Child Health Care Centers Research Articles

The association between outdoor artificial light at night exposure and antenatal depression and anxiety symptoms: A retrospective cohort study in China

BackgroundOutdoor artificial light at night (ALAN) has emerged as a significant source of environmental pollution, however its association with antenatal depression and anxiety symptoms has not been explored before. MethodsThis study was based on a cohort study conducted at the Maternal and Child Health Care Center in Ma’anshan City, Anhui Province, China, which ultimately included 1047 pregnant women. Depression and anxiety symptoms were evaluated utilizing the self-administered Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7), respectively. Exposure levels to outdoor ALAN were calculated utilizing satellite data and the participants’ usual addresses. Logistic regression and restricted cubic spline were used to assess the association between exposure to outdoor ALAN and depression and anxiety symptoms in pregnant women. ResultsAfter adjusting for confounding factors, high ALAN exposure during the pre-pregnancy period (ORdepression = 3.16, 95% CI: 1.14∼8.75; ORanxiety = 3.09, 95% CI: 1.51∼6.28) and first trimester (ORdepression = 2.90, 95% CI: 1.13∼7.45; ORanxiety = 3.11, 95% CI: 1.55∼6.25) were associated with increased risks of antenatal depression and anxiety symptoms. Restricted cubic spline analyses showed the above associations were not nonlinear. ConclusionOur study is the first to propose that exposure to high levels of outdoor ALAN three months before pregnancy and during the first trimester of pregnancy is a risk factor for antenatal depression and anxiety symptoms.

MINISTOP 3.0: Implementation of a mHealth obesity prevention program within Swedish child healthcare – study protocol for a cluster randomized controlled trial

BackgroundPreviously, we have reported on the efficacy and real-world effectiveness of a parent-oriented mobile health intervention (MINISTOP 1.0 and 2.0), which have shown improvements in pre-school children’s lifestyle behaviours. However, there is a need for implementation evidence. The overall aims of this study are to: (i) compare two different implementation strategies for MINISTOP 3.0 (Basic vs. Enhanced) on: acceptability, appropriateness, feasibility, organizational readiness to implement MINISTOP 3.0 within Swedish child healthcare (primary outcomes) as well as reach, costs, and adoption of MINISTOP 3.0 (secondary outcomes); (ii) evaluate cost-effectiveness of MINISTOP 3.0; (iii) explore the sustainability of MINISTOP 3.0; (iv) evaluate the determinants of effectiveness of MINISTOP 3.0 on children’s key lifestyle behaviours; and (v) investigate the long-term effects of MINISTOP 3.0 on children’s body mass index.MethodsA hybrid type III implementation-effectiveness design will be used. A cluster randomized controlled trial will be conducted to compare the effects of basic versus enhanced implementation strategies on the outcomes at the child healthcare level. A minimum of 50 child healthcare centers across Sweden will participate and we aim to recruit 120 nurses. Child healthcare nurses in both groups will offer the MINISTOP 3.0 app to the families at the 2.5/3-year routine visit. Basic implementation strategies include educational meeting with nurses, formal implementation blueprint, develop/distribute educational materials and enhanced implementation includes all aforementioned strategies plus auditing/providing feedback and ongoing training for nurses. All outcomes will be assessed at baseline and 12 months post-implementation. Implementation outcomes will be assessed quantitatively using questionnaires and sustainability will be assessed qualitatively at 12 months. Children’s key lifestyle behaviours will be collected through a parental questionnaire within the MINISTOP app at baseline and 6 months after they have received the app. Children’s weight/height will be measured at routine visits at 2.5/3 (baseline), 4 and 5 years of age.DiscussionThis study will provide important implementation evidence with regards to implementing mHealth interventions within Swedish child healthcare at scale and these results have the potential to be generalized to other digital interventions being implemented in child healthcare.Trial registrationClinicalTrials.gov, NCT05667753. Registered December 29, 2022.

Identifying children at risk in Swedish Child Health Services.

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives

BackgroundNutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.MethodsThree group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.ResultsThree main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.ConclusionThe findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.Trial registrationThe main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967. (Registration date: 19-06-2022).

Young children’s screen habits and first-time parents’ reflections on screen use in socioeconomically disadvantaged Swedish settings: a mixed methods study

BackgroundDespite WHO’s recommendation of limited screen time for children < 2 years, they are worldwide established screen users. Several negative consequences are connected to excessive screen use among children. As parents are key actors in introducing screens to children, it is important to explore children’s screen habits and parents’ perspectives on screen in different populations, which could support the development of guidelines for healthier screen use. This study aimed to explore young children’s screen use habits and describe first-time parents’ reflections on children’s screen use in socioeconomically disadvantaged Swedish settings.MethodsThis mixed methods study was a part of larger studies within Stockholm County. The data were collected through semi-structured questionnaire-based interviews, among first-time parents (N = 386) of 15–18 months-olds at local Child Health Care centres during 2019–2022. Quantitative and qualitative data analyses conducted in parallel resulted in descriptive statistics and qualitative categories.ResultsMost children (92.4%) used screens by the age of 15–18 months, commonly for a maximum of 30 min (48.5%) per day. Participants stated the most suitable age for starting screen use to be after (41.7%) or at (37.9%) the age of two years. Parents’ reflections on screen use formed three main categories, each having two sub-categories: screen use patterns (screen-related time and reasons for screen use), perceived concerns with screen use (child development and social issues), and attitudes related to screen use (parents’ attitudes towards screens and child’s response to screens).ConclusionsFirst-time parents in socioeconomically disadvantaged settings expressed awareness of possible negative screen-related effects and recommendations but did not always focus on long-term consequences when using screens in everyday life. Screens used as a short distraction, time spent together with screens, infants’ contact with relatives overseas, and pedagogical children’s programs and apps can be regarded as screen-related benefits. Encouraging parents’ self-reflection on their screen use may be a way of contributing to healthier screen habits among young children. Future studies are suggested regarding parents’ and children’s excessive interest in screens and how to manage screen use as a family.Trial registrationRetrospectively registered 18 February 2020 (ISRCTN10336603) and 24 May 2021 (ISRCTN66190787) in ISRCTN registry.

Significance of Mid-Pregnancy Down Syndrome Risk Screening in Predicting Adverse Maternal and Fetal Outcomes

Objective: To investigate the value of mid-pregnancy Down syndrome risk screening in predicting adverse maternal and fetal outcomes. Methods: 536 mothers who underwent mid-pregnancy screening for Down syndrome at Chengyang District Maternal and Child Healthcare and Family Planning Service Center from January 2021 to December 2022 were selected for retrospective analysis. The risk was calculated using the Asian population database in the American prenatal screening software PRISCA 4.0, combined with the age, gestational week, and body mass of the day of the pregnant women's blood collection. Results: The screening results showed that there were 469, 54, and 13 cases in the low-risk, critical-risk, and high-risk groups, respectively, and there were no statistically significant differences in the age and body mass of each group (P &gt; 0.05). However, there was a significant difference between the adverse fetal outcomes in low-risk, critical-risk, and high-risk groups (P &lt; 0.05); and the screening results showed that there was a significant difference between the adverse maternal outcomes in the low-risk, critical-risk, and high-risk groups (P &lt; 0.05). Conclusion: There is a relationship between the high risk of Down syndrome detected through screening and adverse maternal and fetal outcomes. Besides, the false positive and negative rates of Down syndrome screening results are positively correlated with adverse maternal and fetal outcomes.

Screening for economic hardship at Child Health Care Centres: A qualitative study of stakeholders' perceptions and experiences of the Healthier Wealthier Families model in Sweden.

The Healthier Wealthier Families model uses the child healthcare services as an access point to screen and connect parents experiencing economic hardship to municipal Budget and Debt Counselling services. This study aimed to explore the perceptions and experiences of the Healthier Wealthier Families model in a Swedish context. Semi-structured interviews were conducted with three stakeholder groups: eligible parents who declined (n=10) and received (n=9) financial counselling; nurses (n=7); and financial counsellors (n=5). The data were analysed using thematic analysis. The analysis resulted in three main themes conveying the stigma of talking about finance, the connection between economic situation and family wellbeing, and the nuts and bolts of providing preventive financial counselling. A working model aiming to ameliorate child poverty in a societal service context needs to address the preconceptions and perceived mandate and role of the professionals, the prevalence of financial stigma in society, especially in relation to being a 'good' parent, and the current preoccupations and perceived financial needs and hopes of the families served.

Health status and public health needs in a Togolese child health care centre modelled after the Dutch system

Background The charity foundation Association Soutien Enfants Togo started a child health care (CHC) centre in Togo that was modelled after the Dutch high-quality CHC system to improve child health. Aim To describe health care data of children who visited the centre. Subjects and methods Data were routinely collected between October 2010-July 2017. Outcomes were completed vaccinations, growth, development, lifestyle, physical examination, and laboratory testing results. Results In total, 8,809 children aged 0–24 years were available. Half (47.5%) of children aged 0–4 years did not receive all eligible free vaccinations from the government. The proportions of stunted children (all) or with a developmental delay (0–4 years) were 10.1% and 9.5%, respectively. In total, 40–50% of all children did not wash their hands with soap after toilet or before eating, or did not use clean drinking water. Furthermore, 5.1–6.6% had insufficient vision, high eye pressure or hearing loss. Sickle cell disease was detected in 5.3%. Conclusion A large group of children in need of prevention and early treatment were detected, informed and treated by the centre. Further research is needed to confirm if this strategy can improve children’s health in Sub-Saharan Africa. Our data are available for further research.

Thoughts and experiences of well-educated fathers about their role when breastfeeding difficulties arose

ObjectiveTo investigate how fathers or partners perceive their roles as new parents when confronted with early breastfeeding challenges, how they navigate these difficulties, and the specific type of support they seek from the Child Health Care Centre (CHCC). MethodIn-depth, individual interviews conducted with 12 partners of women for whom breastfeeding was difficult. Reflexive thematic analysis was applied on the interview data. ResultsInterviews resulted in three themes: 1) ‘It is a revolutionary time to be a new father’ represented a tumultuous time when fathers wanted to be involved in all decisions and part of a strong team with their partners. 2) ‘When a breastfeeding problem arose’; fathers questioned the sovereignty of breast milk and began to seek more knowledge. They experienced a strong social norm about breastfeeding that led to feelings of guilt for their partners. They felt helpless when their partners suffered and lacked support. 3) ‘Child Health Care Centre’s duty’; was instrumental, as knowledge and competence were found to be important for trust. The fathers wanted concrete solutions to breastfeeding problems and more conversations of support with the CHCC nurse. ConclusionWell-educated fathers desire to protect their partners as they experience suffering due to a robust social norm telling them that breastfeeding is best. This can result in them starting to question the sovereignty of breast milk. Fathers need support to help their partners successfully during breastfeeding. They want counselling to strengthen their role as parents and help them build trusting teams with their partners.

BURDEN OF ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN AT KAUSAR HOSPITAL MOTHER AND CHILD HEALTH CARE CENTRE KHAIRPUR MIR’S, PAKISTAN

Anemia is the condition in which hemoglobin level may become lower than normal &lt;11.0g/dl. According to an estimate, about one-third of the world's population (over 2 billion) are anemic. The study aimed to determine the Prevalence of anemia and associated factors among pregnant women at Kausar Hospital Mother and Child Health Care Centre Khairpur Mir’s, Sindh, Pakistan. The cross-sectional study was conducted from August to December 2019. A total number of 100 pregnant women were randomly included in this study. A predesigned questionnaire was filled out by face-to-face interviews consisting of socio-demographic characteristics, including Name, Age, gestational age, educational level, occupation, and monthly income. Anemia was classified as per World Health Organisation (WHO) criteria. The prevalence rate of Anemia in the present study was 69%. Minimum Haemoglobin levels were observed at 5.6 g/dL, and maximum Haemoglobin levels were observed at 12.4 g/dL with an average Haemoglobin of 10.05 g/dL ±1.44. Among them, 49% had mild anemia, 17% moderate anemia, and 3% severe anemia. At the same time, the patients were divided into age groups of 15-20 years, 21 to 25 years, 26 to 30 years, and 31-35 years to compare Anemia or Haemoglobin levels. Results showed a higher prevalence of anemia between the ages of 26 and 30. The minimum age was observed to be 20 years and a maximum of 35 years, with an average age of 28.12 years ±2.5 years. It was observed that the prevalence of Anemia was higher in 7-9 gestational months; socio-economic factors (Age, Gestational month, Number of children, and income source) showed significant association with Anemia. The present study concludes that the Prevalence of Anemia and Associated Factors among Pregnant Women at Kausar Hospital was 69%. Among them, 49% had mild anemia, 17% moderate anemia, and 3% severe anemia.

Factors Determining in The Selection of Pediatrics Health Care Service in Chennai, India

Background: Parents can choose their children's healthcare center; however, the healthcare business struggles to meet the growing health demands of vulnerable groups. Pediatricians now prioritize parental interests to improve their services and healthcare. This study also determined the association of sociodemographic variables with factors influencing the parent's decision. Materials and Methods: A cross-sectional study was undertaken among 146 parents of children aged 0 to 13 years who sought-patient services at a paediatrics department of a tertiary care center in Chennai between July 2023 to October 2023. The Validated semi structured questionnaire was administered. Results: In the present study, mean age group of the study population is 29±4, among them 69% were female and 31% were male. Sociodemographic variables, namely younger age, female gender, middle monthly income, and higher educational status, are influential in the parent's decision-making process for selecting a health care center. Conclusion: Although parents may lack the ability to assess all facets of care and treatment, their perspectives contribute immensely to the interpersonal aspect of care, communication, information, and care organization. The present study has yielded significant results that enhance the knowledge base of practitioners, managers, and other professionals tasked with delivering pediatrics general practice services.

Child healthcare nurses' experience of communication with 4-year-old children during their visit to the child health care center.

To illuminate child healthcare nurses' experiences of communication with 4-year-old children during their visit to the child healthcare center. A qualitative method, using data collected from individual interviews. Fifteen semistructured interviews with nurses working in a child healthcare center. The results were analyzed using reflexive thematic analysis. The analysis resulted in three themes and eight subthemes: Adapting to the child in the conversation, based on the subthemes Preparing for the visit, Listening in and observing, and Creating a welcoming environment; Combining strategies for the conversation, based on the subthemes Engaging the child, Using visual tools, and Parental involvement; and Challenges due to language barriers, based on the subthemes Using an interpreter and Parent acts as interpreter. Child healthcare nurses focus on the child when communicating and strive to create joy and a welcoming environment. The communication strategies employed during the visit include engaging the child directly, involving parents in the conversation, and balancing the parental involvement. Communication challenges related to language barriers are addressed, particularly during interpreter-assisted conversations. The study indicates a need for tailored strategies, collaboration, and sensitivity to ensure a child-centered approach.

Partners' experiences of breastfeeding: a qualitative evaluation of a breastfeeding support intervention in Sweden.

The World Health Organization states that women and their families need breastfeeding support from the healthcare system. However, knowledge about the most effective way to involve the partner in breastfeeding is lacking. A qualitative evaluation can provide insight and knowledge about the partner's experiences towards a breastfeeding support intervention and thus contribute to how forthcoming breastfeeding support policies are designed. The aim of this study was to explore partners' experiences regarding breastfeeding while participating in The Breastfeeding Study. An exploratory, longitudinal and qualitative design was used. This study was part of The Breastfeeding Study, which took place in Sweden. The intervention was performed in line with the Ten Steps to Successful Breastfeeding. Partners in the in the intervention group (IG) were part of a structured breastfeeding support programme. An individual breastfeeding plan was established in cooperation with the parents-to-be during pregnancy, and the plan was followed up at the child healthcare centre. A purposive sample was recruited from March to December 2021. Interviews and diary entries from IG (n = 8) and control group (CG) (n = 8) during pregnancy and 2 months after birth were analysed by content analysis, in accordance with the COREQ guidelines. Partners' experiences can be summarised under the main category of 'Striving to be part of the family and important that the family's everyday life was well-functioning'. IG partners experienced that both parents were involved and cooperated in the breastfeeding process and that guidance from healthcare professionals (HCPs) helped them to feel secure. CG partners experienced feeling excluded and not receiving support from HCPs. Both parents need to be targeted in breastfeeding support policies to meet the support needs. Midwives at antenatal care and child healthcare nurses at the child healthcare centre have important roles to play in providing structured breastfeeding support and a breastfeeding plan. Both IG and CG partners strived to become a part of the infant's life and to make family life work. Midwives should involve both parents in a reflective dialogue on how the partner can be involved, apart from just feeding the infant. Retrospectively registered in ACTRN12623000648628.

To capture the child’s interest - nurses experiences of ‘Saga stories in health talks’

BackgroundAs unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. ‘Saga Stories in health talks’ is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the ‘Saga Stories in health talks’ material.MethodsThis study used a qualitative design. The material ‘Saga Stories in health talks’ was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.ResultsThree categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children’s interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks’ was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child’s interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.ConclusionsThis pilot study show that the material ‘Saga Stories in health talks’ was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

The first three years: The association of early postpartum depressive symptoms with infant and toddler development.

The influence of postpartum depression (PPD) on child development has been a source of professional interest and practical relevance. This study investigated the association of early PPD symptoms with developmental domains. This historical cohort study included 574,282 children attending Mother Child Healthcare Centers in Israel from January 1, 2014 to July 31, 2020, who underwent at least one developmental screening examination by public health nurses up to age 36 months, and whose mothers completed the Edinburgh Postnatal Depression Scale (EPDS) postnatally. Developmental milestone tasks included four domains: fine and gross motor, language/communication, and social/behavioral. The rate of failure to complete age-appropriate tasks was higher among children whose mothers had scored≥10 on the EPDS on the majority of tasks in every domain. This large population-based study has demonstrated the association between early maternal postnatal depressive symptoms and failure to meet developmental milestones across domains, until three years. Recommendations for practice focus on the mother, the child, and health policy.

The more diverse the better: Identifying with a diverse neighbourhood mother community predicts greater intergroup contact

AbstractAlthough it has been shown that identification with a neighbourhood community can support intergroup relations within the community by providing resources to cope with intergroup contact, previous research has not investigated how the perceived diversity of the neighbourhood identity influences this process. This study extends research on neighbourhood identification by focusing on a specific group (mothers of small children), examining how and when identification with other mothers living in the same neighbourhood is related to intergroup contact with local outgroup mothers. We examined this in a survey study, for which we collected data from both Finnish majority and immigrant mothers at public maternal and child healthcare centres (N = 733). Our study showed that identification with the neighbourhood mother community was positively associated with intergroup contact, partly via perceived social support from other neighbourhood mothers for both Finnish majority and immigrant mothers. Our study additionally revealed that the perceived proportion of outgroup mothers in the local mother community moderated the relationship between identification and intergroup contact for both groups. Our findings highlight the significance of considering perceived diversity for determining when identification will support intergroup contact. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Parental views and the key role of nurses for high vaccine acceptance in Sweden – a focus group study

BackgroundIn Sweden, vaccine uptake is exceptionally high due to an efficient child immunization program. More than 97% of Swedish children were vaccinated at child health care centers (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within the school health care. Maintaining high vaccination coverage over time is one of the central motives to explore and understand drivers for vaccine acceptance. The current study aimed to assess parental vaccine acceptance concerning the national immunization program and explore factors contributing to the high vaccine acceptance in Sweden.MethodsParents of children aged 1–2 years and 8–12 years were recruited through purposive sampling and asked to participate in focus groups held in three cities in Sweden, in February and March 2019. In total, 47 parents participated in two focus groups per city, one session for parents of younger (1–2 years) and older (8–12 years) children respectively. The focus group discussions were analyzed using qualitative content analysis.ResultsParents of children aged 1–2 years expressed the themes; strong compliance to and protection of the value of vaccinations; parents feel safe with an attentive relationship with their nurse; the spectrum of communication needs is essential to meet.For parents to children aged 8–12 years, the themes expressed were; vaccinate to do good for the individual and society; a foundation of trust is built at CHCs for decisions later on; decisions for vaccination become more complex as children get older; communication changes as children get older and need to be explicit and tailored to the situation.ConclusionBoth individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations, as manifested in parental reflections and experiences. As nurses have a key role, it is important to provide them with continued support and tools to facilitate their support for parents in making informed decisions. Continuous work for supporting driving factors for vaccination over time is needed to maintain high vaccine acceptance in Sweden.

Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support: A pre-post intervention study

ObjectiveTo describe healthcare professional's (HCP's) perceived self-efficacy in their ability to provide breastfeeding support before and after a breastfeeding training program. DesignPre-post intervention study. SettingAntenatal care and child healthcare (CHC) centres in Sweden during 2020. ParticipantsAn intervention group consisting of 39 HCPs (midwives 51.3%, child healthcare nurses 46.2%) completing a questionnaire at baseline and after intervention, and a control group of 34 HCPs (midwives 61.8%, child healthcare nurses 38.2%) completing a questionnaire at baseline. InterventionA breastfeeding training program in line with the Ten Steps to Successful Breastfeeding and WHO recommendations about breastfeeding. Measurements and findingsThe 11-item Breastfeeding Support Confidence Scale (BSCS) measures HCP's self-efficacy regarding providing breastfeeding support in line with Ten Steps to Successful Breastfeeding and WHO recommendations. The intervention group experienced a significantly increased self-efficacy from pre-intervention to post-intervention for 8 of the 11 BSCS items, with the overall BSCS index score increasing from 36.87 to 39.56 points (p = 0.001). The index score in the intervention group at follow-up was significantly higher than the corresponding score in the control group at baseline (p = 0.025). The intervention group had significantly higher scores at follow-up than the control group at baseline on the questions: “I'm sure that I can help mothers continue to breastfeed even if the infant doesn't follow the growth curve” (p = 0.026) and “I'm sure that I can help mothers continue to breastfeed when the breastfeeding is painful” (p = 0.048). Key conclusionsThe breastfeeding training program improved HCP’ self-efficacy to provide evidence-based support to breastfeeding mothers. Implications for practiceThis training program is well suited to implement in clinical practice and follows the Ten Steps to Successful Breastfeeding. Trial registrationACTRN12623000648628

Development and validation of a questionnaire for assessing parents’ health literacy regarding vision screening for children: a Delphi study

Preschool vision screening is recommended to reduce the incidence of amblyopia that persists into adulthood. However, parent’s perceptions regarding the importance of screening and early intervention may constitute a significant barrier to seeking vision exams and pursuing treatment. The aim of this study is to develop and validate a questionnaire for assessing parent’s awareness, perception and health literacy of children's vision tests. The questionnaire was developed using the Delphi method with experts from the fields of pediatric ophthalmology, optometry, orthoptics, pediatric medicine, social sciences and Mother and Child Health Care centers. Experts were provided with drafts of the questions iteratively in three rounds until a consensus was reached independently on the relevant items, coherently language and redundancies. For the first, second and third stages of the Delphi process, 17, 15 and 13 experts participated in the panel respectively. Validity was achieved by wide consensus among the panel on the relevance of each question, of 75%, 85% and 90%, for the three rounds respectively. Here we describe the final questionnaire, EYES: Evaluating Young-Children Eye health Survey, which includes 31 questions regarding demographics, ocular history, parental health literacy, and perceptions of vision and vison exams.

Health, social, and dental professionals’ experiences of working within an extended home-visit program in the child healthcare: a qualitative interview study in Sweden

BackgroundThe goal of the Swedish child healthcare system is to reach all children with health-promotive actions and to create equal health opportunities for all children. In that context, an extended home-visit program – called Grow Safely – for first-time parents, with an interprofessional collaboration between child healthcare nurses, midwives, social workers, and dental assistants, was initiated. The current study aims at illuminating and evaluating the health, social, and dental professionals’ experiences of working within this program and how such collaboration could benefit the professions.MethodsA qualitative method was chosen, and 13 interviews were carried out with professionals working within child healthcare centers that participated in an extended home-visit program in the southernmost part of Sweden. The interviews were analyzed via Burnard’s approach to content analysis.ResultsThe results showed that it was satisfying for the health, social, and dental professionals to work with the home-visit program and that they encountered positive feelings among the parents receiving it. The creation of deep conversations and parents opening up about feelings that could otherwise be shameful to express, was a positive aspect of the home visits. A negative aspect was the difficulty of handling the (sometimes necessary) interpretation over the phone during the visits, and another one was the fact that the visits were time-consuming and required logistical planning. Overall, the professionals were positive about the home-visit program in that they felt that they were able to give the families what they needed and to have discussions on sensitive issues. They also appreciated the fact that different professions collaborated in order to reach the same goal.ConclusionsThis study showed that the health, social, and dental professionals enjoyed working with the home-visit program and that they encountered positive feelings among the parents regarding the collaborative visits being conducted within the home, where the families felt safe and relaxed. The professionals expressed that the home visits, despite the extended time they required and the logistical challenges involved, created a deeper collaboration between the professionals.