Abstract
BackgroundMore than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice.MethodsData from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis.ResultsMany practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners’ confidence and motivation to perform HKCs.ConclusionApplication of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners’ training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.
Highlights
More than a fifth of Australian children arrive at school developmentally vulnerable
Focus group captured a diverse range of practitioner experiences with the Healthy Kids Check (HKC), in each study area: some had not, as yet, provided a single HKC, others delivered a few checks occasionally, and some practices regularly booked HKC appointments or extended to provide entire clinics of HKC services
We describe how our data aligns within the Theoretical Domains Framework (TDF) and COM-B model (Table 6)
Summary
More than a fifth of Australian children arrive at school developmentally vulnerable. The Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice. Contact diminishes as the child gets older, so that by 3 1⁄2 years of age, less than 60% of children complete health surveillance visits [8]. More than 80% of the Australian population visit a general practitioner (GP) each year [9]
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