Mothers’ Perspectives on Virtually Delivered Online Video Feedback Parenting Interventions: A Qualitative Study

The landscape of early childhood support is undergoing a significant transformation, with a growing emphasis on remote and digitally-enabled interventions. While video feedback (VF) parenting programs have a well-established track record of enhancing maternal sensitivity and mental well-being, their adaptation to virtual, online delivery remains an area requiring deeper investigation. A recent qualitative study, shedding light on mothers’ perceptions of a hypothetical virtually delivered VF parenting intervention, reveals a nuanced picture of both its potential and its challenges. The research, conducted by a team from The University of Manchester, underscores the critical need for careful consideration of parental experiences to optimize engagement and effectiveness in the evolving digital mental health sphere.

Introduction: The Evolving Role of Video Feedback in Parenting Support

Early relational difficulties between infants and their primary caregivers can cast a long shadow, impacting a child’s emotional and social development and potentially contributing to intergenerational cycles of mental health challenges. Attachment theory has long underscored the pivotal role of the parent-infant relationship in shaping a child’s psychological trajectory. In response, a variety of parenting interventions have been developed, often delivered through infant and perinatal mental health teams, social work services, and early education settings. These programs typically target caregivers experiencing elevated stress, mental health difficulties, or broader contextual risks.

Among these interventions, Video Feedback (VF) has emerged as a particularly effective approach. VF utilizes filmed parent-infant interactions as a foundation for guided reflection. While specific methodologies vary, core components typically involve a parent reviewing recorded interactions with their infant alongside a trained practitioner. These reviews are followed by focused, reflective discussions, often centered on particular themes within a structured program. The VF technique itself can be a standalone intervention or integrated into a multi-faceted approach.

The primary objective of VF-based programs is to foster caregiver sensitivity towards their infant, aligning closely with attachment-based principles. Models range from attachment-focused approaches like Video-feedback Intervention to promote Positive Parenting (VIPP) to strengths-based relational models such as Video Interaction Guidance (VIG) and Marte Meo. Despite theoretical differences, most VF programs aim to enhance a parent’s ability to notice, interpret, and respond to their infant’s cues, usually over multiple sessions. In attachment-based frameworks, parental interactive behaviors are seen as reflecting their internal working model of attachment, which in turn influences the infant’s developing expectations of trust and relationships. Many VF programs also extend their reach to broader caregiver outcomes, including enhanced perceived parenting competence, self-confidence, well-being, and reduced stress. For parents of older children, some programs focus on reducing behavioral difficulties, drawing on social learning principles and more directive practitioner guidance.

A recent meta-synthesis of qualitative studies highlights that parents find the direct observation of their own interactions, coupled with a supportive, non-judgmental practitioner stance, to be profoundly powerful and transformative. VF is believed to work by slowing down interactions, drawing attention to subtle cues that might otherwise be missed in real-time, and thereby fostering greater reflective functioning and insight into a child’s intentions. The practitioner’s strengths-based approach is crucial in reducing defensiveness, building confidence, and creating the emotional safety necessary for deep reflection. Guided discussions about carefully selected video clips help parents connect observed behaviors to underlying needs and solidify adaptive interactional patterns. These key elements—attuned practitioner support, emotional containment, fine-grained observation of interactional moments, and the evocative experience of seeing oneself on screen—are considered central to VF’s effectiveness.

Empirical evidence supporting VF interventions is robust, with numerous studies demonstrating benefits for parenting behaviors and child outcomes. A large-scale meta-analysis by Bakermans-Kranenburg et al. (2003) found that attachment-focused interventions incorporating VF were more effective in improving observed relationship outcomes than those without. Extending beyond attachment-based programs, a meta-analysis by O’Hara et al. (2019) of randomized controlled trials (RCTs) found moderate evidence for improved parental sensitivity following VF, comparable to other similar interventions.

The COVID-19 Pandemic: A Catalyst for Virtual Delivery

The COVID-19 pandemic, spanning 2020-2021, acted as a significant accelerator for the development of virtually delivered parenting interventions. The sudden, almost overnight, shift from traditional in-person formats to virtual online delivery was a necessity to maintain research continuity during national lockdowns, although the effectiveness of these virtual adaptations remained largely unevaluated at the time. Initial perceptions from parents indicated that virtual delivery of parenting programs was acceptable and feasible. Subsequently, practitioners have also come to value the flexibility and destigmatizing nature of the online format. Some practitioners reported that rapport could be strengthened online due to the parent’s undivided attention on screen, while others found establishing rapport more challenging. It is important to note that this shift occurred during an unprecedented global event, where many parents may have been grateful for any support they could receive. Persistent barriers such as limited access to suitable devices, reliable internet, or a private space at home continued to shape who could meaningfully engage with virtual provision.

Even as the pandemic recedes, remote parenting interventions have become a standard practice. However, parental perspectives in the post-pandemic era are still being understood. While virtual interventions have demonstrated effectiveness in supporting parents of older children with behavioral difficulties, VF interventions present unique challenges due to their reliance on video technology and the coordinated attention required between parent, practitioner, and screen. In infancy-focused programs, capturing naturalistic parent-infant interactions, editing footage, and facilitating parental reflection on subtle cues can be compromised by virtual delivery. Close observation of nuanced parent-infant interactions may be difficult online, particularly when using mobile phones as the primary device, and video recordings may fail to fully capture non-verbal communication.

Furthermore, virtual delivery places additional demands on parents, often requiring technical and organizational skills for recording, uploading, and submitting videos for feedback sessions. Compared to in-person sessions, virtual interactions can feel less fluid, be more susceptible to technical disruptions, and lack the embodied cues that facilitate therapeutic connection. These challenges are amplified in VF, where the quality of the footage directly influences what can be observed, discussed, and reflected upon. Environmental distractions, such as childcare responsibilities, the presence of other family members, or background noise, can further disrupt sessions. Unlike in-home visits, practitioners have limited ability to help parents manage their immediate environment in real-time. A pilot study offering mothers with perinatal mental health difficulties a choice between virtual or blended VF delivery found that most preferred in-person, home-based sessions, suggesting that while virtual formats enhance accessibility, they may not always provide the relational containment or practical ease that parents value in infancy-focused VF work.

Given the established evidence base for VF parenting programs and the increasing prevalence of remote delivery, this qualitative study aimed to explore the views of mothers with a child under 24 months of age living in the UK regarding a hypothetical virtually delivered VF-based parenting intervention. Unlike previous studies that primarily focused on parents who had already participated in an intervention, this research sought to understand mothers’ anticipated experiences and perspectives on a virtual VF program if it were offered to them.

Methodology: Understanding Mothers’ Hypothetical Experiences

This study adopted a qualitative, exploratory design to investigate mothers’ views on the hypothetical acceptability of a virtually delivered VF-based parenting intervention. Individual semi-structured interviews were conducted to allow mothers to articulate their expectations, perceived benefits, and concerns in their own words, focusing on their potential engagement with VF in a virtual format.

A convenience sampling strategy was employed to recruit mothers of infants under 24 months residing in the UK. This ensured that the captured perspectives were relevant to those most likely to be offered such an intervention. Interviews were conducted either online via videoconferencing or by telephone, audio-recorded, and transcribed verbatim. Ethical approval was obtained from The University of Manchester Research Ethics Committee (ID Reference: 2022-13093-25665), and the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure transparency, reflexivity, and methodological integrity.

Participant Profile and Recruitment

Eligible participants were mothers aged 18 years or older, living in the UK, with a child aged between 0 and 24 months. Further inclusion criteria included being the biological mother, possessing sufficient English fluency for an interview, and having access to videoconferencing tools or a telephone. Participants did not need prior experience with parenting interventions. Fathers were excluded due to resource constraints, with the study prioritizing understanding the perspectives of the parent most frequently involved in parenting interventions. The chosen child age range aligns with the typical window for offering VF interventions focused on the parent-infant relationship.

Recruitment involved advertising on national parenting and community websites, online parenting forums, social media, local community group networks, and community libraries in Manchester. The advertisement invited mothers to complete a short, anonymous online survey about their views on parenting, mental well-being, and online parental guidance, and mentioned the option to participate in an interview. Following informed consent, 52 mothers completed the online survey, which included a simplified explanation of a typical VF parenting intervention and an image depicting a parent-practitioner discussion reviewing parent-infant interaction footage. They then answered multiple-choice questions about their views and preferences for such programs, alongside general questions on perceived parenting needs and mental well-being.

At the survey’s conclusion, mothers were offered the option to provide their contact details for an interview. The survey served a dual purpose: to gather descriptive data from a larger sample on views regarding VF programs and to recruit a diverse range of mothers for interviews, including those who may have heard of parenting interventions but might have been hesitant to participate in an interview directly. While quantitative findings from the survey were not reported due to the small sample size precluding statistical analysis, all survey respondents who consented to be contacted were approached, and ten participated in interviews. Survey respondents were entered into a prize draw for a shopping voucher, and interview participants received a shopping voucher as reimbursement for their time.

The Interview Process and Data Analysis

A semi-structured interview topic guide was developed to explore perceived barriers and motivators for engaging mothers in a hypothetical remotely delivered VF parenting intervention. The guide was informed by the research team’s experience in parenting intervention work, video analysis, feasibility research, and a comprehensive literature review of qualitative studies on parental experiences with VF-based interventions. A University Community Liaison Group was consulted on the accessibility of participant-facing content, leading to the inclusion of an image in the survey and minor wording adjustments. The interview guide was not formally piloted.

The topic guide covered: (1) participation in or consideration of VF parenting programs generally; (2) perceived gains and concerns regarding virtually delivered programs; (3) feasibility of participation, including barriers and specific preferences (e.g., ability to record videos themselves, preferred session length, anticipated emotions during recording); and (4) preferred supports before and during the intervention to alleviate concerns.

Prior to interviews, mothers were informed about various positive parenting programs that enhance parenting confidence, attachment, and infant social-emotional development, highlighting VF as a well-evidenced approach. The description focused on VF as a behavioral video feedback approach, involving parents reflecting on pre-recorded parent-baby interactions, guided by a professional over several sessions. While VF can be a component of broader approaches, the description centered on VF exclusively. Both the survey and interview information clearly stated that participants would not be expected to have prior knowledge and their involvement would not lead to an invitation for a VF or other parenting program. The interviewer identified as a trainee clinical psychologist.

Following informed consent, the lead researcher (TKJ) conducted all ten interviews, with three conducted online via videoconferencing and seven via telephone. Participants were advised to find a quiet space, but the presence of others was not monitored. At the interview’s outset, a brief description of a typical VF program was provided, explaining how parents record short videos of parent-baby interactions (play, feeding, etc.) and submit them to a trained health professional who guides the parent through exercises and reviews the content in feedback sessions. Mothers were informed that this work typically takes place in a clinic or home visit, with the professional supporting the parent and enhancing the parent-baby relationship over several sessions. The interview focused on how mothers would feel undertaking this work online, submitting videos themselves, and meeting the professional via video call. Each interview lasted 30-45 minutes.

Anonymized transcripts were analyzed using Braun and Clarke’s (2006) thematic analysis, chosen for its adaptability and practical relevance in generating themes grounded in participant accounts and applicable to applied practice. The analysis was conducted pragmatically, without a predetermined theoretical framework, aiming to identify and organize patterned responses at the semantic level. TKJ led the analysis, with regular support from MWW and AW in developing emerging codes and themes. The process involved six sequential phases: familiarization with transcripts, generation of initial codes, development of potential themes, review of themes against coded extracts and the entire dataset, definition and naming of themes through refinement, and production of a report with illustrative extracts. Transcripts and findings were not shared with participants. Data saturation was considered, with no new themes emerging in the later interviews (P8-10) compared to earlier ones (P1-7). While sample diversity was noted, limitations in educational level and marital status were acknowledged due to project time constraints.

Researchers’ Positionality

The research team acknowledged their positions. The lead researcher, TKJ, a female clinical psychology doctoral trainee, had no prior direct experience with VF interventions but possessed perinatal psychology training and clinical interview skills. Deliberate steps were taken to understand VF principles and practice, including a comprehensive review of qualitative studies on parental experiences. TKJ’s positionality as a non-parent and trainee was recognized as potentially influencing interview dynamics and disclosure. Openness, humility, and a reflective diary were used to manage assumptions and ensure an objective approach. The wider team included a developmental psychologist and a clinical psychologist, both female, with extensive experience in perinatal mental health, parenting intervention research, and qualitative methods. Their expertise, including some VF training for MWW, shaped their interpretive lenses, aiming for a balanced representation of benefits and limitations. Regular reflexive discussions in supervision meetings ensured that professional commitments did not unduly influence theme development.

Key Findings: A Dual Perspective on Virtual VF

The thematic analysis revealed five overarching themes, reflecting mothers’ appreciation for and concerns about a hypothetical virtually delivered VF parenting intervention.

Theme 1: Accessibility is Enhanced, but Barriers Persist

A significant majority of mothers viewed the online format as a considerable advantage, citing reduced travel, preparation time, and overall time burden. This was particularly emphasized by working mothers and those for whom travel costs were a concern. Increased comfort with videoconferencing platforms and greater digital literacy post-pandemic contributed to this perception, with online consultations becoming a normalized aspect of healthcare. The home setting was also seen as contributing to emotional manageability.

However, substantial barriers to participation were anticipated. Many mothers cited a lack of time due to competing responsibilities, especially for those who had returned to work or had multiple children. The overall intervention length and the requirement to create and submit videos were seen as potentially time-consuming and mentally demanding. Anticipated technical issues, such as poor internet connections, raised concerns about feeling safe and emotionally supported during sessions, with some mothers recognizing that not all families would have access to high-quality devices and broadband.

A significant concern was the difficulty of managing childcare responsibilities while engaging in the intervention. Mothers envisioned challenges in attending to their child’s needs while simultaneously focusing on the virtual session. For mothers from non-majority cultural backgrounds, potential cultural and language barriers were emphasized, even with virtual delivery. They stressed the importance of information regarding who would view the videos and where, and a desire for their cultural beliefs and practices to be respected. The prospect of a program only offered in English raised questions about its applicability for families who did not speak English to their child at home.

Theme 2: Video as a Powerful Yet Exposing Tool

Mothers broadly recognized the value of video in parenting programs, with many anticipating that reviewing recordings of their interactions would help them notice subtle infant cues and their own responses. Video was seen as providing tangible evidence of parenting skills while also highlighting areas for improvement.

However, this powerful tool also carried the potential for self-doubt and reduced parenting confidence. Video offered an unfiltered external perspective, making self-reflection intense. Many mothers anticipated feelings of nervousness, anxiety, and self-consciousness before or during the recording process, fearing the pressure to present an idealized version of their parenting. To mitigate this, some preferred recording interactions involving the whole family rather than solely focusing on themselves.

The ability to choose which videos to submit was interpreted by some mothers as fostering a sense of agency and control compared to a one-off in-person observation. They felt they could delete unsatisfactory recordings, reducing the pressure to capture the "required" elements immediately. This interpretation led to fewer concerns about the process. Nevertheless, the perceived ability to be selective also raised worries about providing an accurate representation of their skills, exacerbating self-consciousness.

Theme 3: Digital Uncertainties and Anxieties

While mothers generally found the online format comfortable and convenient, they expressed reservations about the practical demands of self-recording parent-infant interactions and concerns regarding digital data security.

Subtheme 3.1: Skills and Demands of Self-Recording
Mothers generally felt confident in their ability to record themselves, but anticipated practical issues, particularly in managing their child simultaneously. Concerns included fiddling with camera angles while attending to their child, the child moving out of shot, and potential distractions caused by the device. Issues with sending videos in advance, device storage, and the time required were also raised. Clear, simple instructions on setup and video submission, akin to sharing on social media, were deemed essential to reduce the "hassle factor" and the need for multiple practice runs.

Subtheme 3.2: Concerns about Digital Data Security
Half of the mothers identified online safety as a worry. They were concerned about the secure transmission and storage of video recordings, ensuring their videos would not be used beyond the agreed remit, and understanding what would happen to the footage afterward. The idea of a secure portal or encrypted website for uploading was suggested. However, views varied, with some mothers expressing inherent trust in the clinician, consent process, and safeguarding protocols, and having no concerns about internet security.

Theme 4: The Crucial Role of the Healthcare Professional and Trust-Building

The expertise and specialist knowledge of a trained healthcare professional were highly valued. Discussions with a practitioner were seen as providing reassurance and building parenting confidence. Mothers anticipated the value of a practitioner’s knowledge of child development and sought indicators of their child’s progress. Cultural competence and sensitivity were highlighted as important, with a desire for practitioners to acknowledge diverse parenting styles and family contexts. Mothers who did not primarily speak English at home expressed a need for reassurance that language barriers would not impede their participation.

Nearly all mothers expressed a preference for meeting the practitioner online before the intervention began. This initial meeting was seen as crucial for alleviating concerns about the practitioner’s communication style, qualifications, and approach, and for the opportunity to ask questions. Establishing rapport early was considered vital for reducing anxiety and fostering comfort in subsequent sessions. Knowing in advance that feedback would be supportive rather than critical was also a significant reassurance. Building trust was paramount, as mothers emphasized the importance of the practitioner understanding their family’s unique context while also possessing confidence in their expertise. Given the inherent vulnerability of participating in a parenting intervention, especially online, concerns were raised about receiving feedback that might feel critical.

Theme 5: Understanding Intervention Requirements and Family Integration

Mothers carefully considered how the intervention would fit into their family routines, balancing its demands with their busy lives, and emphasizing the need for a perceived net benefit.

Subtheme 5.1: Intervention Approach and Session Intensity
Mothers valued a positive feedback approach but noted that it could be frustrating if not accompanied by actionable insights for improvement. They sought advice on their relationship with their child, play, feeding, behavior, and meeting developmental milestones, wanting new strategies and constructive criticism. Preferences for session length varied, with some favoring shorter, focused sessions and others more in-depth ones. Flexibility in scheduling was also desired, to align with their child’s naps or work schedules. Many mothers factored in the need for time to implement learning from each session. These preferences did not appear to be significantly influenced by the remote online delivery format.

Subtheme 5.2: Concerns about Information Manageability
Nearly all mothers stressed the importance of clear advance information about the program’s aims, benefits, and time commitment. They suggested that services should carefully consider the volume of text-based materials provided beforehand, given competing responsibilities. Concerns about information overload were expressed, with a preference for concise, actionable guidance and confidence-building "nudges." This desire for manageable information aligned with earlier themes highlighting the challenges of balancing parenting and intervention participation.

Some mothers expressed uncertainty about effectively capturing both themselves and their infant in self-recorded videos, and five requested specific, practical instructions on video recording techniques. Clear guidance on submission procedures was also deemed crucial for accessibility and ease of use. Most preferred receiving this information via email for easy reference and sharing with partners. Preferences for the timing of this guidance varied, with some favoring receipt one to two days before sessions, while others preferred one to two weeks in advance.

Discussion: Bridging the Virtual Divide

This study represents one of the initial explorations into the perspectives of mothers with very young children regarding a hypothetical virtually delivered VF parenting intervention. The inclusion of mothers who had not previously participated in a parenting program (eight out of ten) provides a valuable counterpoint to studies that typically focus on engaged and completed interventions. The findings underscore mothers’ appreciation for virtual VF while also highlighting significant anticipated barriers, including time constraints, the need for technical and childcare support, and internet access limitations. Crucially, some barriers, such as cultural and language differences, are not inherently resolved by virtual delivery. These concerns echo findings from previous research on both virtually delivered and in-person VF interventions.

While mothers acknowledged the potential utility of video, they also anticipated feelings of nervousness, self-consciousness, and fear of judgment when engaging in self-recorded interactive tasks. This resonates strongly with qualitative studies on parents’ actual experiences with VF interventions. The uncertainties surrounding the technical aspects of recording, ensuring adequate capture on screen, were also noted. Interestingly, the potential for remote participation to alleviate some nervousness was not extensively discussed by the mothers. However, the idea of self-producing videos of parent-infant interaction for submission was generally viewed positively, based on their interpretation of pre-session recording requirements. While this study proposed submitting recordings in advance for feedback, other approaches involve in-session recording with real-time practitioner guidance.

Comparing these findings with previous qualitative research on VF interventions reveals commonalities and distinctions. Parents in both current and prior research emphasized the transformative power of video for insight, validation, and change, and highly valued the practitioner’s skill and expertise. Concerns about cultural sensitivity and language barriers were also present. However, parents who had participated in a program often described a shift in experience over time, gaining a sense of ownership and empowerment, with positive changes generalizing to other life areas. These benefits were not anticipated by the mothers in this study, who focused more on practical barriers.

Clinical Implications: Navigating the Digital Frontier

Virtual delivery offers considerable flexibility, particularly in scheduling around daily routines, and can expand access to specialized expertise that might otherwise be unavailable. By removing geographical barriers, virtual formats can enhance reach to multilingual practitioners and culturally specialized professionals. However, successful engagement hinges on addressing practical, technical, emotional, and cultural barriers that persist or may be amplified in remote delivery. These considerations are vital not only for standalone VF programs but also for broader parenting support interventions incorporating VF.

In both standalone and blended programs, VF can serve as a reflective tool to tailor practitioner feedback or reinforce learning. Nevertheless, the cognitive, emotional, and logistical demands of self-recording, co-reviewing footage without distractions, and interpreting subtle cues remain substantial. These demands must be anticipated and scaffolded, especially in virtual formats. Key adaptations include clear communication of goals and expectations, upfront information presented thoughtfully, ensuring alignment with family routines, and reducing rigid time commitments and technical literacy demands. For disadvantaged families, integrating VF sessions into accessible community spaces may be necessary.

Shorter, more frequent sessions can help build rapport with practitioners and reduce emotional intensity. Tailored support, such as advance information shareable with partners, flexible scheduling, and the option to discuss broader parenting concerns, can further strengthen engagement. The physical separation in virtual settings can act as a psychological barrier, particularly if parents feel unable to communicate emotional discomfort. Programs should prepare parents for different stages of their intervention journey and offer multiple communication channels.

For mothers from diverse cultural backgrounds, particularly those for whom English is not the primary home language, the practitioner’s cultural competence and sensitivity are paramount and should be communicated clearly. Co-designing interventions with parents, including those who might not typically engage, can ensure VF is embedded in a way that reflects family needs and values. Addressing performance pressure and maintaining a positive focus during sessions are crucial for participation. The desire to produce "positive" videos, while intended to demonstrate typical interactions, warrants further consideration, as does the sense of control and ownership derived from self-selected video recordings.

Finally, offering an online peer support group could normalize negative feelings and provide additional support, particularly valuable in programs where VF is one component. This could help parents process their experiences and build confidence.

Limitations and Future Research

A primary limitation of this study is its small, self-selected sample, consisting of university-educated mothers living with a partner. These participants likely possessed an interest in or anxieties about their parenting, were more reflective and articulate, and benefited from partner support. Unlike previous studies focusing on intervention completers, this study captured anticipated views from mothers who had not yet participated, which, while valuable, are hypothetical. With the exception of two participants, mothers had no prior experience with parenting interventions. Furthermore, the emphasis on lack of time as a potential barrier suggests that the sample might not fully represent those perceiving a significant need for parenting support. Future research should include larger and more diverse samples, including fathers. The requirement for device and internet access may have inadvertently excluded more marginalized groups.

The study’s initial mixed-methods approach was constrained by the small sample size, precluding statistical analysis. A crucial next step is a qualitative study exploring parents’ actual experiences with virtually delivered VF interventions, ideally within a pilot trial. A longitudinal qualitative approach would be particularly valuable for comparing imagined and lived experiences.

The interviewer’s lack of practical VF delivery experience may have influenced interviews in complex ways. While it reduced the risk of bias, it might have limited the ability to probe specific elements of the novel virtual format. This may have led participants to discuss the intervention holistically rather than focusing on the impact of the delivery mode. The depth of interviews might have been constrained by less probing, potentially limiting theme development. A notable tendency was for mothers to steer conversations toward the intervention itself, rather than the mode of delivery. The wider research team’s experience inevitably shaped the analytic lens, potentially directing attention to certain issues over others.

Conclusion

As online and virtually delivered parent-child interventions become increasingly prevalent, this study provides critical insights into how mothers of young children perceive participating in a hypothetical virtually delivered VF-based intervention. Mothers recognized clear advantages in terms of flexibility and feasibility, particularly for busy working mothers. However, they also anticipated significant technical, practical, and emotional challenges that could impede engagement. These concerns strongly underscore the need for thoughtful adaptations, developed with parental input, to ensure that virtual VF interventions are accessible, supportive, and sustainable for families. The future of early parenting support lies in harnessing the potential of digital technologies while diligently addressing the human element of care.