. 2025 Feb 18;20(1):10.

doi: 10.1186/s13012-025-01421-y.

Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

Kristoffer Pettersson¹, Philip Millroth², Fabrizia Giannotta^{3

4}, Pernilla Liedgren^{5

6}, Aaron R Lyon⁷, Henna Hasson^{8

9}, Ulrica von Thiele Schwarz^{5

8}

Affiliations

¹ School of Health, Care and Social Welfare, Mälardalen University, 721 23, Västerås, SE, Sweden. kristoffer.pettersson@mdu.se.
² Department of Psychology, Uppsala University, 752 37, Uppsala, SE, Sweden.
³ Department of Public Health Sciences, Stockholm University, 106 91, Stockholm, SE, Sweden.
⁴ Department of Psychology, University of Turin, via verdi 10, Turin, 10124, Sweden.
⁵ School of Health, Care and Social Welfare, Mälardalen University, 721 23, Västerås, SE, Sweden.
⁶ Faculty of Caring Science, Work Life and Social Welfare, Department of Work Life and Social Welfare, University of Borås, Borås, Sweden.
⁷ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
⁸ Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.
⁹ Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, SE, Sweden.

PMID: 39966975
PMCID: PMC11837681
DOI: 10.1186/s13012-025-01421-y

Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

Kristoffer Pettersson et al. Implement Sci. 2025.

. 2025 Feb 18;20(1):10.

doi: 10.1186/s13012-025-01421-y.

Authors

Kristoffer Pettersson¹, Philip Millroth², Fabrizia Giannotta^{3

4}, Pernilla Liedgren^{5

6}, Aaron R Lyon⁷, Henna Hasson^{8

9}, Ulrica von Thiele Schwarz^{5

8}

Affiliations

¹ School of Health, Care and Social Welfare, Mälardalen University, 721 23, Västerås, SE, Sweden. kristoffer.pettersson@mdu.se.
² Department of Psychology, Uppsala University, 752 37, Uppsala, SE, Sweden.
³ Department of Public Health Sciences, Stockholm University, 106 91, Stockholm, SE, Sweden.
⁴ Department of Psychology, University of Turin, via verdi 10, Turin, 10124, Sweden.
⁵ School of Health, Care and Social Welfare, Mälardalen University, 721 23, Västerås, SE, Sweden.
⁶ Faculty of Caring Science, Work Life and Social Welfare, Department of Work Life and Social Welfare, University of Borås, Borås, Sweden.
⁷ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
⁸ Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.
⁹ Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, SE, Sweden.

PMID: 39966975
PMCID: PMC11837681
DOI: 10.1186/s13012-025-01421-y

Abstract

Background: Implementing evidence-based parenting programs often involves navigating fidelity-adaptation decisions. While research has explored various aspects of this dilemma, little is known about how practitioners' outcome preferences influence their decisions in real-world scenarios.

Methods: This study employed a discrete choice experiment (DCE) to investigate the relative importance of five outcomes (Relationship Quality, Satisfaction, Workload Strain, Value Conflict, and Reach) in fidelity-adaptation decisions among 209 practitioners delivering evidence-based parenting programs in Sweden. The DCE presented 25 choice sets across five contextual scenarios, analyzed using Bayesian hierarchical logistic regression.

Results: All five outcomes significantly influenced practitioners' choices, with Relationship Quality emerging as the most impactful (log-odds: 4.56, 95% CI [4.16, 4.91]). Satisfaction and minimizing Value Conflict showed similar importance (log odds: 2.45 and -2.40, respectively), while Workload Strain and Reach had slightly less impact (log odds: -2.10 and 1.96, respectively).

Conclusions: This study offers a novel perspective on the role of outcome preference in navigating fidelity-adaptation decisions. The strong preference for improving parent-child relationships aligns with core parenting program goals, while consideration of other outcomes reflects practitioners' holistic approach to implementation. These findings can inform the design of interventions and implementation strategies that balance effectiveness with real-world constraints, potentially enhancing parenting programs' adoption, sustainability, and impact.

Keywords: Adaptation; Dilemmas; Discrete choice experiment; Outcome preference; Parenting programs; Trade-offs.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Swedish Ethical Review Authority (reference no. 2021-00832) granted ethical approval for the study, including all data collection. All study participants provided informed consent. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

**Fig. 1**
Definition of attributes as presented to participants

**Fig. 2**
Example of a choice set included in trials. At the top, colored dots show progress, with colors indicating the scenarios framing the question as a fidelity-adaptation decision. The first column provides descriptions of attributes, while the second and third columns show verbal descriptions and illustrations for attribute levels. Participants were asked to select their preferred configuration of outcomes (the specific combination of levels across attributes) by selecting one of the buttons at the bottom of the screen

**Fig. 3**
Description of the five scenarios preceding choice sets

See this image and copyright information in PMC

References

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Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

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Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Full Text Sources

Medical