Towards effective implementation strategies for ultrasound hip screening in child health care

Abstract

Early diagnosis and treatment of developmental dysplasia of the hip (DDH) is essential to allow for the normal development of the hip. In the Netherlands, the current screening for DDH consists of physical examination and identification of risk factors. In previous studies, ultrasound screening was demonstrated to be more (cost)effective compared to the current screening. However, clinical and economic outcomes can be relatively uncertain since they may not reflect the value of the innovation once implemented in a ‘real‐world’ health care setting. The next step was therefore to investigate ultrasound screening for DDH as part of the preventive child health care program by means of a pilot implementation. This thesis aimed to study determinants related to the implementation of the screening and, particularly, determinants associated with parental participation in and satisfaction with the screening. Prior to the pilot implementation, a focus group study was conducted to identify enhancing factors, impeding factors and preconditions related to several innovation determinants (innovation, user, organization, socio‐political context). The results, such as preferences regarding parental information provision and the training program, could be used in formulating the implementation strategy. The second study identified psychosocial determinants related to parental screening participation. A positive attitude, a high subjective norm, a high self‐efficacy, a low perceived susceptibility and a high perceived effectiveness, were positively related to participation. The third study examined the influence of a gainversus loss‐framed message on parental participation. Parents who received a gain‐framed brochure were more likely to participate. The fourth study examined determinants related to parental satisfaction with the screening. General satisfaction with the screening was high and mostly affected by processrelated factors. The fifth study explored the evaluation of parents regarding a referral to the orthopedic surgeon. Parents preferred to be directly referred instead of indirectly via the general practitioner. Based on the outcomes of the separate studies, effective implementation strategies were formulated, related to the organization of the screening, the communication with parents and the screening process. These strategies can support health care policy decision‐makers with national implementation of ultrasound screening for DDH, so as to facilitate optimal likelihood of implementation.