Family Perspective Research Articles

The Pattern and Determinants of Overweight and Obesity among Adult Patients at the General Outpatient Clinic of Federal Medical Centre Makurdi: The Family Perspective

Background: This study examined the prevalence, patterns, and determinants of overweight and obesity among adult patients attending the general outpatient clinic at Federal Medical Centre (FMC) Makurdi, Benue State, Nigeria. Methods: This was a cross-sectional study of two hundred and ninety-six adult patients aged 18 years and above, selected by systematic random sampling method. Data was collected using an interviewer-administered questionnaire. Weight and height were measured. The non-modifiable, modifiable risk factors of obesity and body mass index were assessed. Chi-square was used to test for significant association between categorical variables and multivariate logistic regression to verify the independent factors associated with overweight and obesity. All statistical analysis was done using SPSS version 21 and were significant at p<0.05 and a 95% confidence interval. Results: The mean age of participants was 39 13 years. The prevalence of overweight and obesity among the study participants was 40.9% and 30.4%, respectively. Overweight and obesity were significantly associated with age (P=0.017) marital status (P=0.017), employment status (P=0.014), monthly income (P=0.040), exercise (P=0.002) and frequency of exercise (P=0.001). Being in government employment (6.945, P=0.035, CI 1.141 – 42.2777) and earning between N54,000.00 and N90,000.00 monthly (11.097 P=0.017 CI 1.541 – 79.927) were independent determinants of overweight and obesity. Conclusion The study showed that a significant proportion of adults in the study population were overweight and obese. Most of the study participants did not routinely engage in healthy lifestyle. It is therefore vital for Family Physicians to routinely screen for overweight and obesity and offer health education and counselling on lifestyle modification to individuals and their families.

The routine and mental health of hospitalized children with cancer: family perspectives

RESUMO Objetivo: Compreender a rotina e as implicações à saúde mental de crianças com câncer hospitalizadas, na perspectiva dos familiares. Método: Pesquisa qualitativa, realizada com 11 familiares de crianças hospitalizadas em uma unidade de internação oncopediátrica, durante o mês de setembro de 2022. Os dados foram produzidos por meio de entrevistas semiestruturadas e analisados conforme Análise Temática de Minayo. Emergiram duas categorias: “A rotina da criança durante a hospitalização” e “A saúde mental da criança durante a hospitalização”. Resultados: Na rotina da criança, os participantes perceberam mudanças provocadas pelo ambiente hospitalar que não coincidem com a dinâmica familiar, no entanto, a presença da equipe multiprofissional atenua o estranhamento vivenciado nesse processo. Em relação à saúde mental, entre os sentimentos experienciados pelas crianças surgiram raiva, saudade e tristeza, repercutindo em comportamentos como desânimo e agressividade. Essas repercussões possuem interface com o entendimento confuso da criança sobre a sua doença. Considerações Finais: As perspectivas dos familiares contribuíram para a reflexão sobre o processo de saúde e doença de pacientes pediátricos em tratamento oncológico, em virtude dos mesmos desempenharem um papel essencial no cuidado, acompanhando de perto tudo aquilo que emerge no dia a dia dessas crianças no ambiente hospitalar.

Kvalitet života porodica dece sa smetnjama u razvoju

Introduction. Quality of life can be defined as a concept that broadly measures one's experience in relation to that person's hopes and aspirations. This definition can be applied to both an individual and a family perspective. Objectives. This research aimed to examine the quality of life of families of children with developmental disabilities and the interrelationship between family quality of life and certain socio-demographic characteristics of the family and the child. The socio-demographic characteristics of the family and the child include family structure, i.e., the total number of family members, the number of adults and the number of children in the family; material conditions, i.e., average monthly income and number of family members who earn money; place of living; availability of family support services; as well as the type of developmental disabilities and the age of the child with developmental disabilities. Methods. The research sample consists of 42 parents of children with developmental disabilities, and the control group consists of 63 parents of children with typical development. The Family Quality of Life Scale was used to assess family quality of life (Beach Center Family Quality of Life Scale - Beach FQOL Scale). Results. The results of the research showed that families of children with developmental disabilities have a significantly lower level of family quality of life compared to families of children with typical development, with the Emotional Well-being domain being the worst rated. In an effort to understand differences in family quality of life, additional analyses were conducted on relationships with certain socio-demographic characteristics of families. Conclusion. The findings suggest that the quality of life of families of children with developmental disabilities is influenced by the average monthly income, family structure, and the use of family support services, while no relationship was found between the level of family quality of life and place of residence, the number of persons in the family providing for the family, the type of developmental disabilities and the age of the child with disabilities.

The routine and mental health of hospitalized children with cancer: family perspectives.

To understand the routine and implications on the mental health of hospitalized children with cancer, from the perspective of family members. Qualitative research, carried out with 11 relatives of children hospitalized in an oncopediatric inpatient unit, during the month of September 2022. The information was produced through semi-structured interviews and was analyzed according to Minayo's Thematic Analysis, emerging two categories: "The child's routine during hospitalization" and "The child's mental health during hospitalization". In the child's routine, participants noticed changes caused by the hospital environment that do not coincide with family dynamics. However, the presence of the multidisciplinary team mitigates the strangeness experienced in this process. Regarding mental health, the feelings experienced by these children included anger, longing, and sadness, resulting in behaviors such as discouragement and aggression. These repercussions are associated with the child's confused understanding of their illness. The perspectives of family members contributed for a reflection on the health and illness process of pediatric patients undergoing cancer treatments, as they play an essential role in care, closely monitoring everything that comes to pass in the daily lives of these children in the hospital environment.

Mapping frameworks for synthesizing qualitative evidence in health technology assessment.

Health Technology Assessment (HTA) practitioners recognize the significance of qualitative methodologies that focus on how a technology is feasible, meaningfulness, acceptable, and equitable. This mapping aimed to delineate the frameworks employed to synthesize qualitative evidence and assess the quality of synthesis in HTA . Mapping was conducted using Medline, LILACS, CINAHL, Embase, Web of Science, Scopus, PsycINFO, Cochrane Library, JBI, and ScienceDirect databases. Gray literature searches included PROQUEST, Open Grey, Canadian Agency for Drugs and Technologies in Health's Grey Matters, Google Scholar, and HTA agency websites. The inclusion criteria were centered on global qualitative evidence synthesis frameworks. The data are presented in the tables. Of the 2054 articles, 31 were included, mostly from Europe. Guide was the type of document more cited, and most authors are from HTA agencies and universities. Incorporating both patient and family perspectives is the most cited reason for include qualitative evidence. Regardless of the framework or tool, SPICE was the main acronym, and RETREAT was preferred for approach selection. Thematic synthesis dominated analytic methods, and CASP was the primary quality appraisal tool. GRADE-CERQual graded evidence synthesis, with ENTREQ as the top reporting guidance. The GRADE evidence-to-decision framework was mentioned for recommendations. This mapping highlights the movement incorporate qualitative evidence in HTA employing specific frameworks. Despite the similarities among documents, most of them describe part of the process to synthesize qualitative evidence. Standardizing procedures to incorporate qualitative evidence into HTA can enhance decision-making. These findings offer essential considerations for HTA practice.

Exploring the world of food with families: perspectives of low-income families on factors influencing their food choices.

The aim of this study was to investigate the social and environmental factors involved in the food decision-making processes of families living on lower incomes on the Island of Ireland. A qualitative design was employed for this study, using photovoice and creative mapping methods. Parents were requested to take photos and draw maps of their food environments. Interviews were then conducted with parents, using the materials produced by parents as a cue to discuss their food environments, influences and decision-making processes around food choices. The participants were interviewed online via Microsoft Teams. The participants were parents or guardians of children between the ages of 2 and 18 who self-defined as 'living on a tight budget'. Twenty-eight participants were recruited and interviewed for this study, including twelve parents in Northern Ireland and sixteen in the Republic of Ireland. The findings were mapped on to Bronfenbrenner's Ecological Systems Theory and showed that multiple, overlapping and intersecting factors at the individual, micro-, meso-, exo-, macro- and chrono-system were implicated in family food choices. Upstream factors in particular, including structural, policy and commercial determinants, appear to be significant drivers of behaviour. While the findings suggest that a complex range of factors are involved in family food choices, it is clear that policy measures and regulations are needed to stave off the impacts of rising social inequality and food poverty. Health promoters should strive to find non-stigmatising interventions to bridge the nutritional divide experienced by lower-income families.

A qualitative study of health visitors' family focused practice with mothers with mental illness in Northern Ireland: Perspectives of health visitors, mothers and partners.

Despite benefits of family focused practice, little is known about health visitor's practice with families when mothers are mentally unwell. Health visitors are midwives and nurses with additional training in community public health. To explore multiple perspectives of health visitor's family focused practice with families when mothers have mental illness in Northern Ireland. Ten health visitors, 11 mothers with mental illness and seven partners completed in-depth interviews in Five Health and Social Care Trusts. Participants were asked to describe their experiences of providing or receiving family focused practice within health visiting and data was analysed using thematic analysis. Health visitors primarily addressed mothers and children's needs rather than also supporting partners. Additionally, they only addressed mother's needs associated with less severe mental illness (i.e. postnatal depression). Health visitors and mothers converged on many issues, including the influence of the health visitor's personal and professional experiences on their practice, central role of the relationship between health visitors and mothers and importance of health visitors supporting partner's well-being. While partners did not perceive that health visitors should support their well-being they expressed a need for further information and knowledge in order to support mothers. Health visitor's practice largely centres around mother and baby. For health visitors to increase their family focused practice they need to meet needs of mothers who have serious mental illness more effectively and consider how partners can be included in their practice, in a manner that is beneficial and acceptable to them. This study contributes to better understanding of health visitor's family focused practice with mentally ill mothers and highlights the need for more effective engagement with mothers with serious mental illness and partners. It also highlights that for health visitors to engage in family focused practice they need the necessary training and time to do so. Results can inform organisational developments in family focused practice within health visiting.

Commentary: Can an effective end-of-life intervention for advanced dementia be viewed as moral?

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia.

Good Death and Quality of End-of-Life Care in Patients with Coexisting Cancer and Dementia: Perspective of Bereaved Families.

Patients with coexisting cancer and dementia often have complex health care needs and face challenges in achieving a good death. To evaluate good death achievement and end-of-life (EOL) care in patients with coexisting cancer and dementia from the perspective of bereaved families. Cross-sectional nationwide postal survey. Bereaved families of patients with cancer who died in hospice and palliative care units across Japan. Bereaved families completed an anonymous, self-reported questionnaire. Their perspective on achieving a good death was assessed using the Good Death Inventory (GDI) (total score: 18-126). The Revised Care Evaluation Scale-short version (CES2) was used to assess EOL care (total score: 10-60). We examined the Brief Grief Questionnaire (BGQ) (total score: 0-10) and Patient Health Questionnaire 9 (PHQ9) (total score: 0-27). Data from 670 participants were analyzed, including 83 (12.4%) bereaved families of patients with coexisting cancer and dementia. No statistical differences were observed in the total GDI score for 18 items (dementia comorbidity vs. nondementia comorbidity groups, mean ± standard deviation, respectively, 78.4 ± 17.7 vs. 80.0 ± 15.5, adjusted [adj] P = 0.186), CES2 score (49.70 ± 9.22 vs. 48.82 ± 8.40, adj P = 0.316), BGQ score (3.40 ± 2.41 vs. 4.36 ± 2.28, adj P = 0.060), and PHQ9 score (4.67 ± 4.71 vs. 5.50 ± 5.37, adj P = 0.788). GDI, CES2, BGQ, and PHQ9 scores did not differ significantly between groups, regardless of the presence of dementia in hospice and palliative care units. Patients with coexisting cancer and dementia can achieve a good death by high-quality EOL care.

Goal setting for family firm owners: An agency-stewardship perspective

Goal setting for family firms is a vital activity since the performance of businesses is measured against their goals. Using prior research on goal-setting in the context of family firms, this narrative literature review paper aims to bring forth, the importance of goal-setting specific to family business owners who straddle family and business. A review of family-business literature indicates that using the three-circle model comprising family, business, and ownership as the base theory, goal setting in family firms has been examined from the perspective of whether they are economic or non-economic and whether they are family-oriented or business-oriented. Both these approaches to family business goal setting are based on the ideology that the unique feature of family businesses is that they aim to satisfy two groups of stakeholders — family members and business members. While family and business perspectives are captured in these two approaches, goal setting from an owner’s perspective has been largely ignored. Rooted in the concept of corporate responsibility, the agency-stewardship framework is emerging as an alternative perspective for family businesses and hence is proposed as a useful dominant logic framework for decisions on goal setting. This conceptual paper based on a narrative literature review aims to present the agency-stewardship framework as a relevant and important lens in the two most important decision contexts of family businesses, i.e., governance and succession. The paper exemplifies how the agency-stewardship continuum can be used for goal setting to nurture next-generation family business leaders and manage family business operations through goal setting in governance policies and succession processes.

Family and caregiver perspectives on gene therapy for Rett syndrome

IntroductionRett syndrome (RTT) is a neurodevelopmental disorder that primarily affects females and can result in cognitive impairment, seizures, spasticity, breathing problems, gastrointestinal issues, motor impairment, and behavioral concerns. Gene therapy may be a potential treatment in the future as clinical trials are underway. AimThis study evaluates the attitudes and opinions of family members and caregivers of patients with RTT towards gene therapy using a mixed-method approach. MethodsSixty-six caregivers of individuals with RTT completed an online survey asking about their previous experience in research and questions about their understanding of gene therapy, their expectations, as well as their hopes and concerns for treating RTT. Ten respondents also participated in online focus groups, which were evaluated using thematic analysis. ResultsOverall, most participants (95.5 %) had heard about gene therapy. More than half of the respondents (68.2 %) reported being somewhat knowledgeable about gene therapy, and 18.2 % reported no understanding of gene therapy. When asked the highest level of risk they would accept when enrolling the individual with Rett syndrome in a gene therapy clinical trial, 47.7 % stated they would accept a low risk, and 7.7 % indicated they would accept a high risk. In the focus groups, individuals discussed barriers to gene therapy, their hopes and concerns regarding gene therapy treatment, and how they would like to receive information about future research and therapies. Participants had concerns about possible side effects of gene therapy, including physical and mental harm, a potential decrease in quality of life, whether individuals with RTT would want to “change who they are,” and the irreversibility of the treatment. ConclusionAlthough most participants have heard about gene therapy, many caregivers would only accept a low risk when considering gene therapy for the individual with RTT. This could be in part due to concerns about side effects and potential harm to the patient as well as anticipated barriers related to cost and accessibility to appropriate follow-up care. Understanding caregiver opinions is important in setting goals and evaluating the success of current studies, identifying and addressing barriers to trials and treatment, and in the development and implementation of educational resources for gene therapy in RTT.

Families experiencing homelessness and the production of everyday urban space in Buenos Aires, Argentina (2017-2022)

This article analyzes the production of space from the perspective of families experiencing homelessness who live in the Buenos Aires, the capital of Argentina. Based on census data and twelve in-depth interviews carried out in 2022, it explores the demographic, the infrastructure they use daily, their reasons for staying in a particular place, their routines, their social networks, and finally, the way they outfit their living area. In terms of housing trajectories, the article shows how those families alternate between boarding houses, shelters, and the street. This vicious circle of poverty is reinforced by public policies that provide only temporary assistance to cover a boarding house room or shelter. The analysis draws on Henri Lefebvre’s notion of “the production of space” and his triad of conceived, lived and perceived space as well as Angela Giglia’s concept of “inhabiting” [habitar].

“Devastating…Having My Child on the Opposite Side of a Window”: Family Visiting Experiences and Considerations for Supporting Youths with Incarcerated Parents

Most people who are incarcerated in the US are parents, yet little is known about the context and experiences of family connection when a parent is incarcerated. This study aims to provide family perspectives and experiences during a parent’s incarceration for providers and organizations to consider when supporting children who have incarcerated parent(s) and their families throughout incarceration. From March to August 2020, we recruited adolescents (12–18 years) who have or had a parent incarcerated, caregivers of children of incarcerated parents, and parents upon one year of release. Families were recruited by emailing flyers to community-based organizations and schools using convenience-based and snowball recruitment methods. Participants were interviewed using a semi-structured interview guide. We interviewed 26 participants: 10 youth, 6 parents released from incarceration in the last year, and 10 caregivers, who mainly resided in the state of Ohio. Three themes emerged during the incarceration phase: the high cost of parental incarceration (financial, emotional, and visiting), barriers to connection (intimidating and strict process, physical barriers, quality of phone calls), and family resource suggestions (age and developmental communication resources, community-based supports, stigma reduction). Families primarily discussed these themes along with the need for additional individual and community-based supports. Findings relay the importance of family-centered interventions during incarceration to reduce barriers to staying connected. We discuss families’ suggestions on supportive services to help the family unit access resources and improve communication during incarceration, to better support the next phase of transition, reintegrating back into society.

Genetic variation and recombination analysis of PRRSV-2 GP3 gene in China from 1996 to 2023.

Porcine reproductive and respiratory syndrome virus (PRRSV) has become widespread in China particularly the highly pathogenic porcine reproductive and respiratory syndromes (HP-PRRSV), NADC30, and NADC34 strains, and has posed a threat to the swine industry for over 20 years. To monitor genetic variation in PRRSV-2 GP3 strains in China, we analyzed 618 strains isolated between 1996 to 2023 and constructed phylogenetic trees. Additionally, 60 selected strains were used to analyze nucleotide and amino acid homology. PRRSV GP3 gene exhibited nucleotide identity ranging from 78.2% to 100.0% and amino acid similarity ranging from 74.9% to 99.6%. The GP3 gene in the 60 selected strains consisted of 254 amino acids, and amino acid mutations in the strains primarily occurred in B-cell epitopes, T-cell epitopes, and highly variable regions. The glycosylation sites of the strains used for amino acid sequence comparisons remained unaltered, except for the N29 site in the GD20220303-2022 strain. PRRSV-2 strains in China belong to lineages 1, 3, 5, and 8. Recombination analysis detected two recombination events, involving lineages 1 and 8. In conclusion, this study investigated multiple strains of the PRRSV-2 GP3 gene to explore the prevalence and genetic diversity of the GP3 gene in China from a gene family perspective. The results of the analyses provide a basis for clinical prevention strategies and vaccine development.

Assessment of an intervention for preventing pediatric overweight and obesity through the World Café technique: A qualitative study

PurposeTo evaluate the self-reported perspectives of participants involved in the Previene Cádiz intervention for preventing pediatric overweight and obesity. Design and methodsThis qualitative study collected information through the World Café technique. A purposive sample of 40 participants was used, of which 14 were schoolchildren, 12 were teachers, and 14 were parent volunteers. The data were segmented, and concepts were created and grouped into dimensions and categories. ResultsThe participants confirmed they had learned new information and behaviors about healthy habits. Parental awareness was considered a crucial and necessary element in changing family habits; therefore, increasing the motivation of family members was deemed a critical task in public health interventions conducted in school settings. DiscussionDespite the suitability of qualitative methodology to evaluate the perceptions of the main players in an educational intervention, scientific literature is scarce. Obtaining information from the educational community about an intervention is not always easy, so the perspectives of teachers, students, and families about the Previene Cádiz intervention through the World Café approach is considered a relevant contribution. ConclusionsThe participants considered the intervention positive in terms of learning and fostering increased knowledge, awareness, and healthy behaviors. Practice implicationsFuture interventions should encourage the active participation of all social groups involved, integrating dynamic and collaborative training activities that are acceptable to all participants.

School management team and inclusion: the perspective of families and teachers in the Spanish context

ABSTRACT School leaders play a key role in improving inclusion in schools. However, information on the practices promoted by headteachers to promote inclusion in their institutions is still scarce. The article analyses the degree of implementation of actions undertaken by principals to favor inclusion in compulsory education schools from the perspective of families and teaching teams. 631 families and 420 teachers from the city of Granada (Spain) participated in the research. It is a quantitative study and follows a comparative design based on survey. In order to collect information the questionnaire Leading Inclusive Education in Compulsory Education Schools was used in its two versions (LIE-Q-Teaching Team and LIE-Q-Families). The data obtained were subjected to both descriptive and inferential analysis. The results reveal that, in the opinion of teachers and families, most actions implemented by school headteachers to favor inclusion, are those that favor the opening of the school to the community and its surroundings. The study has made it possible to verify, among other things, that there are differences in the perception of the inclusion practices of school leaders in compulsory education depending on the group analyzed (family or teaching teams).

Pathology in children with congenital cleft lip and palate.

In children with congenital cleft lip and palate (CCLP), under the influence of endogenous (hereditary) or exogenous (causing disruption of embryogenesis) factors, changes occur in various organs and systems of the body. The commonality of CGN with multiple organ pathologies in the body is explained by the presence of connective tissue dysplasia (CTD). The formation of the multifactorial nature of CGN is realized due to the genetic susceptibility of the organism to the action of externally damaging environmental factors in relation to the fetus. In 75% of children, CRHN is an isolated congenital defect, but it can be combined with other congenital defects. The data presented in the article may be useful for the development of preventive and therapeutic measures, in the prognosis and management of children with this pathology from an individual professional and family perspective.

Adolescents with neuropsychiatric symptoms in the turmoil of the service system: The NEPSOS interdisciplinary study of social work, adolescent psychiatry, special education, and expert organisations

Existing social, health and education services do not respond to the needs of adolescents with neuropsychiatric symptoms. These services are usually fragmented and their professionals’ expertise is insufficient. In this interprofessional context, the integration of specialisations, multidisciplinary expertise and knowledge is a challenge. In the NEPSOS study, we explore the services aimed at and service needs of adolescents with neuropsychiatric symptoms and their families. The NEPSOS study is collaboratively designed and carried out by experts from the University of Turku and the University of Eastern Finland, including researchers of adolescent psychiatry, social work and special education, as well as expert organisations such as the Southwest Finland Centre of Excellence on Social Welfare and the Nationwide Association of Different Learners. These organisations provide their expertise for the implementation and integration of the research results into the service system and the development of recommendations. 
 In this study, the appropriateness of services and service paths are examined from the perspectives of adolescents and families, professionals and interprofessional collaboration. The study has four different lines. Line 1 examines the relationships between a) the socio-economic status of the parent and the situation of the adolescent and b) neuropsychiatric symptoms and child protection support measures. Line 2 examines the experiences and views of adolescents and their parents concerning the functionality of the service system and the functional forms of psychosocial support. Line 3 studies the professionals’ perspectives on the functionality of the service system and interprofessional collaboration in the context of adolescent service paths. Line 4 focuses on communication and interaction activities, including the implementation of the research results.
 The NEPSOS study will provide knowledge and deepen the understanding of the following topics:
 •How interprofessional cooperation is implemented in the service paths for adolescents with neuropsychiatric symptoms from the perspective of professionals from the fields of social work, adolescent psychiatry and education.
 •How existing service networks meet the needs of adolescents and their families, and what kind of psychosocial support is provided to them by the professionals of social work, adolescent psychiatry, and special education. 
 •How psychosocial services and interprofessional collaboration are performed to improve the timeliness, targeting and integration of services for adolescents with neuropsychiatric symptoms and their families.
 Furthermore, the impact of this study’s findings will be manifested as practical recommendations and training materials for professionals. The NEPSOS study forms part of an interdisciplinary research consortium whose ongoing and future studies specifically aim at strengthening the integration of social care, health care and education for the health and wellbeing of children and families. Our experiences regarding interdisciplinary collaboration and the future results of the study can be applied internationally both in higher education and the integration of child social, health and education services.
 Keywords: neuropsychiatric symptoms, adolescents, interdisciplinary collaboration, social work, adolescent psychiatry, special education.

Integration of maternity care as a part of social welfare and health care reform in Finland

Introduction: The vertical integration of primary and specialized care has been identified as a key challenge internationally. In Finland, 23 wellbeing services counties will be responsible for organizing integrated social and health care of primary and specialized care starting 2023. Primary maternity care services are offered in antenatal clinics. Specialized care is offered at 23 maternity hospitals including specialized ante- and postnatal care and childbirth. Specialized maternity care has been burdened due to the ever-increasing number of visits and the insufficient information flow between primary and specialized care. In some wellbeing services counties, services have already been integrated, but no information is available whether this integration has improved processes, outcomes or customer satisfaction. 
 Aims and methods: The first aim is to investigate whether there are differences in maternity care service processes, outcomes and customer satisfaction between the wellbeing services counties. The second aim is to find out perceptions of maternity care managers about the integration of maternity care. Three data sets will be used: the Finnish Medical Birth Register data on all newborns in Finland in 2021 (N=49 726), FinChildren survey on parents with 3-6 months old babies (N=14 820) and qualitative thematic interview among maternity care managers (N=8). All data have been collected and analysis of register and survey data is ongoing. Interview data have been analyzed. 
 Highlights: There are differences in the outcomes and customer satisfaction between the wellbeing services counties. However, more detailed data analyses are needed by adjusting for the most evident confounders and comparing the counties with integrated care to the other counties. These results will be presented at the conference. Maternity care managers felt that the structures within maternity care together with organizational boundaries pose a challenge to integration. Political decision-making was considered to have an influence on maternity care structures. Furthermore, more expertise in maternity care was expected from policy makers to support decision-making. Shared maternity care structure, management, and information systems were seen as factors promoting integration. A partial ambiguity or overlap in the roles between maternity clinics and maternity care at hospitals was observed, as well as inter-professional tensions between public health nurses who are working on primary maternity care and midwives who are working both in primary and specialized maternity care.
 Conclusions: The maternity care system should be more integrated in terms of governance structures, resources, and management. The expertise of maternity care professionals should be utilized in a customer-oriented and cost-effective way. More conclusions will be drawn after finalizing the quantitative analyses.
 Implications: New models of integrated maternity care should be developed, paying attention to the optimal continuity of care from the perspective of pregnant mothers and families. The results of this study can be used to develop the maternity care systems in different countries.

Funds of knowledge: Towards an asset‐based approach to refugee education and family engagement in England

AbstractThis paper reports findings from a doctoral study that investigated how young refugees and their families encounter England's education system. All children have the right to education in England; however, there are no specific educational policies for young refugees' education. Their invisibility in policy makes it more challenging for them to access appropriate support and contributes to them being portrayed through a deficit‐based lens. Due to limited school–home partnerships, educators may often be unaware that people with ‘refugee’ and ‘asylum seeker’ statuses face various barriers in and outside of school, further disadvantaging them. In this doctoral research, I drew on the concept of funds of knowledge (FofK) to highlight young refugees' and their families' practices and knowledge(s). I conducted a critical ethnography combined with arts‐based activities to investigate young people's and their families' experiences and perspectives of education. Based on the research findings, I argue that families' FofK can be used as resources for teaching and learning and to help overcome deficit‐based views of young learners. An FofK framework may help schools establish young people's and families' expectations, understand their circumstances in England and build deeper school–home partnerships.