Dissemination of parenting programs in Sweden during ten years: Lessons for evidence based public health

Background: New parenting programs raise hope on the possibility to prevent mental health problems on a broad scale among children. There is a strong evidence base for three groups of programs: Attachment programs, parent training programs, and alcohol/drug preventive programs. These groups of programs appeared simultaneously and were all recommended early in a national policy. However, Sweden is decentralized and the dissemination speed has varied by group of program. The purpose was to evaluate if these differences in dissemination speed could be explained by differences over key components for successful implementation. Methods: Data on prevalence was collected in 2008, approximately ten years after parenting programs were introduced. A review was conducted and the three groups of programs were compared over key components identified in the implementation literature: Existing needs, visible benefits, compatibility with existing norms and methods, ease of use, possibility to test on a small scale, possibility to adapt to needs of the recipient, and generalizability of the approach. Main preliminary results: Attachment programs were the least spread, despite having the strongest evidence base and an existing arena in the old-established parenting classes provided by the child health care centres in the 21 county councils. Parent training programs, falling under the responsibility of 290 independent municipalities, were more widely spread despite the lack of a given arena. One easy-to-use alcohol preventive program was the most widely spread, despite that the evidence base was stronger for the other groups of programs. Conclusions: In the case of dissemination of parenting programs in Sweden, feasibility trumped evidence base. Further, the dissemination was quicker in a greatly decentralized setting where a given arena was lacking than in an arena where existing methods had to be replaced. Possible lessons for other areas of evidence based public health are discussed.