To What Extent Can Evidence-Based Parenting Interventions Be Transported From One Country to Another? A Systematic Review

Introduction: Although many trials have reported successful ‘transportation’ of parenting interventions across countries (Gardner et al. 2006; Leung et al. 2003; Prinz et al. 2009), others have found much more disappointing results (Sundell et al. 2008). The theoretical basis and process for translating effective interventions according to national differences is not fully understood, but useful frameworks have been developed, especially for cross-cultural, within-country translation (Barrera & Castro 2006; Kumpfer 2008), and there is a growing literature – but no systematic review – on factors affecting whether such transportation is likely to be successful. Paramount among these are cultural and service contexts and how these interact with characteristics of the intervention, including cultural flexibility, competence and adaptation, and the trade-off with fidelity. This is the first study to explore these issues using systematic review methods, asking i) how effective are parenting interventions for conduct problems when transported across countries ii) can we identify country-level cultural and policy variables that are associated with intervention effect size?

Methods: used a 2 stage methodology: 1) identifying parenting programs showing robust effects in multiple RCTs in their ‘origin’ country, for preventing or reducing conduct problems;   2) searching for RCTs testing effects of these interventions in different countries from those in which they were developed. We conducted meta-analyses of i) mean intervention effects in transported countries; ii) exploratory subgroup analyses examining outcome by program factors, including extent of cultural adaptation; and country-level factors, including income, cultural values (specifically ‘cultural distance’ between origin and ‘transported’ country, coded using the World Values survey data), and family policy context.

Results:  Findings were striking in showing i) generally strong effect sizes for parenting interventions when transported to different countries, despite quite modest degree of program adaptation  ii) effects were no smaller when transported to countries with highly contrasting cultural and policy contexts, rather there was a tendency for effects to be larger in these countries. Cultural distance between origin and transported country did not predict size of intervention effects. Conclusions: We focus on implications for international policy dissemination in prevention science, raising questions about what are the characteristics of interventions, as well as contexts, for which international transportation may be appropriate? Different interventions will likely vary in the extent to which they require adaptation or re-designing when taken to very different service and cultural contexts.