J Child Fam Stud (2014) 23:934944

DOI 10.1007/s10826-013-9750-1

ORIGINAL PAPER

Conscious Parenting: A Qualitative Study on Swedish Parents

Motives to Participate in a Parenting Program
Johanna Rahmqvist Michael B. Wells
Anna Sarkadi

Published online: 16 April 2013

 Springer Science+Business Media New York 2013

Abstract Triple P is a parenting program that aims to

prevent behavioral, emotional, and developmental problems in children. Because Triple P is a new parenting
program in Sweden, it is important to see how parents felt
about the intervention. The aim of this study was to find out
why parents of preschool children chose to participate in
Triple P in Sweden, what they thought of the Triple P
curriculum, and how the program related to their parenting
philosophy in general. This is a qualitative study using
semi-structured interviews with seven mothers and three
fathers who participated in Triple P. The interviews were
transcribed verbatim and were analysed using Malteruds
method of Systematic Text Condensation. Parents chose to
participate in Triple P for several reasons: they wanted to
learn more about the intervention; they had specific problems that they sought help for; or they felt encouraged to
participate due to advertisements and recommendations
from friends. Of the Triple P curriculum, the participants
especially enjoyed the directed discussion technique, the
positive reinforcement sections, and the instructions on
how to communicate effectively with their child by staying
calm, close, and maintaining eye contact. It was important
for many of the parents to feel validated and respected, and
they liked having discussions with the preschool teacher
rather than being told what to do. Parents in this Swedish
sample generally liked and selectively used the strategies
they learned from participating in Triple P, depending on
how well these fit with their own parenting experiences and
philosophy.

J. Rahmqvist  M. B. Wells (&)  A. Sarkadi

Department of Womens and Childrens Health, Uppsala
University, Dragarbrunnsgatan 70, SHS Vardcentrum Box 609,
751 25 Uppsala, Sweden
e-mail: michael.wells@kbh.uu.se

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Keywords Sweden  Qualitative research  Triple P 

Child behavior  Parents program

Introduction
The political sphere in Sweden places a great deal of
resources into ensuring that parents have the time, support,
and tools necessary in order to raise their child (Duvander
2008). Two ways in which Sweden helps parents of young
children is by providing families with Maternal and Child
Health Services, as well as allowing parents to utilize a
generous parental leave package (Wells and Sarkadi 2012).
Prior to the birth of their child, Swedish parents are given
support, guidance and advice through the Maternal Health
Clinics (Borjesson et al. 2004), and after the child is born,
parents are provided with 480 days of parental leave, while
continuing to receive support through the Child Health
Centers, which children attend until they are 5 years old
(Wells and Sarkadi 2012).
There is a heavy emphasis on providing familial support
during the infants first year, where the physician and Child
Health nurse check for proper growth and development,
provide parenting support, and provide resources and
referrals to families who may need additional services for
their child (Fagerskiold et al. 2000). Additionally, during the
infants first year, many parents are enrolled in parent support groups through the Child Health Centers, where they
can learn from medical professionals and other parents on
best parenting practices (Fagerskiold and Ek 2003). However, parents feel they lack support for their preschool-aged
children from both the Child Health Centers (Stenhammar
et al. 2012) and from the preschools (Guldbrandsson and
Bremberg 2006; Stenhammar et al. 2012).

J Child Fam Stud (2014) 23:934944

The Rationale of Parenting Programs

Research has shown that there is a strong association
between parental behaviour and developmental outcomes
in children. Parental strategies that can be considered lax
and inconsistent, or over-reactive, authoritarian and coercive, contribute to externalizing behaviour problems
(Patterson et al. 1982). Moreover, harsh and over-reactive
discipline correlates with difficulties in marital adjustment,
child-rearing disagreements and childrens externalizing
problems (Buehler and Gerard 2002; Krishnakumar and
Buehler 2000). Previous studies have shown that when
parents are taught strategies that are more consistent,
warm, authoritative, moderate, and firm, childrens rates of
problematic behaviors decrease (Furlong et al. 2012; Wyatt
et al. 2008).
Triple P or the Positive Parenting Program is an evidenced-based parenting support program (Thomas and
Zimmer-Gembeck 2007) that began in the 1970s (Sanders
1999), and is partly based on the principles of social
learning theory; namely on how the childs environment
can be changed in order to prevent behavior problems in
children. Triple P has been instituted and internationally
tested (Cina et al. 2006; Leung et al. 2003; Triple P 2011),
but has not yet been evaluated in Sweden (Bremberg 2004).
The program is directed towards parents of children aged
016 and aims to prevent major behavioral, emotional, and
developmental problems in children by increasing parents
knowledge, ability, independence and confidence in their
parenting (Sanders 1999).
Triple P is based on five key principles: to ensure a safe
and interesting environment, to create a positive learning
environment, to use assertive discipline, to have realistic
expectations, and to take care of oneself as a parent.
Additionally, how to react and handle stress, anger, and
performance anxiety are taught in the higher levels of
Triple P (Sanders 2008; Sanders et al. 2003).
The Triple P program is available in five levels with
increasing degrees of intervention, with the second and
third levels focusing on mild/everyday behavioral problems (Sanders 1999, 2000). Specifically, Level 2 comprises
three 90-minute seminars that are based around empowering parents. The first seminar, The Power of Positive
Parenting, introduces the five key principles listed above
and teaches parents how to parent in a positive way. The
second seminar, Raising Confident, Competent Children,
teaches the parents how they can teach their children skills,
such as independence, cooperation, respect, and selfesteem, through positive parenting. The third seminar,
Raising Resilient Children, teaches the parents how they
can help their children handle their own feelings, difficult
situations, stress, and express their feelings in an appropriate way. Level 3 consists of a parent/couple meeting

935

with the Triple P practitioner one to four times for

2030 min to discuss a specific concern (Sanders 2008;
Sanders et al. 2003).
Effects and Uptake of the Positive Parenting Program
(Triple P)
The Triple P program has been evaluated at the different
intensity levels (Sanders et al. 2000), with at-risk groups
(Bor et al. 2002), and in different countries (Cina et al.
2006; Leung et al. 2003), finding that parents develop
better parenting skills and that their children have less
behavior problems (de Graaf et al. 2008; Gallart and
Matthey 2005). Specifically, parents show an increased
confidence in parenting, less depression and reduced incidence of conflict in the couple relationship (Nowak and
Heinrichs 2008). In children, Triple P helped to reduce
problems with attention and hyperactivity issues (Bor et al.
2002). Long-term effects were tested up to 1 year, finding
that the positive behavioral effects were maintained (de
Graaf et al. 2008; Turner and Sanders 2006). Additionally,
at the population level, Triple P has shown effects in terms
of reduced incidence of child abuse and foster care placements (Prinz et al. 2009).
Although there have been several studies showing the
positive effects of participating in Triple P (Nowak and
Heinrichs 2008; Thomas and Zimmer-Gembeck 2007),
few studies have assessed why parents chose to attend the
program, and no studies have assessed what Swedish
parents think about this parenting intervention. A recently
published study questioned the effectiveness of the Triple
P program on the population level (Malti et al. 2011).
One of the issues in the implementation of the program
in this Swiss study was that although 31 % of target
parents indicated an initial interest, only 18.6 % of the
target population was exposed to the intervention as
intended. It is imperative to know why parents participate
and what parent support programs can do to encourage
parents to stay involved until the intervention is completed (Morawska and Sanders 2006), especially within
different cultural contexts (Morawska et al. 2011).
Triple P in Sweden
When Triple P was first introduced in Sweden, cultural
adaptation became necessary (Sarkadi 2009). Strategies,
such as time-out and ignoring the child were deemed by
some to disrespect the human rights of the child and caused
public debate (Gustafsson 2009). Therefore, it was by no
means obvious that Swedish parents would endorse the
program or appreciate its contents; therefore, the Swedish
Council of Technology Assessment concluded that more
research is needed on the long-term effects of Triple P in

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the Swedish context (Swedish Council on Health Technology Assessment 2010).

In the fall of 2009, 47 preschool teachers were trained in
levels 2 and 3 of Triple P. During the implementation of
Triple P, 26 % of the parents in the intervention preschools
had participated in the program during an 18-month period. A web survey was conducted and showed that the
most common reasons for not participating were lack of
need, practical barriers and the lack of time (Sarkadi
2009). To gain a deeper understanding of parents perceptions, the survey was followed up by this qualitative
study. The Medical Ethics Committee of Uppsala University (Sweden) granted approval for the study (D.no.
2009/161).

Aim
The aim of this study was to find out why parents of preschool children chose to participate in Triple P in Sweden,
what they thought of the Triple P curriculum, and how the
program related to their parenting philosophy in general.

J Child Fam Stud (2014) 23:934944

Data Collection
We recruited the parents up to a year after their participation to decrease bias due to social desirability or vested
interest and to find out if parents still recalled the program
curriculum. Ten interviews were completed with parents
who participated in the Triple P program. Most of the
parents, five mothers and three fathers, were native
Swedes, while two mothers were born outside of Sweden.
One of the immigrants was from Armenia, and had moved
to Sweden 10 years prior to the study, while the other
mother emigrated from Syria and had been living in
Sweden for about 7 years. Most participants were between
30 and 40 years of age (Table 1).
Each of the interviews took 3090 min, with an average
of 60 min, and were conducted by the first author. The
interviews took place whenever and wherever it was convenient for the parent. Each participant was given a $14
gift card to the cinema as a reward for participating. The
interviews were semi-structured following a 12-question
interview guide (Table 2).
Analysis

Method
Participants and Recruitment
A year after parents participated in the Triple P intervention, parents were recruited to participate in the present
research project either through direct contact or through
fliers that teachers posted at the participating preschools.
Four parents from three different preschools signed up to
participate by writing their contact information on the flier;
the rest of the parents were recruited by two research
assistants who visited preschools to recruit parents when
they picked up their child. An additional 16 parents
(n = 20), who had participated in Triple P, were asked to
join this follow-up study. Two of the 16 parents declined to
participate due to a lack of time. So with the 4 participants
who joined from the fliers and the 14 who agreed to participate after personal contact, a total of 18 parents were
recruited to participate in the present study, including 3
fathers and 15 mothers. When organizing the qualitative
interviews, an additional three mothers could not be
reached by phone, despite leaving messages, and two more
mothers declined to participate, citing time issues.
Including the first two parents who declined during
recruitment, the total attrition rate was 35 % (7/20).
However, three of the mothers who had agreed to participate were never contacted, as the material had reached
saturation, providing a final sample size of n = 10.

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The interviews were recorded and transcribed verbatim by

the first author. The transcribed data was analyzed independently by three researchers, including two authors (J.R.
and A.S.), using Malteruds method of Systematic Text
Condensation (Malterud 2012). This procedure is completed in four stages: In the first stage preliminary themes
are found through reading and re-reading of the data. In the
second stage new themes are discovered by searching only
the data that directly impacts the research question known
as meaning units (i.e. quotations that are relevant to the
research question). At this stage, if parts of the transcript
are not relevant to the research question, then they are
removed from the analysis; resulting in new themes and
code groups (i.e. categories). The third stage consists of
summarizing the code groups into a condensate, which is
an imagined narrative based on the meaning units within
the code group, in order to tell a story. In the final stage the
condensate is used to reconceptualise the data, creating an
analytic text and adding in relevant quotations. Additionally the original transcripts are re-read in order to determine the goodness of fit with the final set of themes and
code groups. When 10 interviews were completed, the
point of saturation was reached. A way to define such
saturation might be that the material was judged to be rich
in details of parents personal descriptions of their situations, also referred to as thick description (Malterud
2012), while there was considerable variation in the kinds
of experiences described (Table 3).

J Child Fam Stud (2014) 23:934944

937

Table 1 Descriptive statistics of study participants

Parents (n = 10)
The project (%)

Sweden (%)

Uppsala (%)

20

41

40

50

43

42

10

13

14

4?

20

Elementary school or information unknown

Upper secondary school

0
30

12
47

10
35

\3 years of University studies

10

15

15

[3 years of University studies

60

26

40

Number of childrena

Educationb

Occupationc
Gainful employment full-time [35 h/week

40

55

Gainful employment part-time \35 h/week

20

15

83

Gainful employment full-time or part-time Studying

10

On parental leave

10

Unemployed

10

4,5

Sick-listed

10

70

52

Civil statusa
Married

55

Common law spouse

20

22

20

Single

10

26

25

SCB. Barn och familjestatistik [children and family statistics]. 2008 [2011-09-02]; Available from: www.scb.se
SCB. Befolkning 1695 ? efter region, utbildningsniva, alder och kon [Population 1695 ? according to region, level of education, age and
gender]. 2010 [2011-08-11]; Available from: www.scb.se

SCB. Registerbaserad arbetsmarknadsstatistik [register based labor market statistics]. 2011 [2011-09-02]; Available from: www.scb.se

Results
The analysis yielded three themes with three to four categories under each theme. The theme Triple P meets parents needs described the reasons for which parents
participated in Triple P. A well-organized toolkit stated
what the parents thought of the Triple P curriculum.
Conscious parenting was a theme that referred to parenting philosophies and showed how the parents are aware
in their parenting, as well as respectful and understanding
towards their children.
In all of the interviews the parents stressed that maintaining the image of a well-functioning family was
important to them. Study participants would describe
examples of their parenting techniques, strategies and
methods that were not working very well, but were then
careful to note that their children normally behaved well.
Another general finding was that the parents stated it had
been a long time since they participated in Triple P and
found it difficult to remember the exact details of the

program content and individual events. The following text

describes the themes and categories, illustrated by quotes
from the interviews.
Triple P Meets Parents Needs
Curious and Wishing to Improve
Most of the parents in this study chose to attend Triple P
because they perceived possible benefits from participating. They were curious about the Triple P curriculum, as
well as meeting other parents at the preschool. Many parents expressed a desire to become better at handling different situations. These parents did not feel that they had
any particular problems with their parenting. They did, of
course experience everyday hassles and also felt that they
could develop their parenting.
I thought it might be a good and fun thing to go to,
and that maybe I would learn something new. []

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Table 2 Interview guide

1.

Tell me what you remember from your participation in Triple P.

2.

Did you participate in selective Triple P, primary care Triple P or both?

3.

Why did you choose to participate in Triple P?

Were you encouraged by the media to participate in Triple P?
Did you feel that you had a specific problem with your child that you wanted to get advice and help with?
Were you affected by other peoples recommendations to participate in Triple P?
Did you have previous experience from other parental education groups?

4.

Did you want to participate because you were having specific discipline issues with your child?

5.

What did you think of the Triple P curriculum?

Did you think it was good or bad?
Did you think you had a knowledgeable and good teacher?
In your opinion, was there something missing in the curriculum?

6.

Were there any specific strategies in Triple P that you liked in particular? Have you been able to make use of the strategies at home? If so,
how?

7.

What did you think about the fact that Triple P was offered at the preschool?
Was it a good location?
Would you prefer a different place, and if so where?

8.

What time of the day would suit you best to participate in Triple P?
In the morning, when you drop off your child at preschool?
In the afternoon, when collecting your child from preschool?
In the evening?
During the weekend?

9.
10.

Do you think that preschool teachers are the appropriate people to coordinate a program like this? Or would you rather see someone else
doing it? If so, why and whom?
What qualities would you, as a parent, want to encourage in your child?

11.

Do you have any specific strategies in doing that? If so, what and how do you think it works?

12.

Have you thought about assertive discipline?

Table 3 An overview of themes and categories

Theme

Category

Triple P meets
parentsneeds

Curious and wishing to improve

Solving problems
External influences and the prospect of
exchanging experiences

A well-organized
toolkit

Clearly structured and common sense

Picking their own piece of pie
The preschool is a suitable arena

Conscious parenting

Practicalities
Competent, but insecure
Trial and error

Solving Problems
Some of the parents expressed a need for help in solving a
specific problem. They requested specific advice and suggestions on how to resolve their issues, and saw it as an
opportunity to pose questions to a non-familial, neutral
person.
Because I know that I cannot do anything with my
son. You might say that he became much worse. He
does not listen to me at all. Yes, I thought, now I have
to talk to someone who knows, or talk to someone
who can help me with [sons name].
Mother of four, 36 years old

Love and respect for the child

External Influences and the Prospect of Exchanging

Experiences
I was hoping to get some advice on how to handle
small problems in everyday life, so that I would
improve as a parent and be able to handle different
situations better.
Mother of four, 38 years old

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Some parents had been inspired by external factors, such as

posters and promotional brochures at the preschool, as well
as through oral presentations made during parent-teacher
meetings. A few parents decided to participate because
their partner wanted them to. Having a dedicated preschool

J Child Fam Stud (2014) 23:934944

teacher or recommendations from other parents were also

important reasons for participation.
My husband had participated before, so I became
interested in hearing about all of the things that he
had told me.
Mother of two, 35 years
A few parents described the need for a discussion group
where parents could meet, discuss and exchange experiences. Parents expressed their interest in discussion groups
because they liked identifying and relating with other
parents who were struggling with similar issues, and they
enjoyed giving advice to each other.
It was good to get something new into our family.
Sometimes I feel quite isolated. Yes, you are on your
own with your family, you usually dont talk very
much with other parents about how to handle different situations in the family. You dont ask well,
how do you solve that? Each family has their own rat
race
Mother of two, 35 years
For several parents, the most important part was the
discussion with the other parents during the seminar.
There were a lot of very good discussions about
common situations and problems that can occur at
home.
Father of two, 42 years old

A Well-organized Toolkit
Clearly Structured and Common Sense
All of the parents expressed several views on Triple Ps
content and structure. Most of the parents thought that the
general message of the program was very good. The fact
that the preschool teachers used examples and varied their
teaching method made the material more interesting and
easier to learn and remember. Several of the parents
thought it was useful to learn a structure to the strategies
and methods they were already using. The parents primary
motivation for learning new techniques was to reduce their
stress levels when difficult situations arose.
I think it was good to get things pointed out to you as
specific strategies or methods. This was new to me,
but this way you can work a bit more systematically
and specifically in certain situations.
Father of two, 42 years old
One parent felt that he did not benefit from participating
because the material was too basic:

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We felt that a lot of what they talked about during the

first meeting was obvious to us; so it didn0 t give us
anything. We didn0 t learn anything that we didn0 t
already know () and therefore we lost the drive to
continue.
Father of one, 33 years old
Picking Their Own Piece of Pie
All of the parents described strategies and methods that
they learned during their participation in Triple P. Parents
remembered and stated that they used the strategies that fit
with their parenting philosophy and were relevant to their
family life. Triple P was perceived as a toolkit, where
parents could pick and choose which tools to use. If a
strategy or idea did not feel natural to the parent, they
simply chose to ignore it. Many of the parents were
attracted to the positive reinforcement section of the program, such as using body language, verbal and/or tangible
rewards and communicating effectively with their child by
staying calm, close, and maintaining eye contact with their
child. The strategy Directed discussion was the most
commonly mentioned tool for helping the child follow
family rules.
I know weve tried this Directed discussion
strategy. It seems so easy, but still we felt like it was
something we hadnt thought about before. Like
doing a reboot on something. It works quite well
actually.
Father of two, 42 years old
Parents questioned the impact of utilizing a particular
strategy before building it into their own parenting
repertoire.
In the seminar series, I remember that one of the
messages stated that it was very important to stay
calm and not raise your voice with your child. But I
wondered where the limit is? Sometimes you must
raise your voice or in some other way get your child0 s
attention, mustn0 t you?
Mother of two, 37 years old
It was important for many of the parents to feel validated and respected. Parents liked being consulted and
having discussions with the preschool teacher, as opposed
to being told what to do by the preschool teacher. Parents
said the program helped them realize that they are good
enough just the way they are, and learned that it was ok to
make mistakes.
I think theyve been reasoning with me rather than
giving straight orders. They usually asked me 0 Have
you tried anything else? 0 or 0 Do you think there could

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be another way of looking at this problem? Instead

of just saying 0 do this0 . That makes you start thinking
for yourself, and gives you the feeling of solving the
problem yourself.
Mother of three, 33 years old
The Preschool is a Suitable Arena
Almost all parents appreciated that the parent support
programs were held at the preschool. The preschool was
considered to have authority while representing a homelike environment. Practically, parents stated that the preschool was close to their homes, and hosting meetings at
the preschool allowed for the parents of the community to
come together and learn more about each other.
One drawback that emerged from the parent interviews
was that private family problems might be difficult to share
with other parents at the preschool. Similarly, parents stated that other parents would see those attending individual
consultations and speculate on their familys problems.
From my point of view, we have no problems. Or at
least we arent problem-parents. So I wasnt
ashamed to go to the preschool for this. But I can
imagine that if your self-confidence isnt very good,
you might be ashamed about going there and showing
everyone else that you have problems in your family.
Father of two, 34 years old
Furthermore, parents stated that they enjoyed the Triple
P sessions being led by the preschool teacher, because the
preschool teachers already knew their child, which allowed
them to provide individual assessments. Parents also liked
that their childs teacher was knowledgeable, had their own
experiences in working with the children, and felt like they
could ask the teacher about new strategies if new problems
occurred or old ones continued.
She [the preschools teacher] knows my child. [] I
mean, she knows him and how he is at the preschool.
She can see if there are any differences in his
behavior or mood. [] It would feel strange if I was
to talk about problems with my son to a complete
stranger; a person I had never met.
Father of two, 34 years old
Practicalities
At some Triple P seminars childcare was offered to the
parents, and this was appreciated. It gave both of the parents an opportunity to participate simultaneously. Several
parents noted that the preschool teachers were not always
great at providing lectures and requested that they receive
more training and practice in presentation techniques.

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J Child Fam Stud (2014) 23:934944

The preschool teacher who held the seminar was very

quick and forced in her presentation. She just went
through each point very quickly to keep with the time
limit, and then it felt a bit like she just read out loud.
Mother of three, 33 years old
In terms of advertising the program, some of the parents
reacted to the use of the words support and problems,
and emphasized that it was important to defuse these words
when announcing the program to parents by providing
examples of the meanings behind those words.
All of the parents agreed that they would not take time
off from work to attend parenting support programs.
However, parents had mixed feelings on what times were
best to have support programs and individual consultations.
Some felt that the weekends were better, because it interfered less with their workday schedules, while others
argued that they had busy schedules on the weekends, and
that they wished to save the weekends for family activities.
There is usually a lot going on during the weekends.
[] A weekday evening, when the children have
almost gone to bed []. Then it is pretty smooth if
one of us, either me, as it was in this case, or my
husband, goes off to something like this.
Mother of three, 33 years old.
A few parents thought it was best to have different time
options. Parents also noted that having a break in between
each meeting would give participants time to digest and
reflect on the material, and reduce the feelings of being
over-scheduled.
Conscious Parenting
Competent, but Insecure
All parents felt that they were aware and competent
regarding techniques and strategies towards raising their
children. Parents perceived themselves as being knowledgeable, using books, magazines, television programs,
Internet websites, and radio programs to inform them about
the latest in parenting strategies.
When being a parent of small children, you0 re very
open to learning anything that will help you raise
your child. I love to talk about things like this; I never
get tired of itanything concerning what to do, how
to do it and how to handle conflicts with your child
and all of that.
Mother of two, 37 years old
Discussions with other parents were also an important
source of information. Parents were interested in the childrens developmental stages, typical difficulties and

J Child Fam Stud (2014) 23:934944

problems during those stages, as well as strategies and tips

for working through those issues. Furthermore, most of the
parents expressed that they know what is best for their
family and want to provide the best support that they can to
their children.
Many of the parents spent time reflecting on their role as a
parent. In terms of parenting philosophies, parents felt it was
important that their child knows they are loved and cared for,
develops respect for other individuals, develops a high selfesteem, and grows up to be an independent thinker.
I would like him to think for himself, and to feel free
to think and have his own opinions. But I also think
it0 s important that he considers the consequences of
what he0 s about to do. He shouldn0 t be too spontaneous or impulsive. My responsibility is to encourage
him to stop and think about the consequences of his
behavior.
Father of one, 33 years old.

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He was probably hurt because he couldn0 t do it his

way. He felt that I didn0 t respect him, and he was
angry about being forced away from the preschool,
his friends and all of that.
Mother of three, 33 years old
Many parents also showed an understanding towards
their childrens limitations, recognizing that young children
have different needs and thought processes than themselves. Parents therefore stated that they adjusted their
instructions according to the childs abilities.
We have no clear border at the end of our garden []
Here you get to play, but not beyond this point.
Therefore we usually, at least in the summer time,
draw a line using chalk along the road. It has been a
great border; it has been so clear to the children. Of
course they would forget where the border is when
there is no clear mark!
Mother of two, 37 years old

Trial and Error

Many parents stated that they learned to execute a particular strategy by making mistakes and compromising with
their children. The parents discussed the importance in
picking battles in order to maintain harmony within the
home.
If I just sayno, you won0 t get that, then he is either
sad or angry. But if I instead try to explain to him that
he can0 t always have something, then he can take it.
Father of two, 34 years old
Most parents also expressed how critical they are of
themselves, and how they sometimes, despite their
knowledge and available resources, did not know what to
do in certain situations. Parents questioned how they handled specific situations, the impact of utilizing a particular
strategy, being consistent, how much freedom to give their
young children, and if there was anything they could
change about themselves, rather than working with their
children, to solve the issue.
Love and Respect for the Child
Most of the parents stated that they have great respect for
their children. The parents considered their childs skills,
knowledge, and understanding capacity when deciding on
which method or strategy to use. They often explained or
excused their childrens behavior as being caused by
uncontrolled emotion, such as enthusiasm or sadness. All
of the parents said that they sympathized with their child
becoming irritated or upset when their feelings were not
respected.

Discussion
Parents wanted to participate in Triple P because of a
general interest in parenting issues or because they wanted
to learn techniques and strategies that would help them
work through some hassles or problems. Most of the parents in this Swedish study on Levels 2 and 3 of Triple P
stated that they learned some new techniques, but mostly
appreciated learning how to organize their techniques and
being acknowledged for the strategies they were already
doing. In general, parents were attracted to the positive
methods of the program, such as the directed discussion
technique, the positive reinforcement sections, and the
instructions on how to communicate effectively with their
child. The preschool was seen as a positive and trustworthy
arena to host Triple P meetings. This is an important result
in terms of future implementation as there was some concern that parents would have privacy issues with receiving
parenting support through the preschool. Although some
parents expressed certain concerns in discussing private
issues in large groups, the general perception was clearly
positive.
Methodological Considerations
The interviews took place wherever the parent felt comfortable and were completed using a semi-structured
interview guide throughout all of the interviews, thus
increasing the credibility (validity) of the study. Each
interview was about an hour in length, allowing for
an abundance of data to be analyzed. Dependability

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(reliability) was achieved by having the interviews independently analyzed by the interviewer and two other
researchers. Independent analysis was done in the first and
last steps of the procedure, whereas the team of analysts
met several times and worked through the findings together
in the second step to determine the code groups. Such
procedures are argued to increase the reliability of findings
as the influence of a single individuals subjectivity is
reduced (Sandelowski 1986).
Following Malteruds analysis (Malterud 2012), saturation was met when several participants, with a good variation
of experiences, expressed similar views independently.
Parents participated at different preschools, in different
levels of the program, on different days and times, allowing
for some variability of their program exposure. However,
transferability of this study is still limited to middle-class
parents as most participants had high levels of education.
Why Parents Participate in a Parenting Program
In a US sample, parents chose to participate in parent
support programs if parents perceived program benefits,
perceived few program barriers, and had used other parenting resources before (Spoth and Redmond 1995). More
specifically, an Australian study noted that the location,
time, work commitments, as well as the cost of the program
were barriers to parental participation within a parenting
support program (Morawska et al. 2011). Swedish parents
in the present study had similar barriers to participating,
stating that they would not take time off of work to attend
Triple P, and therefore the intervention should be offered at
a variety of times during the evenings and weekends.
Parents also acknowledged and appreciated receiving free
child care while they completed the intervention, in
accordance with earlier findings (Taylor and Biglan 1998;
Zubrick et al. 2005), especially in hard-to-reach groups
(Taylor and Biglan 1998), such as immigrants, single
parents, and fathers.
In terms of perceived benefits, parents wanted to participate in Triple P because of a general interest in parenting issues or because they wanted to learn techniques to
work through some issues. Most of them also looked forward to and greatly valued the discussions, contradictory
to the findings of previous studies (Hannon et al. 2006).
However, this difference in findings could be explained by
the different kinds of interventions. In fact, in this study,
the parents suggested that the discussion part could have
held a more central position during the intervention.
Additional barriers parents in the present study emphasized were that the Triple P curriculum should not use
words like support and problem in Triple P advertisements, as they are demeaning and might lead parents to opt
out of the program.

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J Child Fam Stud (2014) 23:934944

Conscious Parents Picked and Chose Based on their

Parenting Philosophies
The parents in this study consciously thought about
parenting techniques and viewed Triple P as a toolkit,
allowing them to choose from different strategies. Exactly
what strategies or methods the parents chose to implement
was dependent on their personal parenting philosophies.
Although parents felt that most strategies were rather
obvious and already used by them, all of the parents recited
specific information and explicit strategies that they had
learned from Triple P, in accordance with previous studies
(de Graaf et al. 2008).
Offering a parenting program with an evidence-based
curriculum that meets parental needs and preferences in a
non-threating and inclusive environment, such as the preschools, is a potentially successful public health strategy
for preventing behavior problems in children. However,
this study describes the engagement of middle-class parents and says almost nothing about how vulnerable parents
might perceive such offers. From a public health perspective, non-stigmatizing and universal programs are promoted as a solution to health inequities (Marmot et al.
2010). However, only if universal offers are truly universally accessible can we assume that the magic pill of
universal service delivery will have an effect on population
health. Further studies are therefore needed to study the
recruitment patterns of low-income or otherwise vulnerable
parents into universal parenting programs.

Conclusion
Delivering Triple P as a universal parenting support
program through the preschools seems to be a promising
strategy in the Swedish context from the parents perspective. Major motives for participation were a general
interest in parenting issues and wanting to learn more
parenting techniques and strategies for everyday issues. In
order for this type of program to have its largest impact
on improving child behavior problems, more parents will
need to participate; the results of this study helped to
highlight enablers and barriers to parent participation. It is
especially interesting that Swedish parents in this study
seemed confident in choosing whatever strategy suited
their parenting philosophies, while discarding strategies
they did not like. However, further studies are needed
on the motives and perceptions of groups that are generally more hard-to-reach, such as immigrant and single
parents.
Acknowledgments The research was supported by a grant from the
2008/214. We
National Institute of Public Health, grant number HSA

J Child Fam Stud (2014) 23:934944

wish to thank Par Bokstrom for helping to analyze the interviews and
supervising the research project.

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