163 Summary and general discussion 7 Whitehouse et al., 2021). When evaluating a new intervention like BEAR, the first step is to determine its effectiveness (IF it works). The research presented in this thesis is the first to examine the effectiveness of the BEAR intervention. These studies represent an initial step in addressing the question of whether the intervention works. However, to provide a more definitive answer, it may be necessary to conduct a follow-up effectiveness study. Then, a subsequent step should go beyond this, focusing on understanding WHY the intervention works, (and for who, when, how etc.). There remain significant gaps in our knowledge regarding the optimal timing, target populations, duration, expected outcomes, and costeffectiveness of pre-emptive interventions in general (Lord et al., 2021). Understanding the mechanisms behind the efficacy of interventions is crucial for refining their design and enhancing their overall impact. It is important that future research should also focus on identifying moderators, to gain more insights for which groups the BEAR intervention is most effective. Additionally, it is important for future intervention studies to further investigate parental satisfaction and consider cultural diversity and to ensure accessibility for diverse groups of parents, including non-native speakers and those with low health literacy. During the course of this thesis, the BEAR intervention was further developed, transitioning from a paper-based format to an online e-health program accessible via computer. However, it became evident that this format was not sufficiently accessible for all parents. Therefore, in 2023-2024, BEAR has been further developed in an app-based version (iBEAR) that is translated into multiple languages and includes a read-aloud feature and is easy to use via smartphone (and therefore in principle usable for everybody). To further contribute to the accessibility and “easy” care an implementation study is currently being conducted. The focus of this study is to investigate barriers and facilitators of implementation and to suggest an implementation plan, as well as to gain insight into user experiences with regard to functionality, applicability and usability of the BEAR app, in order to further improve it. Young children develop within a broad social context. This thesis focused on one of these key contexts: the home environment and the interactions between young children and their parents. During infancy and toddlerhood, parents are among the most important partners in their child’s learning and development. One advantage of parent-mediated interventions is that parents can practice skills with their child throughout the day. In addition, other social environments such as daycare centers also provide essential opportunities for the child’s cognitive, social, and emotional development. It is essential that these environments also align with the developmental needs and capacities of young children. This provides opportunities for future research to explore the effects of pre-emptive interventions in these additional contexts.
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