Svenska föräldrars reflektioner om faktorer som främjat förändring efter deltagande i det evidensbaserade föräldrastödsprogrammet Family Check-up
Project number : 266711
Created by: Julie Showich Lundgren, 2019-04-04
Last revised by: Researchweb Support, 2019-04-04
Project created in: FoU i Västra Götalandsregionen


1. Översiktlig projektbeskrivning

Engelsk titel

Swedish parents’ reflections on the facilitators of change in the evidence based parent support program Family Check-up

Populärvetenskaplig sammanfattning av projektet

Mål: Studiens syftade till att utforska svenska föräldrars erfarenheter av ett evidensbaserad föräldrastödsprogram, Family Check-up, med fokus på nöjdhet och uppfattningar av hinder och fragångsfaktorer för förändring.

Metoder: Blandade metoder användes, som kombinerar kvantitativa och kvalitativa metoder. Fem fokusgrupper hölls med föräldrar till (n = 15) som hade deltagit i Family Check-up. Fokusgruppsdiskussionerna audioinspelades, transkriberades och analyseras med tematisk analys.

Resultat: Deltagarnas rapporterade nöjdhet med programmet rapporteras. Deltagarnas erfarenheter och uppfattningar från programmen kategoriserades i hinder och framgångsfaktorer i relation till programkomponenter, programleverans och den kliniska processen.

Diskussion: Resutlat diskuteras utifrån implementeringsvetenskap och bidrar till kunskap kring att matcha familjers behov och önskemål med programkompenteneter och leverans i tillämpning av evidensbaserat föräldrastöd i praktiken.

Vetenskaplig sammanfattning av projektet


Parental competence is a significant determining factor for long-term adjustment for youth exhibiting conduct problems (Patterson et al 1989). Parent management training (PMT) programs developed at the Oregon Social Learning Center have been shown to be effective for preventing and treating socially deviant behavior in at-risk youth (Dishion et al, 2016; Weisz & Kazdin, 2010). Adapted American PMT programs are considered to be transportable in Europe (EMCDDA, 2013) and there is evidence for their effectiveness in many other cultures (Leijten et al, 2015). Results of randomized, controlled studies in Sweden support these findings (Jalling et al, 2015; Stattin et al., 2015) and parent management training programs out of Oregon have been successfully implemented on a national level in Norway and Iceland (Forgatch & DeGarmo, 2011; Sigmarsdóttir et al 2014). Taken together, these findings lend support for the appropriateness of these programs as interventions for youth externalizing behavior in a Nordic cultural context. Regardless of whether a program is transported from North America or “homegrown” (i.e., locally developed), programs based on the PMT principles lead to similar outcomes (Gardner & Leijten, 2016), and there is evidence supporting the effectiveness of self-directed (internet based) PMT programs (Lundahl, 2006).

The challenge for future research and practice is successfully implementing these programs in real world settings (Forgatch, Patterson, & Gewirtz, 2013; Kazdin, 2008, 2013; La Greca, Silverman, & Lochman, 2009). Measuring client perceptions of barriers and facilitators of change falls within the purview of implementation science (Proctor et al, 2009). and is central to achieving a match between needs and services, which in turn enhances patient-centered and equitable care (Owens et al 2007).Studies of client perceptions of evidence based parent support programs have centered on barriers and facilitators affecting treatment access and adherence (Koerting et al 2013), as well as the relative influence of specific program elements and nonspecific treatment factors, such as therapeutic alliance, and the credibility and acceptability of the program (Kazdin 2018). These studies provide a conceptual framework for the current study which seeks to explore Swedish parents’ reflections on facilitators of change after participating in the evidence based parenting programs, the Family Check-up which represents a second generation PMT program with adaptations and developments designed to improve reach, access and retainment in treatment through the use of motivation interviewing techniques and home visiting.



Participants were recruited in conjunction with a randomized, controlled effectiveness trial comparing FCU and iComet (Ghaderi et al 2018). Participants recruited to the original study were families with a child aged 10 to 13 years living in six different districts of the city Gothenburg. The criterion for inclusion was parent or teacher rated concern about child behavior as indicated by scoring 3 points or more on the Conduct Problems subscale of the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997, 2001).

The current study was conducted with a subset of families from the original study sample in conjunction with a three-year follow-up of study outcomes. The Client Satisfaction Questionnaire (CSS; Nyguyen, 1983) was included in the assessment package. The CSS has previously been adapted for use in evaluating parent experience of the Family Check-up and has been shown to have excellent internal consistency (α = .95; Smith et al, 2014). The questionnaire consists of nine questions rated on a Likert scale from 1 (strongly disagree) to 5 (strongly agree). A summary score for client satisfaction is calculated by averaging the scale’s nine questions. Higher points indicate a high degree of satisfaction. Previous studies have reported a high degree of satisfaction with Family Check-up (M=4.29, SD = .87).

One hundred and thirty-two families (57%) returned follow-up questionnaires. Of these, seventy-seven of the families who submitted CSS responses had participated in the Family Check-up intervention. Parents were also asked to indicate if they would be interested in being contacted regarding participation in an interview study. Thirty-four (63%) of the 132 families who expressed interest had participated in the FCU condition. These families were then contacted by a research assistant by telephone, who informed participants about the nature of the study, and scheduled interview sessions. When participants arrived at their scheduled session, they were given written information about the study, and an opportunity to ask questions. At this time written consent was collected. Parents who expressed a current concern about their child’s behavior or adjustment were given the option of being referred to a social service family support consultant in their district. Lastly, parents who wished to receive information about the study results could leave their contact information with the research assistant.

Three focus groups were conducted with FCU participants (n = 15) of which 5 were fathers and 10 were mothers. The interviews focus group discussions were structured around the following three open-ended questions: 1) Talk about how your parenting has changed over the last few years; 2) What has been your experience of receiving help with your parenting?; and, 3) If a friend came to you and told you that they were having conflicts with their child, what advice would you give them? Follow-up probes were inserted as needed, with a focus around the following subthemes: strengths, hope, change, parenting, facilitators and barriers. After the first focus group interview discussion was conducted, it became apparent that the parents did not respond to the lead in beginning with a general discussion of change, but rather wanted instead to describe why they sought treatment in the first place. Therefore, an adaptation to the interview focus group protocol was made in the form of the addition of an open ended question to subsequent interview focus group sessions where parents were encouraged to describe what they remembered about why they entered the program.

A research assistant led the focus group sessions, assisted by a secondary observer who took notes and facilitated with follow-up prompts if needed. Audio recordings were made of the focus groups sessions, which were then transcribed verbatim by a research assistant. Approval was granted by the Regional Ethical Review Board in Uppsala to extend the original study protocol in order to encompass the addition of the CSS to the follow-up questionnaire as well as the qualitative interview focus group study (dnr 2010/119/2).


Responses to the CSS questionnaire were analyzed using nonparametric statistics.

Analysis of the focus groups transcriptions was conducted using the thematic analysis technique as outlined in Braun & Clarke (2006). Two independent coders derived initial themes from the raw material. The two sets of themes were then consolidated with the aid of a conceptual model for understanding parent perceptions of evidence based programs. The model was adapted from previous research investigating parent perceptions of parenting programs (Kazdin, 2018; Koerting et al, 2013). Within this model, each theme was conceptualized according to its relationship to the process of change.Themes were identified as either facilitators or barriers, and then cross classified as either a program component, a program delivery component, or a process component. No distinction is made in the analysis between themes conveying program elements that the subjects actually experienced and themes conveying elements that would or would not have been helpful in theory, such as participating in a parenting group.

Typ av projekt


MeSH-termer för att beskriva typ av studier

checked Kvalitativ forskning (Qualitative Research)
checked Fokusgrupper (Focus Groups)

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MeSH-termer för att beskriva ämnesområdet

information Added MeSH terms
Behavioral Disciplines and Activities
The specialties in psychiatry and psychology, their diagnostic techniques and tests, their therapeutic methods, and psychiatric and psychological services.
The state of the organism when it functions optimally without evidence of disease.
Psychological Phenomena and Processes
Mechanisms and underlying psychological principles of mental processes and their applications.
Mental Health
The state wherein the person is well adjusted.

Projektets delaktighet i utbildning

checked Ej del i utbildning

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2. Projektorganisation och finansiering

Arbetsplatser involverade i projektet

information Added workplaces
Regioner - Västra Götalandsregionen - Närhälsan - Hälso- och specialistvård för barn och unga - Närhälsans utvecklingscentrum för barns psykiska hälsa workplace verified by Västra Götalandsregionen on 2018-02-27
Regioner - Västra Götalandsregionen - Närhälsan - FoU primärvård - Närhälsan FoU-centrum Göteborg och Södra Bohuslän workplace verified by Västra Götalandsregionen on 2018-02-27


Susanne Bernhardsson
FoU-strateg, Närhälsan FoU-centrum Göteborg och Södra Bohuslän

Svenska föräldrars reflektioner om faktorer som främjat förändring efter deltagande i det evidensbaserade föräldrastödsprogrammet Family Check-up, from FoU i Västra Götalandsregionen