was to capture a child’s perspective of what aids wellbeing, and despite all articles using child-reported data, this does not guarantee the findings representing the child’s perspective. The key flaw to raise here is that only parent-reported data was used for parental warmth in one study (Wang et al., 2014) and for family cohesion in another (Scott et al., 2016) which can be debated if that is the most optimal way of measuring those concepts. Additionally, it can be discussed if using child-reported data ensures a child’s perspective or not. Whichever way a study is undertaken, there are ways to making children active participants and thereby giving them a voice (Nilsson et al., 2015), and this could have been adhered to more closely.
Type and quality of study
Four of the 12 reviewed studies were longitudinal and the remaining eight were cross-sec-tional. In most research, systematic literature reviews and meta-analyses are considered the highest level of evidence, but in order to only review research first-hand these were excluded during the search process. In medical research, this is followed by blind or double-blind randomised control trials which minimizes risk of bias and promotes the highest level of evidence (Jesson et al., 2011), but this was naturally not relevant either in this review due to the nature of the research questions. However, that does not indicate that the level of evidence should not be challenged. Longitudinal (cohort) studies are generally considered higher up than cross-sectional studies in the hierarchy of evidence (Jesson et al., 2011), but unfortunately only a third of the studies were longitudinal. In addition, resilience is best studied over time (Rutter, 2000). Therefore, if more of the studies had been longitudinal the findings would have had the chance to be more deeply grounded through observations over time.
Recruitment and participants
Recruiting through schools, which was the most frequently used method, can skew the results as this is likely to inadvertently miss truant children and those who do not attend school at all, and none of the articles addressed this problem. Often these are children in most need of being heard, and the recruitment pathways must consider this and not take advantage of the easiest option for recruitment.

Ethical considerations and issues

It is imperative to ensure that ethical standards are maintained in research, especially when it concerns children. The four cornerstones of Beauchamp and Childress (2009) were all present in the reviewed studies and it was clear that the authors’ intentions were in the best interest of the participating children. However, there are steps which – if done inattentively – can unintentionally compromise these values. Methods of ensuring that a study maintains ethical standards include gaining ethical approval from relevant ethics board, maintaining the participants’ confidentiality when storing and presenting data, providing information to the participants and obtaining consent (Creswell, 2009). Two of the twelve studies explicitly expressed using active (parental) consent and assent. Two had no mention of neither consent nor assent. The remaining eight had a mixture of active and passive consent or assent. This is particularly interesting considering the relatively high age of the participating children, and causes a call in line with Nilsson et al. (2015) for an increased level of information to the child – written or verbal – as the foundation for informed consent or assent. Another issue regarding consent is that of passive parental consent in cultures where illiter-acy levels may be high. Four of the studies concentrated on Roma youth, whereof three (Dimitrova et al., 2014; Dimitrova et al., 2018; Kolarcik et al., 2015) used passive parental consent. In the south-eastern European region, 22% of Roma men and 32% of Roma women are illiterate (UNICEF, 2011). Besides the light it sheds on the needs to promote education for the Roma, it sharply chal-lenges whether passive parental consent is ethically sound and appropriate in those situations and if it gives the parents a fair opportunity to choose not to participate. This raises the issue of ‘hard to reach’ groups. The groups which are in most need of helping to inform research and subse-quently interventions and policies are often the most difficult groups to reach, and this can lead to both methodological and ethical challenges such as this (Kennan, Fives, & Canavan, 2012).

Future research and implications for practice

Looking forward, there are lessons from this systematic literature review to consider in future research. Firstly, there were not many child-centred studies focusing on the parent-child aspect in regard to protective and promotive factors for ethnic minority children in relative poverty. This despite them being an acknowledged vulnerable group at risk for remaining in the vicious circle of poverty and at risk for suffering many physical and psychological disadvantages. They are a target group which is often hard to reach, making the need for studies even greater.
Ethnic identity and/or ethnic socialization were constructs which were associated with pos-itive outcomes in wellbeing among all four ethnic minorities (Dimitrova et al., 2014; Dimitrova et al., 2015; Dimitrova et al., 2018; Smokowski et al., 2014) and supports the findings of Zapolski, Beutlich, Fisher, and Barnes-Najor (2018) who underscore the need to involve parents and care-givers in interventions for wellbeing. The concepts of ethnic identity and ethnic socialization were however only part of four of the studies reviewed, leaving ample space for broadening that partic-ular field of research to more fully understand the effect of ethnic identity and socialization on youth wellbeing. This is in line with Zimmerman et al. (2013) who argue that ethnic identity and social support should be a central focus for intervention as they can be altered and can help by using positive characteristics for youth adjustment.
As the results showed such benefits of parental factors (be it joint, maternal or paternal), interventions for youth – and children – in these circumstances ought to focus more closely on family-based interventions. Carlson and Magnuson (2011) called for further research on how the fathering process among low-income fathers and the effect of it varied by culture, ethnicity and race – a call with which this review can only agree. This would require rather complex aspects to be considered, such as absent fathers, mothers with children from different partners and cultural beliefs about fatherhood. The question is also how ethnic minority youth differ or do not differ from mainstream youth in their countries – do they need interventions that are different from other youth also living in relative poverty? How much does discrimination affect outcomes? Or does it simply come back to Sameroff and Fiese’s (2000) individual perspective of seeing ‘a particular child in a particular family’? Is research prone to wanting to generalise too frequently, and can all children within a certain ethnic minority group be assumed to respond in the same way to protective and promotive factors? These are questions to consider and weigh, whilst not forgetting to strive for these children’s rights and their best.
A gap in the research which became evident during even the early search stages were the age groups represented in studies on ethnic minority children. Despite only limiting the initial search through filters removing articles focusing on children under 2 and over 18 years, only seven studies out of the 25 articles reviewed at full-text level included children under the age of 10. It can be argued that if a child’s perspective is desired, youth will be the most suitable group for self-report. However, youth are not the only age group of children able to provide a child’s perspective (Nilsson et al., 2015). There is a need to look beyond fixed assumptions and to return to the foundation of the effectiveness and importance of early childhood intervention. Surely here further research with younger children is required to provide them with the best possible start as early in life as possible.
Applying the findings to practice, practitioners in all fields can facilitate the results from this review in daily work and intervention planning. In the educational field, the fact that parental educational involvement decreased problem behaviour among African American youth and that the quality of parent-teacher communication was significant (Wang et al., 2014) signals the im-portance of good parent-teacher relations as a route to positive outcomes for these youth (Trieu & Jayakody, 2018). Although the findings cannot be generalised to other groups without further re-search they can still be considered. Within the field of social work and other community-based roles, the positive effect of parental wellbeing on child wellbeing among Roma (Dimitrova et al., 2015; Dimitrova et al., 2018) can be absorbed into practice through increased services to parents as a mean to child and youth wellbeing. This can partly be enhanced through strengthening their informal support (Trivette et al., 1997). Also in healthcare results from this review can be applied, including facilitating maternal and paternal resources for reducing depressive symptoms in ethnic minority youth (Carter et al., 2014; Leidy et al., 2011).

1 Table of Contents
1 Introduction
1.1 Background
1.2 Theoretical frameworks
1.3 Rationale
1.4 Aim
1.5 Research questions
2 Method
2.1 Systematic literature review
2.2 Search strategy
2.3 Selection criteria
2.4 Selection Process
2.5 Data analysis
3 Results
3.1 Descriptive results
3.2 Protective and Promotive Factors Identified Relating to Parent-Child relations
3.3 Differences between ethnic minorities
4 Discussion
4.1 Reflections on findings
4.2 Limitations and methodological issues
4.3 Future research and implications for practice
5 Conclusion
6 References
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