Facilitators and Barriers in Cross-Country Transport of Evidence-based Preventive Interventions: a Case Study Using the Family Check-Up

Abstract

This study is a qualitative analysis of facilitators and barriers in the dissemination of Family Check-Up (FCU), a U.S.-developed preventive intervention in Sweden. The FCU is inherently culturally flexible because it was designed to be tailored to each family's needs and context, including cultural norms and values. We present the FCU implementation framework (IF) as a conceptual framework for cross-country transport of the FCU and evidence-based programs (EBP) more generally. The FCU IF draws from implementation science literature and involves specifying barriers and facilitators related to implementation drivers (e.g., competency) at each implementation phase and applying these data to inform phase-specific, readiness-building activities for each driver. In addition to driver-related influences, barriers and facilitators specific to the FCU and the collaborative partnership between the U.S. and Swedish purveyors emerged in the data. The partnership's reliance on a hybrid bottom-up, top-down approach that balanced the Swedish purveyor's autonomy and cultural expertise with guidance from the U.S. purveyor facilitated adaptation of the FCU for Sweden. Relying on previously collected data, we also explored similarities and differences in barriers and facilitators to FCU scale-up in the United States versus Sweden. In general, across drivers, the same barriers and facilitators were salient. This study suggests that dissemination of culturally flexible EBPs guided by a dynamic implementation framework can facilitate cross-country transport of EBPs. This study promotes a culture of prevention by highlighting barriers, facilitators, and readiness-building strategies that influence the cross-cultural transportability of EBPs that prevent the onset and escalation of child problem behavior.

Professional Learning in Family Support Social Work in Sweden

“…Consistent with previous studies, the importance of sufficient resources for working with evidence-based models, like FCU, is evident (Bertram et al, 2015;Heiwe et al, 2013;Mauricio et al, 2018;Ryding & Wernersson, 2019). As with the importance of a sufficient knowledgebase for achieving successful implementation and later work with the model, the need for sufficient learning time to master the model cannot be stressed enough.…”

Commentary on the Culture of Prevention

“…The successful implementation of these programs is part of building a culture of prevention from the ground up-a way of creating a demand for these effective strategies that depend on prevention science. Mauricio et al (2018) highlight the commonality of facilitators and barriers and the need for readiness building in their work in disseminating Family Check-Up in the USA and Sweden. Their findings reinforce the importance of applying an implementation science framework when introducing evidence-based prevention programs internationally.…”

Addressing Barriers to Primary Care Screening and Referral to Prevention for Youth Risky Health Behaviors: Evidence Regarding Potential Cost-Savings and Provider Concerns

“…Engaging and retaining prevention recipients is often challenging and could itself be an important focus of implementation. Regarding client transportation as a barrier, multiple prevention programs including Family Check-Up can be delivered virtually, although best practices for this venue are still evolving (Hoffnung et al, 2021;Mauricio et al, 2021). Virtual delivery of behavioral health services is currently reimbursable due to policy changes in response to COVID-19 social distancing (Whaibeh et al, 2020).…”