Introduction

Respect for children’s rights is one of the top priorities of public health and is ensured by a strong commitment to child protection [1]. Research has proven that the family is the primary context for children’s well-being and healthy development, and growing awareness has been devoted to the need to support parents in fulfilling their childcare responsibilities [2]. Evidence-based parenting programs (EBPP) effectiveness in addressing child behavioral problems and improving parenting practices has been established [2, 3]. As a result, practices based on the best research evidence are increasingly encouraged by the scientific community [4]. There has been increasing recognition of the importance of incorporating these empirically supported practices into the daily services attending children and families [5]. This necessity is motivated by the belief that prevention efforts should be guided by science and that interventions shown to be effective through rigorous evaluation should be used [6].

Prevention scientists distinguish between efficacy and effectiveness studies [7]. Efficacy represents the positive effects of a program under optimal implementation conditions, whereas effectiveness refers to the effects of a program implemented under real-world conditions [7]. However, the results of EBPP efficacy studies often are not replicated when these programs are transferred to widespread implementation in communities [8]. Despite its high relevance, the question of efficacy provides little insight into how best to implement the intervention in different real-world settings [9]. Indeed, efforts to implement interventions under real-world conditions are typically much less effective than outcomes achieved through randomized clinical trials in laboratories [9]. The positive outcomes achieved in controlled research settings are not always replicated in natural settings within mainstream services [7, 10]. While it is of great relevance to use EBPP in real-world settings [11], the transition of these programs from the initial trial stage to real-world implementation is both complex and poorly understood [6]. There remains a gap in translating the success of programs in efficacy trials into natural settings [11]. The implementation process influences the outcomes achieved in parenting programs [9]. Therefore, the evaluation of implementation can contribute to researchers’ knowledge of whether an intervention failed because it was ineffective or implemented incorrectly [12].

Implementing EBPP in the real world is an essential step in translational research to make effective programs widely available to improve public health [13]. Some EBPP have attracted international investment beyond their original place of development and have been widely disseminated and implemented in various countries. Examples include EBPP of the Triple P System [14] and the Incredible Years Program [15]. Nevertheless, some researchers highlighted that evidence-based approaches remain insufficiently available in many key services for children and families delivered in the community [16, 17]. Today, practitioners can access many registry tools that evaluate programs using evidence criteria [18]. However, our knowledge of published studies examining EBPP inclusion in real-world settings [19] and barriers and facilitators to EBPP implementation in these settings is limited [20]. In 2016, a special issue with a collection of articles was dedicated to the identification, description, and evaluation of some EBPP implemented in real settings in Spain [12]. The need to expand this work is acknowledged, highlighting the relevance of developing further reviews of EBPP implemented under real-world conditions [12].

Although there is a global interest in the field of Implementation Science [21, 22], high-quality implementation of programs in real-world contexts is acknowledged as a significant challenge [5]. The many complexities involved hinder the study of the implementation process in detail [23]. Notwithstanding the complexity of designing and conducting implementation studies, reviewing the implementation process is an essential feature of program evaluations [12, 21]. In order to increase knowledge about the best policies and practices related to specific interventions, settings, populations, and conditions, it is essential to evaluate the implementation process [12]. The studies that focus on implementation provide information about the feasibility of a particular EBPP and the effort required to implement it effectively under real-world conditions [12]. For all these reasons, the implementation process is now recognized as a quality standard for EBPP [21, 22, 24]. There is a growing awareness that implementation research is critical to the adoption, replication, and scale-up of EBPP [25].

In general, prevention science research has moved from identifying the efficacy of programs to evaluating their effectiveness under real-world conditions [7]. However, while research on effective practices continues to increase, research on implementation is lacking [9]. Consequently, a knowledge gap remains between how EBPP should be implemented and how they are actually implemented in the real world [26, 27]. Therefore, researchers now recognize that the focus should not only be on measuring program outcomes ("Did it work?"), but that attention needs to be paid to the evaluation of the implementation process ("Under what conditions?") [24]. However, researchers highlight that there is not yet agreement on what specific implementation information should be examined and reported in studies [24]. Some suggestions for key implementation components include fidelity (i.e., adherence to the program model, content, and dosage), quality of delivery (i.e., the skill with which practitioners conduct program sessions and interact with participants), and program adaptation (i.e., changes made to the program) [28].

Much has been written about the lack of knowledge in the transition from research to practice [19]. Nonetheless, as far as can be determined, this would be the first time a review has been written with an implementation lens to map the evidence in the field of EBPP implemented under real-world conditions. Scoping reviews can be particularly useful for collecting literature in areas of emerging evidence [29], such as Implementation Science. To this end, a scoping review will be conducted to establish a comprehensive understanding of how EBPP have been implemented under real-world conditions, providing a map of the available evidence and identifying knowledge gaps.

Materials and methods

The proposed scoping review is guided by the six-step framework originally described by Arksey and O’Malley [30], which was later reviewed, endorsed, and extended in the methodological literature by Levac and colleagues [31] and the Joanna Briggs Institute [29]. The stages of the review include: (1) identifying the research questions; (2) identifying the relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. Each phase is described in more detail below in line with the objectives of the current scoping review. The last literature search will take place on 31 December 2021.

This protocol has been registered at the Open Science Framework (available at: osf.io/4fydu).

Stage 3: Study selection

PCC mnemonics will guide the screening of each title and abstract. Other eligibility criteria will ensure that the content of included studies is relevant to the research question. Search terms will be determined in consultation with the research team. The searches will continue until saturation is reached and no new studies meeting the inclusion and exclusion criteria are identified. The primary author and one of the co-authors will conduct independent assessments of the full-text articles to determine whether they meet the inclusion/exclusion criteria. Any disagreements will be discussed between the two reviewers until consensus is reached, or by arbitration of a third reviewer. Reasons for exclusion will be noted, and the process of study selection will be documented in a flow chart (Fig 1), according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [33]. The electronic database search will be recorded in a table, as well as the characteristics of the included studies. The software used to manage references and search results will be Zotero [34] and Rayyan [35], respectively.

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Fig 1. PRISMA flow chart for the scoping review process.

Adapted from: Moher, Liberati, Tetzlaff, and Altman [36].

https://doi.org/10.1371/journal.pone.0256392.g001

Discussion

The ultimate goal of the proposed scoping review is to identify, characterize, and summarize the evidence on the topic under review, including the identification of knowledge gaps. This study protocol describes a detailed plan for conducting the review, including background, objectives, and methodology. Publishing this protocol will ensure the reproducibility of the study and benefit from expert review feedback.

A comprehensive literature search will be conducted across multiple electronic databases, using a methodological framework to chart and map findings, and present a discussion of knowledge gaps and future research opportunities. The purpose of the scoping review is to provide an overview of the existing evidence, and as such, the methodological assessment to determine the quality of the data retrieved from the selected studies will not be performed.

Over the past few decades, the field of implementation research has grown considerably, resulting in increased interest from researchers, funders, practitioners, and policymakers [37]. Despite its potential to advance science, limited research has focused on mapping issues in this field [38]. Therefore, by mapping evidence in the field of real-world implementations of EBPP, this scoping review will help to bridge the implementation gap between research evidence and its translation into practice.

Any changes to the study protocol will be reported in the scoping review, as well as the discussion of the limitations of the scoping review process.

The findings of the proposed review will be disseminated through relevant stakeholder groups (e.g., professionals providing family and parenting support) and presentations at relevant scientific meetings. In addition, an article outlining the results of the scoping review will be submitted for publication in a scientific journal.