Screening tools used in primary health care settings to identify health behaviours in children (birth-16 years); A systematic review of their effectiveness, feasibility and acceptability

BACKGROUND

Child health behaviour screening tools have potential to enhance the effectiveness of health promotion and early intervention. This systematic review aimed to examine the effectiveness, acceptability and feasibility of child health behaviour screening tools used in primary health care settings.

METHODS

A systematic review of studies published in English in five databases (CINAHL, Medline, Scopus, PsycINFO and Web of Science) prior to July 2022 was undertaken. Eligible studies described: 1) screening tools for health behaviours (dietary, physical activity, sedentary or sleep-related behaviours) used in primary health care settings in children birth to 16 years; 2) tool effectiveness for identifying child health behaviours and changing practitioner behaviour; 3) tool acceptability or feasibility from child, caregiver or practitioner perspective and/or 4) implementation of the screening tool.

RESULTS

Of the 7145 papers identified, 22 studies describing 14 screening tools were included. Only four screening tools measured all four behaviour domains. Fourteen studies reported changes in practitioner self-reported behaviour, knowledge and practice. Practitioners and caregivers identified numerous benefits and challenges to screening.

CONCLUSIONS

Health behaviour screening can be an acceptable and feasible strategy to assess children's health behaviours in primary health care. Further evaluation is needed to determine effectiveness on child health outcomes.

Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app

Despite the well-known benefits of breastfeeding, breastfeeding rates remain suboptimal, particularly for women with lower socioeconomic position. Although popular, breastfeeding apps are often poor quality; their impact on breastfeeding knowledge, attitudes, confidence and intentions is unknown. A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education. The My Baby Now app was offered to pregnant women 20-30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36-38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8-12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1-T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1-T2 and T1-T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1-T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions. Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.

Primary healthcare professionals' role in monitoring infant growth: A scoping review

Excessive weight gain in infancy is an established risk for childhood obesity. Primary healthcare professionals have regular contact with infants and are well placed to monitor their growth. This review explores primary healthcare professionals' practice in monitoring growth for infants from birth to 2 years, addressing assessment methods, practitioner confidence and interventions for unhealthy weight gain. Reviewers searched four databases for studies of primary healthcare professionals working in high-income countries that reported on practice monitoring infant growth. Thirty-six eligible studies documented health professionals' practice with infants. While most clinicians regularly weighed and measured infants, some did not record measurements comprehensively. Growth monitoring occurred regularly during well-child visits but was less common during unscheduled visits. Some participants were less proficient at interpreting growth trajectories or lacked confidence in detecting excessive weight gain and in communicating concerns to parents. Few interventions addressed unhealthy growth among infants. Primary healthcare professionals require support to monitor growth trajectories effectively, to communicate appropriately with parents and to engage them in developing healthy behaviours early. Strategies are also required to monitor infants not regularly attending primary health care.

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study

BACKGROUND

Little is known about the pathways linking parent feeding practices with appetitive traits and BMIz throughout infancy. This study examined bidirectional associations between parental feeding practices, infant appetitive traits, and infant BMIz.

METHODS

Parents (n = 380) of infants aged less than 6 months at baseline reported their feeding practices (using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers), infant appetitive traits (using the Baby Eating Behaviour Questionnaire) and infant BMIz (parent-reported) at three timepoints (< 6 months, ~ 9 months, ~ 12 months) up to 12 months of age. Cross-lagged models examined bidirectional associations between parent feeding practices, infant appetitive traits and infant BMIz.

RESULTS

There was strong continuity across the three timepoints for maternal feeding practices, infant appetitive traits, and infant BMIz. Infant food avoidance was prospectively associated with higher parental persuasive feeding. Infant BMIz was prospectively associated with higher parent-led feeding. Parent use of food to calm was prospectively associated with lower infant BMIz, and infant BMIz was prospectively associated with higher infant food approach. Feeding on demand was prospectively associated with lower infant food approach.

CONCLUSION

This study highlights the complex associations between parental feeding practices, infant appetitive traits and infant BMIz. The study demonstrated that both child and parent effects are important, suggesting a need for tailored programs beginning in infancy to promote and support infant appetitive traits and parent feeding practices that support healthy development.

COVID-19, lifestyle behaviors and mental health: A mixed methods study of women 6 months following a hypertensive pregnancy

Introduction

The COVID-19 pandemic introduced unprecedented challenges to both the physical and psychological health of postpartum women. The aim of this study was to determine how the COVID-19 pandemic affected the diet, physical activity and mental health of women 6 months following a hypertensive disorder of pregnancy.

Methods

Mixed methods sub-study of the Blood Pressure Postpartum trial, which recruited women following a hypertensive disorder of pregnancy from six Sydney metropolitan hospitals. Cross sectional analysis of baseline quantitative data, collected at 6-months postpartum from March 2019-February 2022, and qualitative data analysis from semi-structured telephone interviews, was performed. Dates of COVID-19 lockdowns for Sydney, Australia were collected from government websites. Diet (vegetable, fruit, alcohol, take away intake) and physical activity (walking, vigorous activity, strength training frequency and duration) were assessed using the self-report NSW Population Health Survey. Depression and anxiety were assessed using the Edinburgh Depression Scale and GAD-7 scale, respectively. Outcome data were compared between women who completed surveys "In Lockdown" vs. "Not in Lockdown" as well as "Prior to any Lockdown" vs. "During or Following any Lockdown".

Results

Of 506 participants, 84 women completed the study surveys "In Lockdown," and 149 completed the surveys "Prior to any Lockdown." Thirty-four participants were interviewed. There were no statistically significant differences in diet, physical activity, depression and anxiety among women who completed the survey "In Lockdown" vs. "Not in Lockdown." "Prior to any Lockdown," participants were more likely to do any walking (95% vs. 89%, p = 0.017), any vigorous activity (43% vs. 30%, p = 0.006) or any strength training (44% vs. 33%, p = 0.024), spent more time doing vigorous activity (p = 0.003) and strength training (p = 0.047) and were more likely to drink alcohol at least monthly (54% vs. 38%, p < 0.001) compared with "During or Following any Lockdown."

Conclusions

Our findings suggest that the confinements of lockdown did not markedly influence the mental health, diet and physical activity behaviors of women 6 months following hypertensive pregnancy. However, physical activity levels were reduced following the emergence of COVID-19, suggesting targeted efforts may be necessary to re-engage postpartum women with exercise.

Trial registration

https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376286&isReview=true, identifier: ACTRN12618002004246.

P-263 Clinical factors influencing the incidence of tripronuclear zygotes in IVF

Study question

Is the incidence of tripronuclear zygotes (3PN) in IVF cycles influenced by clinical, patient and treatment parameters?

Summary answer

Tripronuclear zygotes incidence in IVF cycles was influenced by Antral Follicle Count, number of oocytes retrieved, sperm progressive motility, and the use of fresh semen.

What is known already

Tripronuclear zygotes are indicative of abnormal fertilisation and are not routinely considered suitable for transfer. It is therefore important to optimise their detection and minimise their occurrence. Tripronuclear zygotes can originate as a result of the combination of one maternal and two paternal sets of chromosomes (fertilisation of a haploid oocyte by two haploid spermatozoa or by one diploid spermatozoon) or the combination of one paternal and two maternal sets of chromosomes (fertilisation of a diploid oocyte by one haploid spermatozoon) (1).

Study design, size, duration

This is a retrospective study of 550 IVF cycles performed between April 2018- April 2021, in a single UK clinic. IVF cycles either within (group 1) or exceeding (group 2) the key performance indicator (KPI) for the incidence of 3PN (&lt;6%) (2), were assessed for associations with quantitative cycle variables. Proportion of 3PN per cycle was assessed for associations with qualitative variables. Cycles using donor oocytes (n = 73) were excluded for analyses assessing patient (maternal) parameters.

Participants/materials, setting, methods

Continuous variables including age, body mass index, Antral Follicle Count (AFC), anti-Mullerian hormone (AMH), oocytes recovered, timing from sperm production to insemination or oocyte recovery to insemination, sperm concentration, progressive motility and morphology were analysed by Mann-Whitney U Test. Qualitative variables including patient ethnicity, own/donor oocyte source, fresh/frozen sperm, stimulation regimen and oocyte recovery needle were analysed by logistic regression assuming binomial errors. Significance was assumed at p &lt; 0.05.

Main results and the role of chance

There was no difference between groups where 3PN incidence exceeded or fell within the KPI when procedure timings and clinical parameters were assessed. There was also no relationship between patient characteristics (age, body mass index, AMH levels, ethnicity, oocyte source (own/donor)), semen concentration or semen morphology and the proportion of 3PN per cycle. However, number of oocytes retrieved in group 2 was significantly higher than group 1 (group 1, n cycles = 307, median oocytes retrieved = 8; group 2, n cycles = 170, median oocytes retrieved = 12 [95% CI -4, -1]) (p &lt; 0.001). Similarly, AFC was significantly increased in group 2 (group 1, n cycles = 254, median AFC = 11; group 2, cycles n = 150, median AFC = 13 [95% CI -4, -1]) (p = 0.009). Likewise, the mean sperm motility parameters were higher for cycles exceeding the 6% 3PN KPI, with 64.6 ± 0.91% vs 68.8 ± 1.11% total motility (p = 0.004), and 57.1 ± 0.97% vs 61.7 ± 1.2% progressive motility (p = 0.003) for group 1 and 2 respectively. Proportion of 3PN per cycle was also significantly higher with fresh semen compared to frozen (6.6 ± 0.39% vs 4.7 ± 0.51%) (p = 0.006).

Limitations, reasons for caution

This is a retrospective study of a single UK clinic. Further analysis, expanding sample size, are required to confirm these findings.

Wider implications of the findings

Our finding that number of oocytes recovered influences 3PN incidence is in agreement with previous studies (3, 4). Fresh and high progressively motile sperm may be more capable of zona pellucida penetration leading to polyspermy and 3PN. Adjustment of sperm concentration at insemination could be considered in higher risk circumstances.

Trial registration number

na

Optimising mothers' health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention

Background

Hypertensive disorders of pregnancy have longer-term implications, increasing women’s lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy eating and physical activity during the first postpartum year. This qualitative sub-study nested within the main trial aimed to investigate whether and how women adopted healthy behaviours after a pregnancy complicated by a hypertensive disorder.

Methods

Semi-structured telephone interviews were recorded, transcribed and analysed thematically, following Braun and Clarke principles. They explored behaviour change among new mothers following their hypertensive pregnancy, and the intervention’s effect on their capacity and motivation to pursue healthy lifestyles.

Results

Thirty-four women from all three trial arms participated at 10–12 months postpartum. The three main themes were 1) Awareness of cardiovascular risk: some did not acknowledge the health risks, whereas others embraced this information. 2) Sources of motivation: while the majority were motivated to make a concerted effort to adapt their health behaviour, motivation often centred on their baby and family rather than their own needs. 3) Sustaining behaviour change with a new baby: women in the more intensive intervention arm demonstrated increased recognition of the importance of reducing cardiovascular health risks, with greater motivation and guidance to change their health behaviour. There was minimal evidence of crossover amongst groups, with women largely accepting their randomised level of intervention and not seeking additional help when randomised to minimal intervention.

Conclusions

Among women participating in an early post-hypertensive disorders of pregnancy randomised controlled trial aimed at improving their cardiovascular disease risk profile, the majority recognised the future health risks and appeared motivated to improve their lifestyle, particularly women in the highest-intensity intervention group. This highlights the importance of structured support to assist women embrace healthy lifestyles especially during the challenges of new parenthood.

Trial registration

The Blood Pressure Postpartum study was prospectively registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (anzctr.org.au) on 13 December 2018 (registration number: ACTRN12618002004246).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13590-2.

Comprehensiveness of infant formula and bottle feeding resources: A review of information from Australian healthcare organisations

The use of infant formula is widespread internationally. In Australia, 55% of infants receive formula before 6 months of age, with higher rates among disadvantaged communities. Infant formula use can contribute to childhood overweight and obesity, through formula composition and feeding behaviours, such as adding cereal to bottles and parental feeding style. While information abounds to promote and support breastfeeding, formula‐feeding parents report a paucity of advice and support; many rely on formula packaging for information. This study systematically searched and reviewed online resources for infant formula and bottle feeding from Australian governments, health services, hospitals, and not‐for‐profit parenting organisations. A comprehensive search strategy located 74 current resources, mostly for parents. Researchers evaluated the resources against best practice criteria derived from Australian government and UNICEF guidelines on six topics. They assessed how comprehensively the resources addressed each topic and whether the resources provided all the information necessary for parents to understand each topic. The mean ‘comprehensiveness’ rating for topics across all resources was 54.36%. However, some topics were addressed more fully than others. Information on ‘discussing infant formula with health workers’ and on ‘preparing infant formula’ was more frequently accurate and comprehensive. However, there was much less comprehensive information on ‘using infant formula’, including amounts of formula to feed, use of bottle teats, appropriate bottle‐feeding practice and responsiveness to infant satiety cues. Over half the resources were written at an acceptable reading level.

Insufficient formula‐feeding support from health services can lead to parents relying on formula packaging or other commercial information.

Most formula‐feeding resources from Australian healthcare organisations focus on preparing infant formula and using infant formula. However, comprehensiveness of information varies—on average, information on preparing infant formula was more comprehensive than that on using infant formula.

Many resources do not address responsive bottle‐feeding practices, which impacts risk of infant overweight and obesity.

The Australian government infant feeding guidelines should be revised to include more comprehensive best‐practice formula‐feeding recommendations; subsequently, this should be reflected in formula‐feeding information from health organisations.

Maternal incarceration: Impact on parent-child relationships

Female incarceration is rising steeply in Australia and other high-income countries. The majority of incarcerated women are mothers. Their children represent a particularly vulnerable group, often subject to adverse experiences due to their family's disadvantaged circumstances involving inadequate housing, food insecurity, poverty, poor health, a lack of personal safety due to violence and resulting trauma. This qualitative study explores parenting experiences of incarcerated mothers separated from their children. Interviews involved 65 mothers in three Australian prisons and 19 stakeholders providing correctional services and support for incarcerated women. Data were analysed using interpretive description. Mothers' accounts highlighted frustrations resulting from trying to maintain relationships with their children, often exacerbating their separation and compounding parenting difficulties. Two major themes emerged from the data: 'protecting their children' and 'at the mercy of the system'. Mothers described how they tried to protect their children from the consequences of their incarceration, yet many of the correctional system processes and procedures made it even harder to maintain connection. Incarcerated mothers need support in their parenting role. Ideally, this support should commence during incarceration. Further, changes within prison routines could enhance mothers' efforts to keep in contact with their children, through visits and phone calls.

Infant Appetitive Phenotypes: A Group-Based Multi-Trajectory Analysis

Background: Examining appetitive traits with person-centered analytical approaches can advance the understanding of appetitive phenotype trajectories across infancy, their origins, and influences upon them. The objective of the present study was to empirically describe appetitive phenotype trajectories in infancy and examine the associations with infant and parent factors.

Materials and Methods: In this longitudinal cohort study of Australian infants, parents completed three online surveys ~3 months apart, beginning when the infant was <6 months. Appetitive traits were assessed with the Baby Eating Behavior Questionnaire (BEBQ) and parent feeding practices with the Feeding Practices and Structure Questionnaire (FPSQ) infant and toddler version. Parent demographics and cognitions were also collected. Infant weight and length were transcribed from health records and converted to a BMI z-score. Group-based trajectory modeling identified appetitive phenotype trajectories using the BEBQ. Multilevel modeling examined change in feeding practices and child BMI z-score over time by appetitive phenotype trajectories.

Results: At time 1, 380 participants completed the survey (mean infant age 98 days), 178 at time 2 (mean infant age 198 days), and 154 at time 3 (mean infant age 303 days). Three multi-trajectory appetitive phenotype groups were identified and labeled as (Phenotype 1) food avoidant trending toward low food approach (21.32% of infants), (Phenotype 2) persistently balanced (50.53% of infants), and (Phenotype 3) high and continuing food approach (28.16% of infants). Formula feeding was more common in Phenotype 1 (p = 0.016). Parents of infants in Phenotype 1 were more likely to rate them as being more difficult than average, compared to infants with phenotypes 2 or 3. Phenotype 2 had the greatest increase in persuasive feeding over time [0.30; 95% CI (0.12, −0.47)].

Conclusions: Distinct multi-trajectory appetitive phenotype groups emerge early in infancy. These trajectories appear to have origins in both infant and parent characteristics as well as parent behaviors and cognitions. The infant multi-trajectory appetitive phenotype groups suggest that for some infants, difficulties in self-regulating appetite emerge early in life. Investigation of infant multi-trajectory appetitive phenotype groups that utilize a range of measures, examine relationships to key covariates and outcomes, and extend from infancy into childhood are needed.

Start Healthy and Stay Healthy: A workplace health promotion intervention for new graduate nurses: A mixed-methods study

AIMS

This study explored the acceptability of a workplace health promotion intervention embedded into a transition to practice (TTP) programme to assist new graduate nurses in establishing healthy dietary and physical activity (PA) behaviours from career commencement.

DESIGN

A sequential mixed methods design.

METHODS

The Start Healthy and Stay Healthy (SH&SH) intervention, informed by the Behaviour Change Wheel, was conducted in an Australian Local Health District. It included face-to-face education sessions, the use of a fitness tracker and twice-weekly short answer messages. Participants completed three online surveys: at orientation, 6 weeks and 6 months. A sub-sample participated in semi-structured interviews to explore their experience of the intervention. Interview data were analysed thematically.

RESULTS

The intervention was delivered from February to December 2019. A total of 99 nurses completed the baseline survey, 62 at 6 weeks and 69 at 6 months. After 6 months, health knowledge increased as participants correctly identified recommended amounts of fruits, vegetables and PA. Fruit consumption increased at 6 months with little change to vegetable intake. Takeaway consumption decreased, but consumption of some discretionary foods increased. Across the three time points, there was a low engagement in PA during leisure time. The interviews identified three themes: (1) Support of Colleagues and Peers, (2) The Work Environment and (3) Engagement with SH&SH.

CONCLUSION

Providing a targeted intervention for new graduate nurses embedded into a TTP programme improved their health knowledge, some dietary behaviours, and participation in PA by some participants.

IMPACT

Ensuring a healthy nursing workforce is critical to retaining staff. Implementing a workplace health promotion intervention that targets new graduate nurses can help them adopt and maintain healthy lifestyle behaviours to support them in their future careers.

Extending the role of nursing assistants in mental health inpatient settings: A multi-method study

With continued growth in the demand for nursing care, many organizations have incorporated nursing assistants into the acute care workforce. However, role descriptions are often generic and do not provide clarity in specialist areas such as mental health inpatient settings. Issues have been noted regarding the role of assistants, delegation, and their integration with the nursing team. This study extended an existing set of care activities and explored the perceptions of nursing assistants and registered nurses regarding these activities. A modified Delphi approach added 14 new care activities for nursing assistants. A follow-up survey found significant differences between nursing assistants and registered nurses regarding utilization of the activities, delegation, teamwork, and role clarity. Future research must incorporate the perspectives of those with lived experience of mental health issues, and develop an understanding of the interactions between nursing assistant care activities and other factors such as local supports, skillmix, and the practice environment, as these may impact how an organization can introduce nursing assistants to specialty areas while maintaining consumer and staff safety.

Midwifery workplace culture in Sydney, Australia

PROBLEM

Aspects of the midwifery workplace culture have previously been measured as negative with limited leadership or support. Support for midwives is essential for them to face the complexity and workloads in Australian maternity units.

BACKGROUND

Understanding the culture of the midwifery workplace is important to develop strategies to stem workforce attrition and to optimise care of women and their families.

AIMS

This study aimed to assess midwives' perceptions of workplace culture in two maternity units in Sydney, Australia, and compare the results with a national study using the same validated instrument.

METHOD

This study reports results using the Australian Midwifery Workplace Culture instrument (n = 49 midwives) and stakeholder groups (n = 10). Simple descriptive statistics were used, and the qualitative responses were analysed thematically.

FINDINGS

Compared to the national sample, participants rated their workplace more favourably, especially their relationships with managers and colleagues. Over one-third (36.7%) considered that their workplace had a positive culture, compared with 27.9%e. However, they rated their workplaces more negatively on time constraints and staff resources, and reported limited autonomy. Workplaces were highly medicalised which impacted their philosophy of woman-centred care and their ability to work autonomously.

DISCUSSION

Factors related to collegiality in the workplace, relationship with managers, midwives' intention to leave the profession and time constraints are discussed in comparison to the national study, as well as other relevant research. Conclusion Workplace collaboration, support, respect and understanding were extremely important to midwives, as were adequate staffing levels, teamwork and opportunities for further education.

Addressing obesity in the first 1000 days in high risk infants: Systematic review

Early intervention is critical for addressing the challenge of childhood obesity. Yet many preventive interventions do not target infants most at risk of future overweight or obesity. This systematic review examines interventions delivered before 2 years that aim to ameliorate excess weight gain among infants at high risk of overweight or obesity, due to sociodemographic characteristics, parental weight or health status, infant feeding or health behaviours. We searched six databases for interventions: (a) delivered before age two, (b) specifically aimed at infants at high risk of childhood obesity and (c) that reported outcomes by weight status beyond 28 days. The search identified over 27,000 titles, and 49 papers from 38 studies met inclusion criteria: 10 antenatal interventions, 16 postnatal and 12 conducted both before and after birth. Nearly all targeted infant and/or maternal nutrition. Studies varied widely in design, obesity risk factors, outcomes and quality. Overall, nine interventions of varying quality reported some evidence of significantly improved child weight trajectory, although effects tended to diminish over time. Interventions that improved weight outcomes tended to engage parents for a longer period, and most offered health professional input and support. Two studies of limited quality reported significantly worse weight outcomes in the intervention group.

The Feeding Practices and Structure Questionnaire: development and validation of age appropriate versions for infants and toddlers

Background

In order to measure and understand trajectories of parental feeding practices and their relationship with child eating and weight, it is desirable to perform assessment from infancy and across time, in age-appropriate ways. While many feeding practices questionnaires exist, none is presently available that enables tracking of feeding practices from infancy through childhood. The aim of the study was to develop a version of the Feeding Practices and Structure Questionnaire (FPSQ) for parents with infants and toddlers (< 2 years) to be used in conjunction with the original FPSQ for older children (≥2 years) to measure feeding practices related to non-responsiveness and structure across childhood.

Methods

Constructs and items for the FPSQ for infants and toddlers were derived from the existing and validated FPSQ for older children and supplemented by a review of the literature on infant feeding questionnaires. Following expert review, two versions of the questionnaire were developed, one for milk feeding parents and one for solid feeding parents. Data from two studies were combined (child ages 0–24 months) to test the derived constructs with Confirmatory Factor Analysis for the milk feeding (N = 731) and solid feeding (N = 611) versions.

Results

The milk feeding version consisted of four factors (18 items) and showed acceptable model fit and good internal reliability: ‘feeding on demand vs. feeding routine’ (α = 0.87), ‘using food to calm’ (α = 0.87), ‘persuasive feeding’ (α = 0.71), ‘parent-led feeding’ (α = 0.79). The same four factors showed acceptable model fit for the solid feeding version (21 items), likewise with good internal reliability (α = 0.74, 0.86, 0.85, 0.84 respectively). Two additional factors (13 items) were developed for the solid feeding version that appeared developmentally appropriate only for children aged 12 months or older: ‘family meal environment’ (α = 0.81) and ‘using (non-)food rewards’ (α = 0.92). The majority of factor-factor correlations were in line with those of the original FPSQ.

Conclusions

The FPSQ milk and solid feeding versions are the first measures specifically developed as precursors to the FPSQ to measure parental feeding practices in children < 2 years, particularly practices related to non-responsiveness and structure. Further validation in more diverse samples is required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01079-x.

Promoting healthy weight for all young children: a mixed methods study of child and family health nurses' perceptions of barriers and how to overcome them

BACKGROUND

Childhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth.

METHODS

This mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported.

RESULTS

CFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members.

CONCLUSIONS

CFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents' understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time.

The impact of person-centred care on patient safety: An umbrella review of systematic reviews

BACKGROUND

Nursing literature frequently emphasises the benefits of person-centred approaches for healthcare quality and safety.

OBJECTIVE

This umbrella review aimed to synthesise the combined evidence from systematic reviews assessing the impact of person-centred care interventions on patient safety.

DESIGN

A three-step review process included a preliminary review of literature, a comprehensive search, and manual searching of reference lists and forward citations of selected reviews. The review protocol was registered with Prospero (CRD42018090048).

DATA SOURCES

Reviewers searched 10 databases for systematic reviews published in English-language peer-reviewed journals between 2000 and 2019: Academic Search Complete, CINAHL, Cochrane Library, EMBASE, JBI Database, Medline, ProQuest Health & Medicine, PROSPERO Register, PubMed and Scopus.

REVIEW METHODS

Covidence software was used to manage screening and eligibility. Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.

RESULTS

From an initial total of 3412 potential titles, 16 reviews met the inclusion criteria. The selected reviews examined the impact of person-centred care for diverse groups of patients (children, adults and older people) in varied settings. Most systematic reviews assessed experimental studies, generally comparing person-centred interventions with 'usual care', often demonstrating limited evidence of impact on safety. Reviews addressed several patient safety outcomes relevant to nursing, including falls, infections, medication use and misuse, and mortality rates. The systematic reviews were generally well conducted, although several included studies of poor or fair quality. Given the heterogeneity of the interventions, outcomes and research designs of studies included in the selected reviews, we were unable to draw unequivocal conclusions about the implications of person-centred care for patient safety in this umbrella review. However, there was some encouraging evidence that person-centred care initiatives may result in reduced rates of falls (in acute care and residential aged care settings). The review also highlighted reductions in agitation for people with dementia and some improvement in anti-psychotic medication use in older people with dementia.

CONCLUSIONS

Although abundant evidence exists demonstrating the positive effects of person-centred care on healthcare quality and on patient (and provider) wellbeing, there is little research focussing specifically on the impact of person-centred care on patient safety. Thus, there is scope for further high-quality nursing research into how person-centred interventions improve specific patient safety outcomes in order to inform more widespread adoption of person-centred practice.

Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation

Background

Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality.

Objective

This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers.

Methods

The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information.

Results

A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers.

Conclusions

The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources.

Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012

BACKGROUND

In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown.

AIM

The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW.

METHODS

Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37-41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity.

RESULTS

Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively).

CONCLUSIONS

Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW.

Developing the Australian Midwifery Workplace Culture instrument

AIM

To develop and psychometrically test the Australian Midwifery Workplace Culture instrument.

BACKGROUND

Workplace culture is critical within midwifery settings. Culture determines not only the well-being and continued retention of maternity staff and managers but it also affects the quality and ultimate safety of the care they provide to women, infants and families. Several studies have identified cultural problems within maternity services. Relatively few instruments take account of the unique aspects of these workplaces and the relationship between midwives and women.

DESIGN

Three-stage instrument development involved item generation (based on the Culture of Care Barometer), expert content validation and a pilot test.

METHODS

During 2016, 38 midwifery experts reviewed the initial items, and 322 midwives then pilot-tested the draft instrument. We used exploratory factor analysis to identify key domains and to refine the instrument.

RESULTS

The refined instrument contained 22 items in three distinct domains: relationship with managers, empowerment and collegiality.

CONCLUSION

The instrument can contribute to understanding important dimensions of the culture in maternity workplaces and thus to examining problematic attitudes and practices. The instrument requires further development and testing with larger and more diverse samples of midwives and validation in specific midwifery settings and models of care.

Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study

OBJECTIVE

To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home.

DESIGN

A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ² tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance.

SETTING

All eight Australian states and territories.

PARTICIPANTS

Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home.

MAIN OUTCOME MEASURES

Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death).

RESULTS

Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth.

CONCLUSIONS

This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.

The Emergency Department Response to Women Experiencing Intimate Partner Violence: Insights From Interviews With Clinicians in Australia

BACKGROUND AND OBJECTIVES

Emergency departments (EDs) are essential providers of compassionate, immediate treatment and referral for women experiencing intimate partner violence (IPV). IPV, largely perpetrated by men against women, exerts a substantial burden on the health systems and economies of all nations. There is little known about how staff in Australian EDs respond to the challenges such violence generates. We therefore examined the clinical team response to women experiencing IPV in two large Australian metropolitan hospital EDs.

METHODS

We undertook qualitative semistructured interviews and focus group discussions with 35 social workers, nurses, and doctors. Transcripts were recorded and transcribed verbatim. We analyzed the data thematically. We first undertook line-by-line coding and organized content into descriptive categories. Latent and manifest patterns were identified across the data and mapped to key themes in negotiation with all authors.

RESULTS

Respondents emphasized challenges identifying IPV resulting from professional uncertainty or discomfort and women's fear of the ramifications of disclosure. Emergency clinicians routinely referred women to social workers after medical treatment and described effective collaboration across professions. Social workers outlined difficulties coordinating care with health and community agencies. Staff highlighted challenges maintaining nonjudgmental attitudes and managing their own feelings-especially clinicians who had personally experienced violence.

CONCLUSIONS

Emergency departments can provide caring environments for women experiencing IPV. Effective interprofessional teamwork across nursing, medical, and social work professionals may mitigate the need for formal screening tools. Supportive workforce environments can improve staff understanding, reduce stigma, enhance appropriate treatment, and counsel health professionals experiencing violence. However, staff training and advocacy and referral relationships with local programs require strengthening. A connected multisystems-level response is required to coordinate and resource services for all affected by violence.

Creating the first national linked dataset on perinatal and maternal outcomes in Australia: Methods and challenges

BACKGROUND

Data linkage offers a powerful mechanism for examining healthcare outcomes across populations and can generate substantial robust datasets using routinely collected electronic data. However, it presents methodological challenges, especially in Australia where eight separate states and territories maintain health datasets. This study used linked data to investigate perinatal and maternal outcomes in relation to place of birth. It examined data from all eight jurisdictions regarding births planned in hospitals, birth centres and at home. Data linkage enabled the first Australia-wide dataset on birth outcomes. However, jurisdictional differences in data collection created challenges in obtaining comparable cohorts of women with similar low-risk pregnancies in all birth settings. The objective of this paper is to describe the techniques for managing previously linked data, and specifically for ensuring the resulting dataset contained only low-risk pregnancies.

METHODS

This paper indicates the procedures for preparing and merging linked perinatal, inpatient and mortality data from different sources, providing technical guidance to address challenges arising in linked data study designs.

RESULTS

We combined data from eight jurisdictions linking four collections of administrative healthcare and civil registration data. The merging process ensured that variables were consistent, compatible and relevant to study aims. To generate comparable cohorts for all three birth settings, we developed increasingly complex strategies to ensure that the dataset eliminated women with pregnancies at risk of complications during labour and birth. It was then possible to compare birth outcomes for comparable samples, enabling specific examination of the impact of birth setting on maternal and infant safety across Australia.

CONCLUSIONS

Data linkage is a valuable resource to enhance knowledge about birth outcomes from different settings, notwithstanding methodological challenges. Researchers can develop and share practical techniques to address these challenges. Study findings suggest that jurisdictions develop more consistent data collections to facilitate future data linkage.

Australian parents' use of universal child and family health services: A consumer survey

This study aimed to explore Australian parents' use of universally available well-child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents' use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well-child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.

Cultural empathy in midwifery students: Assessment of an education program

BACKGROUND

The ability of midwives to provide empathic care that is culturally appropriate is critical for women to feel accepted by the midwives who support them. Australia is a culturally diverse society, yet there is evidence of poorer maternity outcomes for some women and infants, related to their cultural background.

OBJECTIVES

This study's objective was to evaluate the effectiveness of an education program for student midwives. The program was intended to increase the cultural empathy of future midwives, to help ensure greater cultural safety and optimal maternity outcomes across all sections of Australian society.

DESIGN

This quantitative study compared pre- and post-intervention measures of students' empathy.

SETTING

The health faculty of a large urban university in Australia.

PARTICIPANTS

Fifty-five students from all three years of an undergraduate midwifery program participated.

METHODS

The study examined students' scores on the Jefferson Scale of Empathy for health profession students, measured before and immediately after the education program, and again after four weeks.

RESULTS

The midwifery students had a high mean baseline score on the empathy scale. Scores increased significantly after the education program. Students with lower pre-test scores recorded significantly greater increases in their empathy levels than those who were more empathic initially. Empathy scores declined one month after the program, but remained higher than baseline levels.

CONCLUSIONS

Several studies have explored empathy levels amongst current and future health professionals. However, few studies of health professional students have evaluated the impact of specific education interventions addressing cultural empathy. This study found that midwifery students tended to have higher empathy scores than students in other health disciplines. The education workshop further increased participants' scores.

The ResQu Index: A new instrument to appraise the quality of research on birth place

Objective

Place of birth is a known determinant of health care outcomes, interventions and costs. Many studies have examined the maternal and perinatal outcomes when women plan to give birth in hospitals compared with births in birth centres or at home. However, these studies vary substantially in rigour; assessing their quality is challenging. Existing research appraisal tools do not always capture important elements of study design that are critical when comparing outcomes by planned place of birth. To address this deficiency, we aimed to develop a reliable instrument to rate the quality of primary research on maternal and newborn outcomes by place of birth.

Study design

The instrument development process involved five phases: 1) generation of items and a weighted scoring system; 2) content validation via a quantitative survey and a modified Delphi process with an international, multi-disciplinary panel of experts; 3) inter-rater consistency; 4) alignment with established research appraisal tools; and 5) pilot-testing of instrument usability.

Results

A Birth Place Research Quality Index (ResQu Index) was developed comprising 27 scored items that are summed to generate a weighted composite score out of 100 for studies comparing planned place of birth. Scale content validation indices were .89 for clarity, .94 for relevance and .90 for importance. The Index demonstrated substantial inter-rater consistency; pilot-testing confirmed feasibility and user-friendliness.

Conclusion

The ResQu Index is a reliable instrument to evaluate the quality of design, methods and interpretation of reported outcomes from research about place of birth. Higher-scoring studies have greater potential to inform evidence-based selection of birth place by clinicians, policy makers, and women and their families. The Index can also guide the design of future research on place of birth.

‘Lost and confused’: parent representative groups’ perspectives on child and family health services in Australia

Consumer involvement in health care is widely accepted in policy and service delivery. Australia offers universal health services for families with children aged 0 to 5 years, provided by child and family health nurses and general practitioners. Services include, but are not limited to, monitoring and promoting child health and development, and supporting parents. This paper reports consumer representatives’ perspectives on Australian parents’ needs and experiences of child and family health services, identifying facilitators and barriers to service utilisation. Twenty-six representatives from consumer organisations explored families’ experiences through focus groups. Qualitative data were analysed thematically. Consumer representatives identified several key implications for families using primary health services: feeling ‘lost and confused’ on the parenting journey; seeking continuity and partnership; feeling judged; and deciding to discontinue services. Participants highlighted accessible, timely, non-judgmental and appropriate interactions with healthcare professionals as vital to positive consumer experiences and optimal health and developmental outcomes. Representatives indicated that families value the fundamentals of well-designed health services: trust, accessibility, continuity, knowledge and approachability. However, both consumers and service providers face barriers to effective ongoing engagement in universally provided services.

Responding to families with complex needs: a national survey of child and family health nurses

AIMS

The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families.

BACKGROUND

Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families.

DESIGN

The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011.

METHODS

Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks.

FINDINGS

Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence.

CONCLUSION

For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally.

Mothering at a Distance: what incarcerated mothers value about a parenting programme

BACKGROUND

Children with incarcerated mothers experience adverse health, social and emotional circumstances, and are a particularly vulnerable group. Mothers in custody face significant challenges in parenting their children.

AIMS

The study aimed to identify participants' views on impact of a parenting support programme for incarcerated mothers in NSW Australia.

METHODS

The mixed-methods study examined 134 responses to open and closed questions on a questionnaire for programme participants.

RESULTS

Participants found the programme worthwhile, engaging and relevant. It enhanced their parenting knowledge and confidence. Open-ended responses highlighted program elements which participants valued, specifically support for their parenting role in complicated circumstances, greater understanding of child development and perspectives, and practical strategies for facilitating connections with their children during their incarceration.

CONCLUSIONS

The study informs nurses working with women who have experienced incarceration and their children, both in custodial and community settings.

Ready for practice: what child and family health nurses say about education

BACKGROUND

Australia has a well-established universal child and family health service predominately staffed by specialist/qualified child and family health nurses. Two common and interrelated concerns are the need for nurses to be ready for practice after completing a nursing education program and the means to ensure ongoing nursing competence.

OBJECTIVE

To investigate the readiness of CFH nurses to practise after qualification and their continuing engagement with learning.

DESIGN

The study used an interpretive descriptive approach.

SETTING

This paper presents data from four questions from a larger survey of child and family health nurses across Australia.

PARTICIPANTS

1098 child and family health nurses responded to the survey.

METHOD

Qualitative survey responses from the four education questions were analysed using inductive thematic content analysis.

RESULTS

Five significant themes were identified: hands-on experience (student clinical practice/placement); drawing on prior experience; learning on the job; learning (learning over time); and barriers to learning.

CONCLUSION

This paper provides insights into nurses' readiness for practice at the completion of a postgraduate child and family health nursing qualification and their maintenance of competence and specialist knowledge. It highlights: the need for clinical placement to be retained and enhanced; the significant contribution of more experienced child and family health nurses mentoring newly graduated child and family health nurses; the need for minimum education standards; the importance of reviewing education courses in relation to graduates' readiness for child and family health nursing practice; the importance of supporting ongoing professional development; and the removal of barriers to accessing education opportunities.

Nature and frequency of services provided by child and family health nurses in Australia: results of a national survey

OBJECTIVE

Australia has a system of universal child and family health (CFH) nursing services providing primary health services from birth to school entry. Herein, we report on the findings of the first national survey of CFH nurses, including the ages and circumstances of children and families seen by CFH nurses and the nature and frequency of the services provided by these nurses across Australia.

METHODS

A national survey of CFH nurses was conducted.

RESULTS

In all, 1098 CFH nurses responded to the survey. Over 60% were engaged in delivering primary prevention services from a universal platform. Overall, 82.8% reported that their service made first contact with families within 2 weeks of birth, usually in the home (80.7%). The proportion of respondents providing regular support to families decreased as the child aged. Services were primarily health centre based, although 25% reported providing services in other locations (parks, preschools).The timing and location of first contact, the frequency of ongoing services and the composition of families seen by nurses varied across Australian jurisdictions. Nurses identified time constraints as the key barrier to the delivery of comprehensive services.

CONCLUSIONS

CFH nurses play an important role in supporting families across Australia. The impact of differences in the CFH nursing provision across Australia requires further investigation. What is known about the topic? Countries that offer universal well child health services demonstrate better child health and developmental outcomes than countries that do not. Australian jurisdictions offer free, universal child and family health (CFH) nursing services from birth to school entry. What does this paper add? This paper provides nation-wide data on the nature of work undertaken by CFH nurses offering universal care. Across Australia, there are differences in the timing and location of first contact, the frequency of ongoing services and the range of families seen by nurses. What are the implications for practitioners? The impact for families of the variation in CFH nursing services offered across Australia is not known. Further research is required to investigate the outcomes of the service provision variations identified in the present study.

Understanding partnership practice in child and family nursing through the concept of practice architectures

A significant international development agenda in the practice of nurses supporting families with young children focuses on establishing partnerships between professionals and service users. Qualitative data were generated through interviews and focus groups with 22 nurses from three child and family health service organisations, two in Australia and one in New Zealand. The aim was to explore what is needed in order to sustain partnership in practice, and to investigate how the concept of practice architectures can help understand attempts to enhance partnerships between nurses and families. Implementation of the Family Partnership Model (FPM) is taken as a specific point of reference. Analysis highlights a number of tensions between the goals of FPM and practice architectures relating to opportunities for ongoing learning; the role of individual nurses in shaping the practice; relationships with peers and managers; organisational features; and extra-organisational factors. The concept of practice architectures shows how changing practice requires more than developing individual knowledge and skills, and avoids treating individuals and context separately. The value of this framework for understanding change with reference to context rather than just individual's knowledge and skills is demonstrated, particularly with respect to approaches to practice development focused on providing additional training to nurses.

Working in partnership with parents: the experience and challenge of practice innovation in child and family health nursing

AIMS AND OBJECTIVE

This study investigated what Family Partnership Model practice means in the day-to-day practice of child and family health nurses working with parents.

BACKGROUND

The Family Partnership Model has been widely implemented in child and family health services in Australia and New Zealand, with limited understanding of the implications for nursing practice.

DESIGN

A qualitative interpretive study design was used.

METHOD

Semi-structured interviews were conducted with 22 nurse participants, who had completed the Family Partnership Model training programme. Subsequent focus groups enabled these participants to validate the themes identified in the initial analysis and to confirm that the nurses concurred with the issues raised. Thematic content analysis produced rich descriptions and explanation of nurses' experiences and perspectives. results: Four themes emerged from the analysis: experience of changing practices, exploring with parents, challenging unhelpful constructions and a commitment to examining practice.

CONCLUSION

Overall, the participants embraced the use of the Family Partnership Model, providing examples of change and increasing confidence in their approach to working with parents.

RELEVANCE TO CLINICAL PRACTICE

This study demonstrates that the effective utilisation of the Family Partnership Model in nursing practice is a more complex and dynamic process than simply embracing the model. There are significant challenges to be negotiated when implementing new ways of working with parents, particularly questioning existing dominant forms of practice for nurses, managers and wider health organisations, and their clients. This paper also raises issues about sustaining practice innovation, which extends beyond the best intent of individual nurses, requiring receptive organisational conditions and leadership.

Working in partnership with vulnerable families: the experience of child and family health practitioners

Family circumstances in infancy are persistent and powerful determinants of children’s physical and mental health, influencing inequalities that trace from childhood through to adulthood. While the social factors that perpetuate patterns of inequality are more complex than can be addressed through single interventions, child and family health (CFH) services represent crucial sites where trajectories of inequality can be disrupted. In particular, approaches that foster opportunities for practitioner–parent engagement that challenge traditional hierarchical health care practice, such as the Family Partnership Model (FPM), are recommended as ways of addressing disadvantage. Little is known about how practitioners implement models of working in partnership with families and, consequently, there is a gap in understanding how best to develop and sustain these new CFH practices. This paper reports a research project that investigated the experiences of 25 health professionals working within a FPM framework with vulnerable families. Through discussion of four key themes – redefining expertise, changing practices, establishing new relationships with parents and the complexities of partnership practice – the paper offers first-hand accounts of reframing practices that recognise the needs, skills and expertise of parents and thus contribute to empowerment of families.

Effectiveness of an individualized multidisciplinary programme for managing unsettled infants

OBJECTIVE

To ascertain the effectiveness of an individualized multidisciplinary residential programme for managing young unsettled infants and whether changes in unsettled behaviour were maintained.

METHODS

One hundred and nine clients of a Tresillian residential unit with singleton infants aged less than 20 weeks were studied before, during and after intervention. Mothers completed a 24 h infant activity record prior to admission, during the stay and 1 month after discharge. Intervention consisted of settling techniques, parent education, support and counselling.

RESULTS

By day 4 of admission, the mean duration of unsettled (fussing, crying) behaviour had decreased significantly and mean sleeping time and awake/content times both increased significantly (P < 0.001). These changes were maintained 1 month after discharge. Changes in behaviour were particularly marked for very unsettled infants.

CONCLUSIONS

In the absence of formal controls, the individualized programme appears effective in managing the behaviour of unsettled infants.

The pathology of spontaneous paratuberculosis in the North American bison (Bison bison)

Gross and histopathologic examinations were performed on 70 North American bison (Bison bison) from a Mycobacterium avium paratuberculosis culture-positive herd. The bison examined were part of a breeding herd totaling 2,800 animals. Eight of 70 (11%) animals had gross findings of intestinal mucosal thickening, and 16 of 70 (23%) of the animals had enlarged mesenteric lymph nodes. Histologic lesions compatible with Johne's disease were diagnosed in 30 of 70 (43%) bison on the basis of the demonstration of noncaseating granulomatous inflammatory infiltrates and of one or more acid-fast bacilli characteristic of Mycobacterium avium paratuberculosis. A suspicious diagnosis of Johne's disease was obtained in 11 of 70 (16%) bison on the basis of the observation of noncaseating granulomatous inflammatory infiltrates without demonstrable acid-fast bacteria. Twenty-nine of 70 (41%) animals were assessed as histologically paratuberculosis free. Histologic results were compared to Johne's disease tests such as culture, serology, and polymerase chain reaction, which were performed on some of the cohort animals.

A quasi-experimental evaluation of Students Against Driving Drunk

The current research was designed to assess the effectiveness of one nationally prominent and highly publicized driving while intoxicated (DWI) prevention program for youth, Students Against Driving Drunk (S.A.D.D.). Process and outcome data were collected over a 2-year period in two states--California and New Mexico. In each state, one treatment school which implemented S.A.D.D. was compared to a closely matched comparison school on a variety of DWI-related measures over three waves of survey data collection. Process data indicated that in neither school was the entire S.A.D.D. model implemented. Student participation was moderate in the California school and marginal in the New Mexico school. There was also little evidence that S.A.D.D. stimulated increased curriculum attention to DWI issues. Outcome data provided no evidence for effects of S.A.D.D. on any of the DWI measures. General maturational trends in these variables were observed in the study cohorts, but these trends were not differentiated between the treatment and comparison schools. There was also no support for the concern that S.A.D.D. may stimulate student drinking by encouraging alternative means of transportation for intoxicated students.

Association of Mycobacterium paratuberculosis infection with reduced mastitis, but with decreased milk production and increased cull rate in clinically normal dairy cows

Approximately 45 Holstein cows that were Mycobacterium paratuberculosis-positive on the basis of fecal culture results were maintained at any one time in a 210-cow dairy herd. Farm management participated in the New York State Paratuberculosis Eradication Program. Paratuberculosis-positive cows were grouped separately from paratuberculosis-negative cows, but they were otherwise managed identically. During a 1-year study, 180 paratuberculosis-negative cows and 113 clinically normal paratuberculosis-positive cows were identified. Quarter milk samples (n = 6,100) were aseptically collected for microbiologic culture of mastitis pathogens from paratuberculosis-negative cows, and 3,129 quarter samples were obtained from paratuberculosis-positive cows. Dairy Herd Improvement Association (DHIA) records were used to monitor milk somatic cell count linear scores, mature equivalent milk production, new mastitis infections, and chronic mastitis infections. For second-lactation cows greater than 100 days in milk production, and increasing with age beyond that point, paratuberculosis-positive cows had lower mature equivalent milk production than did negative herdmates. Rates of new and chronic mastitis infections, as measured by DHIA linear scores were significantly (P < 0.05, P = 0.05, respectively) lower in cows with nonclinical paratuberculosis. Infected cows were culled from the herd at a faster rate than were paratuberculosis-negative herdmates. Therefore, paratuberculosis was associated with financial loss attributable to reduced milk production and increased culling of infected cows.