Background The Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany. Methods Communities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach. Discussion This is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach. Trial registration This study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.

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Background One barrier to hand hygiene compliance is overestimation of one’s own performance. Overconfidence research shows that overestimation tends to be higher for difficult tasks, which suggests that the magnitude of overestimation also depends on how it is assessed. Thus, we tested the hypothesis that overestimation was stronger for hand hygiene indications with low compliance (i.e., high difficulty), and the hypothesis that self-reported overall compliance based on a single item is higher than based on “5 Moments of Hand Hygiene” (WHO-5) items, since the single item implies an aggregation across indications. Methods In the WACH trial (German Clinical Trials Register [DRKS] ID: DRKS00015502), a questionnaire survey was conducted among physicians and nurses in nine surgical clinics (general/visceral surgery or orthopedics/trauma surgery) of six German hospitals. Self-reported compliance was assessed both by a single item and the WHO-5-items using percentage scales. These were compared with each other and with direct observations. Relative frequencies of the WHO-5 indications used to calculate the WHO-5-based self-reported overall compliance rate were estimated by a systematized review of the literature (see appendix). In analysis, t-tests, Chi2-tests and multiple linear regressions were used. Results Ninety-three physicians (response rate: 28.4%) and 225 nurses (30.4%) participated. Significant compliance differences between physicians and nurses were found for direct observations and were in favor of nurses, while no such differences were found for self-reports. Across the WHO-5, overestimation showed inverse correlations with observed compliance (physicians: r = −0.88, p = 0.049; nurses: r = −0.81, p = 0.093). Support for the hypothesis that the self-reported overall compliance based on one item is higher than that based on WHO-5 items was found for physicians (M = 87.2 vs. 84.1%, p = 0.041; nurses: 84.4 vs. 85.5%, p = 0.296). Exploratory analyses showed that this effect was confined to orthopedic/trauma surgeons (89.9 vs. 81.7%, p = 0.006). Conclusion Among physicians, results indicate stronger hand hygiene overestimation for low-compliance indications, and when measurements are based on a single item versus the five WHO-5 items. For practice, results contribute to infection prevention and control’s understanding of overestimation as a psychological mechanism that is relevant to professional hand hygiene.

Zusammenfassung Hintergrund Communities That Care (CTC) ist ein Ansatz zur Übertragung präventionswissenschaftlicher Grundlagen in die kommunale Präventionspraxis. Mittels Schulungen und Tools unterstützt CTC Kommunen beim Aufbau lokaler Netzwerke zur Förderung der psychosozialen Gesundheit von Kindern und Jugendlichen. Bürgerbeteiligung, intersektorale Zusammenarbeit, wissenschaftsbasierte Prävention, Monitoring und Qualitätsentwicklung sind zentrale Elemente von CTC. Ergebnisse aus den USA legen nahe, dass die Wirkung von CTC auf Gesundheitsverhalten durch fünf intermediäre Outcomes vermittelt wird. Der Beitrag stellt erste Ergebnisse der Studie „Effektivität des kommunalen Präventionssystems Communities That Care“ (CTC-EFF) vor, die die Effektivität von CTC für Deutschland untersucht. Daten und Methoden Die CTC-EFF-Studie ist eine quasiexperimentelle Studie. Einbezogen sind 21 Kommunen, die CTC einführen (IK) und 21 a priori gematchte Vergleichskommunen (VK), die diesen hinsichtlich demographischen, wirtschaftlichen und kriminalstatistischen Merkmalen ähneln. 2021 wurden Befragungen mit 192 kommunalen Schlüsselpersonen (u. a. Amts- und Einrichtungsleitungen) durchgeführt. Bivariat wurde untersucht, ob sich die Befragten von IK und VK hinsichtlich acht soziodemographischer Merkmale, ihrer Einschätzungen zu Präventionszusammenarbeit, intersektoraler Kooperation, finanzieller Unterstützung, Rückhalt in der Bevölkerung sowie Übernahme wissenschaftsbasierter Prävention unterscheiden. Ergebnisse Die Befragten aus IK und VK unterscheiden sich in den soziodemographischen Merkmalen mit Ausnahme der Hochschulzugangsberechtigung (IK: 86 % vs. VK: 96 %) nicht signifikant. Auch werden Präventionszusammenarbeit, intersektorale Kooperation, finanzielle Unterstützung und Rückhalt in der Bevölkerung von den Befragten nicht unterschiedlich eingeschätzt. Eine Ausnahme bildet die Übernahme wissenschaftsbasierter Prävention. Schlussfolgerung Das Matching führte weitgehend zu Baseline-Äquivalenz in den untersuchten Merkmalen. Der kleine Vorsprung der IK gegenüber den VK in der Übernahme wissenschaftsbasierter Prävention ist plausibel, da die IK vor der Erhebung bereits erste Schulungen und Implementationsschritte vollzogen hatten.