Plain English Summary
Background and study aims
Many studies have shown that parenting support programs are effective in reducing behavioural and emotional problems in children. However, resources are limited and there is a debate about which program should be made available to parents. Triple P - Positive Parenting Program is an evidence-based program that is currently available in Sweden. Triple P level 2 is a low-cost program that consists of three large group seminars. Triple P level 3 and 4 are more intensive, with level 3 being delivered in one-to-one sessions and level 4 being delivered in small groups. In this study, we examine whether combining the three levels of Triple P is more effective than offering Triple P level 2 alone.
Who can participate?
All families with a child aged 3 to 5 in participating preschools in Uppsala, Sweden who can speak Swedish, Arabic, Somali, Persian, Sorani or English.
What does the study involve?
Participants will be asked to complete a set of questionnaires annually until the child is 5. Participating preschools will be randomly divided into three conditions: Universal, Universal Plus and Services as Usual. Families in the Universal and Universal Plus preschools will be invited to participate in a series of parenting seminars run by trained preschool teachers or community workers. These are Triple P seminars and provide practical advice on how to raise healthier and more competent children. Families in the Universal Plus preschools will receive additional parenting support by attending one-to-one or group sessions (Triple P primary Care or Group). These programs have a greater focus on parenting strategies that help to prevent behavioural problems. All three programs will be available throughout the project and parents can attend any time that is convenient for them.
What are the possible benefits and risks of participating?
Parents participating in one or more of the Triple P sessions may benefit from improved parenting skills, child behaviour and mental health. We do not expect any risks to be associated with participation.
Where is the study run from?
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
When is the study starting and how long is it expected to run for?
Recruitment is expected to start in August 2013 and end in July 2017.
Who is funding the study?
Joint grant FORMAS (Sweden).
Who is the main contact?
Associate Professor Anna Sarkadi
Dr Anna Sarkadi
Department of Women's and Children's Health
SHS Vårdcentrum Box 609
+ 46 (0) 18-611 59 65
The children and parents in Focus project: a population-based cluster randomised controlled trial to prevent behavioural and emotional problems in children
The aim of this population-based cluster randomised controlled trial is to prevent behavioural and emotional problems in pre-school children. The study has three arms:
1. Universal approach
2. Universal plus (universal and targeted) approach
We hypothesise that compared to the services as usual, universal approach and the universal plus approach will have greater population reach and be more effective.
Regional Ethics Committee in Uppsala, 14/11/2012, ref: 2012/437
Cluster randomised controlled trial
Primary study design
Secondary study design
Cluster randomised trial
Patient information sheet
Not available in web format, please contact Ms Anna Backman (firstname.lastname@example.org) to request a patient information sheet.
Child behaviour and emotional problems
Universal arm: All families in this condition will be offered a light parenting program. The program includes 3 stand alone parenting seminars (Triple P level 2) and will be offered periodically throughout the implementation phase (August 2014 - July 2017). Parents are free to attend at any time.
Universal plus arm: All families in this condition will be offered the light parenting program described above as well as some extra support namely Triple P level 3 which consists of up to 4 brief individual sessions and Triple P level 4 which is an 8-seesion group program. All the three programs would be available throughout the implementation phase. Parents are
free to attend at any time.
Services-as-usual arm: Families in this condition will only be offered the services as usual in their child health centre and preschool.
Primary outcome measure
Child externalising and internalising symptoms at ages 3, 4 and 5 measured by Strengths and Difficulties Questionnaires (SDQ)
Secondary outcome measures
1. Parenting practices
2. Parent mental health
3. Economic evaluation
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
Eligible participants are all parents with a 3, 4, or 5-year-old child enrolled in the participating preschools in the municipality of Uppsala.
Target number of participants
Target sample size is 3000
Participant exclusion criteria
The study main language is Swedish. Study information and questionnaires are also available in the five most common languages in the immigrant community in Uppsala: Arabic, Somali, Persian, Sorani, and English. Parents will not be able to participate in the study if they neither understand Swedish nor any of the above languages.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
The trial is funded by a joint grant from FORMAS (The Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning) (Sweden), Vetenskapsrådet (Swedish Research Council) (Sweden), FAS (Swedish Council for Working Life and Social Research) (Sweden), and VINNOVA (Swedish Governmental Agency for Innovation Systems) (Sweden).
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
2013 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/24131587
Salari R, Fabian H, Prinz R, Lucas S, Feldman I, Fairchild A, Sarkadi A, The Children and Parents in Focus project: a population-based cluster-randomised controlled trial to prevent behavioural and emotional problems in children., BMC Public Health, 2013, 13, 961, doi: 10.1186/1471-2458-13-961.