Table 3.

Descriptive information summary of papers using Learning Principles (LP) aligning with Dimensions of Learning.

Author/year/ country	Aim, design, sample size, duration	Health professional	DoL1-5			Theory/construct/model	Examples of Learning Principles: DoL1: perception, attitude to learning; DoL2: Acquire, integrate knowledge; DoL3: extend, refine knowledge; DoL4: apply knowledge meaningfully; DoL5: tasks become regular part of life, develop autonomy. Barriers are to HPs use of LPs.
			a	b	c
Australian Confederation of Paediatric and Child Health Nurses 2016 [33] (Australia)	Standards of Practice for Children's and Young People's Nurses (CYPN): Purpose: To provide minimum standards, framework to 1) inform practice 2) enable practice review 3) support curriculum development and assessment. Design: practice standard Sample: N/A Duration: N/A	Children's nurse	✓	x	x	Partnership approach	Terms used for LPs: education strategies: anticipatory guidance, health promotion activities DoL 1 – Cultural safe environment, multiple approaches, communication, promotes health literacy DoL 2 – Learning, care partnership (enabler for using LPs): plans, goals, health, life changes. HPs liaison, discharge plans DoL 3 – enables family, child, collaborative, interactive educational strategies, facilitate decision making skills DoL 4 – New knowledge and skills helps parents apply strategies, engaged with care, self-management DoL 5 – Increased knowledge, achievable, safe discharge care, lifestyle changes. Evaluation (of learning) General evaluation of nurses' practice, not parent learning.
Australian Diabetes Educators Association (ADEA) 2014 [34] (Australia)	ADEA National Standards of Practice Credentialed Diabetes Educators. Purpose: to provide Standards of practice framework to assess clients, improve practice, develop education, use quality assessment programs, peer review. Design: practice standard Sample: N/A Duration: N/A	Diabetes educators	✓ x x			Health belief model	Terms used for LPs: Teaching and Learning Principles DoL 1- Aware of culture, physical, social, privacy, safe teaching space, health literacy needs, interpreter used DoL 2 – knowledge of causes, management, metabolic control, growth/development issues. Plans created collaboratively DoL 3 – facilitate self-management skills/capacity, understanding. Follow-up appointments. DoL 4 – HPs evaluate patient/parent learning, problem solving, self-management, decision-making skills, sick day management, blood glucose monitoring (BGL), insulin adjustments, healthy diet. DoL 5 – Long-term behavioural changes: mastery of self-management tasks. Evaluation of Learning: data monitoring of client care, less presentations to emergency department, less hospital stay.
Australian Diabetes Educators Association 2015 [35] (Australia)	Role and Scope of practice for credentialed diabetes educators (DE) in Australia Purpose: to provide the standards of best practice – diabetic nurses Design: practice standard Sample size: N/A Duration: N/A	Diabetes educators	✓ x x			Theories: Teaching, Learning, Behaviour Change Chronic Disease	Terms used for LPs: learning styles, readiness, self-mastery, changed behaviours. DoL 1 – assess learning needs, readiness, extent of behaviour change. Recognise stress of diagnosis, mental health, psychosocial impacts. DoL 2 – declarative and procedural knowledge: healthy eating, being active, monitoring condition, taking medication, reducing risks, client, family driven learning, guided by DE, set goals: identifying current knowledge, abilities. DoL 3 – build on strategies to manage diabetes, management of diabetes for sport, school, using care plans DoL 4 – develops problem solving skills for diabetes control, masters monitoring, implements care plan. DoL 5 – changed behaviours enabling optimal diabetes care Evaluation: How HPs evaluate the effectiveness of pre and post diabetes education.
Australian Health Ministers' Advisory Council (AHMAC) 2011 [36] (Australia)	A National Framework for Family and Child Health Services Purpose: To articulate objectives, vision and principles for universal child and family health services for Australian children, 0–8 years. Design: practice standard Sample: N/A Duration: N/A	Nurses, allied health professionals, Indigenous health workers	✓ x x			none.	Terms used for LPs: educational strategies DoL 1 – parent readiness, capacity to learn, identify literacy levels, prior knowledge, assess fatigue, depression, mental health. Negotiate learning partnership (enabler for using LPs):. DoL 2 – facilitate anticipatory guidance, hands-on skills. Declarative, procedural education on feeding, safe sleep, reading to child, nurturing relationships, play, nutrition, oral care, healthy eating, not smoking. DoL 3 – builds on previous and knowledge as child grows, develops. Follow-up scheduled timepoint visits. Drop-in clinics to discuss concerns of parents or any identified by HPs. DoL 4 – Parent can use knowledge gained, adjust, adapt as child changes over time. DoL 5 – Autonomous mastery of care. Evaluation: Performance indicators: meet organisational targets, service usage by families. Parent satisfaction measures.
Blunt 2009 [37] (USA)	Supporting Mothers in Recovery: Parenting Classes: Discussion paper: proposed strategy for mothers of babies in Neonatal Intensive care unit (NICU) after birth. Design: Discussion paper Sample size: N/A Duration: N/A	Nurses	✓ ✓ x			Social Learning Theory	Terms used for LPs: education strategies, willingness to learn, peer learning DoL 1 – NICU mother receptive to help, readiness to learn, PEP in safe place, mother's prior life-experience and mental health status acknowledged. Peer learning: mothers were prior drug users, but learned parenting skills DoL 2 – factual information on caring for baby, shown skills, help learning of baby's cues, practical skills. DoL 3 – practised parenting, coping, dealing with stressors skills with HPs, refined to life-situation and baby. Phone support by nurse. DoL 4 – able to provide care at home. Realise why they need to problem-solve, not revert to prior drug habits. Peer mentors. DoL 5– lifestyle change is not only learning parenting skills but changing drug use behaviour. Evaluation: Identified as ‘needed’ Barriers: stress of situation, mental health of mothers, previous life experiences
Bonner et al. 2002 [38] (USA)	Identify if Asthma Self- regulation (ASR) education intervention improved parent knowledge, management and adherence to treatments of their child's asthma. Design: RCT Sample size: (n = 100) Duration: 3 months	Allied Health	✓ ✓ ✓			Readiness to learn. Self-regulation	Terms used for LPs: Learning sequence, coaching DoL 1 – readiness to learn, change attitudes, cultural beliefs to see Dr only if asthma severe. Used interpreters DoL 2 – identified needs, declarative and procedural knowledge, ASR model DoL 3 – use of diary, build parent skills to talk to Dr. Care plan when to treat and seek medical help. Phone support. DoL 4 – proactive in adjusting asthma medications, confident to actively interact with GP. DoL 5 – changed behaviours, more pro-active in management, symptom recognition Evaluation: success-decrease in symptoms, changes in medication use, confidence. Barriers: cultural beliefs variance, language differences.
Burkhart et al. 2007 [39] (USA)	Test educational intervention (school) by asthma education nurse (AEN) and contingency management protocol effect on parents' asthma management of their child. Design: RCT Sample size (n = 77; 38 controls, 39 intervention group [IG]) Duration: 16 weeks	Asthma nurse	✓ ✓ ✓			Cognitive, Social Learning Theory	Terms used for LPs: teaching, observing, practising, self-managing DoL 1 – safe learning environment for child & parents (school) DoL 2 – multi-modal explanations, demonstrations. Nurses also visited at home DoL 3 – symptom diary use, traffic light analogy in asthma care plan. Phone support, extend knowledge DoL 4 – parents' learning at school session enabled treatments at home: better symptom recognition, used action plans to problem-solve changes in asthma DoL 5 – Changed behaviours: better symptom management. Confidence. Evaluation: decrease in disease severity. Asthma QoL scales. No parent knowledge evaluated. Barrier: maintaining motivation of parents for ongoing care
Butz et al. 2005 [40] (USA)	Evaluate home-based asthma symptom education intervention, by asthma community nurse (ACN), targeting symptom identification for parents of children with asthma. Design: RCT (n = 251; 105 control, 105 intervention group [IG]) Duration: 6 months	Asthma community nurse.	✓ ✓ ✓			Model of symptom management	Terms used for LPs: only used term teach, ‘learn’ not mentioned at all, self-management DoL 1 – home visit by ACN, safe environment for parent education, ready to learn DoL 2 – teach declarative and procedural knowledge about asthma, asthma plan, 8 modules, checklist DoL 3 -– peak flow monitoring, refining skills and knowledge DoL 4 – problem-solving, decision-making skills used, symptom identification and actions DoL 5 – changed behaviours in longer-term symptom management Evaluation: home record visits over 6 months and parent self-report survey of changes
Canino et al. 2007 [41] (USA)	Identify effectiveness of a culturally adapted family-based intervention (CALMA) for reducing asthma morbidity in Puerto-Rican children Design: RCT Sample: (n = 231). Duration: 4 months	Allied Health	✓ ✓ ✓			none	Terms used for LPs: self-management; cultural competence. DoL 1 – home visit, motivation, cultural awareness, safety, used interpreters, readiness to learn DoL 2 – declarative and procedural knowledge about asthma & treatments over 18 days, checklist. DoL 3 – diary use, refining knowledge, skills, asthma care plans: symptom management knowledge DoL 4 - problem solving, decision making, symptom recognition DoL 5 – confidence gained, fewer emergency department visits Evaluation: Juniper QoL survey, Caregiver outcome measure, baseline parent interview, repeated 4 months after project start, improved treatment strategies. Barriers: cultural health belief variance, language differences
Cox and Oaks Westbrook 2005 [42] (USA)	To identify and describe family caregiver views of learning chemotherapy home infusion therapy and the nursing actions aiding this learning Design: Grounded theory Sample: (n = 4) Duration: 5 months	Paediatric nurses	✓ ✓ ✓			Adult Learning Theory Knowles 1984, Bandura Self-efficacy, Swanson's Theory of Caring	Terms used for LPs: social and educative process of learning with 4 domains; learning how, what was helpful (context), can I do this? (meaningful), doing it at home myself. DoL 1 – emotional considerations, beliefs, stress of diagnosis, home environment for PEP, readiness to learn DoL 2 – declarative, procedural knowledge and skills for infusion at home, used models, diagrams, equipment DoL 3 – correcting and extending home-management knowledge and skills, phone support. DoL 4 – make care decisions, problem-solving scenarios, revised skills, knowledge DoL 5 – developed confidence, capability to do care at home Evaluation: nurse saw parent perform skills repeatedly, correct answers to problem-solving scenarios. Barriers: shock of diagnosis and magnitude of required care, fear of hurting child
Craft-Rosenberg and the American Academy of Nursing Child Family Expert Panel 2002 [43] (USA)	Identification of quality and outcome indicators for Maternal Child Nursing. Purpose: to define core values, concepts, assumptions defining Child Health Nursing for establishing quality and outcome indicators. Design: Discussion paper Sample size: N/A Duration: N/A	Child Health Nurses	✓ x x			none	Terms used for LPs: educational needs DoL 1 – child and parent focused care, culturally safe learning environment. Identify learning needs, caregiving burden recognised DoL 2 – parents counselled; theoretical, practical teaching aligns with identified needs, builds caregiving skills, validate learning with family. DoL 3 – builds on child and family goals. DoL 4 – facilitate parents applying learned skills, build strengths, understanding DoL 5 – encourage changed behaviours that promote optimal outcomes and reduce risk. Evaluation: Evaluation of desired outcomes varies for each practice subspecialty
Ersser et al. 2013 [44] (UK)	Evaluate service impact outcomes of nurse-led, social learning theory model for Parent education on child, parent and service-related outcomes for eczema management. Design: Quantitative Sample (n = 257 purposive parent/child dyads) Duration: 10 weeks	Community nurses	✓ ✓ ✓			Bandura Self-efficacy	Terms used for LPs: interactive learning, problem-solving DoL 1 – attitudes towards under-treatment, failure, fear of topical steroids DoL 2 – linking prior knowledge to new. Analogies, volumes, timings of treatments. 3 weekly 2-hour sessions. DoL 3 – eczema care plans. Nurse phone support available to answer questions DoL 4 – on-going decision making in treatment adjustments: when to use steroids, use of moisturisers DoL 5 – developed confidence, capability to treat eczema, maintain moisturiser use. Evaluation: parental self-efficacy of treatment adherence changes; self-reported qualitative parent information on management pre and post-test. Barriers: Topic knowledge and confidence of the nurses
Fowler et al. 2012a [45] (Australia)	Explored Reciprocal learning in partnerships in practice: family home visiting program (FHV) of 10 visits by Child Health Nurses for mothers with depression, compared to didactic model. Design: Qualitative Sample: (n = 3 nurses, n = 3 mothers) Duration: 1 interview.	Child Health nurse	✓ ✓ ✓			Reciprocal learning in family partnerships	Terms used for LPs: shared learning, knowledge enquiry, learning and knowledge development, knowledge production, developing effective parenting solutions DoL 1 – mother's mental health state, joint decision-making, trust, relaxed setting, nurse/parent questions determined learning needs. DoL 2 – individualised learning, learning cues, skills for recognising baby's needs, video-taped session for mother to see, partnership approach (enabler for using LPs): DoL 3 – parents supported to develop knowledge and parenting skills further from viewing video, phone support DoL 4 – developed problem-solving and decision-making skills: moved from uncertainty to capability DoL 5 – diverse ways of knowing about their baby, deeper knowledge, changed behaviours Evaluation: Qualitative responses of mothers. Barriers: parent mental health issues
Fowler et al. 2012b [46] (Australia)	Co-producing parenting practice: Learning how to do child and family health nursing differently. Design: Discussion paper Sample size: N/A Duration: N/A	Child Health Nurses	✓ ✓ x			Reflection-in- action, Reflection-on- action (Schon1983); Reciprocal learning	Terms used for LPs: partners in learning and knowledge construction DoL 1 – Parent/nurse establishing shared learning, readiness, health literacy, trust, safe learning environment, mental health state of parents, goal setting DoL 2 – existing knowledge established, built new knowledge about caring for baby in parent classes, health checks or home visits, partnership approach (enabler for using LPs):. DoL 3 – nurse helped mother to see issues from perspective of baby and parent to increase understanding, skills, recognise baby cues. Phone support DoL 4 – mothers applied knowledge meaningfully at home and in between visits. Built capacity, confidence DoL 5 – behaviour change, caring became part of daily life, build capacity and capability. Evaluation: reported need for evaluation by observing mother and baby interaction. Barriers: nurses changing from didactic approaches for parent education
Furlong et al. 2012 [47] (USA)	Assess cost effectiveness and outcomes of Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children 3–12 years (Only parent skills learning reported here) Design: Systematic Review (n = 1 paper, Martin & Sanders 2003) Duration: 4 months.	Allied Health	✓ ✓ ✓			Social Learning Theory, operant learning theory	Terms used for LPs: Learning ‘How and When’. DoL 1 – compelling reason to learn: child's distorted cognitions DoL 2 – declarative and procedural: taught 17 core positive parenting/child behaviour strategies; learned reasons for cognition problems, practical solutions some operant learning involved. Checklist to assess behaviour changes. DoL 3 – building, applying strategies, goal setting, seeing videos, sibling involvement, revising weekly. DoL 4 – increased problem-solving skills, anger management improved DoL 5 – changed behaviours, parents could use strategies learned to apply for child's behaviour in any settings Evaluation: self-reporting, parent behaviour scales, child behaviour inventory, parent depression/anxiety scale, problem setting-behaviour checklists for parents' responses. Barriers: mental health, life situations of parents
Furmedge et al. 2013 [48] (Australia)	To gain insight on parents' experiences of learning to administer Clotting factor (CF) concentrate via their child's Implanted Central Venous Access Device (CVAD): first step in developing educational program. Design: Qualitative Sample: (n = 15) Duration: none stated	Paediatric nurse	✓ ✓ ✓			none	Terms used for LPs: educational needs DoL 1 – confronting diagnosis, motivation to reduce hospital presentations, parents' anxiety in doing procedures, learning in home environment was important. DoL 2 – goals set, stepped information, practice at each step. Revisited skills until capable. Written, verbal resources. DoL 3 – parents asked questions, revisited skills if parents made errors, phone support. DoL 4 – problem-solving and decision- making, answering scenario-based questions DoL 5 – sense of empowerment, changed lifestyle to recognise treatment requirements. Evaluation: parents seen by nurses capably doing procedure in hospital and home, could explain verbally, rationales. Focus Group Barriers: overwhelmed at diagnosis, capabilities needed to manage, fear of hurting child
Grant et al. 2017 [49] (Australia)	National Standards of Practice for Maternal, Child and Family Health Nursing Practice in Australia. Purpose: To provide the role, scope of practice nationally: providing education support, guidance to optimise health, well-being of child. Parent knowledge, understanding, skill building in partnership with family Design: Practice standard Sample size: N/A Duration: N/A	Child Health Nurses	✓ x x			Family theories (un-named)	Terms used for LPs: anticipatory guidance, shared partnerships DoL 1 – guided by parents' needs readiness to learn, psychosocial stresses and mental health situations DoL 2 – parents' knowledge, skill development in health and child development, provides anticipatory guidance. Goal setting, support facilitating knowledge development, partnerships in learning (enabler for using LPs): DoL 3 – nurse facilitates increased parents' knowledge, skills to parent safely and effectively, health surveillance and promotion. DoL 4 – knowledge, skills extended, refined through anticipatory guidance and become meaningful to family. DoL 5 – positive, nurturing parent behaviours adopted to optimise health, wellbeing, growth and development, safety of baby/child and parents' mental health and wellbeing. Evaluation: Parent feedback, peer evaluation, practice reviews, examines surveillance/health assessment client engagement data.
Greber et al. 2011 [50] (Australia)	Clinical utility of the four-quadrant model of facilitated learning: Perspectives of experienced occupational therapists (OT) Design: Mixed method Sample: (n = 15: n = 7 were OT parents' education) Duration: not stated	Allied Health	✓ ✓ x			Four quadrant Model of Facilitated Learning	Terms used for LPs: teaching-learning approach, learning facilitation, client collaboration, learning needs, DoL 1 – readiness to learn, previous learning experiences motivation, learning styles, set learning goals, DoL 2 – planned approach, declarative and procedural, verbal, demonstrated teach-back, skill building, communication between multi-disciplinary teams. DoL 3 – skill development, HP facilitates parents' higher-level cognitive thinking. DoL 4 – task mastery, vicarious learning of parent, problem-solving DoL 5 – master tasks confidently, becomes almost automatic, self-monitoring Evaluation: proposed as outcome of seeing parent confidently master tasks with rationales understood. Barriers: lack of a framework to support HPs in how to teach cognitive learning
Horner 2004 [51] (USA)	Pilot study to test effectiveness of school -based asthma education intervention for children with home-based education for parents, to improve asthma Design Quantitative (n = 44) No intervention and control group numbers provided. Duration: 12 months	Asthma nurse (AN)	✓ ✓ ✓			None	Terms used for LPs: learning needs, mastery learning, education, information terms used interchangeably DoL 1 – appropriate formats for child and parents, PEP in home setting DoL 2 -– declarative and procedural asthma knowledge, used models. DoL 3 -– development of asthma care plan, which also facilitated dialogue with GP/parent. DoL 4 -– problem-solving and decision-making for medications, use of asthma monitoring devices, asthma plans. DoL 5 – some reference to changed behaviour change Evaluation: parent knowledge, learning assumed from parent self-reporting and child assessment, parent behaviour scale. Asthma severity by 4 item scale: measured reduced disease severity.
Horodynski et al. 2012 [52] (USA)	Integration of program to promote the development of healthy eating habits at an early age through effective nutrition and parenting education. Design: Qualitative Sample: (n = 628) Duration: 8 weeks	Allied Health	✓ ✓ ✓			Adult Learning (Norris 2003) Social Cognitive Theory	Terms used for LPs: learning, parenting education, applying learning based on ‘from telling to teaching’ (Norris 2003) DoL 1 – home visits, multi-lingual, culturally safe DoL 2 – knowledge about toddlers' food preparation techniques, previous knowledge about foods, any experiential knowledge DoL 3 – challenges, special requirements toddlers, teeth, nutrition, safety. DoL 4 – set healthy meal goals, parent ability to apply knowledge gained DoL 5 – some self-reported changed behaviour Evaluation: No learning assessed, only parent satisfaction survey Barriers: language and cultural health beliefs variation
Jackson et al. 2007 [53] (UK)	Parents' information needs and psychosocial experiences when supporting children with health care needs. Design: qualitative Sample: (n = 10) Duration: not stated	Paediatric nurses	✓ ✓ x			none	Terms used for LPs: information needs DoL 1 – shared decision-making (enabler for using LPs), fear, readiness, individualised planning and goals DoL 2 – face-to-face approach, written resources to learn facts, practical skills, practice, nurse with sound topic knowledge, organisational resource support DoL 3 – refining skills learned, follow-up face-to face and/or phone HP support DoL 4 – parent can do necessary care, cope with fluctuations confidently DoL 5 – parents care capably for child in variety of environments Evaluation: reported needs to be undertaken but not done
Jönsson et al. 2010 [54] (Sweden)	A multi-disciplinary education process related to the discharging of children from hospital when the child has been diagnosed with type 1 diabetes. Design Qualitative Sample: (n = 16). Duration: autumn 2008-Spring 2009.	Multi-disciplinary team (specialist nurse, dietitian, counsellor, psychologist, specialist physician)	✓ ✓ ✓			Mol's Logic of Care	Terms used for LPs: self-care utilisation, family-centred learning, motivation, difference between acquiring and applying knowledge DoL 1 – emotions associated with diagnosis, person centred care focus, mutual trust DoL 2 – teaching & learning process, factual & practical information. Nurse demonstration of skills, checklist. DoL 3 – mastery home management skills, follow-up appointment for skill refinement & further building: confidence DoL 4 – Home leave one night to see how parent managed treatments at home, skills refined if needed, parents' questions arising from home visit answered, relearned if problems or lacked confidence. Home management skills feedback, phone support over time. DoL 5 – autonomous self-care, parents became experts Evaluation: no evaluation of outcomes, although parent interviews revealed parents did not agree with nurses' ideas they have ‘educated well’. Barriers: shock of diagnosis, magnitude of what parents need to learn, fear, language
Kelo et al. 2013a [55] (Finland)	Pilot educational program to enhance empowering patient education of school-age children with diabetes (parent role aspect discussed) Design: qualitative deductive analysis Sample:(n = 10) Duration: 1 year	Nurses	✓ ✓ x			Empowerment	Terms used for LPs: learning needs, shared goals, participatory learning, decision making DoL 1 – health literacy, readiness to learn, safe location, identified learning needs, set individual goals DoL 2 – declarative and procedural knowledge on diabetes survival skills, care, teach-back, feedback approach. DoL 3 – revise. extra feedback after practice, revisit skills where needed, DoL 4 – checklist parent progression with survival skills, parents felt capable (empowered) DoL 5 – treatments became part of life, changes in family lifestyle. Evaluation: multi-methods: verifying learning outcomes, observing capabilities, problem-solving scenarios, also documented learning that had taken place. Barriers: parents shock of diagnosis and magnitude of care, HPs using didactic paradigm for teaching.
Kelo et al. 2013b [56] (Finland)	Describe significant patient education sessions, explore nurses' empowering and traditional behaviours in patient education process of children and their families Design: qualitative critical incident technique Sample: (n = 45) Duration: data collection over 2 months	Nurses	✓ ✓ x			Empowerment	Terms used for LPs: education, learning needs (social, functional, experiential), cognitive and concrete preparation, followed by Interactive learning. DoL 1 – identified parents/patient holistic and multi-modal learning needs, abilities, fears, prior experiences, readiness to learn by observation, notes, interviews and other HPs. DoL 2 – declarative and procedural knowledge on treating/managing condition, needs identified in shared process ((enabler for using LPs), demonstrations, multi-modal resources DoL 3 – revise with extra feedback after practice, offered alternatives if not successful DoL 4 – motivated patient/parents during progress and learning, confident and capable DoL 5 – treatments became part of life, changed family life-long coping with treatments. Evaluation: by multi-methods for each patient/parent, observation, answering scenario-based questions, asked family also to evaluate their own capability. Barriers: parents shock of diagnosis and magnitude of care, HPs didactic teaching methods
Koopman van der Berg et al. 2001 [57] (The Netherlands)	The use of self-efficacy enhancing methods in diabetes education in the Netherlands Design: mixed method Sample: (n = 261) Duration: unclear	Diabetes educators	✓ ✓ x			Self-efficacy (Bandura 1977)	Terms used for LPs: self-efficacy, knowledge transfer, skills, attitude training, modelling DoL 1 – safe, calm environment for learning, parent goal setting (not seen in study) DoL 2 – declarative and procedural knowledge, small steps, used diagrams, models DoL 3 – build on parents' performance achievements, revisit skills, revise, peer parent learning DoL 4 – verbal persuasion, vicarious experience for parent learning, parents answered scenario-based questions. DoL 5 – parents became confident with diabetes care, implemented lifestyle changes. Evaluation: should occur from modelling, but not seen in study.
McCarty and Rogers 2012 [58] (USA)	Describe impact of inpatient evidence-based asthma education program delivered by asthma Nurse practitioner for children with asthma and parents. Goal: Help parents develop knowledge, skills to avoid triggers, recognise symptoms, act for exacerbations. Design: Discussion paper Sample: (n = 156) Study duration: 2 years.	Asthma Nurse Practitioner	✓ ✓ ✓			none	Terms used for LPs: Learning, education needs, styles, teach back, return demonstration DoL 1 – safe, relaxed learning environment in hospital DoL 2 – identify literacy levels, multi-modal resources, interactive teaching sessions, help parents learn about asthma, using models, diagrams of airways, lungs, role of action plans DoL 3 – practised, refine skills, recognise asthma symptoms, check understanding of action plan, adjusted medications. DoL 4 – focus on problem-solving scenarios about asthma symptoms and what to do DoL 5 – confident in using treatments, following care plans became part of family life Evaluation: Feedback: after each class, parent satisfaction survey. Survey not included in publication. Parents found teaching and resources useful.
McDonald et al. 2016 [59] (NZ)	Describe the learning process of family/carers needing to learn to manage technical health procedures at home (e.g. enteral feeding, cannulation, dialysis, tracheostomy care) Design: Grounded theory Sample: (n = 20) Duration: 19 months	Nurses	✓ ✓ ✓			Knowles' Adult Learning Principles (1984)	Terms used for LPs: Learning needs, adult learning principles, process of learning, DoL 1 – parents over-whelmed by diagnosis, confused, nurse/parent shared role of education, readiness to learn, parents wanted nurse with sound topic knowledge, but some nurses reluctant to trust parent with required care DoL 2 – declarative and procedural knowledge, step by step learning, checklists, ready for home administration, HPs used parent feedback for verification of learning, understanding. DoL 3 – refining knowledge and practising procedures, developing skills for home setting DoL 4 – problem-solving, decision-making when given scenarios DoL 5– added responsibilities accepted over time, developed autonomy in caring, coping. Evaluation: parent self-reports, scenario-solving, nurses seeing parents perform procedures capably, eventual partnerships in learning (enabler for using LPs). Barriers: magnitude of condition, challenges, fluctuations in long-term care
McGrath et al. 2007 [60] (Australia)	Learning a new language: informational issues for parents of children treated for acute lymphoblastic leukaemia (ALL). Design: Qualitative Sample: (n = 62) Duration: First year of a 5-year study	Nurses	✓ ✓ x			none	Terms used for LPs: information needs, educational needs DoL 1 – shock of diagnosis, identify parents' needs, honesty, trust, readiness to learn DoL 2 – factual and practical information in understandable language, multi-modal teaching resources, written resources, small steps DoL 3 – parents provided with rationales for constant treatment changes DoL 4 – nurse asks scenario-based questions, support for parents' additional queries, DoL 5 – treatments accepted as part of life, lifestyle changes, parent masters capability to manage Evaluation: none Barriers: HPs use of jargon in explanations/demonstrations.
McMurray et al. 2004 [61] (UK)	Managing controversy through consultation communication and trust around MMR vaccination decisions. Design: Qualitative Sample: (n = 69 parents) Duration: 16 months	General Practitioners	✓ ✓ x			none	Terms used for LPs: educational needs, ongoing learning process, partners in a learning enterprise DoL 1 – parent anxiety over vaccine side-effects, two-way communication, time to process information, honest approach, parents' view respected, influence of previous experiences DoL 2 – facts about vaccines and diseases, mis-conceptions corrected DoL 3 – follow-up appointment, further concerns, re-assured DoL P4 – parents could reason about impact of vaccination on their child DoL 5 – behaviour change, continue vaccination schedule when previously refusing. Evaluation: none Barriers: parents having gained conflicting information from media and friends
Nightingale et al. 2015 [62] (UK)	Parents' learning needs and preferences when sharing management of their child's long-term condition: A systematic review. Design: Systematic Review Sample: (n = 23 studies) Duration: November 2013–January 2014	Nurses	✓ ✓ x			none	Terms for LPs: learning needs, information needs, different ways to respond to management DoL 1 – timely learning situation, learning needs, health literacy evaluation, stress of diagnosis, condition trajectory, trust in HP knowledge, teaching skills, communication DoL 2 – declarative and procedural knowledge and skills taught in small steps, adjusted to parents needs at time, link to pre-existing knowledge. Nurse must have sound topic knowledge. DoL 3 – revisiting information with parents, checking understanding, skill development, phone support DoL 4 – problem-solving, decision-making skills. Group education sessions, answered scenario-based questions DoL 5 – behaviour changes Evaluation: stated as needed, not described nor undertaken Barriers HPs not identifying parents needs, information overload, inconsistent teaching styles
Panicker 2013 [63] (Ireland)	Nurses' perceptions of parent empowerment in chronic illness Design: Qualitative Sample (n = 14) Duration: not stated	Nurses	✓ ✓ x			Empowerment	Terms for LPs: education and training DoL 1 – readiness of parent to accept care of child, trust, shared decision-making (enabler for using LPs): individualised needs and health literacy issues identified, goal setting. DoL 2 – knowledge, skills to care for child provided by nurses, provide plans, tools for parents to learn. DoL 3 – use of care plans, teach parents to analyse what they need to do. Build confidence. Phone support DoL 4 – parents can apply knowledge and skills meaningfully, solve problems. DoL 5 – behaviour changes, competence in care of child Evaluation: none, changes assumed from empowerment
Policicchio et al. 2011 [64] (USA)	Bringing evidence-based continuing National asthma education (NACE) to nurses. Design: quasi-experimental Sample: (n = 34) Duration: 1 day	Nurses	✓ ✓ x			Self-efficacy	Terms for LPs: teaching, demonstrations, self-observing, self-regulation, achievement DoL 1 – nurses using NACE program enhanced parent learning and increased their own skills, cultural awareness, goal setting. DoL 2 – nurses increased skills in how to provide knowledge, practical skills, care plans, feedback, teach-back. DoL 3 – nurses understood need of parents to refine skills, analyse asthma. DoL 4 – better nurse recognition of parents to be problem solvers, make decisions DoL 5 – changed behaviour of community nurses- improved practice Evaluation: only nurse behaviour, confidence. No evaluation of parents' cognitive learning effect/impact
Registered Nurses Association of Ontario, 2012 [65]. (Canada)	Clinical Best Practice Guidelines: Facilitating Client Centred Learning. Purpose: Systematically developed statements to assist practitioners and clients to make decisions about their health care and master knowledge and skills to achieve this. Design: Best Practice Guide Sample size N/A Duration: N/A	Nurses	✓ x x			Social Constructivism	Terms used for LPs: learning needs, LEARNS (Listen, establish, reinforce, strengthen). DoL 1 – cultural considerations, learner needs, values, safe setting, readiness to learn, mental health situation. DoL 2 – links to previous learning, partnership approach nurse is facilitator, (enabler for using LPs): DoL 3 – follow-up appointments, client practising with nurse, feedback skills building, client can interact better with HCPs and health system. DoL 4 – self-care skills development, model recognises skill mastery is essential to promoting behaviour change. Problem-solving capabilities. Nurse's involvement declines as client's skills and understanding increase. DoL 5 – Empowerment resulting from applying learning, mastering skills, changed behaviour to become autonomous in their care. Evaluation: Optimising client-centred learning.
Registered Nurses Association of Ontario, 2015 [66]. (Canada)	Clinical Best Practice Guidelines: Person and Family Centred Care. Purpose: Provides template on best practice in person and family centred care to assist therapeutic, client directed care. Design: Best Practice Guide Sample size N/A Duration: N/A	Nurses	✓ x x			Knowledge -to-action, Maslow's Hierarchy of Needs,	Terms used for LPs: learning needs, active partnerships, tailoring strategies DoL 1 – identifies, respects clients, parents' personal, cultural, health literacy, life context needs, life circumstances, mental health situation, creates safe environment for goals, client/parent directed. DoL 2 – Interactive learning in partnership with client/parent, identifies existing preferences, knowledge, builds new factual and practical knowledge and skills, nurse/client feedback. Multi-modal resources. DoL 3 – Follow-up on care, gains confidence in decision-making to manage health. DoL 4 – gains confidence, skills and capability., DoL 5 – client/parent empowered to manage health autonomously Evaluation: seeing client manage, patient satisfaction surveys, perceptions of care.
Rowe and Fisher 2010 [67] (Australia)	Development of a universal psycho-educational intervention to prevent common postpartum mental dis-orders in primiparas women. Design: Discussion Paper Sample: N/A Duration: N/A	Nurses	✓ ✓ x			What were we thinking model	Terms used for LPs: salient and interactive learning needs, role play, DoL 1 – identification of women's mental health, health literacy needs, shared learning DoL 2 – declarative, procedural knowledge ‘learning though doing’ for baby's needs, cues. DoL 3 – learning to trust their ‘instincts’ also about their baby DoL 4 – problem-solving techniques practised DoL 5 – changes in behaviours, protective instincts of mothers Evaluation: Proposed: nurses to see patients perform interactions and activities with baby (and partner) competently. Barriers: Mental health status and life situations of parents
Sanders and Burke 2014 [68] (Australia)	Hidden Technology of Effective Parent consultation: Guided Participation to promote change. Design: Discussion paper Sample: parents undergoing Triple P Positive Parenting Program: learning and skills Duration: not stated	Practitioners (not clarified).	✓ ✓ ✓			Guided Participation Model	Terms used for LPs: social learning, generalising skills learned to new contexts DoL 1 – readiness to learn, understand objectives of program, safety, health literacy, identify needs of parents, previous learning experiences, life situations, mental health of parents, relevance. DoL 2 – shared learning partnership with practitioner, learn strategies to promote positive family environment (verbal, written, modelling, behaviours), monitor progress DoL 3 – small steps, revisiting what was seen if videoed, or self-evaluated. DoL 4 – help parents develop coping skills for setbacks, resilience and capacity building, develop independent problem-solving skills, transfer learning to new context DoL 5 – Sustains the changes in behaviours, become independent problem-solvers Evaluation: evaluate process adopted by practitioners, involves assessment of outcomes of the intervention AND the mechanisms by which they were achieved.
Schroeder and Pridham 2006 [69] (USA)	Explore the effect of Guided Anticipation intervention (IG) on mothers' progress for them to be competent with their pre-term infants in neo-natal intensive care (NICU) compared to standard care teaching [SCT]. Design: RCT Sample: (n = 16, control n = 8, intervention group [IG] n = 8) Duration: 6 weeks	NICU nurses	✓ ✓ ✓			Guided Participation Model	Terms used for LPs: Learning needs, guided participation DoL 1 – needed confidence caring for premature babies, identifying goals, NICU stressful. DoL 2 – IG: HPs used resources to help parents learn cues, act for baby, videoed, watched back-participatory learning. Mother's learning adaptive, ‘expectations & intention’ and attachment relationship. HPs used checklist. DoL 3 – parents became attuned to needs of baby, mothers' knowledge extended, nurse phone support. DoL 4 - anticipate changes in baby, relationship fostering, problem-solving, more adaptive to baby's needs DoL 5 – parents became confident, capable with caregiving and anticipating baby's needs Evaluation: mother's capability in relationship and behavioural aspects. Nurses' teaching process stated as ‘discreet’. Barriers: shock of the early birth, situation and fragility of baby.
Seid et al. 2010 [70] (USA)	To test the efficacy of Problem-solving Skills Training (PST) in improving health related Quality of Life of children with persistent asthma, from lower socio-economic status (SES) families. Design: RCT Sample: (n = 211) Standard care vs co-ordinated care and PST parents' data. Duration: 9 months	Allied Health	✓ ✓ ✓			Problem solving technique (Zurilla 1986)	Terms used for LPs: problem-solving skills, education DoL 1 – identified parents' fears of asthma, bi-lingual and cultural needs and beliefs, interpreter used DoL 2 – asthma facts, skills, medication management, checklist DoL 3 – trigger and symptom recognition, options for asthma management, plans DoL 4 – evaluated options, problem-solving of asthma scenarios. DoL 5 – reflect, evaluate, some changed behaviours Evaluation: Health Related Quality of Life (QoL), reduced disease outcome and less health service use. Barriers: High dropout rate in study, language barriers to patient teaching & understanding.
South Australia Health 2015a [71] (Australia)	Partnership for Entering the Pathway of Education (PEPE): A clinical support program for child health nurses (CHN). Handbook: Core skills nurses use in Child and Family Health Encounters: used with resource below. Design: Practice guide Sample: N/A Duration: N/A	Child Health Nurses	✓ x x			Adult Learning Principles; Family Partnership	Terms used for LPs: learning pathway. DoL 1 – respect parent/carer as expert of their child. Recognise parenting is a time of stress. Attitudes to learning and parents learning needs vary greatly. Respect. DoL 2 – identify parents' existing knowledge. Build knowledge in partnership with parents. (enabler for using LPs): Demonstrate skills DoL 3 – facilitate parents to practise skills, revisit. DoL 4 – help parents' motivation to keep building, applying knowledge, skills. Build parents' confidence to adapt care. DoL 5 – Parents become empowered to care autonomously for their child. Evaluation: satisfaction surveys, parents' engagement with services,
South Australia Health 2015b [72] (Australia)	Partnership for Entering the Pathway of Education (PEPE): A clinical support program for CHN Attitudes Knowledge and Skills (1) and (2) Design: Practice guide Purpose: to determine Knowledge, Skills, develop core practice skills, key principles required to attain practice, refine skills as a CHN. Sample size: N/A Duration: N/A	Child Health Nurses	✓ x x			Adult Learning Principles; Family Partnership	Terms used for LPs: knowledge building, asking ‘exploring questions’, DoL 1 - Culturally safe, family focused, nurses recognise parents' mental health state, social, physical issues home visits, clinic and group learning settings. DoL 2 - client-led teaching, nurse builds on client's knowledge, skills goals, care plans, practical demonstrations. DoL 3 – nurse/parent: help parents refine developing skills to care for baby. DoL 4 – partnership in facilitating parents' decision-making, problem-solving skills, parents confident. DoL 5 – empowering, child, parents reaching potential by learning, changed behaviours, parents' confidence, capability in parenting skills developed Evaluation: nurse self-evaluation, parents' service utilisation, peer and self-evaluation, parent satisfaction surveys, practice reviews, nurse observation-parent perform skills repeatedly, problem-solving scenarios.
Stevens et al. 2014 [73] (USA)	To explore parent learning experiences to increase understanding of the process parents use in learning to feed their pre-term infant feeding. Design: Phenomenology Sample: (n = 20) Duration: January to May 2010	Nurses	✓ ✓ X			none	Terms used for LPs: learning needs, education support, DoL 1 emotions, anxiety, overwhelmed, fearful of baby DoL 2 different learning paces, stepped through factual and practical knowledge, demonstrations, asked questions, formal and informal learning activities practiced. Checklist ensured topics covered, especially for home setting. DoL 3 practiced and refined skills, learned from errors, asked questions, nurses' help in refining parent techniques. Phone support by nurse to answer, clarify parent questions: refine, extend knowledge DoL 4 gained confidence, parents ‘felt they had it’, felt capable. Could answer scenario-based questions for home care. DoL 5 behaviour change feeding baby, become part of homelife. Parents needed to be capable, confident by discharge. Evaluation: implied by observing mothers; not explicitly discussed
Swallow et al. 2009 [74] (UK)	To explore nurses' contribution to families' learning in shared management of childhood chronic kidney disease (CKD) from parents' perspective. Design: Grounded theory Sample: (n = 5) Duration: 2003–2005	Nurses	✓ ✓ ✓			Positioning Theory	Terms used for LPs: learning facilitation, teaching strategies DoL 1 - Shared care, overcome feeling of fear, reluctance, assess learning needs. Home environment is best where care takes place but starts in hospital. DoL 2 – opportunities to gain practical and factual knowledge, parent feedback, nurse having sound knowledge. Nurse uses documentation like a checklist. DoL 3 – Nurse documented education provided. Clarified parent questions. If parents reluctant to learn, strategies to meet parents' needs. DoL 4 – problem-solving session, parents became independent learners, answer scenarios, confident, capable. Nurse phone support check learning translates from hospital to home. DoL 5 – child's management became part of daily life as capable, resilient carers. Evaluation: nurses seeing parents undertaking treatments/management strategies until capable.
Thompson and Thompson 2014 [75] (Australia)	Help nurses understand the steps in the learning process, in patient education that can facilitate behaviour change in parents caring for children with eczema Design: Discussion paper Sample: N/A Duration: N/A	Nurses	✓ ✓ x			Nature of Knowledge and Human Inquiry (Keeves 1997). Three World's view (Popper and Eccles 1997). Bandura Social Cognitive Theory	Terms used for LPs: learning process, nature of knowledge, declarative, procedural DoL 1 – establish health literacy levels, learning needs, readiness to learn, cultural safety, goals, fears of topical steroid use DoL 2 – identify factual and practical knowledge using diagrams, models, analogies, stepped skills development, nurse demonstrates treatments, enables parent to practise (procedural knowledge). Reciprocal feedback, written, verbal resources. DoL 3 – answer questions on follow-up appointment/visit. Help patient analyse, see meaning of treatments, understanding of eczema care plans. DoL 4 – Parents develop problem-solving and decision-making skills, can answer scenario-based questions, know rationales for actions. DoL 5 – management is part of daily life, behaviour and lifestyle changes; patients/parents do treatments autonomously. Have sense of capability, confidence, empowerment is an outcome of effective learning process. Evaluation: Proposed that nurses to see patients perform procedure competently, answer scenario-based questions
Thompson 2017 [76] (Australia)	Discuss the reason eczema interventions by nurse are successful, with the subsequent development of a theoretical framework to guide nurses to become effective educators. Design: Discussion paper Sample: N/A Duration: N/A	Nurses	✓ ✓ x			Nature of Knowledge and Human Inquiry (Keeves 1997). Three World's view (Popper and Eccles 1997), Bandura Social Cognitive Theory	Terms used for LPs: Learning needs, nature of knowledge, declarative, procedural DoL 1 – establish health literacy, readiness to learn, goal setting, cultural safety, fears of treatments. DoL 2 – break down knowledge into steps. Use diagrams/analogies for declarative knowledge. Demonstrate treatments, skills, parent to practise skills at each step, revisited until gained capability, written, verbal resources, care plans DoL 3 – answer questions on follow-up appointment/visit. HP helps parents analyse, see meaning to treatments. Better understand care plans. DoL 4 – Patients developing problem solving, decision-making skills, scenario-based learning. DoL 5 – management becomes part of daily life, behaviour, lifestyle changes; patients not anxious, do treatments almost without conscious thinking. Sense of capability, confidence, empowerment outcome of effective learning process. Evaluation: Proposed that nurses to see patients competently perform procedure, patients/parents can explain verbally, with rationales.
Wenniger et al. 2000 [77] (Germany)	Describe the Berlin Model of eczema care using Eczema school model (preliminary data) Design: Discussion paper Sample: (n = 63) Duration: 12 months	Multidisciplinary team	✓ ✓ ✓			Social Cognitive Theory & Health Belief Model	Terms used for LPs: knowledge, modelling and positive reinforcement, applying knowledge, monitoring of behaviours, decision-making capacity and confidence DoL 1 – Readiness & motivation to learn, set goals DoL 2 – multi-modal factual and practical information weekly, group sessions, 2-hour sessions for 6 weeks, used analogies. DoL 3 – refining skills, symptom diary, adapting treatments, action plan extends parent’ knowledge and symptom recognition DoL 4 – changed context, problem-solving when eczema changed, adjusted treatments. DoL 5 – longer-term behaviour changes to manage eczema with confidence and capability. Evaluation: Health related QoL scale, reduction in disease severity, parent coping scale. Barrier: HPs finding balance between parent needs, group delivery, skills development