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Authors: Dominik Röding (Hannover Medical School), Isabell von Holt (Hannover Medical School), Lea Decker (Hannover Medical School), Sibel Ünlü (Hannover Medical School), Ulla Walter (Hannover Medical School)
Background: Communities That Care (CTC) is a prevention support system that empowers communities to adopt a science-based strategy to prevent youth problem behavior. As a capacity-building approach, CTC aims to foster system change outcomes such as increased collaboration for prevention. This paper presents the first study in Germany to examine whether the effect of CTC on these outcomes varies across communities and which factors contribute to this variation.
Methods: For the non-randomized cluster-controlled study, CTC communities were matched a-priori 1:1 with comparison communities. The primary short-term outcome is the adoption of evidence-based prevention (adoption), while secondary outcomes include prevention collaboration (PC) and sectoral collaboration (SC). Data from 205 community key informants across twelve matched community pairs were analyzed, calculating community-specific means for each outcome. A meta-analysis assessed the variation in effects across the matched pairs, with meta-regressions examining implementation quality and community characteristics as potential predictors.
Results: Results show significant variation in effect sizes (p < .05) and substantial heterogeneity (I² = .59-.75) between matched pairs. The overall effect indicates higher adoption levels in CTC compared to comparison communities (g = 0.57, p = .019). Higher levels of adoption are associated with higher implementation quality (b = 1.61, p = 0.02), explaining 40.5% of the heterogeneity. Additionally, CTC had a stronger effect on adoption (b = 1.612, p = .160, r² = .163) and SC (b = 1.738, p = .25, r² = .104) in deprived communities as well as on SC in peripheral communities (b = 0.42, p = .180, r² = .248).
Discussion: CTC's effectiveness varies across communities, with implementation quality being crucial for the primary short-term outcome. The findings suggest that CTC is particularly effective in deprived and peripheral areas, but further analyses with additional predictors are needed to fully understand the variance in effect sizes.
| Conflict of interest | non |
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