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Barr KR, Hawker P, Winata T, Wang S, Smead M, Ignatius H, Kohlhoff J, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Lam-Cassettari C, Boydell K, Lin PI, Katz I, Dadich A, Raman S, Grace R, Doyle AK, McClean T, Di Mento B, Preddy J, Woolfenden S, Eapen V. Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community. BMC Health Serv Res 2024; 24:978. [PMID: 39180037 PMCID: PMC11344394 DOI: 10.1186/s12913-024-11397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program. METHODS Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data. RESULTS Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink. CONCLUSIONS Families and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child's development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program. TRIAL REGISTRATION The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- Karlen R Barr
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Patrick Hawker
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Teresa Winata
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- National Disability Insurance Scheme Quality and Safeguards Commission, Parramatta, NSW, Australia
| | - Si Wang
- Research and Evaluation Group, The Salvation Army, Sydney, NSW, Australia
| | - Melissa Smead
- Murrumbidgee Local Health District, Wagga Wagga, NSW, Australia
| | - Hilda Ignatius
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Karitane, Carramar, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Public Health and Community Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Kenny Lawson
- School of Business, Western Sydney University, Campbelltown, NSW, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, NSW, Australia
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Page
- School of Medicine, Western Sydney University, Parramatta, NSW, Australia
| | - Christa Lam-Cassettari
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Boydell
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
| | - Ping-I Lin
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ilan Katz
- Social Policy Research Centre, Faculty of Arts, Design, and Architecture, University of New South Wales, Sydney, NSW, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Campbelltown, NSW, Australia
| | - Shanti Raman
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Rebekah Grace
- Transforming Early Education and Child Health Research Centre, Western Sydney University, Campbelltown, NSW, Australia
| | - Aunty Kerrie Doyle
- School of Medicine, Western Sydney University, Parramatta, NSW, Australia
| | | | - Blaise Di Mento
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - John Preddy
- Murrumbidgee Local Health District, Wagga Wagga, NSW, Australia
- Rural Clinical School, School of Clinical Medicine, University of New South Wales, Wagga Wagga, NSW, Australia
| | - Susan Woolfenden
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Valsamma Eapen
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia.
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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Thaineua V, Sirithongthaworn S, Kanshana S, Isaranurak S, Karnkawinpong O, Benjaponpitak A, Wattanayingcharoen S, Piensrivachara E, Srikummoon P, Thumronglaohapun S, Nakharutai N, Traisathit P, Tangviriyapaiboon D. A 9-year retrospective cohort study of the monitoring and screening of childhood developmental delay in Thailand. Child Care Health Dev 2024; 50:e13233. [PMID: 38345164 DOI: 10.1111/cch.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Developmental delay in early childhood can have negative long-term cognitive and psychiatric sequelae, along with poor academic achievement, so early screening and surveillance are paramount. The aim of this study is to evaluate the impact of screening and surveillance on child developmental delay using the Developmental Surveillance and Promotion Manual (DSPM) and the Thai Early Developmental Assessment for Intervention (TEDA4I) for Thai children aged 0-5 years old. METHODS Data were obtained from the routine developmental screening for specific disorders at ages 9, 18, 30, 42 and 60 months conducted using DSPM and TEDA4I from 2013 to 2021. Descriptive statistics were used to analyse the data, and the results are visualised graphically herein. RESULTS Only 56% of the children were screened for child developmental delay using DSPM. The proportion of children screened increased from <1% in 2013 to 90% in 2021. Suspected developmental delay prevalence increased significantly from 3.91% in 2013-2015 to 10.00% in 2016-2018 and 26.48% in 2019-2021. Moreover, of the children with suspected developmental delay who received developmental stimulation within a month, only 87.9% returned for follow-up visits when they were evaluated again using TEDA4I to ascertain any abnormalities and specific areas of deficit. The overall proportion of children diagnosed with developmental delay was 1.29%. During the pandemic, the proportion of screening tests for child developmental delay at routine vaccination visits and follow-ups decreased but was still at least 80% in each region. CONCLUSIONS Since 1%-3% of children have suspected developmental delay, early detection is key to treating it as soon as possible. We anticipate that our findings will raise awareness in parents and caregivers about childhood developmental delay and lead to the implementation of early intervention and follow-up at the rural level in Thailand.
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Affiliation(s)
- Vallop Thaineua
- Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Siripon Kanshana
- Thai Breastfeeding Center Foundation, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Opart Karnkawinpong
- Office of the Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | | | - Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Medical Statistics and Data Analytics for Child and Youth Well-Being Research Group, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Salinee Thumronglaohapun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Medical Statistics and Data Analytics for Child and Youth Well-Being Research Group, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Nawapon Nakharutai
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Medical Statistics and Data Analytics for Child and Youth Well-Being Research Group, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Medical Statistics and Data Analytics for Child and Youth Well-Being Research Group, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
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Barbaro J, Winata T, Gilbert M, Nair R, Khan F, Lucien A, Islam R, Masi A, Diaz AM, Dissanayake C, Karlov L, Descallar J, Eastwood J, Hasan I, Jalaludin B, Kohlhoff J, Liaw ST, Lingam R, Ong N, Tam CWM, Woolfenden S, Eapen V. General practitioners' perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study. BMC PRIMARY CARE 2023; 24:159. [PMID: 37563549 PMCID: PMC10416397 DOI: 10.1186/s12875-023-02121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics. METHODS A qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program ("GP Surveillance for Autism") were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically. RESULTS Twenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services. CONCLUSIONS The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Teresa Winata
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Feroza Khan
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Abbie Lucien
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raisa Islam
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anne Masi
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Lisa Karlov
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Joseph Descallar
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - John Eastwood
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Iqbal Hasan
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bin Jalaludin
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Siaw-Teng Liaw
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Sue Woolfenden
- Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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Harris N, Roche E, Lee P, Asper L, Wiseman N, Keel R, Duffy S, Sofija E. Vision screening outcomes of 4-5 year-olds reflect the social gradient. Clin Exp Optom 2023; 106:640-644. [PMID: 36038506 DOI: 10.1080/08164622.2022.2109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/02/2022] [Accepted: 03/13/2022] [Indexed: 10/14/2022] Open
Abstract
CLINICAL RELEVANCE Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. BACKGROUND Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4- to 5-year-olds delivered in Queensland, Australia. METHODS The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores . RESULTS Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). CONCLUSION It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.
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Affiliation(s)
- Neil Harris
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Elisha Roche
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Patricia Lee
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Lisa Asper
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Nicola Wiseman
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Rachel Keel
- Children's Health Queensland Hospital and Health Services, Brisbane, Australia
| | - Shelley Duffy
- Children's Health Queensland Hospital and Health Services, Brisbane, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
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Puglisi CJ, McDonough J, Bianco-Miotto T, A Grieger J. General Practitioners perspectives on infant telomere length screening after a pregnancy complication: a qualitative analysis. Fam Pract 2023:7188177. [PMID: 37262296 DOI: 10.1093/fampra/cmad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Pregnancy complications can impact the mother and child's health in the short and longterm resulting in an increased risk of chronic disease later in life. Telomere length is a biomarker of future cardiometabolic diseases and may offer a novel way of identifying offspring most at risk for future chronic diseases. OBJECTIVE(S) To qualitatively explore General Practitioners' (GPs) perspectives on the feasibility and uptake for recommending a telomere screening test in children who were born after a pregnancy complication. METHODS Twelve semi-structured interviews were conducted with GPs within metropolitan Adelaide, South Australia. Interviews were audio recorded, transcribed verbatim, and analysed for codes and themes. RESULTS Two themes were generated: ethical considerations and practical considerations. Ethically, the GP participants discussed barriers including consenting on behalf of a child, parental guilt, and the impact of health insurance, whereas viewing it for health promotion was a facilitator. For practical considerations, barriers included the difficulty in identifying people eligible for screening, maintaining medical communication between service providers, and time and financial constraints, whereas linking screening for telomere length with existing screening would facilitate uptake. CONCLUSIONS GPs were generally supportive of potential telomere screening in infants, particularly via a saliva test that could be embedded in current antenatal care. However, several challenges, such as lack of knowledge, ethical considerations, and time and financial constraints, need to be overcome before such a test could be implemented into practice.
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Affiliation(s)
- Carolyn J Puglisi
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide 5005, Australia
| | - Joshua McDonough
- School of Public Health, University of Adelaide, Adelaide 5005, Australia
| | - Tina Bianco-Miotto
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide 5005, Australia
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
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Coscini N, Heyes P, Bedford H, Cohen E, D'Aprano A, Goldfeld S, Hargreaves D, Loveday S, Nejat S, Roberts G, Sarkadi A, Saunders NR, Woolfenden S, Milner K. Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians. Arch Dis Child 2023; 108:153-159. [PMID: 35764409 DOI: 10.1136/archdischild-2021-322799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
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Affiliation(s)
- Nadia Coscini
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Priya Heyes
- Department of Child Development Service, Government of Western Australia Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Helen Bedford
- Population, Policy and Practice Department, University College London Institute of Child Health, London, UK
| | - Eyal Cohen
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Anita D'Aprano
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah Loveday
- Health Services Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sahar Nejat
- Department of Public Health and Caring Sciences, Uppsala Universitet Institutionen for euroasiatiska studier, Uppsala, Sweden
| | - Gehan Roberts
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Natasha Ruth Saunders
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Susan Woolfenden
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Kate Milner
- Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurodisability and Rehabilitation Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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7
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Mendoza Diaz A, Brooker R, Cibralic S, Murphy E, Woolfenden S, Eapen V. Adapting the 'First 2000 Days maternal and child healthcare framework' in the aftermath of the COVID-19 pandemic: ensuring equity in the new world. AUST HEALTH REV 2023; 47:72-76. [PMID: 36657451 DOI: 10.1071/ah22228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/21/2023]
Abstract
The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic.
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Affiliation(s)
- Antonio Mendoza Diaz
- Infant, Child and Adolescent Mental Health Services (ICAMHS), South Western Sydney Local Health District (SWSLHD), NSW, Australia; and Academic Unit of Child Psychiatry South-West Sydney (AUCS), Discipline of Psychiatry and Mental Health, UNSW Sydney, NSW, Australia
| | - Ron Brooker
- Early Life Determinants of Health, Maridulu Budyari Gumal (Sydney Partnership for Health, Education, Research, and Enterprise), Ingham Institute, Sydney, NSW, Australia
| | - Sara Cibralic
- Academic Unit of Child Psychiatry South-West Sydney (AUCS), Discipline of Psychiatry and Mental Health, UNSW Sydney, NSW, Australia
| | - Elisabeth Murphy
- Child Health, Health and Social Policy Branch - NSW Ministry of Health, NSW, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, NSW, Australia; and Department of Community Child Health, Sydney Children's Hospitals Network, NSW, Australia
| | - Valsamma Eapen
- Infant, Child and Adolescent Mental Health Services (ICAMHS), South Western Sydney Local Health District (SWSLHD), NSW, Australia; and Academic Unit of Child Psychiatry South-West Sydney (AUCS), Discipline of Psychiatry and Mental Health, UNSW Sydney, NSW, Australia; and Early Life Determinants of Health, Maridulu Budyari Gumal (Sydney Partnership for Health, Education, Research, and Enterprise), Ingham Institute, Sydney, NSW, Australia
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8
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Eapen V, Winata T, Gilbert M, Nair R, Khan F, Lucien A, Islam R, Masi A, Lam-Cassettari C, Mendoza Diaz A, Dissanayake C, Karlov L, Descallar J, Eastwood J, Hasan I, Jalaludin B, Kohlhoff J, Liaw ST, Lingam R, Ong N, Tam CWM, Woolfenden S, Barbaro J. Parental experience of an early developmental surveillance programme for autism within Australian general practice: a qualitative study. BMJ Open 2022; 12:e064375. [PMID: 36442896 PMCID: PMC9710335 DOI: 10.1136/bmjopen-2022-064375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents'/caregivers' experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting. DESIGN This qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, 'General Practice Surveillance for Autism', a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically. PARTICIPANTS Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed. SETTINGS All interviews were completed over the phone. RESULTS There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient-doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers. CONCLUSION The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting. TRIAL REGISTRATION NUMBER ANZCTR (ACTRN12619001200178).
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Affiliation(s)
- Valsamma Eapen
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Teresa Winata
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Feroza Khan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Raisa Islam
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Anne Masi
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christa Lam-Cassettari
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Saint Lucia, Queensland, Australia
| | - Lisa Karlov
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Joseph Descallar
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Iqbal Hasan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Centre for Research, Evidence Management and Surveillance, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
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9
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Wightman L, Hutton A, Grant J. Child and family health nurses' roles in the care of infants and children: A scoping review. J Child Health Care 2022; 26:448-460. [PMID: 34116592 DOI: 10.1177/13674935211026123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Child and family health nurses (CFHNs) work in a variety of settings with families to promote optimal growth and development in infants and children from birth to 5 years. Literature is available about models of care that CFHNs use in their work, but there is limited information about how CFHNs enact care specifically for infants and children. The aim of this scoping review was to identify and contextualize existing knowledge of how CFHNs, both in Australia and internationally, care for infants and children. Arksey and O'Malley's (2005) framework was used to review 27 studies from Australia, Sweden, Finland, United Kingdom (UK), United States of America (USA), Ireland, Netherlands, Denmark and Canada. It was identified that CFHNs, equipped with a range of assessment tools for early intervention and health promotion, use a partnership approach when working with parents to promote the health and well-being of infants and children. The literature revealed the complexity of the roles undertaken by CFHNs when caring for infants and children. Review findings indicated that CFHNs' work is distinctive because it is conducted in home and community settings, is relational and salutogenic in nature and is also located in the domain of preventative health and early intervention.
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Affiliation(s)
- Louise Wightman
- College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Alison Hutton
- School of Nursing and Midwifery, Faculty of Health and Medicine, 5982The University of Newcastle, Callaghan NSW, Australia
| | - Julian Grant
- School of Nursing, Midwifery & Indigenous Health, 89470Charles Sturt University, Bathurst, NSW, Australia
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10
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Borkhoff CM, Atalla M, Bayoumi I, Birken CS, Maguire JL, Parkin PC. Predictive validity of the Infant Toddler Checklist in primary care at the 18-month visit and developmental diagnosis at 3-5 years: a prospective cohort study. BMJ Paediatr Open 2022; 6:e001524. [PMID: 36053584 PMCID: PMC9234802 DOI: 10.1136/bmjpo-2022-001524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE There is international variation in recommendations regarding developmental screening and growing recognition of the low sensitivity of commonly used developmental screening tools. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at 18 months to predict a developmental diagnosis at 3-5 years, in a primary care setting. METHODS We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit and reported developmental diagnosis at 3-5 years (developmental delay, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), learning problem). We calculated screening test properties with 95% CIs. We used multivariable logistic regression analyses adjusted for important covariates. RESULTS In the final sample (n=488), mean age at screening was 18.5 (SD 1.1) months, and at follow-up was 46.6 (SD 10.0) months. At screening, 46 (9.4%) had a positive ITC. At follow-up, 26 (5.3%) had a developmental diagnosis, including: developmental delay (n=22), ASD (n=4), ADHD (n=1), learning problem (n=1); parents of two children each reported two diagnoses (total of 28 diagnoses). Of four children with a diagnosis of ASD at follow-up, three had a positive ITC at 18 months. The ITC specificity (92%, 95% CI: 89% to 94%) and negative predictive value (96%, 95% CI: 95% to 97%) were high; false positive rate was low (8%, 95% CI: 6% to 11%); sensitivity was low (31%, 95% CI: 14% to 52%). There was a strong association between a positive ITC at 18 months and later developmental diagnosis (adjusted OR 4.48, 95% CI: 1.72 to 11.64; p=0.002). CONCLUSION The ITC had high specificity, high negative predictive value, low false positive rate, and identified children with later developmental delay and ASD. The ITC had low sensitivity, similar to other screening tools underscoring the importance of continuous developmental surveillance at all health supervision visits.
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Affiliation(s)
| | - Marina Atalla
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Bayoumi
- Department of Family Medicine and Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
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11
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Nyande FK, Ricks E, Williams M, Jardien-Baboo S. Socio-cultural barriers to the delivery and utilisation of child healthcare services in rural Ghana: a qualitative study. BMC Health Serv Res 2022; 22:289. [PMID: 35241071 PMCID: PMC8892726 DOI: 10.1186/s12913-022-07660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Over half of global deaths among children under five years of age occur in sub-Saharan Africa. Prompt and consistent access to and utilisation of child healthcare services improves child health outcomes. However, socio-cultural barriers impede the utilisation of child healthcare services among rural dwellers in Ghana. There is a paucity of studies that explore the experiences of nurses and caregivers regarding the socio-cultural barriers to the delivery and utilisation of child healthcare services in rural areas in Ghana such as the Nkwanta South Municipality. PURPOSE The purpose of this study was to explore the experiences of nurses and caregivers regarding the socio-cultural barriers that impede the delivery and utilisation of child healthcare services by caregivers for their children in the Nkwanta South Municipality, Ghana. METHODS Data were collected through semi-structured interviews conducted with a purposive sample of ten nurses and nine caregivers of children under five years of age who utilised the available child healthcare services in a rural setting. The consent of all participants was sought and given before interviews were conducted. Data analysis entailed coding and the generation of themes the codes. RESULTS The exploration of experiences of nurses and caregivers of children under-five years of age revealed that certain socio-cultural beliefs and practices, language barriers and reliance of caregivers on self-medication were the main socio-cultural barriers that impeded the delivery and utilisation of child healthcare services in the Nkwanta South Municipality. CONCLUSION Nurses and caregivers experienced several socio-cultural barriers which either delayed care seeking by caregivers for their sick children or interfered with the smooth and prompt delivery of needed child healthcare services by nurses. Some of the barriers negatively affected the interaction between nurses and caregivers with the tendency to affect subsequent child healthcare service utilisation. It is recommended that healthcare managers and nurses should foster close collaboration with caregivers and community leaders to address these socio-cultural barriers and facilitate prompt and consistent utilisation of child healthcare service in rural areas.
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Affiliation(s)
- Felix Kwasi Nyande
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Esmeralda Ricks
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Margaret Williams
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Sihaam Jardien-Baboo
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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12
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Yaeger JP, Alio AP, Fiscella K. Addressing Child Health Equity Through Clinical Decision-Making. Pediatrics 2022; 149:184449. [PMID: 35102415 DOI: 10.1542/peds.2021-053698] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Amina P Alio
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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13
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Jain K, Solomon J, Ramachandran S. Knowledge, attitude and practices on developmental surveillance and screening among health professionals in Indian health care settings: An exploratory sequential mixed methods study. J Pediatr Rehabil Med 2021; 14:55-63. [PMID: 33492251 DOI: 10.3233/prm-190649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the knowledge, attitude and practices of health care professionals in pediatric settings on developmental surveillance and screening programs and also to identify the barriers and facilitators during its implementation. METHODS The data were collected from health professionals involved in pediatric developmental care, practicing in various hospitals, clinics and nursing homes in a suburban city on west coast of Southern India. The study involved cross-sectional exploratory sequential mixed method design which included a quantitative questionnaire survey on health professionals (n= 52) followed by qualitative face-to-face interviews with chosen respondents who participated in the survey (n= 8). The survey data are reported with descriptive statistics, and interview data are subjected to inductive content analysis for deriving codes, categories and themes. RESULTS The study results indicate that health professionals involved in pediatric developmental care in Indian health care settings have fair knowledge and a favorable attitude towards the use of developmental surveillance and screening. Furthermore, the facilitators and barriers of implementation have been reported. The strategies outlined by interview respondents to improve adherence to implementation have been discussed. CONCLUSIONS The practice of developmental surveillance and screening is limited despite favorable knowledge and attitude among health professionals in pediatric developmental care and is dependent on health care organizational setup.
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14
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Faruk T, King C, Muhit M, Islam MK, Jahan I, Baset KU, Badawi N, Khandaker G. Screening tools for early identification of children with developmental delay in low- and middle-income countries: a systematic review. BMJ Open 2020; 10:e038182. [PMID: 33234622 PMCID: PMC7684835 DOI: 10.1136/bmjopen-2020-038182] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To systematically review, identify and report the screening tools used for early identification of developmental delay in low- and middle-income countries. DESIGN Systematic review. DATA SOURCES Four bibliographic databases: Medline (1946 to 13 July 2020), Embase (1974 to 13 July 2020), Scopus (1823 to 11 July 2020) and PsycINFO (1987 to July week 1 2020). ELIGIBILITY CRITERIA Peer-reviewed original articles published in English addressing validated culturally sensitive developmental screening tools among children aged <5 years were included in this review. DATA EXTRACTION AND SYNTHESIS One author (CK, medical librarian) developed the search strategy. Three authors conducted the database search (phase I: CK; phase II: IJ and MKI). Three authors (TF, IJ and MKI) independently screened the title and abstracts. TF, MKI and GK independently performed the full-text review of the screened articles. During each step of the study selection process, disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the systematic review. Data extraction and analysis were performed using MS Excel. Meta-analysis was not possible due to heterogeneity of the study findings. RESULTS We identified 3349 articles, of which 18 studies from 10 countries, reporting 16 screening tools, were selected for qualitative synthesis. Six cultural contexts were explored. Twelve general, two motor and two speech-language tools were identified. Seven of them found to be parent-completed ones. Five screening tools (American Speech-Language and Hearing Association, Guide for Monitoring Child Development, Infant Neurological International Battery, New Delhi-Development Screening Questionnaire and Woodside Screening Technique) reported relatively higher sensitivity (82.5%-100%) and specificity (83%-98.93%). CONCLUSIONS Limited number of culturally sensitive developmental screening tools were validated for children aged <5 years in low- and middle-income countries. Revising existing screening tools in different ethnic and cultural settings and subsequent validation with normative value should be a research priority.
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Affiliation(s)
- Tasnuva Faruk
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
| | - Catherine King
- The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammad Muhit
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Md Kafiul Islam
- Department of Electrical and Electronic Engineering, Independent University Bangladesh, Dhaka, Bangladesh
| | - Israt Jahan
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kamran Ul Baset
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
- Road Safety and Driving School, BRAC, Dhaka, Bangladesh
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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15
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Alexander KE, Mazza D. Improving assessment of child development: Results of a quality improvement intervention in general practice. J Paediatr Child Health 2020; 56:1053-1059. [PMID: 32073191 DOI: 10.1111/jpc.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/20/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022]
Abstract
AIMS Parents' Evaluation of Developmental Status (PEDS) is a validated tool used to assess child development that has not previously been tested in Australian general practice. We examined the effect of a Quality-Improvement intervention in a single general practice in Melbourne, Australia, that aimed to use this tool to improve the documented assessment of child developmental surveillance during vaccination visits. METHODS Mixed methods incorporated audits of clinical records of children aged 1-5 years, before and after intervention, written questionnaires and a focus group (informed by the theoretical domains framework and Capability, Opportunity, Motivation-Behaviour (COM-B model)) with clinical and non-clinical staff. RESULTS After 6 months, developmental surveillance more than doubled and was documented in more than one in three visits (34.1%). Almost one in five (18.6%) vaccination visits included the PEDS tool. Overall, the tool was positively received with staff expressing high levels of comfort asking parents to complete it (92.8%), increasing development of professional skills (71.4% staff) and confidence (55% clinicians) detecting developmental delays. Thematic analysis of the focus group transcript revealed underlying barriers arising from the practice environment, staff capabilities and motivation. CONCLUSIONS In a whole of practice Quality-Improvement intervention that applied PEDS training and implementation, including the receptionist in the medical team more than doubled documented rates of child developmental surveillance during vaccination visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance.
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Affiliation(s)
- Karyn E Alexander
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
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16
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Baker J, Kohlhoff J, Onobrakpor SI, Woolfenden S, Smith R, Knebel C, Eapen V. The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review. JMIR Mhealth Uhealth 2020; 8:e16085. [PMID: 32324149 PMCID: PMC7206511 DOI: 10.2196/16085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/05/2020] [Accepted: 02/10/2020] [Indexed: 12/05/2022] Open
Abstract
Background Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses–informed protocol. Data extraction included variables related to health equity. Results In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions Although evidence is limited as to the necessity of web- versus face-to-face–based developmental screening, there are clear efficiencies in its use. Trial Registration PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127894
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Affiliation(s)
- Jess Baker
- The University of New South Wales, Liverpool, Australia
| | - Jane Kohlhoff
- The University of New South Wales, Carramarr, Australia
| | | | | | - Rebecca Smith
- South Eastern Sydney Local Health District, Sydney, Australia
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17
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Kehoe M, Winton-Brown T, Lee S, Hopkins L, Pedwell G. General Practitioners' management of young people with mental health conditions in Australia. Early Interv Psychiatry 2020; 14:124-129. [PMID: 31642179 DOI: 10.1111/eip.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 08/27/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Abstract
AIM Detecting and diagnosing youth mental health issues can be challenging for General Practitioners (GPs) who are often the first to encounter them. One aim of this study was to understand the challenges GPs faced in identifying, treating and referring young people with mental health issues in Melbourne, Australia. A second aim was to identify gaps in GP knowledge and service provision in order to design a service and training program for GPs that addresses those gaps. METHOD A representative sampling method was used to invite GPs in south-east Melbourne to complete the study survey. Seventy-seven GPs completed the questionnaire consisting of 10 questions in 3 sections. RESULTS The results showed that GPs who consulted with young people more often had greater levels of confidence in identifying and treating their mental health issues but not referring. Forty-four percent identified the need for training in regards to youth mental health. GPs considered that the most effective care was provided in youth-friendly spaces but tended to primarily refer young people to private providers. CONCLUSION GPs need access to ongoing professional development and education programs on youth mental health, in particular more severe issues such as psychosis. Specialist youth mental health services such as CYMHS/CAMHS and headspace can offer GPs support in managing mental health issues in young people. However, there is a need to strengthen the link between GPs and specialist youth mental health service. Stronger links between services will ensure young people have timely and increased access to treatment.
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Affiliation(s)
- Michelle Kehoe
- Alfred CYMHS and Headspace, Alfred Health, Melbourne, Victoria, Australia
| | - Toby Winton-Brown
- Department of Neuroscience, Central Clinical School, Monash University Australia, Melbourne, Victoria, Australia.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stuart Lee
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical and Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Liza Hopkins
- Alfred CYMHS and Headspace, Alfred Health, Melbourne, Victoria, Australia
| | - Glenda Pedwell
- Alfred CYMHS and Headspace, Alfred Health, Melbourne, Victoria, Australia
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18
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van Minde MRC, Hulst SM, Raat H, Steegers EAP, de Kroon MLA. Postnatal screening and care for non-medical risk factors by preventive child healthcare in deprived and non-deprived neighbourhoods. BMC Health Serv Res 2018; 18:432. [PMID: 29884178 PMCID: PMC5994004 DOI: 10.1186/s12913-018-3243-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Children born in families with non-medical risk factors, such as deprivation, have higher odds of preterm birth (< 37 weeks of gestation) or being born small for gestational age (birth weight < 10th percentile). In addition, growing up they are at risk for growth and developmental problems. Preventive Child Healthcare (PCHC) monitors growth and development of babies and children. Early identification of children at risk could result in early interventions to prevent growth and developmental problems in later life. Therefore, we aimed to assess current practices in postnatal risk screening and care for non-medical risk factors and the collaboration with other healthcare professionals, in both deprived and non-deprived neighbourhoods in the Netherlands. Methods Eight out of ten invited PCHC organisations, from different areas in the Netherlands, consented to participate in this study. A questionnaire was designed and digitally distributed to professionals working at these organisations, where 370 physicians and nurses were employed. Data was collected between June and September 2016. Descriptive statistics, chi square tests and t-tests were applied. Results Eighty-nine questionnaires were eligible for analyses. Twenty percent of the respondents were working in a deprived neighbourhood and 70.8% of the respondents were employed as nurse. Most of them performed screening for non-medical risk factors in at least 50% of their consultations. PCHC professionals working in deprived neighbourhoods encountered significantly more often families with non-medical risk factors and experienced significantly more communication problems than their colleagues working in non-deprived neighbourhoods. 48.2% of the respondents were satisfied with the current form of postnatal risk screening in their organisation, whereas 41.2% felt a need for a structured postnatal risk assessment. Intensified collaboration is preferred with district-teams, general practitioners and midwifes, concerning clients with non-medical risk factors. Conclusion This study shows that postnatal screening for non-medical risk factors is part of current PCHC practice, regardless the neighbourhood status they are deployed. PCHC professionals consider screening for non-medical risk factors as their responsibility. Consequently, they felt a need for a structured postnatal risk assessment and for an intensified collaboration with other healthcare professionals. Electronic supplementary material The online version of this article (10.1186/s12913-018-3243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M R C van Minde
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - S M Hulst
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M L A de Kroon
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
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