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Open Access Commentary

Triple P-Positive Parenting programs: the folly of basing social policy on underpowered flawed studies

James C Coyne12* and Linda Kwakkenbos34

Author Affiliations

1 University of Pennsylvania, Philadelphia, PA 19104, USA

2 University of Groningen, Groningen, The Netherlands

3 Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada

4 Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste Catherine Road, Montreal, QC H3T 1E4, Canada

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BMC Medicine 2013, 11:11  doi:10.1186/1741-7015-11-11

Published: 16 January 2013


Wilson et al. provided a valuable systematic and meta-analytic review of the Triple P-Positive Parenting program in which they identified substantial problems in the quality of available evidence. Their review largely escaped unscathed after Sanders et al.'s critical commentary. However, both of these sources overlook the most serious problem with the Triple P literature, namely, the over-reliance on positive but substantially underpowered trials. Such trials are particularly susceptible to risks of bias and investigator manipulation of apparent results. We offer a justification for the criterion of no fewer than 35 participants in either the intervention or control group. Applying this criterion, 19 of the 23 trials identified by Wilson et al. were eliminated. A number of these trials were so small that it would be statistically improbable that they would detect an effect even if it were present. We argued that clinicians and policymakers implementing Triple P programs incorporate evaluations to ensure that goals are being met and resources are not being squandered.

Please see related articles webcite and webcite

meta-analysis; publication bias; conflict of interest; dissemination; confirmatory bias