The large number of different programs confirms that eHealth interventions are a growing strategy in the domain of health related parenting interventions in the domain of health-related parenting interventions (Table 1). The diversity of target populations and aims were organized into two large groups. The first one included universal interventions directed at supporting parents, from the child’s birth to the transition to college, in their tasks to promote healthy behaviours and attitudes or to identify and solve common health problems. As expected, the most frequently identified programs were those directed at promoting healthy eating habits or at obesity prevention.

The second group included all programs directed to specific chronic conditions or severe acute diseases or procedures. Several interventions were directed to the most common pediatric chronic conditions, while others targeted rare conditions, for which it is more difficult to obtain information and support. Again, overweight was the the most frequently targeted condition, followed by asthma, allergies, and respiratory diseases, corresponding to common and difficult to manage chronic childhood conditions. However, some rare problems are very frequently addressed (sequels of traumatic brain injury), while more common problems (e.g., enuresis) were not at all or rarely (e.g., sleep problems) addressed.

The conducted scoping review identified interventions solely directed towards parents (Merkel & Wright, 2012; Stark et al., 2015) and child or youth-centered interventions involving parents as an adjunct. In this case, the role of the parent can be parallel to the one of the child, such as in one chronic pain intervention (Palermo et al., 2009), in which parents and children participate in a web-based program which includes specific modules directed to each one. Some programs are directed to parents and children together and

aim to stimulate specific interactions or family behavior patterns (Delamater et al., 2013; Fang & Schinke, 2013). Yet, others such as that proposed by Baranowski et al. (2003) are child or adolescentcentered programs, often in a face-to-face or group format, and provide information or coaching to parents through online complementary modules. Most interventions that target adolescent health problems have an important component directed to them, and the parents play an adjunctive role, while most programs for younger children-related issues are centered on parents alone.

Table 1

The conducted scoping review showed the creative use of a wide range of technological applications. In this section, the main characteristics of each technology are described and examples are provided. However, many of the programs reviewed used a combination of different technologies to ensure a more comprehensive and integrated intervention. The major technologies involved in each program are described below.

The majority of the programs identified (N = 61) were structured self-guided interventions operated through a website. They usually included a sequence of online sessions, provided at regularly scheduled intervals (e.g., once a week) and used several components such as information, quizzes, suggestions of activities, or coaching and behavioral skills training. Task completion is followed by individually tailored feedback on progress, incentives, and reinforcement or suggestions to overcome difficulties. Most online programs are theory-driven interventions, and replicate face-to-face programs that have been previously empirically validated (Clarke, Calam, Morawska, & Sanders, 2013; Doherty, Calam, & Sanders, 2013). In some cases, the technologymediated programs are delivered combined with face-to-face sessions (e.g., Maddison et al., 2014).

The second largest group of interventions (N = 18) included easy-to-use platforms with a large variety of information that parents can consult whenever they wish to learn the most relevant information on their child’s health or illness. This method of disseminating information can be more appealing, flexible, and suitable to the needs and preferences of diverse populations, since they include videos and audio clips, animations, illustrations, pictures, and text materials.

These programs often include interactive elements so that parents can receive answers tailored to their doubts or worries (Starling et al., 2014). A particular adaptation of this technology (Carlson Gielen et al., 2007) involved inviting parents visiting an emergency service to use a computer kiosk containing a website on child safety measures and to fill in a questionnaire. The participant parents received a printed tailored report with suggestions to change their child’s safety behaviors.

Nine interventions involved computer or mobile phone-mediated support groups, allowing parents to communicate, discuss, and share issues related to their children’s health conditions or illnesses by connecting with other parents facing similar challenges in a secure environment. Several technologies may be involved, such as email (Bragadóttir, 2008), Facebook parent group (Campbell et al., 2016; Gruver et al., 2016), chat rooms, forums, blogs, or discussion boards (Ewing et al., 2009; Martin et al., 2016). The common feature is that these groups are always mediated by a psychologist or a health professional that monitors the adequacy of messages and information and provides additional information or feedback when appropriate.

The use of mobile phone or tablet applications was tested in eight interventions designed to help parents monitor and change their child’s health related behavior. These applications may include a variety of formats allowing parents to receive individually tailored short informational or motivational messages providing feedback on progress or outcomes (Curtis, Lahiri, & Brown, 2015). These applications may have a feature that allows parents to enter information about specific occurrences or events (e.g., eating behaviors and physical activity) and children’s clinical parameters or participation in scheduled activities. Some interventions include parental goal setting, monitoring, and feedback (Nezami, Lytle, & Tate, 2016).

A number of programs and applications (N = 7) have been developed to facilitate decisions about the child’s health using platforms or applications that provide tailored information and decision aids designed to help parents understand their options and potential outcomes and consider the possible benefits and harms of their choices. These may include probabilistic information in easy to understand presentations, information about the potential outcomes of each choice, and exercises to clarify values and guide parents through their thinking process (O’Connor et al., 2009). For instance, parents receive preliminary information and fill in an individual questionnaire and are then guided through their decision making process concerning immunizations (Seeber et al., 2017) or are coached on how to monitor and control chronic asthma through an adaptation of previously prescribed measures (Nkoy et al., 2012).

Five programs used technologies such as videoconferences or video telephone to make scheduled individual or group calls, allowing synchronous communication with parents who have difficulties in attending face-to-face consultations. Specialized healthcare professionals provide specific education, counseling, and monitoring concerning difficult parenting tasks or problems. Harris, Freeman, and Duke (2015), for example, used a structured parent and adolescent training program through scheduled Skype calls with a psychologist to improve diabetes outcome in youth.

Individually tailored messages were used alone or as a component in more complex interventions (N = 5). Their common feature was message scheduling and customized contents, which was used to support parents’ efforts to change their role in supporting their child/ adolescent’s progress. Simple messages are used mostly to remind and motivate parents (e.g., to improve vaccination rates) (Domek et al., 2016). A creative technology, the Talking-Card, was proposed by Cowden et al. (2015), through which, after the medical consultation, parents received a card containing a chip with recorded customized instructions by the pediatrician.

Four interventions used Interactive Voice Response (IVR) technologies to guide parents at home through interactive, speech-based discussions to gather information about the treatment and the child’s progress or to reinforce recommendations and treatments. IVR systems are particularly well suited for use by vulnerable populations because they only require users to have access to a telephone. They use synthetic speech and spoken responses (Adams et al., 2014). The used informatics system allows personalization of the calls, for instance, by identifying the child by their name and mentioning specific aspects of the child’s process (e.g., medication).

Although most eHealth videogames are directed at children, two examples directed at parents were found. They involved games addressing parent-child/adolescent interactions, allowing parents to improve communication by teaching them skills to talk about sexuality with their adolescent children (Bayley & Brown, 2015) or to lead their child to comply with a specific health behavior (Beltran et al., 2012).

As mentioned before, the use of technologies in parenting programs results mainly from the belief that they could be more accessible, acceptable, and easy to disseminate among hard-to-reach populations, and that they have lower costeffectiveness ratios. Therefore, they are mainly grounded on behavioral evidence-based methods. In some of the articles reviewed, the use of a theory-driven approach is clearly stated and detailed, whether in others it was more implicit. It is important to investigate how technology mediated interventions can successfully replicate face-to-face interventions and also how these technologies can enhance the applicability and efficacy of other methods or even develop new methods of intervention.

According to the organization proposed by Kahana, Drotar, and Frazier (2008), it can be observed that most programs included informational or educational strategies. These interventions are aimed at promoting parental competence and autonomy, adherence to preventive practices or medication regimens, to offer the cognitive requisites for parents to be able to set health goals for their children, take informed decisions, and monitor their child’s health progress.

However, most programs reviewed are not limited to information and education and aim directly to change parenting behaviour through the acquisition of effective self-management skills, more effective coping strategies, or positive parenting strategies (Fidika et al., 2015). A large number of programs addressed specific components outlined by self-regulation and self-efficacy theories (i.e., intrinsic goal setting, and self-monitoring) by providing information, guided feedback, and social support (Curtis et al., 2015). Changing outcome expectations, perception of barriers to effective behavior change, and the ability to restructure the child’s environment are important parenting competencies targeted in several programs (Nezami et al., 2016). Promoting parental motivation to implement a healthier lifestyle for their children, to change specific health behaviors, to increase adherence to preventive or treatment measures, and promoting parental self-efficacy are explicit key dimensions in most of these programs (e.g. Armbrust et al., 2015; Chen, Weiss, Heyman, Cooper, & Lustig, 2011; Merkel & Wright, 2012).

Direct instructions reinforced by coaching or modelling were used to help parents develop or adopt positive parenting strategies (reflective listening, reinforcing, relaxation training) related to healthy life-styles or to the adherence to treatment. Antonini, Raj, Oberjohn, and Wade (2012) developed a training program for parents of brain injured children combining modelling with a parental role-play of their newly acquired skills, which was recorded and sent to the therapist so that direct feedback could be provided.

Many of the interventions included a component of self-monitoring or monitoring of the child’s behaviours and symptoms as a critical element to promote effective parental self-management (Nkoy et al., 2012). Portable devices, such as a pedometer (Delamater et al., 2013), can facilitate the monitoring of the child’s physical activity.

Several programs using parental selfmonitoring also included some type of customized feedback to help parents recognize their progress and reinforce their behaviour change efforts (Cook et al., 2015; Delisle et al., 2015; Militello, Melnyk, Hekler, Small, & Jacobson, 2016). Self-monitoring with timely feedback can improve motivation and maintain adherence to behaviour modification programs by reinforcing involvement efforts and correcting errors and failures. Interventions targeting preventive parenting behaviors were based on giving feedback to parents to change their perception of social norms and increase their awareness of their child’s behavior towards normative guidelines and possible consequences of these behaviors. A program aiming at controlling adolescent alcohol consumption (Brown, Dunn, & Budney, 2014) is a good example of this concept. Fidika et al. (2015) proposed an intervention for parents of children with cystic fibrosis, in which a therapist gave individualized weekly feedback to parents to coach them toward the adoption of more effective coping strategies.

Several interventions provide social support for parents that may feel more isolated, aiming to help them adapt to difficult transitions or chronic conditions. Receiving adequate social support can help decrease emotional disturbance, facilitate parental self-efficacy (Stewart, Letourneau, Masuda, Anderson, & McGhan, 2011), and enhance the quality of life of families (Bensink et al., 2007). The possibility of synchronous communication with other parents that are experiencing similar problems through videoconferencing or establishing communication at their own pace using blogs or Facebook groups can make a difference for more isolated and vulnerable parents (Bragadóttir, 2008).

When targeting specific chronic conditions, several interventions use Cognitive-Behaviour Therapy (CBT) principles and techniques and integrate cognitive and behavioural evidence-based methods to encourage parents to change their maladaptive beliefs about their child’s health conditions, control anxiety, and increase perceived control. These programs aim to encourage parents to use more positive and effective educational practices and to teach them how to coach their chronically ill child to control pain or other symptoms. Several family-based CBT programs to control chronic pain, which include multiple elements, such as relaxation training, activity pacing, problem solving, and distraction techniques (Nieto et al., 2015; Palermo et al., 2016, 2009; Stinson et al., 2010) have offered preliminary evidence Other examples are the Triple-P programs for parents of children with asthma (Clarke et al., 2013) and type1 diabetes (Doherty et al., 2013). These programs, derived from the Triple P Positive Parenting Program to prevent behavioural and emotional child problems, are based on the social learning theory and are aimed at increasing parental self-efficacy, through training on disease management strategies. An innovative approach uses CBT with adolescents with gastrointestinal functional disorders, emphasizing the use of exposure treatment to practice experiencing symptoms in difficult situations, to reduce avoidance behaviors and fear of symptoms (Bonnert et al., 2014). In this case, the role of the parents in helping and reinforcing the exposure component seems critical to the success of the intervention (Levy et al., 2010).