Open Access Study protocol

Measuring the impact and costs of a universal group based parenting programme: protocol and implementation of a trial

Douglas E Simkiss1*, Helen A Snooks2, Nigel Stallard1, Shan Davies3, Marie A Thomas2, Becky Anthony2, Sarah Winstanley2, Lynsey Wilson2 and Sarah Stewart-Brown1

Author Affiliations

1 Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England

2 Centre for Health Information Research and Evaluation, School of Medicine, Swansea University, SA2 8PP, Wales

3 School of Health Science, Swansea University, SA2 8PP, Wales

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BMC Public Health 2010, 10:364  doi:10.1186/1471-2458-10-364

Published: 23 June 2010



Sub-optimal parenting is a common risk factor for a wide range of negative health, social and educational outcomes. Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management. The Family Links Nurturing Programme (FLNP) focuses on family relationships as well as behaviour management and is offered on a universal basis. As a result it may be better placed to improve health and educational outcomes. Developed in the UK voluntary sector, FLNP is popular with practitioners, has impressed policy makers throughout the UK, has been found to be effective in before/after and qualitative studies, but lacks a randomised controlled trial (RCT) evidence base.


A multi-centre, investigator blind, randomised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2-4 yrs living in or near to Flying Start/Sure Start areas. Changes in parenting, parent child relations and parent and child wellbeing are assessed with validated measures immediately and at 6 months post intervention. Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life. Attendance and completion rates and fidelity to the FLNP course delivery are assessed. A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families. By the end of May 2010, 287 families have been recruited into the trial across four areas of south Wales. Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial, family concern about video and audio recording, programme facilitator concern about the recording of FLNP sessions for fidelity purposes and delays due to the new UK research governance procedures.


Whilst there are strong theoretical arguments to support universal provision of parenting programmes, few universal programmes have been subjected to randomised controlled trials. In this paper we describe a RCT protocol with quantitative and qualitative outcome measures and an economic evaluation designed to provide clear evidence with regard to effectiveness and costs. We describe challenges implementing the protocol and how we are addressing these.

Trial Registration

Current Controlled Trials ISRCTN13919732