A challenging balancing act to engage children and their families in a healthy lifestyle - Nurses' experiences of child-centred health dialogue in child health services in Sweden

The Concept of Child-Centred Care in Healthcare: A Scoping Review

Although child-centred care is increasingly referred to within the nursing literature, a clear definition of child-centred care and clarity around the concept is yet to be achieved. The objectives of this review were to examine the following: (1) What constitutes the concept of child-centred care in healthcare? (2) How has the concept of child-centred care developed? (3) What is the applicability of child-centred care and what are its limitations? (4) How does the concept of child-centred care benefit and inform children's healthcare? In total, 2984 papers were imported for screening, and, following the removal of duplicates and screening, 21 papers were included in the scoping review. The findings suggest that child-centred care is an emerging, ambiguous poorly defined concept; no clear consensus exists about what constitutes child-centred care. Although it seems antithetical to argue against child-centred care, little robust evidence was identified that demonstrates the impact and benefit of child-centred care. If child-centred care is to be a sustainable, convincing model to guide practice and compete with other models of care, it needs to establish robust evidence of its effectiveness, the impact on children and their families, as well as the wider impacts on the healthcare system.

To capture the child's interest - nurses experiences of 'Saga stories in health talks'

BACKGROUND

As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. 'Saga Stories in health talks' is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the 'Saga Stories in health talks' material.

METHODS

This study used a qualitative design. The material 'Saga Stories in health talks' was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.

RESULTS

Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children's interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks' was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child's interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.

CONCLUSIONS

This pilot study show that the material 'Saga Stories in health talks' was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

Parents' recalled experiences of the child centred health dialogue in children with overweight: a qualitative study

BACKGROUND

Because overweight and obesity are still increasing and prevention of childhood obesity is more likely to be effective when initiated in preschool children, the Child Health Service in the south of Sweden developed a structured child-centred health dialogue model targeting all 4-year-old children and their families. The aim of this study was to describe parents' recalled experiences of this health dialogue in children with overweight.

METHODS

A qualitative inductive approach with purposeful sampling was used. Thirteen individual interviews with parents (including 11 mothers and 3 fathers) were conducted and analysed with qualitative content analysis.

RESULTS

The analysis resulted in two categories: 'A valuable visit with a subtle individual impact' that described parents' recalled experiences of the health dialogue and 'There is a complex interaction between weight and lifestyle' that reflected the parents' perceptions of the relationship between their children's weight and lifestyle.

CONCLUSIONS

Parents recalled the child-centred health dialogue as important and described discussing a healthy lifestyle as one of the obligations of the Child Health Service. Parents wanted confirmation that their family lifestyle was healthy; however, they did not want to discuss the relationship between their family lifestyle and their children's weight. Parents expressed that when their child followed the child's growth curve, then this indicated healthy growth. This study supports using the child-centred health dialogue as a model to provide structure for discussing a healthy lifestyle and growth but highlights the difficulties of discussing body mass index and overweight, especially in the presence of children.

Psychometric validation of the Child Healthy Lifestyle Profile in South Korea: a cross-sectional study

PURPOSE

This study aimed to validate the Child Healthy Lifestyle Profile as an instrument for screening healthy behaviors in school-aged children in South Korea.

METHODS

Self-reported questionnaires were administered to 454 students, comprising elementary-school students (n=221) and child cancer survivors (n=233). Reliability and validity were assessed using Cronbach's ⍺, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

RESULTS

Cronbach's ⍺, as a reliability test, was 0.87. Varimax rotation yielded nine factors with eigenvalues greater than 1 in the EFA, which explained 61.0% of the total variance. In the CFA, both convergent and discriminant validities were acceptable. Therefore, the Child Healthy Lifestyle Profile was validated as an assessment tool for Korean school-aged children.

CONCLUSION

Based on the results of this study, the Child Healthy Lifestyle Profile was identified as a reliable and valid instrument for assessing healthy lifestyles in elementary-school children in South Korea.

Changes in perceived parental self-efficacy after a Child-Centred Health Dialogue about preventing obesity

Aim

This randomised controlled trial evaluated changes in parental self‐efficacy and children's weight, after a Child‐Centred Health Dialogue about preventing obesity.

Methods

We randomly assigned 37 Child Health Centres in Skåne county Sweden to provide usual care or the dialogue intervention. They included centres from high and low socioeconomic areas. The outcomes were changes in parental self‐efficacy and any moderating effect on their children's body mass index 1 year later.

Results

The baseline data were based on 1115 mothers and 869 fathers representing 1197 children (52% females) aged 4 years (3.9–4.2) with a standardised body mass index (zBMI) of 0.1 ± 0.9. The participation rates at follow‐up, 1.1 ± 0.2 years after the intervention were 817 mothers and 508 fathers. Overall, parental self‐efficacy had decreased by the 1‐year follow‐up. There was a significant intervention effect on maternal self‐efficacy in promoting physical activity, however with unclear clinical relevance. Mothers' change in perceived self‐efficacy in promoting a healthy diet seemed to moderate the intervention effect on zBMI change in children with zBMI > 0 with −0.01 (95% CI: −0.025 to −0.001; p = 0.03).

Conclusion

Our study suggested a possible link between increased maternal self‐efficacy in promoting a healthy diet and a favourable development of zBMI.

A child-centered health dialogue for the prevention of obesity in child health services in Sweden - A randomized controlled trial including an economic evaluation

BACKGROUND

Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost-effective interventions for children aged 2-6 years and their caregivers in Child Health Services are lacking.

OBJECTIVES

To evaluate the effects and cost-effectiveness of a child-centered health dialogue in the Child Health Services in Sweden on 4-year-old children with normal weight and overweight.

METHODS

Thirty-seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI-change.

RESULTS

A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow-up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI-change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI-change for children with overweight was -0.11, with a 95% confidence interval of -0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child-Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost-effectiveness ratio was 183 euros per 0.1 zBMI unit prevented.

CONCLUSIONS

This low-intensive multicomponent child-centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost-effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio-economic factors in universally implemented obesity prevention programs.