effectiveness of group positive parenting program (triple p) in changing child behavior, parenting...
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ORIGINAL PAPER
Effectiveness of Group Positive Parenting Program (Triple P)in Changing Child Behavior, Parenting Style, and ParentalAdjustment: An Intervention Study in Japan
Takeo Fujiwara • Noriko Kato • Matthew R. Sanders
Published online: 9 February 2011
� Springer Science+Business Media, LLC 2011
Abstract The purpose of this study is to investigate the
effectiveness of a group-based family intervention program
known as the Group Positive Parenting Program (Triple P),
with families in Japan. Reductions in children’s behavioral
problems, changes in dysfunctional parenting practices,
and affects on parenting adjustment were examined. Par-
ticipants of both the intervention and control groups
(N = 91 and N = 24, respectively) were recruited from
mothers visiting health clinics in Kawasaki City, Kanaga-
wa. Intervention and control groups were assessed in terms
of child behavior (Strength and Difficulty Questionnaire,
SDQ), parenting style (Parenting Scale, PS), and parenting
adjustment (Depression-Anxiety-Stress Scale, DASS; and
Parenting Experience Survey, PES), both pre- and postin-
tervention. A repeated measures multivariate analysis of
variance was used to determine the intervention’s effects.
The SDQ score for the conduct problems subscale indi-
cated a significant intervention effect. In addition, the
postintervention scores for all subscales of the PS, the
DASS depression subscale and total scores, as well as
ratings for perceived difficulty of parenting in the PES,
were significantly reduced in the intervention group alone.
The PES also revealed that confidence in parenting
significantly increased only in the intervention group.
Group Triple P is effective in decreasing child conduct
problems, dysfunctional parenting practices, depression,
anxiety, stress, and the perceived level of parenting diffi-
culty, as well as in improving parenting confidence, among
Japanese families.
Keywords Child abuse � Parenting � Intervention �Behavior problem � Adjustment
Introduction
Addressing and remedying child abuse and neglect, also
known as child maltreatment, is a high-priority public
health issue in Japan. Even after the enactment of the Child
Abuse Protection Law in Japan, the number of cases
reported to the Child Guidance Center—which is similar to
the Child Protection Service in the UK or US—has
increased dramatically to total 40,639 cases in 2007—
around 40-fold increase since 1990 (1,101 cases) and a 1.7-
fold increase since 2001 (23,274 cases) (Children’s Rain-
bow Center 2009). It is unknown whether this growth is
due to a real increase in the number of children being
maltreated or simply because of an increase in the number
of cases being reported. In any case, other statistics reveal
that a significant number of Japanese mothers are dis-
tressed about their parenting skills. One study, for example,
found that 65% of mothers in Japan do not have confidence
in their parenting abilities, 33% of mothers find parenting
difficult, and 18% of mothers believe that they maltreat
their children (Nihon Shouni Hoken Kyokai (The Japanese
Society of Child Health) 2001). The types of abusive
behaviors exhibited by parents vary, including emotional
abuse (80%), physical abuse (49%), excessive discipline
T. Fujiwara (&)
Department of Social Medicine, National Research Institute
for Child Health and Development, Setagaya-ku,
Tokyo 157-8535, Japan
e-mail: [email protected]
N. Kato
Department of Health Promotion, National Institute
of Public Health, Wako-shi, Saitama, Japan
M. R. Sanders
School of Psychology, University of Queensland,
Brisbane, QLD, Australia
123
J Child Fam Stud (2011) 20:804–813
DOI 10.1007/s10826-011-9448-1
(17%), and neglect (0.4%) (Nihon Shouni Hoken Kyokai
(The Japanese Society of Child Health) 2001).
To address this situation, it is necessary to adopt pre-
vention strategies comprising those that are population-
based and those that focus on high-risk families (Fujiwara
2007). However, since the prevention of child maltreat-
ment is an urgent issue, strategies that target high-risk
parents are considered the most efficient means of helping
distressed mothers or mothers with difficult children in the
short term.
The children at highest risk of being maltreated include
those from low-income families (Brown et al. 1998;
Cappelleri et al. 1993; Kotch et al. 1999; Wu et al. 2004),
those with mothers who have a mental illness (Brown et al.
1998; Chaffin et al. 1996; Dinwiddie and Bucholz 1993;
Kotch et al. 1999; Windham et al. 2004), those with one or
more siblings (Fujiwara et al. 2008; Kotch et al. 1999; Wu
et al. 2004), and those with developmental delays
(Famularo et al. 1992; Sidebotham and Heron 2003;
Zelenko et al. 2000). Previous studies have reported the
effectiveness of intervention as a strategy for preventing
child maltreatment in high-risk situations (Eckenrode et al.
2000; Olds et al. 1997; Roberts et al. 1996).
A review of 21 studies involving home-visitation
programs for parents at risk for child maltreatment found,
on average, a 40% reduction in child maltreatment out-
comes among program participants, compared to the
control group (Hahn et al. 2003). This intervention was
considered effective, since it provided parents with
information on child health and development, enabled
them to build problem-solving skills, and gave them
greater access to social services and other resources, all
of which enabled the parents to reduce misbehavior in
their children (Yoshikawa 1995). There is also evidence
supporting the effectiveness of both intensive, short-term
therapy geared toward family preservation, and parenting
education that targets high-risk families (MacLeod and
Nelson 2000).
The Triple P (Positive Parenting Program) is a form of
behavioral family intervention based on social-learning
principles; it was designed as a comprehensive, multilevel,
and prevention-oriented system to support parenting
(Sanders 1999). Triple P showed a large effect size in
reducing child maltreatment in a large population-based
randomized controlled study in the US (Prinz et al. 2009).
Triple P comprises five levels of intervention, with group-
based interventions (Group Triple P) included in level 4;
this intervention is conducted for groups consisting of
10–12 parents, all of whom are imparted new knowledge
and active skills. The intervention is an approach that tar-
gets parents of children who have detectable problems but
do not exhibit sufficient symptoms to be diagnosed with a
behavioral disorder (Sanders 1999).
While there is ample research-based evidence indicating
the effectiveness of Group Triple P in reducing disruptive
behavior among Western children (Turner et al. 2007,
1997; Zubrick et al. 2005), limited research has been
conducted on its effectiveness with regards to children
raised in an East Asian culture. Of the studies conducted
with East Asian subjects, Leung et al. (2003) investigated
the effectiveness of Group Triple P on families living in
Hong Kong and found that it reduced parental reports of
conduct problems in children, suggesting the acceptability
of Group Triple P in East Asian cultures. In addition,
Matsumoto et al. (2007) report the effectiveness of Group
Triple P for Japanese families living in Australia, and
acceptability in Japanese society (Matsumoto et al. 2010).
It remains to be seen, whether such success with regard to
Group Triple P can be replicated for Japanese families
living in Japan in general and for those recruited through
the routine child health service delivery in particular.
Group Triple P is thought to be quite robust across
different cultures, despite cultural differences therein.
Group Triple P emphasizes self-regulation—that is, parents
form their own goals, which are informed by their culture
rather than by the mere adoption of Western ideas about
raising children. Therefore, it is likely that Japanese indi-
viduals in Japan will incorporate the ideas inherent in
Group Triple P and adjust it in ‘‘Japanese’’ ways, to
improve their parenting practice and adjustment; this, in
turn, will reduce behavioral problems in their children.
The purpose of this study was to investigate the effec-
tiveness of Group Triple P in reducing behavioral problems
in children, changing dysfunctional parenting practices,
and influencing parenting adjustment among families in
Japan.
Methods
Participants
Participants in this intervention study were recruited from
mothers visiting health clinics for mandatory health
checkups for their 3-year-old children. Recruitments were
carried out in 2007–2008 in three areas in Kawasaki City,
Kanagawa Prefecture, which is a suburban residential area
near Tokyo. Flyers were also distributed to find mothers
who felt that their child had behavior problems or who
found parenting to be difficult. In addition, public health
nurses who observed behavioral problems in children were
asked to recommend to those children’s mothers that they
participate in the study. In several cases, the sibling of a
child undergoing the health checkup exhibited behavior
problems; the mothers of such children were also eligible
for participation. Control-group participants were recruited
J Child Fam Stud (2011) 20:804–813 805
123
along with those of the intervention group, during the same
health checkups; thus, for the current study, participants
could not be randomized, and a service-based evaluation
using a quasi-experimental design was considered optimal.
In total, 91 mothers participated in the intervention group,
while 24 mothers participated in the control group.
Intervention
In general, Group Triple P comprises eight sessions over an
eight-week period, and it is ideally conducted in groups of
10–12 parents. Since it is extremely difficult to persuade
Japanese fathers to participate in such programs, we focused
only on mothers. Group Triple P uses an active skills-
training process to help mothers acquire new knowledge and
skills. The eight sessions are as follows: one group session
geared toward providing an overview of the program and
establishing rapport within the group (2 h each), three group
sessions in which parent training is conducted (2 h each),
three follow-up consultations by telephone (15–30 min
each), and a final group session. The integrated telephone
consultations provide additional support to mothers while
they practice what they have learned in the group session, all
while following self-regulation theory.
The parent-training component involves discussions of
17 core child-management strategies designed to help
parents promote their children’s competence and develop-
ment (e.g., praise for good behavior, creating engaging
activities, and imparting incidental teaching) and to man-
age misbehavior (e.g., by setting rules, providing clear
instructions, communicating the consequences of an action,
and enforcing quiet time). In addition, participants are
introduced to a ‘‘planned activities routine’’ to generalize
what they have learned and help them strengthen their
parenting skills. Active training methods such as modeling,
rehearsal, practice, feedback, and goal-setting are used
throughout the duration of the program, to teach specific
parenting skills. In the final group session, participants
share the knowledge and insights they acquired during the
program, set future goals, and create plans to achieve those
goals; the session also provides an opportunity for partic-
ipants to celebrate the completion of the program.
Measures
Child Behavior
The Strengths and Difficulties Questionnaire (SDQ). The
SDQ is a 25-item measure of parents’ perceptions of pro-
social and difficult behaviors in their child, and it is
designed to assess the frequency of positive and negative
behaviors in children (Goodman 1997). It consists of five
subscales (i.e., emotional symptoms, conduct problems,
hyperactivity, peer problems, and prosocial behavior), and
the score for each subscale is computed by summing the
scores for the five items therein. The difficult behavior
score in the SDQ is calculated as the sum of the scores
obtained for the emotional symptoms, conduct problems,
hyperactivity, and peer problems subscales. The SDQ in
Japanese has been validated as having adequate internal
reliability (emotional symptoms, 0.61; conduct problems,
0.51; hyperactivity, 0.75; peer problems, 0.52; and proso-
cial behavior, 0.69) (Matsuishi et al. 2008). The difficult
behavior score has also been found to have adequate
internal reliability (r = 0.76) and good test–retest reli-
ability (r = 0.85) (Smedje et al. 1999).
Parenting Style
Parenting Scale (PS). The PS is a 30-item questionnaire
that measures dysfunctional discipline styles in parents
(Arnold et al. 1993); it yields a total score based on three
factors: (1) laxness (permissive discipline), (2) over-reac-
tivity (authoritarian discipline, displays of anger and irri-
tability), and (3) verbosity (overly long reprimands or
reliance on talking to impart discipline). The scale shows
adequate internal consistency with respect to the total
(a = 0.84), laxness (a = 0.83), and over-reactivity
(a = 0.82), but only modest internal consistency with
respect to verbosity (a = 0.63). It also has good test–retest
reliability (r = 0.84, 0.83, 0.82, and 0.79, respectively).
Parenting Adjustment
Depression-Anxiety-Stress Scales (DASS). The DASS is a
42-item questionnaire designed to assess symptoms of
depression, anxiety, and stress in adults (Lovibond and
Lovibond 1995). All three of the DASS subscales have
been demonstrated to have high reliability (depression,
a = 0.91; anxiety, a = 0.84; and stress, a = 0.90).
Parenting Experience Survey (PES). In the PES, parents
are asked to rate the following: (1) the perceived level of
difficult behavior in their child; (2) their subjective per-
ceptions of their parenting role (e.g., how rewarding,
demanding, and stressful they find parenting to be); (3)
their confidence level and level of support they receive as a
parent; (4) for two-parent families, the extent of agreement
between partners over child discipline and the level of
support they receive from their partner in their role as
parent; and (5) their degree of happiness with the rela-
tionship with their partner (Turner et al. 1999).
Procedures
The intervention group was asked to complete the afore-
mentioned questionnaires during the first and last sessions of
806 J Child Fam Stud (2011) 20:804–813
123
the Group Triple P. For the control group, the questionnaires
were mailed to the participants at the time of recruitment;
they completed the questionnaires at home and returned the
responses by mail. After 8 weeks, the participants were
again sent the same questionnaires, to be returned by mail.
Statistical Analysis
As the current study did not employ randomization to
choose the participants who would undergo intervention,
the intervention and control groups were compared in
terms of their demographic characteristics (Table 1). A
repeated measures multivariate analysis of variance (MA-
NOVA), adjusted for the covariates that differed signifi-
cantly between the groups, was used to analyze the two
groups’ responses to the aforementioned questionnaires.
Pairwise t-test comparisons between the pre- and postin-
tervention responses were also performed. Statistical
analyses were performed with the aid of Stata 10 SE
software (StataCorp, College Station, TX, USA).
Ethics
Informed consent was obtained from each participant,
under the condition that any information obtained from the
study would not be used for other purposes or shared with a
third party. Each participant was assigned an anonymous
identification number, and the data associated with the
participants were linked to their respective identification
numbers. The Institutional Review Board at the National
Institute of Public Health approved the protocols of this
study (NIPH-IBRA #06013).
Results
Characteristics of the Recruited Sample
Table 1 shows the demographic characteristics of the
intervention and control groups. The areas from which the
participants were recruited differed among the groups: 60%
of the intervention group was from area C, while 50% of
the control group was from area B. The gender distribu-
tions of the children also differed: boys were predominant
among the intervention group (67%), while girls consti-
tuted the majority (56%) in the control group. Age varied
widely among the children in the intervention group—from
one to 8 years—while most of the children in the control
group were 2 or 3 years old. However, there was no sta-
tistically significant difference between the average age of
the children in the two groups; it was 3.10 (SD = 1.35) and
2.92 (SD = 0.58) years for the intervention and control
groups, respectively. The mothers’ age distribution was
large in the intervention group (24–45 years), but the
average age was not different between the groups (inter-
vention group, 36.1 years [SD = 3.84]; control group,
34.8 years [SD = 5.01]). Other variables were similar, or
at least not statistically different, between the two groups.
Intervention Effects
Table 2 presents the means and standard deviations of each
dependent measure before and after the intervention, along
with the F statistics and significance values yielded by
repeated measures MANOVA, all of which show the effect
of the intervention. As described above, there were dif-
ferences between the two groups in terms of residential
area and the gender of the children; therefore, these vari-
ables were included in the repeated measures MANOVA.
Child Behavior
The repeated measures MANOVA revealed a significant
intervention effect on the SDQ conduct problems subscale
(F (2, 108) = 6.11, p = 0.003), with only the intervention
group showing a reduction, of 1.01 points (t = -5.89,
p \ 0.001). The intervention group demonstrated a 2.10-
point reduction in terms of the SDQ difficult behavior score
(t = -5.75, p \ 0.001). The mean score on the SDQ
prosocial subscale increased by 0.58 points in the inter-
vention group (t = 2.97, p = 0.004). The significant effect
of area was noted only with respect to the SDQ conduct
problems subscale (F (4, 216), p = 0.015).
Parenting Style
The repeated measures MANOVA indicated a strong sig-
nificant intervention effect on all the subscales of the PS.
Only the mothers in the intervention group reported a
significant reduction in the use of dysfunctional parenting
strategies: after the intervention, the group’s total score
decreased by 0.71 points (t = -12.3, p \ 0.001); in the
score for the laxness subscale, by 0.52 points (t = -6.58,
p \ 0.001); in the score for the over-reactive subscale, by
0.96 points (t = -9.10, p \ 0.001); and in the score for the
verbosity subscale, by 0.84 points (t = -8.38, p \ 0.001).
In addition, the mean scores for the laxness, over-reactiv-
ity, and verbosity subscales were each within the clinical
range (Matsuishi et al. 2008) before the intervention, but
outside the clinical range after intervention. There were no
significant gender and area effects on the PS scores.
Parenting Adjustment
According to repeated measures MANOVA, the postin-
tervention mean score for the DASS depression subscale
J Child Fam Stud (2011) 20:804–813 807
123
Table 1 Demographic characteristics of the intervention and control groups (N = 115)
Intervention (N = 91) Control (N = 24) Chi-square or t p value
N (%) or Mean (SD) N (%) or Mean (SD)
Area A 10 (11.0) 7 (29.2) 12.6 0.002
B 26 (28.6) 12 (50.0)
C 55 (60.4) 5 (20.8)
Gender Female 30 (33.0) 13 (56.5) 4.34 0.037
Male 61 (67.0) 10 (43.5)
Missing 0 1
Age (years) 1 3 (3.3) 0 (0) 13.7 0.018
2 31 (34.1) 4 (16.7)
3 35 (38.5) 19 (79.2)
4 8 (8.8) 0 (0)
5 7 (7.7) 1 (4.2)
6? 7 (7.7) 0 (0)
Average 3.10 (1.35) 2.92 (0.58) 0.64 0.521
Number of children 1 49 (53.9) 6 (25.0) 10.3 0.016
2 35 (38.5) 17 (70.8)
3 6 (6.6) 0 (0)
4 1 (1.1) 1 (4.2)
Average 1.55 (0.67) 1.83 (0.64) 1.86 0.065
For children with siblings,
order of child among siblings
Eldest 31 (73.8) 8 (44.4) 7.16 0.028
Youngest 9 (21.4) 10 (55.6)
Middle 2 (4.8) 0 (0)
Mother’s age B19 0 (0) 0 (0) 12.6 0.027
20–24 1 (1.2) 0 (0)
25–29 2 (2.4) 3 (13.6)
30–34 21 (25.0) 9 (40.9)
35–39 48 (57.1) 5 (22.7)
40–44 10 (11.9) 5 (22.7)
45? 2 (2.4) 0 (0)
Missing 7 2
Average 36.1 (3.84) 34.8 (5.01) 1.35 0.181
Father’s age B24 0 (0) 0 (0) 6.50 0.165
25–29 1 (1.2) 2 (9.1)
30–34 22 (25.9) 4 (18.2)
35–39 40 (47.1) 10 (45.5)
40–44 16 (18.8) 6 (27.3)
45? 6 (7.1) 0 (0)
Missing 6 2
Average 37.3 (4.29) 37.5 (4.73) 0.19 0.854
Mother’s education level \High school 1 (1.1) 0 (0) 9.58 0.088
High school 12 (13.3) 5 (22.7)
Professional school 11 (12.2) 7 (31.8)
Some college 22 (24.4) 6 (27.3)
College 41 (45.6) 4 (18.2)
Graduate school 3 (3.3) 0 (0)
Missing 1 2
808 J Child Fam Stud (2011) 20:804–813
123
was significantly reduced in the intervention group
(p = 0.023), compared to the control group. Overall, the
repeated measures MANOVA revealed a significant inter-
vention effect on the DASS total score of the intervention
group, which decreased by 8.66 points (t = -5.03,
p \ 0.001). There were no significant gender and area
effects on the DASS scale.
The repeated measures MANOVA for the PES
revealed a significant intervention effect on the mothers’
perception of difficult behavior in their children: the mean
rating by those in the intervention group decreased by
0.65 points after the intervention (t = -5.13, p \ 0.001).
There was also a significant intervention effect on the
mothers’ rating vis-a-vis the degree to which they find
parenting stressful, with only those in the intervention
group reporting a significant decrease (t = -3.24,
p = 0.002). A significant intervention effect was also
found on the mothers’ rating of how confident they felt in
their parenting role, with only the intervention group
reporting a significant increase (0.6 points; t = 5.57,
p \ 0.001). The repeated measures MANOVA did not
demonstrate a significant intervention effect on the
mothers’ ratings, indicating (1) their perceived level of
support in their parenting role, (2) the extent of agreement
between them and their respective partners regarding
child discipline, as well as the level of support they
receive from their partners in their role as parent, and (3)
their degree of happiness with the relationship with their
respective partners. This was despite the fact that the pre-
and postintervention ratings for these measures were
significantly different in the intervention group, but not in
the control group.
Discussion
To the best of our knowledge, the present study is the first
evaluation of the effectiveness of Group Triple P for
families in Japan, recruited through the routine child health
service delivery. In brief, the overall findings demonstrate
that among families living in suburban areas near Tokyo,
Group Triple P was effective in reducing mothers’ reports
of conduct problems in their children, promoting appro-
priate parenting styles, and reducing maternal distress
arising from parenting.
This study has some limitations. First, it employed a
nonrandomized design that induced selection bias in the
intervention group. For example, the sample characteristics
indicate that mothers with a male child were more likely to
join the intervention group. However, to reflect this bias,
the baseline difference on SDQ was adjusted in the anal-
ysis. In addition, the preintervention parenting style and
parenting adjustment measures were generally similar
between the two groups. It should be noted that previous
studies on Group Triple P employed a randomized design
by randomly assigning participants to either an intervention
group or a waitlist control group (Leung et al. 2003;
Matsumoto et al. 2010; Turner et al. 2007). Further
research should consider using a cross-over randomized
study design, to evaluate the effectiveness of Group Triple
P use in Japan.
Another limitation of this study is in its use of subjective
measurements. While we used validated scales, they were
nonetheless self-reported measures. Future research should
entail a combination of subjective measurements under-
taken by the parents of the children’s behaviors, as well as
Table 1 continued
Intervention (N = 91) Control (N = 24) Chi-square or t p value
N (%) or Mean (SD) N (%) or Mean (SD)
Father’s education level \High school 0 (0) 1 (4.6) 8.07 0.089
High school 11 (12.5) 4 (18.2)
Professional school 10 (11.4) 5 (22.7)
Some college 0 (0) 0 (0)
College 53 (60.2) 11 (50.0)
Graduate school 14 (15.9) 1 (4.6)
Missing 3 2
Annual household income
(in millions of yen)
\3 2 (2.3) 0 (0) 2.98 0.702
3–5 15 (17.4) 6 (30.0)
5–7 27 (31.4) 4 (20.0)
7–10 24 (27.9) 6 (30.0)
10–15 16 (18.6) 4 (20.0)
15? 2 (2.3) 0 (0)
J Child Fam Stud (2011) 20:804–813 809
123
objective measurements undertaken by psychologists or
psychiatrists. In addition, direct observations of child–
parent interactions were not incorporated into the design of
the current study, but should be added to future research
plans.
Nonetheless, the current study does have strong points,
as it employed a service-based evaluation—that is, in this
study, mothers were recruited via the regular child health
service, which is the most feasible way of introducing
parent-training in Japan. Therefore, the effectiveness of
Group Triple P, which was delivered to parents in the most
feasible way, was able to assess parenting-related matters.
In addition, as the provider of child health services can
serve as an initial gateway for consultation on child mal-
treatment, it is possible to deliver consultations in the case
of child maltreatment among participants—and, if needed,
a prompt referral to a Child Guidance Center (similar to
child protection services in the US or UK) can be provided.
The present study clearly showed the effectiveness of
Group Triple P in reducing conduct problems and hyper-
activity as measured with the SDQ. These findings are
consistent with those of Matsumoto et al. (2007), who
report a significant intervention effect on child behavior as
measured with the Eyberg Child Behavior Inventory
(Eyberg and Pincus 1999). Additionally, according to
that study, Cohen’s effect size (Cohen 1988) for the
Table 2 Pre- and post-dependent measures for the intervention and control groups and comparisons obtained with repeated measures MANOVA
Scale Score
range
Intervention group Control group Adjusted pre/post time effect�
Pre Post Pre Post F (df) p-value
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
SDQ
Emotional symptoms 0–10 1.81 (0.21) 1.68 (1.75) 1.42 (1.35) 1.54 (1.32) 0.51 (2, 108) 0.600
Conduct problems 0–10 3.14 (1.75)a 2.13 (1.66)a 2.17 (1.43) 1.96 (1.30) 6.11 (2, 108) 0.003**
Hyperactivity 0–10 4.46 (2.28)a 3.66 (2.21)a 4.38 (2.41) 4.25 (2.29) 0.88 (2, 108) 0.420
Peer problems 0–10 2.78 (1.99) 2.63 (1.75) 2.79 (1.53) 2.71 (1.57) 0.27 (2, 108) 0.762
Difficult behavior 0–40 12.2 (5.34)a 10.1 (4.61)a 10.8 (4.96) 10.5 (4.19) 2.89 (2, 108) 0.060
Prosocial behavior 0–10 5.34 (2.60)a 5.92 (2.51)a 6.17 (2.39) 5.71 (2.65) 2.73 (2, 108) 0.070
PS
Laxness 1–7 3.52 (0.69)a 3.00 (0.62)a 3.57 (0.71) 3.66 (0.62) 10.5 (2, 108) \0.001***
Over-reactivity 1–7 3.89 (1.16)a 2.93 (1.12)a 3.33 (0.26) 3.39 (1.19) 9.58 (2, 108) \0.001***
Verbosity 1–7 4.35 (0.58)a 3.50 (0.93)a 4.21 (0.69) 4.45 (0.54) 9.52 (2, 108) \0.001***
Total 1–7 3.84 (0.50)a 3.13 (0.59)a 3.62 (0.54)b 3.73 (0.54)b 22.2 (2, 108) \0.001***
DASS
Depression 0–14 6.31 (7.50)a 3.02 (5.23)a 4.33 (6.14) 4.38 (6.28) 3.89 (2, 108) 0.023*
Anxiety 0–14 2.90 (4.76)a 1.20 (2.13)a 1.25 (1.80) 1.54 (3.24) 2.58 (2, 108) 0.081
Stress 0–14 10.5 (9.18)a 6.78 (6.53)a 8.17 (7.20) 7.58 (8.63) 2.93 (2, 108) 0.057
Total 0–42 19.7 (20.0)a 11.0 (12.7)a 13.8 (14.4) 13.5 (17.1) 3.91 (2, 108) 0.023*
PES
Parenting is difficult 1–5 3.07 (1.09)a 2.39 (0.80)a 2.50 (0.74) 2.50 (0.83) 5.54 (2, 100) 0.005**
Parenting is rewarding 1–5 3.07 (1.29)a 3.57 (1.14)a 3.13 (1.26) 3.33 (1.27) 0.42 (2, 105) 0.655
Parenting is demanding 1–5 2.99 (1.14) 2.78 (1.14) 2.58 (1.02) 2.58 (0.97) 2.43 (2, 105) 0.093
Parenting is stressful 1–5 3.10 (1.24)a 2.69 (1.05)a 2.42 (1.06) 2.50 (1.14) 4.58 (2, 106) 0.012*
Parenting is fulfilling 1–5 3.07 (1.23)a 3.66 (1.10)a 3.08 (1.32) 3.21 (1.28) 0.87 (2, 105) 0.421
Parenting is depressive 1–5 2.87 (1.32)a 2.33 (1.09)a 2.33 (1.31) 2.04 (1.37) 2.05 (2, 105) 0.134
Confidence in parenting 1–5 2.44 (0.86)a 3.06 (0.89)a 3.00 (0.59) 2.79 (0.93) 7.01 (2, 106) 0.001**
Support for parenting 1–5 2.84 (1.02)a 3.46 (1.10)a 3.08 (1.02) 3.17 (1.13) 2.44 (2, 104) 0.092
Agreement with partner
regarding child discipline
1–5 3.08 (0.97)a 3.37 (0.83)a 3.04 (1.07) 3.25 (0.90) 0.11 (2, 105) 0.894
Support received from partner 1–5 3.28 (1.02)b 3.53 (0.97)b 2.91 (0.90) 3.13 (1.12) 1.45 (2, 105) 0.240
Happiness with partner 0–6 3.49 (1.28)a 3.87 (1.18)a 3.54 (1.22) 3.42 (1.41) 2.18 (2, 106) 0.118
* p \ 0.05, ** p \ 0.01, *** p \ 0.001
Superscripts indicate the means that differ significantly according to pairwise comparisons (a, p \ 0.01; b, p \ 0.05)� Adjusted for children’s gender and their families’ areas of residence
810 J Child Fam Stud (2011) 20:804–813
123
postintervention reduction in the SDQ conduct problems
score in the intervention group was 0.59, which is a
moderate effect size. This effect size was comparable to
that noted with a clinical sample in the case of Group
Triple P interventions (Sanders et al. 2000) and indigenous
groups (Turner et al. 2007) in Australia. Leung et al. (2003)
also report a significant intervention effect on child
behavior as measured by the ECBI and SDQ. In Leung
et al. (2003), not only the SDQ conduct problems and
hyperactivity scores but also the emotional symptoms and
peer problems scores were significantly reduced in the
intervention group, compared to the waitlist control group.
It is unknown why Group Triple P in the current study was
effective only for child conduct problems, and not for
emotional symptoms or peer problems. It might be due to
the ceiling effect: the meanpreintervention score for the
SDQ emotional symptoms subscale was already quite low
in the intervention group (1.81), in comparison to that in
their study (2.79). In addition, it might be difficult to
observe reductions in peer problems within an 8-week
time-span. Additional follow-up studies, especially over
longer periods, are warranted in evaluating the effective-
ness of Group Triple P on child behavior.
The study found that Group Triple P was able to bring
about great improvements in parenting style and parenting
adjustment among Japanese participants. For the interven-
tion group, the effect size for the mean PS total score was
0.79, while those of the mean scores for the laxness, over-
reactivity, and verbosity subscales before and after inter-
vention were 0.84, 1.09, and 1.30, respectively; all of these
are large effect sizes. These results are consistent with those
of Leung et al. (2003) and Matsumoto et al. (2010), sug-
gesting that Group Triple P is suitable for use in East Asian
cultures and effective in affecting change in parenting styles
among East Asian families. In addition, our study indicates
that Group Triple P brought about significant improvements
in parenting adjustment, as measured by the DASS. For the
intervention group, moderate effect sizes were calculated
for the mean DASS depression, anxiety, stress, and total
scores before and after the intervention (0.51, 0.46, 0.46,
and 0.52, respectively). This is a novel finding of our study,
since Matsumoto et al. (2007) did not report a significant
intervention effect on the DASS scores, probably due to its
limited sample size (N = 50). Since our study enrolled 115
participants—a sample size more than twice that of Mat-
sumoto et al. (2007)—we had sufficient statistical power to
show the significant effect of intervention in improving
parenting adjustment.
Regarding PES, Group Triple P was effective in
decreasing the extent to which mothers found parenting to
be difficult and stressful, and in improving their confidence
in their parenting skills. However, although the other
maternal perceptions of parenting—including the degree to
which it was considered rewarding, demanding, fulfilling,
and depressive—changed in the expected direction post-
intervention, no significant intervention effect was
observed. Thus, Group Triple P might be effective in
improving maternal perceptions of the negative aspects of
parenting, such as its difficulty or stressfulness.
On the other hand, the current study did not find Group
Triple P to be effective in bringing about improvements in
areas related to the parent’s partner. This might be due to
our study method: only mothers underwent intervention,
and the fathers were not involved. Group Triple P should
be targeted toward both the mother and father. However,
since we carried out the Group Triple P sessions on
weekdays, participation by working fathers was not pos-
sible. The findings of previous studies have suggested the
association between father involvement and child func-
tioning (Dubowitz et al. 2001; Yogman et al. 1995), which
in turn suggests better outcomes if fathers were involved in
Group Triple P. A recent study reports that paternal
involvement in parenting reduces the risk of injury among
young children in Japan, suggesting that paternal involve-
ment might be associated with providing a safer family
environment (Fujiwara et al. 2010). Future studies should
involve fathers and test the effectiveness of Group Triple P
on scales related to both parents.
In conclusion, the mothers who underwent Group Triple
P intervention reported improved conduct in their children,
a reduction in the use of dysfunctional parenting styles, and
better parenting adjustment, compared to those who did not
undergo intervention. It is necessary and desirable to carry
out further studies that use a randomized design and
include fathers, in order to assess the long-term effects of
intervention and confirm the validity of the current study’s
results. Nonetheless, the current study recommends that
Group Triple P intervention be employed widely as a
strategy for addressing the critical issue of child maltreat-
ment in high-risk situations in Japan.
Acknowledgments This research is supported by Research on
Children and Families, Health and Labor Sciences Research Grants
for the program ‘‘Support Activity on Early Detection of Develop-
mental Disorders Using the Infant–Toddler Health Checkups and Its
Evaluation,’’ funded by the Ministry of Health, Labor, and Welfare
(PI: Noriko Kato). The authors gratefully acknowledge the coopera-
tion of Dr. Hiroko Ishidu and Dr. Mari Mashiko from Kawasaki
City’s local government. We especially appreciate the mothers and
children who participated in this study, without whom the study
would not have been possible.
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