This thesis presents research exploring the organisational factors that contribute to the effective implementation 1 of evidence-based programs (EBP) as a public health strategy. The field of psychology, despite being a discipline that works within a scientific framework with well established outcomes at both the research and clinical levels, has faced challenges in disseminating EBPs. Guidelines established by the Society for Prevention Research (SPR, 2004), and discussed within this study, have now set a benchmark for the selection of EBPs in the field of prevention considered suitable for wider scale dissemination. Specifically, the aim of this study has been to explore a set of proposed organisational variables as measured by the newly developed Organisational Climate of Change ( OCC) measure to expand knowledge and understanding of what may contribute to an effective dissemination process. Strong internal consistency was established across sub scales of the OCC (i.e., policy and funding support, advocacy, professional training and workplace support, evaluation, and quality assurance) which became the basis for further research on effective dissemination within this exploratory study.
The Triple P-Positive Parenting Program was adopted as the program of choice for this study due to its strong evidence base and wide scale international adoption. The Triple P system has been designed as an effective multilevel public health strategy aimed at strengthening parenting at a population level by promoting positive relationships within families by developing effective preventative and management strategies for a range of common childhood behavioural problems (Sanders et al., 2005). In total, organisations from eleven countries disseminating Triple P participated in this study.
Given the considerable knowledge acquired through the widespread dissemination of Triple P, the next stage of the study was to examine training outcomes from an international sample of practitioners (N = 6,682) trained across the various levels of the program. These analyses examined both the demographic data from participants attending the Triple P Provider Training Courses in six of the eleven countries, in addition to outcomes in practitioner self-confidence, training quality and overall satisfaction with the training process. These findings confirmed consistency in outcomes across all of the participating countries with the rollout of a standardised training program.
Having established empirical support for professional training outcomes internationally, the study further explored relationships between management responses (N = 41) to the OCC from each of the participating countries and Triple P Providers within their services. Strong relationships were noted between the OCC subscales, as mentioned above, and practitioner variables (i.e., training quality; self efficacy; and percentage of families accessing Triple P services). Furthermore, management responses related to the implementation of Triple P were linked to practitioner outcomes (e.g., self efficacy, training quality, percentage of families accessing Triple P).
Although exploratory, it may be deduced from this research that quality assurance mechanisms protecting the integrity of EBPs appear central to the dissemination of programs (e.g., Triple P) as population health strategies. Overall, this exploratory research has been a first step in developing a new conceptual theory for understanding the relationships that exist between factors that underlie the effective implementation of EBPs and outcomes within organisations disseminating Triple P internationally.
1 Within this study effective dissemination has been defined as the percentage of families accessing the Triple P- Positive Parenting Program, proportion of accredited Triple P Providers implementing the program within an organisation, and relationship between management responses to the OCC and practitioner outcomes (e.g., practitioner self-efficacy, training quality and satisfaction).