How Communities That Care strengthens evidence-based practice in Germany – community-level analyses

Abstract Background Communities That Care (CTC) is an internationally widespread evidence-based prevention support system designed to help communities adopt a science-based approach to prevention. This is the first study in Germany to examine which factors influence CTC implementation (e.g. community readiness) and how system change outcomes (e.g. collaboration for prevention) contribute to increased use and reach of evidence-based prevention programs (EBPs). Methods In 2023, 22 members from seven CTC coalitions were surveyed about factors potentially affecting CTC implementation. Additional data were collected using a tool designed to monitor the quality and progress of CTC implementation (n = 13). In both 2021 and 2023, 330 key informants from 17 CTC and 16 control communities were interviewed regarding system change outcomes. In the same years, program implementers were surveyed about the implementation and population reach of EBPs. Bivariate linear regression analyses were conducted at the community-level (1-sided p-values). Results Nine factors were associated with implementation quality (β ranging from .763, p=.023 to .928, p=.002 and -.712, p=.037 to -.928, p=.002). Higher implementation quality was linked to increased collaboration for prevention (β=.637, p=.018), while higher implementation progress was associated with greater adoption of a science-based prevention approach (β=.565, p=.027). In turn, both greater adoption of this approach (β=.368, p=.029) and increased financial support (β=.500, p=.004) were related to higher levels of EBP implementation. Enhanced community support was linked to broader population reach (β=.393, p=.021). Discussion Due to limited statistical power, only large effect sizes reached statistical significance. Nevertheless, the findings are consistent with theoretical expectations and provide actionable insights for the implementation and quality assurance of CTC coalitions. Key messages • We identified nine factors with strong effects on the quality of CTC implementation. • CTC promotes EBP implementation and population reach through specific system change outcomes.