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Flores S, Sarkadi A. Experiences of central child health services teams regarding a special governmental investment in child health services. BMC Health Serv Res 2024; 24:1046. [PMID: 39256747 PMCID: PMC11389328 DOI: 10.1186/s12913-024-11492-0] [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: 02/07/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Historically marked by a high infant mortality rate, Sweden's healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0-5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively. METHODS CCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement's implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke's framework. Participants represented a cross-section of Sweden's varied healthcare regions. RESULTS Three main themes emerged from the thematic analysis: "Easy come, easy go," highlighting funding uncertainties; "What are we supposed to do?" expressing dilemmas over project prioritization and partner collaboration; and "Building castles on sand," focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services. CONCLUSIONS This study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.
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Affiliation(s)
- Sergio Flores
- Department of Public Health and Caring Sciences/CHAP, Uppsala University, Uppsala, Sweden.
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences/CHAP, Uppsala University, Uppsala, Sweden
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Lundgren JS, Nilses Å, Eckerdal EL, Bernhardsson S. Perceptions of facilitators, barriers and solutions when preparing to implement a home visiting program in Sweden: a mixed-methods study. FRONTIERS IN HEALTH SERVICES 2024; 4:1335559. [PMID: 38562653 PMCID: PMC10982395 DOI: 10.3389/frhs.2024.1335559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Background Although there is growing awareness that early childhood development programs are important for a sustainable society, there is a knowledge gap about how to implement such programs. Successful implementation requires attention to implementation drivers (competency, organization, and leadership) during all phases of the implementation. The purpose of this study was to describe cross-sectoral operational workgroups' perceptions of facilitators, barriers and solutions related to implementation drivers in the preparationphase of implementing an evidence-based early childhood home visiting program. Methods Quantitative and qualitative data were collected from twenty-four participants, divided into 5 groups, during implementation planning workshops. The workshops were guided by a structured method informed by the principles of Motivational Interviewing and within a framework of implementation drivers. Groups sorted cards with statements representing implementation drivers according to perceptions of facilitators and barriers, and percentages were calculated for each type of implementation determinant, for each type of driver. The groups discussed their card sorting and wrote action plans to address barriers, yielding documentation that was analyzed using deductive qualitative content analysis. Results A mixed-methods analysis resulted identification of facilitators, barriers, unknowns and solutions in two to three subcategories under each main category of implementation driver. A competent and confident workforce, and enthusiasm and commitment were key facilitators. Key barriers were unclear roles and responsibilities, and insufficient articulation of local vision and goals. Many factors were described as yet unknown. Specific solutions were generated to support the implementation. Conclusions Our study furthers the scientific understanding of how to take evidence-based early childhood programs from research to practice within an implementation drivers framework. Facilitators, barriers and solutions in key areas during the preparation phase were identified with the help of a novel tool. The results provide useful knowledge for decision makers and organizations preparing similar initiatives in communities striving to attain sustainable development goals.
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Affiliation(s)
- Julie S. Lundgren
- Region Västra Götaland, Center for Progress in Children’s Mental Health, Child and Youth Health Specialty Services, Regional Healthcare, Gothenburg, Sweden
| | - Åsa Nilses
- Region Västra Götaland, Center for Progress in Children’s Mental Health, Child and Youth Health Specialty Services, Regional Healthcare, Gothenburg, Sweden
| | - Ebba-Lisa Eckerdal
- Region Västra Götaland, Center for Progress in Children’s Mental Health, Child and Youth Health Specialty Services, Regional Healthcare, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Region Västra Götaland, Research, Education, Development and Innovation Primary Health Care, Vänersborg, Sweden
- Department of Health and Rehabilitation, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Chin KZ, Marklund B, Kylén S, Dalemo S. Extended prenatal and postnatal home visits in a vulnerable area in Sweden-a pilot study. Scand J Prim Health Care 2023; 41:486-494. [PMID: 37910395 PMCID: PMC11001331 DOI: 10.1080/02813432.2023.2277756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results. DESIGN Longitudinal, prospective study and register study from medical records. SETTING A vulnerable rural area in Sweden. INTERVENTION A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children's first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers. SUBJECTS All firstborn children at the study site (N = 30 study, N = 55 control group). MAIN OUTCOME MEASURES The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations. RESULTS There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%). CONCLUSION Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.
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Affiliation(s)
- Kuo Zhe Chin
- Närhälsan Guldvingen Healthcare Centre, Lidköping, Sweden
- R&D Centre Skaraborg, Skövde, Sweden
| | - Bertil Marklund
- Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- R&D Centre Fyrbodal, Vänersborg, Sweden
| | - Sven Kylén
- R&D Centre Fyrbodal, Vänersborg, Sweden
- Centre on Health Care Improvement and Innovation, Chalmers University of Technology, Gothenburg, Sweden
| | - Sofia Dalemo
- Närhälsan Guldvingen Healthcare Centre, Lidköping, Sweden
- R&D Centre Skaraborg, Skövde, Sweden
- Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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McGowan DA, Mather C, Stirling C. Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review. NURSING REPORTS 2023; 13:194-213. [PMID: 36810271 PMCID: PMC9944459 DOI: 10.3390/nursrep13010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
The aims of the study are to evaluate and synthesise research that has investigated social determinants of health screening by primary healthcare nurses; how and when primary health care nurses perform social determinants of health screening; and implications for advancing nursing practice. Systematic searches in electronic databases identified fifteen published studies which met the inclusion criteria. Studies were synthesised using reflexive thematic analysis. This review found little evidence of primary health care nurses using standardised social determinants of health screening tools. Eleven subthemes were identified and collapsed into three main themes: organisation and health system supports are required to enable primary health care nurses; primary health care nurses are often reluctant to perform social determinants of health screening; and the importance of interpersonal relationships for social determinants of health screening. The social determinants of health screening practices of primary health care nurses are poorly defined and understood. Evidence suggests that primary health care nurses are not routinely using standardised screening tools or other objective methods. Recommendations are made for valuing therapeutic relationships, social determinants of health education and the promotion of screening by health systems and professional bodies. Overall, further research examining the best social determinant of health screening method is required.
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Affiliation(s)
- Deirdre A. McGowan
- School of Nursing, College of Health and Medicine, University of Tasmania, Glebe, TAS 7000, Australia
| | - Carey Mather
- Australian Institute of Health Services Management, College of Business and Economics, University of Tasmania, Launceston, TAS 7250, Australia
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Glebe, TAS 7000, Australia
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Wennergren M, Berg K, Frisk Cavefors AS, Edin H, Ekholm L, Gelander L, Golsäter M, Hedman J, Holmgren A, Karlsson Videhult F, Levin A, Silfverdal SA, Wallby T, Fäldt AE. Swedish Child Health Services Register: a quality register for child health services and children's well-being. BMJ Paediatr Open 2023; 7:e001805. [PMID: 36669832 PMCID: PMC9872488 DOI: 10.1136/bmjpo-2022-001805] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/07/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Swedish child health services (CHS) is a free-of-charge healthcare system that reaches almost all children under the age of 6. The aim for the CHS is to improve children's physical, psychological and social health by promoting health and development, preventing illness and detecting emerging problems early in the child's life. The services are defined in a national programme divided into three parts: universal interventions, targeted interventions and indicated interventions.The Swedish Child Health Services Register (BHVQ) is a national Quality Register developed in 2013. The register extracts data from the child's health record and automatically presents current data in real time. At present, the register includes 21 variables. AIM We aim to describe data available in the BHVQ and the completeness of data in BHVQ across variables. METHODS Child-specific data were exported from the register, and data for children born in the regions were retrieved from Statistics Sweden to calculate coverage. RESULTS The register includes over 110 000 children born between 2011 and 2022 from 221 child healthcare centres in eight of Sweden's 21 regions. In seven of the eight regions, 100% of centres report data.The completeness of data differs between participating regions and birth cohorts. The average coverage for children born in 2021 is 71%. CONCLUSIONS The BHVQ is a valuable resource for evaluating Child Health Services nationally, with high coverage for the youngest children. As a result of continuous improvement of the services, the possibility to follow the development of children's health in Sweden is possible through the register. When fully expanded, the register will be a natural and essential part of developing preventive services, improving healthcare for children below 6 years of age and a tool for developing evidence-based child health interventions.
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Affiliation(s)
- Mattias Wennergren
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Göteborg, Sweden
- Centre of Child Health Services, Regionhälsan, Region Västra Götaland, Göteborg, Sweden
| | - Karin Berg
- Centre of Child Health Services, Regionhälsan, Region Västra Götaland, Borås, Sweden
| | | | - Helena Edin
- Centre of Child Health Services, Department of Children's Health, Academic Hospital, Region Uppsala, Uppsala, Sweden
| | - Leif Ekholm
- Centre of Child Health Services, Regional Office, Region Örebro län, Örebro, Sweden
| | - Lars Gelander
- Centre of Child Health Services, Regionhälsan, Region Västra Götaland, Borås, Sweden
- Department of Physiology/Endocrinology, Institute of Neuroscience & Physiology, University of Gothenburg Sahlgrenska Academy, Göteborg, Sweden
| | - Marie Golsäter
- Child Health Services, Futurum-Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
- CHILD-Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jennie Hedman
- Local Health Care, Centre of Child Health Services, Region Jämtland Härjedalen, Östersund, Sweden
| | - Anton Holmgren
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Göteborg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Region Halland, Halmstad, Sweden
| | - Frida Karlsson Videhult
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Competence Centre for Mother and Child Health Care, Regional Office, Region Västerbotten, Umeå, Sweden
| | - Anna Levin
- Department of Pediatrics, Institute of Clinical Sciences, Region Gotland, Visby, Sweden
| | - Sven Arne Silfverdal
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Competence Centre for Mother and Child Health Care, Regional Office, Region Västerbotten, Umeå, Sweden
| | - Thomas Wallby
- Department of Womens and Childrens Health, Uppsala Universitet, Uppsala, Sweden
| | - Anna Erica Fäldt
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
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Barboza M, Marttila A, Burström B, Kulane A. Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden. BMC Public Health 2022; 22:1091. [PMID: 35650586 PMCID: PMC9158140 DOI: 10.1186/s12889-022-13492-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood. METHODS Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme. RESULTS The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme. CONCLUSIONS The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities. TRIAL REGISTRATION The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 ).
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Affiliation(s)
- Madelene Barboza
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.
| | - Anneli Marttila
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 80176, Gävle, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Region Stockholm, Centre for Epidemiology and Community Medicine, Box 45436, 104 31, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
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Desenvolvimento infantil e visita domiciliar na primeira infância: mapa conceitual. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar03653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Francis-Oliviero F, Cambon L, Wittwer J, Marmot M, Alla F. [Theoretical and practical challenges of proportionate universalism: a reviewAnálise dos desafios teóricos e práticos de universalismo proporcional]. Rev Panam Salud Publica 2021; 45:e102. [PMID: 34703455 PMCID: PMC8529998 DOI: 10.26633/rpsp.2021.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. METHODS We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases. RESULTS This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. CONCLUSION This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.
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Affiliation(s)
| | - Linda Cambon
- University of BordeauxBordeauxFranciaUniversity of Bordeaux, Bordeaux, Francia.
| | - Jérôme Wittwer
- University of BordeauxBordeauxFranciaUniversity of Bordeaux, Bordeaux, Francia.
| | - Michael Marmot
- Institute of Health Equity at the University College LondonLondresReino UnidoInstitute of Health Equity at the University College London, Londres, Reino Unido.
| | - François Alla
- University of BordeauxBordeauxFranciaUniversity of Bordeaux, Bordeaux, Francia.
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Barboza M, Marttila A, Burström B, Kulane A. Covid-19 and pathways to health inequities for families in a socioeconomically disadvantaged area of Sweden - qualitative analysis of home visitors' observations. Int J Equity Health 2021; 20:215. [PMID: 34565387 PMCID: PMC8474881 DOI: 10.1186/s12939-021-01556-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Lack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic. Methods Semi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis. Results The analysis resulted in five pathways on two explanatory levels, affecting parents’ health and parenting capacity and children’s health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families’ access to resources and increases isolation for parents with already limited social support. Conclusions The diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity. Trial registration The study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097). Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01556-6.
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Affiliation(s)
- Madelene Barboza
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.
| | - Anneli Marttila
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Region Stockholm, Centre for Epidemiology and Community Medicine, Box 45436, 104 31, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
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Bohlin V, Nolbris MJ, Wigert H. Child health care nurses' experiences of language barriers during home visits. Public Health Nurs 2021; 39:146-152. [PMID: 34558103 DOI: 10.1111/phn.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of the study was to explore the communication tools that child healthcare nurses can use during home visits to families when language barriers exist. DESIGN Qualitative study using data collected from focus group sessions. SAMPLE Six semi-structured focus group interviews with twenty nurses in child healthcare services. MEASUREMENTS The results were analyzed with a thematic content analysis. RESULTS The analysis resulted in two themes: Using pictures as support in the conversation, with subthemes Not using pictures as support, Wanting to know how to use pictures as support, Pictures as support for invitations, Different types of pictures as support, and Alternative means of communication with the subthemes Possibilities of using an interpreter, Obstacles to using an interpreter, Mixed communication. CONCLUSION If language barriers are present during home visits, decision-making nurses in Child Health Care (CHC) put families in an unequal position when communicating with them. These results point to a need for more education, guidelines and support regarding alternative and augmentative communication (AAC) tools and structures to assist in overcoming language barriers.
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Affiliation(s)
- Veronica Bohlin
- Child Health Care unit, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Margaretha Jenholt Nolbris
- Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden and Department of Pediatrics The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bäckström C, Thorstensson S, Pihlblad J, Forsman AC, Larsson M. Parents' Experiences of Receiving Professional Support Through Extended Home Visits During Pregnancy and Early Childhood-A Phenomenographic Study. Front Public Health 2021; 9:578917. [PMID: 33692979 PMCID: PMC7937614 DOI: 10.3389/fpubh.2021.578917] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: While becoming a parent can be challenging for all, it can particularly be challenging for those parents and children who are in a vulnerable situation—e.g., in families whose members have problems related to health, relationships, or socioeconomic status. It is essential for health care professionals to identify the more vulnerable families at an early stage. Home visits are one cost-effective way of identifying and supporting such families. This study describes the parental experiences of an intervention that involves professional support in the form of extended home visits. The aim of the study is to describe the parents' understanding of their experiences of receiving professional support through extended home visits both during pregnancy and the first 15 months of their child's life. Methods/Design: A phenomenographic approach was used. Semi-structured interviews were conducted with 12 parents who had received the intervention. The interviews were analyzed using the seven-step phenomenography model described by Sjöström and Dahlgren. Results: The following three descriptive categories emerged from the analysis: (1) conceptions concerning the meaning of the physical environment, (2) conceptions concerning extended home visits promoting feelings of self-confidence in the parental role, and (3) conceptions concerning extended home visits promoting parental participation and relations. Conclusion and Clinical Implications: Extended home visits as a form of professional support appear to promote parental self-confidence in parenting ability, giving parents a feeling of security that facilitates conversation with professionals. Children and their entire families had natural roles during home visits, which allowed the children to behave more characteristically. Furthermore, the home visits were understood to facilitate social support through social activities at the child health center as well as integration into Swedish society for migrant parents. Professional support should be adjusted to the unique individual needs of parents, which demands a variety of supportive interventions—for example, reorganizing one or two of the regular clinical visits currently being scheduled as home visits instead.
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Francis-Oliviero F, Cambon L, Wittwer J, Marmot M, Alla F. Theoretical and practical challenges of proportionate universalism: a review. Rev Panam Salud Publica 2020; 44:e110. [PMID: 33088291 PMCID: PMC7556407 DOI: 10.26633/rpsp.2020.110] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/23/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it.The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. METHODS We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases. RESULTS This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. CONCLUSION This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.
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Affiliation(s)
| | - Linda Cambon
- University of BordeauxBordeauxFranceUniversity of Bordeaux, Bordeaux, France
| | - Jérôme Wittwer
- University of BordeauxBordeauxFranceUniversity of Bordeaux, Bordeaux, France
| | - Michael Marmot
- Institute of Health Equity at the University College LondonLondonUnited KingdomInstitute of Health Equity at the University College London, London, United Kingdom
| | - François Alla
- University of BordeauxBordeauxFranceUniversity of Bordeaux, Bordeaux, France
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13
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Burström B, Mellblom J, Marttila A, Kulane A, Martin H, Lindberg L, Burström K. Healthcare utilisation and measles, mumps and rubella vaccination rates among children with an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden-A 3-year follow-up. Acta Paediatr 2020; 109:1847-1853. [PMID: 31957046 DOI: 10.1111/apa.15176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/18/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
Abstract
AIM To follow up healthcare utilisation and measles, mumps and rubella (MMR) vaccination rates among children 0-36 months, receiving an extended postnatal home visiting programme in a disadvantaged area with poorer child health, and in control groups, in Stockholm, Sweden. METHODS We analysed electronic child health records regarding outpatient visits, inpatient episodes and MMR vaccination for children 0-36 months receiving the home visiting programme (Intervention Group) and in control groups (Control Group and Rinkeby Comparison Group). RESULTS Children in the Intervention Group had significantly higher MMR vaccination rate than children in the Rinkeby Comparison Group. Healthcare utilisation was similar in the Intervention Group and the control groups. In stratified analyses by number of home visits received, children receiving the recommended six home visits had significantly fewer inpatient episodes and somewhat fewer emergency visits than those receiving fewer home visits. CONCLUSION The extended home visiting programme had a positive impact on the MMR vaccination rate. Children receiving the recommended six home visits had lower use of inpatient care. In addition to being positively perceived by parents in an area with greater healthcare needs, the programme may have a positive impact on their children's healthcare utilisation.
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Affiliation(s)
- Bo Burström
- Department of Public Health Sciences Equity and Health Policy Research Group Karolinska Institutet Stockholm Sweden
- Centre for Epidemiology and Community Medicine Stockholm County Council Health Services Stockholm Sweden
| | - Johanna Mellblom
- Rinkeby Child Health Care Centre Stockholm County Council Health Services Stockholm Sweden
| | - Anneli Marttila
- Department of Public Health Sciences Equity and Health Policy Research Group Karolinska Institutet Stockholm Sweden
| | - Asli Kulane
- Department of Public Health Sciences Equity and Health Policy Research Group Karolinska Institutet Stockholm Sweden
| | - Helena Martin
- Stockholm County Council Child Health Services Stockholm Sweden
| | - Lene Lindberg
- Centre for Epidemiology and Community Medicine Stockholm County Council Health Services Stockholm Sweden
- Department of Public Health Sciences Prevention, Intervention and Mechanisms in Public Health Research Group Karolinska Institutet Stockholm Sweden
| | - Kristina Burström
- Department of Public Health Sciences Equity and Health Policy Research Group Karolinska Institutet Stockholm Sweden
- Department of Learning, Informatics, Medical Management and Ethics Stockholm Centre for Healthcare Ethics Health Outcomes and Economic Evaluation Research Group Karolinska Institutet Stockholm Sweden
- Centre for Health Economics, Informatics and Healthcare Research Stockholm County Council Health Services Stockholm Sweden
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14
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Larsson M, Eriksson I, Johansson K, Stigsson AK, Svahn R, Wetterström J, Wilhsson M. Individual parental conversations with non-birthing parents. Prim Health Care Res Dev 2020; 21:e25. [PMID: 32727632 PMCID: PMC7443773 DOI: 10.1017/s1463423620000286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/11/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022] Open
Abstract
AIM The aim of this study was to describe Child Health Service (CHS) nurses' experiences with conducting individual parental conversations (IPCs) with non-birthing parents. BACKGROUND CHS nurses in Sweden mainly focus on monitoring a child's physical and mental development and the mothers' health in order to support their parenthood. The assignment of the CHS includes identifying dysfunctional social relationships in a family and strengthening responsive parenting. An imbalance arises within the family when someone in the family suffers from illness, which could have a negative effect on the whole family's health and well-being. METHODS An inductive, descriptive qualitative study design was used to describe and to gain an understanding of the CHS nurses' experiences. Data were collected in 13 interviews, and a qualitative content analysis was performed. FINDINGS The analysis of interviews with CHS nurses resulted in two main categories, each with three subcategories. The main categories are: working for equality and applying a family focus, and dealing with challenges in the developing assignment. The IPCs stimulate the CHS nurses to work for more equality and to apply a family focus, which can be a way of strengthening the families' health and the children's upbringing. Developing the CHS nurses' assignment can be a challenge that appears to entail positive outcomes for CHS nurses, while also generating the need for CHS nurses to receive supervision to find ways to improve their approach and practice.
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Affiliation(s)
| | - Irene Eriksson
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | | | | | | | | | - Marie Wilhsson
- School of Health Sciences, University of Skövde, Skövde, Sweden
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15
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Walker SB, Rossi DM, Sander TM. Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature. Midwifery 2019; 79:102552. [PMID: 31605940 DOI: 10.1016/j.midw.2019.102552] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process. DESIGN The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process. SETTING AND PARTICIPANTS Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles. MEASUREMENTS AND FINDINGS Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support. KEY CONCLUSIONS The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period. IMPLICATIONS FOR PRACTICE Strategies are needed ensure women have access to midwives in the early postnatal period.
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Affiliation(s)
- Sandra B Walker
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton, Queensland 4702, Australia.
| | - Dolene M Rossi
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton, Queensland 4702, Australia.
| | - Teresa M Sander
- Maternity Unit Rockhampton Hospital, Canning Street, Rockhampton, Queensland 4700, Australia
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16
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Tiitinen Mekhail K, Lindberg L, Burström B, Marttila A. Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: fathers striving for stability. BMC Public Health 2019; 19:102. [PMID: 30670034 PMCID: PMC6343238 DOI: 10.1186/s12889-019-6440-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To improve prerequisites for better health development among children growing up in multicultural suburbs in Stockholm County, where poorer health is displayed in several aspects including child health, early support was initiated for first-time parents in one of the suburbs. An extended postnatal home visiting program during the child's first 15 months was offered to families with first-time mothers during 2013-2014 and consisted of six home visits by a child health care nurse and a parental advisor from social services. Almost all invited families (94%) participated in the program and the program evaluation. Fathers' participation in two or more home visits within the program was 53%. The aim of this study was to explore the experiences of fathers participating in the program, with respect to their role as a first-time parent from a resilience perspective. METHODS In-depth interviews were conducted with nine fathers. Constructivist grounded theory (GT) was applied in the analysis. RESULTS The fathers' experiences formed the core category of the study, 'striving for stability in living conditions', as well as three categories: 'everyday life conditions', 'adjustment to fatherhood in Sweden' and 'channels of support'. The fathers perceived that the home visiting program strengthened their parental confidence and increased their knowledge of societal services and local resources for their family. CONCLUSIONS In terms of resilience, the extended postnatal home visiting program benefitted the interviewed migrant fathers on an individual level by meeting part of their need for support regarding knowledge and parental confidence; on a structural level the program helped fathers gain information about available societal services and resources in their local area. TRIAL REGISTRATION The study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097 DOI: https://doi.org/10.1186/ISRCTN11832097 ).
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Affiliation(s)
- Kirsi Tiitinen Mekhail
- Department of Public Health Sciences (PHS) K9, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lene Lindberg
- Department of Public Health Sciences (PHS) K9, Karolinska Institutet, 171 77 Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Bo Burström
- Department of Public Health Sciences (PHS) K9, Karolinska Institutet, 171 77 Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anneli Marttila
- Department of Public Health Sciences (PHS) K9, Karolinska Institutet, 171 77 Stockholm, Sweden
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Rifai E, Janlöv AC, Garmy P. Public health nurses' experiences of using interpreters when meeting with Arabic-speaking first-time mothers. Public Health Nurs 2018; 35:574-580. [PMID: 30225947 DOI: 10.1111/phn.12539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/29/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to investigate public health nurses' experiences of using interpreters when meeting with Arabic-speaking first-time mothers. DESIGN AND SAMPLE An inductive qualitative design was used. Individual interviews were conducted with Swedish public health nurses (n = 11) with experience of working in child health care with interpreters when meeting with Arabic-speaking first-time mothers. MEASURES Data were analyzed using qualitative content analysis. RESULTS The analysis of the interviews resulted in one overarching theme: Having to accept and learn to incorporate interpreters when meeting with Arabic-speaking first-time mothers. Three subthemes were identified: (a) enabling an understanding of the situation of the mothers; (b) contributing to a trustful relationship; and (c) creating disturbing elements in the dialogue. CONCLUSIONS Using interpreters optimized the conversation between the public health nurse and the Arab-speaking first-time mother; however, the complexity of using interpreters was also apparent.
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Affiliation(s)
- Elissa Rifai
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | | | - Pernilla Garmy
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Science, Clinical Health Promotion Center, Lund University, Lund, Sweden
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