4. Discussion
SECONDARY
This pragmatic controlled study which was carried out with incarcerated mothers and fathers in prisons in Sweden with the aim to support positive parenting to influence healthy child development showed significant effects on quality in the relationship between parent and child and indicated effects on criminal attitude and interest in participating in additional treatment programmes during the time in prison. These are encouraging results for both the children, who face great risk of poor-health and marginalisation across development, and for the parents who may be supported in changing their criminal behaviour in addition to engaging in more positive parenting.The results of this study showed a significant effect of intervention on the primary outcome quality in relationship between child and parent in both the ITT and per protocol analyses, which confirms the hypothesis of the study, although the hypothesised primary end point was T1, after the intervention, when the effects were in fact identified at the follow-up measurement T2. The beneficial effects on the primary outcome align with previous evaluations of interventions for incarcerated parents on the international arena [The results of the intervention effects on the secondary outcome are also in line with the hypothesised results of the study, although weaker than the results for the primary outcome. These outcomes comprise interest in participating in additional treatment during the incarceration, and criminal attitude, which have been less studied in previous trials that investigate the effectiveness of parenting interventions for incarcerated parents. This restricts the possibility to compare these findings with previous studies, but where the findings of this study indicate the possibility of effects on outcomes related to criminal attitude and rehabilitation as a results of parenting interventions for incarcerated parents. Intervention effects at the follow-up measurement were found for improved criminal attitude when comparing parents in the intervention group who participated in all 10 sessions with parents in the control group, and for interest in participating in treatment programmes in the analysis using the ITT approach. Thus, the intervention, with a focus on enhancing the parenting role in terms of recognition of parenting responsibility and positive practices, increasing knowledge and understanding of children’s development and needs, seemed to have an influence on aspects that are related to attitudes towards criminality, where a decrease in criminal attitude resonates with a more prosocial attitude, and where interest in treatment programmes in prison conveys a motivation to change criminal behaviour as treatment interventions in prison are focusing on supporting behaviour change towards a non-criminal lifestyle [The secondary outcome child-parent contact frequency did not render any effect of intervention and is also difficult to interpret. The contact that the parent is allowed to have with a child is dependent on the regulations in the prison, where different security levels have different regulations for telephone contact, visits, and leave. In future studies, a measurement that better reflects the contact between child and parent should be considered.Although the results of this trial have shown beneficial intervention effects on both primary and secondary outcomes, a greater magnitude and more consistent effects over both the ITT and per protocol analyses would have been desired regarding the secondary outcomes. Therefore, revisions of the intervention activities should be considered to possibly increase intervention effectiveness. Importantly, the results of process evaluations of the FOCS intervention which are reported in a mixed-methods study found that delivering group leaders, and managers responsible for the implementation of FOCS in prison called for further development and revisions of FOCS to make the intervention adaptable to the different needs of the parents who participate, e.g., extend the intervention to include additional themes, adapt certain themes to cater to gender differences, include individual sessions in addition to group sessions to facilitate discussion regarding sensitive topics, and more in-depth knowledge on parenting practices [Yet another factor which can be increased in order to improve intervention effects on outcomes is the fidelity to intervention delivery. High fidelity of intervention delivery of parenting programmes has been linked to higher intervention effects on outcomes [