📄 social_science

Valued outcomes across stakeholders of parenting programs in Sweden

This study of Swedish parenting programs reveals substantial alignment among practitioners, managers, and parents regarding valued outcomes across multiple levels, challenging the common implementation science assumption of inherent stakeholder conflicts and suggesting a need to address system-level constraints rather than prioritizing trade-offs.

Original authors: Kristoffer Pettersson, Pernilla Liedgren, Fabrizia Giannotta, Ulrica von Thiele Schwarz

Published 2026-07-09

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Kristoffer Pettersson, Pernilla Liedgren, Fabrizia Giannotta, Ulrica von Thiele Schwarz

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine parenting programs as a recipe for raising happy, well-adjusted children. This recipe has been tested and proven to work (it's "evidence-based"). However, when a chef (a group leader) tries to cook this dish in a real kitchen (a Swedish community), they often have to make choices: Do I follow the recipe exactly, or do I tweak the ingredients to suit the local taste?

This paper explores a big question: When these chefs, the restaurant owners (managers), and the diners (parents) sit down to discuss the meal, do they all want the same thing, or are they fighting over the menu?

Here is the breakdown of what the researchers found, using simple analogies.

The Big Misunderstanding

For a long time, experts in "implementation science" (the study of how to get good ideas into real life) assumed that these three groups were always at odds. They thought:

The Chefs (Group Leaders) wanted flexibility to make the food tasty for the specific people in the room.
The Owners (Managers) wanted efficiency and to serve as many people as possible.
The Diners (Parents) just wanted something that worked for them right now.

The assumption was that these groups were constantly pulling the rope in different directions, creating a tug-of-war.

The Surprise: Everyone Wants the Same Feast

The researchers gathered 56 people (leaders, managers, and parents) in Sweden and asked them what they valued most about these parenting programs. They used a "ladder" of success (called the Kirkpatrick model) to sort the answers, from the immediate feeling to the long-term result.

The result? Everyone was surprisingly on the same page.

Instead of a tug-of-war, it was more like a choir singing the same song. Here is what they all agreed on, from the "first bite" to the "after-dinner feeling":

The "First Bite" (Immediate Reaction):
- The Feeling: Everyone loved the idea of sitting together. Parents felt relief realizing, "I'm not the only one struggling." Leaders and managers saw this group support as the foundation of the whole program.
- The Metaphor: It's like realizing you aren't the only one who burned the toast. Sharing the kitchen makes the cooking less scary.
The "Cooking Class" (Learning):
- The Skill: Everyone wanted parents to think differently. They wanted parents to pause and reflect on their actions rather than just reacting.
- The Metaphor: It's not just about giving parents a new tool; it's about teaching them how to see the problem so they can choose a better solution.
The "New Menu" (Behavior):
- The Change: The goal was better relationships and fewer arguments at home.
- The Metaphor: The kitchen becomes a calmer place where everyone gets along better.
The "Long-Term Health" (Results):
- The Future: Everyone agreed the ultimate goal is healthy, happy children and preventing future social problems (like crime).
- The Metaphor: It's about raising kids who grow up to be strong, secure adults who contribute to society.

The Hidden "Kitchen Rules" (System-Level Outcomes)

While everyone agreed on the food, the researchers found two huge factors that operate outside the kitchen, affecting whether the meal can even happen. These are called System-Level Outcomes:

Reach (The Size of the Restaurant):
- Everyone agreed the program needs to reach as many people as possible, especially those who are hard to find or help.
- The Metaphor: It's not enough to have a great recipe if only the people who already know how to cook can find the restaurant. You need to open the doors wider.
Trust (The Reputation):
- This was the most interesting part. To get people to come in, the program needs to be trusted.
- The Metaphor: If people think the restaurant is "dangerous" or that coming there means the government will take their kids away, they won't come. Leaders sometimes have to tweak the recipe (adapt the program) just to prove, "We are safe, we are here to help, and we aren't judging you."

The Real Problem Isn't "Who Wants What"

The paper concludes that the big conflict isn't actually between the leaders, managers, and parents fighting over different goals. They all want the same thing: a happy family and a healthy society.

The real tension is between the "Perfect Recipe" and the "Real World Kitchen."

Sometimes, a leader has to change the recipe (adapt) not because they disagree with the manager or the parent, but because:

They need to make the program reach more people (Reach).
They need to make sure the community trusts them enough to show up (Trust).

The Takeaway

The paper suggests that instead of spending all our energy trying to mediate fights between these groups (because they actually agree!), we should focus on fixing the structural barriers.

The Analogy:
If three people want to drive to the same destination (a happy family), but the car has a flat tire and the road is blocked, arguing about who should hold the steering wheel won't help. You need to fix the tire and clear the road.

In this case, the "tire" is the lack of resources or the fear of stigma. If we fix those system-level issues, the leaders, managers, and parents can work together smoothly to deliver the best "meal" for everyone.

Technical Summary: Valued Outcomes Across Stakeholders of Parenting Programs in Sweden

Problem Statement
Implementation science frequently operates under the assumption that inherent tensions exist between the priorities of different stakeholders (practitioners, managers, and service users) when delivering evidence-based interventions. These assumed conflicts often drive the "fidelity-adaptation dilemma," where professionals must choose between maintaining strict adherence to a protocol (fidelity) and modifying it to fit local contexts (adaptation). While frameworks suggest these groups prioritize divergent outcomes—such as practitioners valuing flexibility, managers prioritizing efficiency and reach, and users seeking immediate relevance—these assumptions lack empirical validation in specific intervention contexts. Specifically, there is a gap in understanding how stakeholders in parenting programs actually value outcomes and whether their priorities truly conflict or align, which is critical for understanding how adaptation decisions are managed in practice.

Methodology
This study employed a qualitative research design utilizing directed content analysis to explore valued outcomes in Swedish parenting programs.

Participants: The study involved three key stakeholder groups: parenting group leaders ( $n=28$ ), service managers ( $n=16$ ), and parents who had participated in the programs ( $n=12$ ). Participants were recruited from municipalities across Sweden offering evidence-based programs such as All Children in Focus, Comet, Triple P, and Connect.
Data Collection: Data was gathered through eight focus groups (five with leaders, three with managers) and twelve individual interviews with parents. Semi-structured interview guides were used, with the fidelity-adaptation dilemma explicitly introduced to leaders and managers to stimulate discussion on trade-offs.
Analytical Framework: The analysis utilized Kirkpatrick's training evaluation model as a primary framework to categorize outcomes into four levels: Reaction (immediate), Learning (short-term), Behavior (intermediate), and Results (long-term). The researchers employed a directed content analysis approach, coding transcripts for phrases indicating value or priority, while remaining open to emergent categories that did not fit the existing model.
Ethical Considerations: The study received approval from the Swedish Ethical Review Authority, and all participants provided informed consent.

Key Results
The analysis revealed a substantial alignment across all stakeholder groups regarding the value of specific outcomes, challenging the assumption of inherent conflict.

Alignment on Individual-Level Outcomes:
- Immediate (Reaction): All groups valued group support, shared experiences, and engagement. Parents and leaders emphasized the therapeutic value of realizing they are not alone, while managers recognized this as a driver for program reach.
- Short-Term (Learning): Stakeholders uniformly valued self-reflection, increased awareness, and parental empowerment. Leaders and managers focused on the acquisition of knowledge and confidence, while parents valued the ability to make active, conscious choices in their parenting.
- Intermediate (Behavior): Improving parent-child relationship quality and reducing conflicts were central goals for all groups.
- Long-Term (Results): All stakeholders prioritized child well-being, healthy development, and the prevention of broader social problems (e.g., crime, lack of belonging).
Emergence of System-Level Outcomes:
- Beyond Kirkpatrick's individual-focused framework, the study identified two critical system-level outcomes: Reach and Trust.
- Reach: All stakeholders emphasized the importance of extending program benefits to the broadest possible audience, particularly those who are hard to reach.
- Trust: Building community trust and reducing the stigma of seeking help were viewed as necessary preconditions for program success. Leaders noted that building trust sometimes necessitated adaptations that might compromise strict fidelity.
Divergences:
- While goals were aligned, perspectives on how to achieve them differed. Managers tended to emphasize organizational sustainability and broad reach, whereas practitioners focused on the quality of immediate engagement.
- Unexpectedly, some parents expressed a strong preference for evidence-based credibility and strict fidelity, concerned that adaptations might dilute the program's effectiveness, contrasting with the literature's assumption that users prioritize flexibility over protocol.

Key Contributions

Empirical Validation of Alignment: The study provides empirical evidence that, contrary to common implementation frameworks, stakeholders in Swedish parenting programs largely agree on the hierarchy of valued outcomes (from group support to child well-being). This suggests that the "fidelity-adaptation dilemma" may not always stem from conflicting stakeholder values.
Identification of System-Level Drivers: The research highlights that adaptation decisions are often driven by system-level constraints (specifically the need for reach and trust) rather than direct conflicts between stakeholder priorities.
Refinement of Evaluation Frameworks: The findings suggest that traditional training evaluation models like Kirkpatrick's, which focus on individual-level outcomes, may be insufficient for capturing the full scope of implementation success. The study argues for the inclusion of system-level outcomes (organizational and community conditions) in implementation models.

Significance and Claims
The authors claim that their findings nuance the prevailing narrative in implementation science regarding stakeholder conflict. They argue that implementation strategies should not solely focus on reconciling presumed value conflicts between groups. Instead, the paper posits that the primary challenge in managing the fidelity-adaptation dilemma may be addressing system-level constraints (such as resource limitations affecting reach or the need to build community trust) that prevent stakeholders from achieving their largely aligned goals.

Consequently, the study suggests that effective implementation strategies should:

Develop adaptive program designs that maintain core components while accommodating system-level requirements for reach and trust.
Create support structures to help practitioners navigate resource constraints without compromising key outcomes.
Focus stakeholder engagement on identifying and removing system-level barriers rather than mediating non-existent value conflicts.

The authors maintain a modest stance, acknowledging that their findings are specific to the Swedish context and that the study did not observe real-time decision-making processes. They call for future research to examine how system-level factors influence the achievement of outcomes in different cultural and organizational settings.