1
|
Franck LS, Johnson I, Mehra R, Remy L, Rienks J. A Qualitative Analysis of Low-Income Pregnant and Parenting Caregivers' Experiences With Home Visiting in California During the First 2 Years of the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:158-167. [PMID: 37646559 PMCID: PMC10833179 DOI: 10.1097/phh.0000000000001820] [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] [Indexed: 09/01/2023]
Abstract
CONTEXT In-person home visiting programs that provide evidence-based parenting and child development support improve outcomes for low-income children and families. The COVID-19 pandemic led to a shift from primarily in-person to virtual home visiting services, and little is known about clients' experience of home visiting in this context. OBJECTIVE To describe the experience of clients in the California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program (HVP) across California during the first 2 years of the pandemic. DESIGN Three repeated cross-sectional surveys over a 2-year period. Clients' free-text responses to open-ended questions were analyzed using a directed content analysis approach. SETTING Forty-one counties in California. PARTICIPANTS Current CalWORKs HVP clients and those who left the program in the 6 months prior to each survey. MAIN OUTCOME MEASURES Clients' experience of the CalWORKs HVP. RESULTS Five main themes emerged: (1) benefits received from the program; (2) life challenges; (3) COVID-19-related or other program changes; (4) client dissatisfaction and suggestions for improvement; and (5) appreciation for the program. Clients valued the practical, financial, parenting, and interpersonal support provided to themselves and their children. Almost three-quarters commented on life challenges experienced during the program. Significant programmatic changes related to COVID-19 pandemic public health safety and organizational constraints impacted clients both positively and negatively. Very few clients experienced overt dissatisfaction with the program. Many clients expressed appreciation for the program, particularly the individualized and relational support offered by a consistent home visitor. CONCLUSIONS The findings provide insights into the benefits and challenges experienced by clients receiving evidence-based home visiting services. The findings highlight the ongoing life challenges faced by clients who experience poverty, and how those challenges were exacerbated by a global pandemic. The CalWORKs HVP may buffer the substantial personal stresses clients experience related to parenting in the context of poverty and major public health challenges.
Collapse
Affiliation(s)
- Linda S. Franck
- Departments of Family Health Care Nursing, School of Nursing (Drs Franck and Mehra and Ms Johnson) and Family and Community Medicine (Drs Remy and Rienks), University of California San Francisco, San Francisco, California
| | - Isabella Johnson
- Departments of Family Health Care Nursing, School of Nursing (Drs Franck and Mehra and Ms Johnson) and Family and Community Medicine (Drs Remy and Rienks), University of California San Francisco, San Francisco, California
| | - Renee Mehra
- Departments of Family Health Care Nursing, School of Nursing (Drs Franck and Mehra and Ms Johnson) and Family and Community Medicine (Drs Remy and Rienks), University of California San Francisco, San Francisco, California
| | - Linda Remy
- Departments of Family Health Care Nursing, School of Nursing (Drs Franck and Mehra and Ms Johnson) and Family and Community Medicine (Drs Remy and Rienks), University of California San Francisco, San Francisco, California
| | - Jennifer Rienks
- Departments of Family Health Care Nursing, School of Nursing (Drs Franck and Mehra and Ms Johnson) and Family and Community Medicine (Drs Remy and Rienks), University of California San Francisco, San Francisco, California
| |
Collapse
|
2
|
Sæther KM, Holmberg Fagerlund B, Glavin K, Jøranson N. First-Time Parents' Support Needs and Perceived Support From a Child Health Service With the Integrated New Families Home Visiting Programme. QUALITATIVE HEALTH RESEARCH 2024; 34:20-32. [PMID: 37923302 PMCID: PMC10714706 DOI: 10.1177/10497323231208972] [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] [Indexed: 11/07/2023]
Abstract
The transition to parenthood is complex and influenced by interacting factors related to society, the parents and the child. Professional support is considered to be one of the societal factors affecting this transition by facilitating parents' sense of confidence and their competence as parents. In this study, we aimed to explore first-time parents' support needs and experiences of support from a child health service with the integrated New Families home visiting programme, in the context of their transition to parenthood in the first year postnatally. Interpretive description guided this qualitative study. Six couples and one mother, all well-educated and employed, were interviewed individually (N = 13). The parents were recruited from the research project 'New Families - Innovation and Development of the Child Health Service in Oslo'. We found that being a first-time parent is perceived as overwhelming and that defining support needs may be challenging, particularly in the first period postnatally. In addition, the support needs are constantly changing due to the complexity of interacting factors and the ongoing development of confidence in the parental role. Retrospectively, the parents were satisfied overall with the support from the child health service. The home visit during pregnancy facilitated management and relational and informational continuity. However, we identified a need for even more proactive information provision and communication to optimise the service's availability and efficiency postnatally. In addition, the importance of peers and of approaching both mothers and fathers must be acknowledged in facilitating parental confidence.
Collapse
Affiliation(s)
| | | | - Kari Glavin
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| |
Collapse
|
3
|
Brekke M, Småstuen MC, Glavin K, Amro A, Solberg B, Øygarden AMU, Sæther KM, Haugland T. The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled study. BMC Public Health 2023; 23:2457. [PMID: 38066502 PMCID: PMC10704737 DOI: 10.1186/s12889-023-17285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers' QoL and to investigate the association between their QoL, social support, and selected possible predictive factors. METHODS A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations. RESULTS Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain. CONCLUSIONS Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers' QoL and could be provided and facilitated by public health nurses. TRIAL REGISTRATION clinicaltrial.gov NCT04162626.
Collapse
Affiliation(s)
- Malene Brekke
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway.
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway.
| | - Milada Cvancarova Småstuen
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
- Oslo Metropolitan University, Oslo, Norway
| | - Kari Glavin
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| | - Amin Amro
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| | - Beate Solberg
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
| | | | - Kristin Marie Sæther
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| | - Trude Haugland
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Schwind B, Zemp E, Jafflin K, Späth A, Barth M, Maigetter K, Merten S, Kurth E. "But at home, with the midwife, you are a person": experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations. BMC Health Serv Res 2023; 23:375. [PMID: 37076842 PMCID: PMC10114462 DOI: 10.1186/s12913-023-09352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Postpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund. AIM The aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact. METHODS Findings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis. RESULTS Interviewed women experienced the early postpartum care at home, as "relieving and strengthening" in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude. CONCLUSION The findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.
Collapse
Affiliation(s)
- Bettina Schwind
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Späth
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Monika Barth
- Midwifery Network, Familystart beider Basel, Basel, Switzerland
| | - Karen Maigetter
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elisabeth Kurth
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Midwifery Network, Familystart beider Basel, Basel, Switzerland
| |
Collapse
|
6
|
In the need of a digital cicerone in healthcare? - Guidance for parents. BMC Pregnancy Childbirth 2022; 22:863. [PMID: 36419024 PMCID: PMC9685150 DOI: 10.1186/s12884-022-05120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore parents' experiences using digital tools in relation to pregnancy, labor and birth, and the child's first 18 months. BACKGROUND Parents find relevant information using digital healthcare tools, material obtained from professionals, as well as personal opinions and experiences that vary in quality. METHOD Fifteen parents were interviewed and data were analyzed beginning with content analysis and followed by thematic analysis. RESULTS The main theme was insecurity and responsibility for own choices and knowledge. Parents use digital tools to take responsibility for their insecurity and need for knowledge when entering parenthood. CONCLUSION The parents' experiences highlighted that (1) insecurity can be both eased and enhanced using digital tools, (2) they took responsibility for feelings of insecurity and the search for knowledge, and (3) they needed knowledge to make the right choices and feel secure that these choices are made in the best interest of their new family.
Collapse
|
7
|
Iwanowicz-Palus G, Mróz M, Korda A, Marcewicz A, Palus A. Perinatal Anxiety among Women during the COVID-19 Pandemic-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052603. [PMID: 35270296 PMCID: PMC8909536 DOI: 10.3390/ijerph19052603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has changed the way prenatal education and obstetric care are provided. Pandemic-related anxiety, restrictions, limitations in perinatal care, and the inability to be accompanied by a loved one can have negative psychological consequences for future parents and their child. The aim of this study was to analyze the determinants and assess the anxiety of pregnant women in individual trimesters, as well as to learn about the sources of support and medical personnel proceeding methods. MATERIALS AND METHODS This research was conducted as a diagnostic survey, using the State-Trait Anxiety Inventory (STAI), Childbirth Anxiety Questionnaire (CAQ), and a standardized interview questionnaire, on 534 pregnant women in Poland. Resultsand Conclusions: The pregnant women, regardless of the trimester of pregnancy, are characterized by: increased anxiety level influenced by the current epidemiological situation, psychophysical condition, previous maternal experiences, participation in classes preparing for childbirth, organization of perinatal care, their relationship with a partner, and the presence of a loved one during childbirth. A negative correlation was shown between the level of childbirth anxiety and maternal experience, as well as the support of a doctor and midwife.
Collapse
Affiliation(s)
- Grażyna Iwanowicz-Palus
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica Str., 20-081 Lublin, Poland; (G.I.-P.); (A.M.)
| | - Mariola Mróz
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica Str., 20-081 Lublin, Poland; (G.I.-P.); (A.M.)
- Correspondence: ; Tel.: +48-81-448-6840
| | - Aleksandra Korda
- Students’ Scientific Circle at the Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Agnieszka Marcewicz
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica Str., 20-081 Lublin, Poland; (G.I.-P.); (A.M.)
| | - Agnieszka Palus
- Medical Doctor in Medical Center in NowyDwór Mazowiecki, Faculty of Medicine, Warsaw Medical University, 02-091 Warsaw, Poland;
| |
Collapse
|
8
|
Ekström‐Bergström A, Thorstensson S, Bäckström C. The concept, importance and values of support during childbearing and breastfeeding - A discourse paper. Nurs Open 2022; 9:156-167. [PMID: 34741500 PMCID: PMC8685869 DOI: 10.1002/nop2.1108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing. AIM The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites. DESIGN Discourse paper. METHODS This discourse paper is based on our own experiences and is supported by literature and theory. RESULTS Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.
Collapse
Affiliation(s)
- Anette Ekström‐Bergström
- Department of Health SciencesUniversity WestTrollhättanSweden
- Research Group Family Centered Health (FamCeH)University of SkövdeSkövdeSweden
- School of Health SciencesUniversity of SkövdeSkövdeSweden
| | - Stina Thorstensson
- Research Group Family Centered Health (FamCeH)University of SkövdeSkövdeSweden
- School of Health SciencesUniversity of SkövdeSkövdeSweden
| | - Caroline Bäckström
- Research Group Family Centered Health (FamCeH)University of SkövdeSkövdeSweden
- School of Health SciencesUniversity of SkövdeSkövdeSweden
| |
Collapse
|
9
|
Caroline B, Sandi C, Shazima T, Viveca L. Parents' Perceptions About Future Digital Parental Support-A Phenomenographic Interview Study. Front Digit Health 2021; 3:729697. [PMID: 34778868 PMCID: PMC8578718 DOI: 10.3389/fdgth.2021.729697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Parents use digital sources (such as the internet or online forums and applications) during pregnancy and after childbirth to receive informative support. Research shows that there is further need for innovation development in digital parental support despite informative support available in digital form. Purpose: To explore parents' perceptions of future digital parental support concerning pregnancy and the first 18 months of parenthood. Method: A phenomenographic interview study with an inductive approach including 15 semi-structured interviews was conducted. Results: The analysis process resulted in three descriptive categories: Opportunities for virtual and in-person meetings, Individualized digital parental support, and Professional knowledge and trustworthiness concerning future digital parental support. Conclusion: The results broaden the knowledge about how future digital parental support can be designed to facilitate the functional, interactive, and critical digital health literacy of new and would-be parents. To succeed, healthcare organizations should allow healthcare professionals to assume an active role in developing digital parental support, both as health educators (i.e., providing parents with knowledge) and facilitators (i.e., facilitating parents' use of digital parental support). However, parents perceived that future digital parental support should complement standard care instead of replacing in-person meetings with healthcare professionals.
Collapse
Affiliation(s)
- Bäckström Caroline
- School of Health Sciences, University of Skövde, Skövde, Sweden.,Research Group Family Centered Health (FamCeH), University of Skövde, Skövde, Sweden
| | - Chamoun Sandi
- Region Jönköping County, Högland Hospital of Eksjö, Maternity Ward, Eksjö, Sweden
| | | | - Larsson Viveca
- School of Health Sciences, University of Skövde, Skövde, Sweden.,Research Group Family Centered Health (FamCeH), University of Skövde, Skövde, Sweden
| |
Collapse
|