Preventive Child Health Care Research Articles

SDQ bruikbaar voor jongeren tot achttien jaar

In Dutch Preventive Child Healthcare (Jeugdgezondheidszorg), the Strengths and Difficulties Questionnaire (SDQ) is used to identify adolescents with psychosocial problems. Research shows that the SDQ, especially the parent-reported version, is useful among 12- to 17-year-olds.

Parental engagement in preventive youth health care: Effect evaluation

• Inadequate identification of families care needs leads to sub-optimal care. • A novel methodology GIZ for joint assessment of care needs was developed. • The current study evaluated the effects of GIZ within preventive child health care. • GIZ has positive effects on discussing parenting and environmental circumstances, • On the parent-professional agreement and parental satisfaction. It is common for parents to have concerns or questions regarding their child. However, parental concerns are not always recognised by the youth healthcare professional. At the same time, not all parents agree with concerns identified by the professional. Identifying and agreeing on concerns is an essential step in the assessment of care needs within child health care. This article describes the effects of an innovative 'GIZ' 2 GIZ = Gezamenlijk Inschatten Zorgbehoeften [in Dutch], translated as Joint Assessment of Care Needs. 2 methodology for joint assessment of care-needs developed to support the professional in engaging parents in assessing strengths, developmental concerns and care needs of the child and family. The current study compares parent-professional agreement on concerns and follow-up actions, and parents' satisfaction with the consultation with and without the GIZ. During this non-randomised controlled trial, 733 parents of children aged 0–12 and their professional completed a questionnaire after the consultation. In 526 assessments, the GIZ was used, and in 207 care as usual. Outcome measures were: concerns discussed, parent-professional agreement on strengths, concerns and follow-up actions and parents' satisfaction with the consultation. Multilevel analyses were used to answer the research questions. In the GIZ group, parental concerns (specifically regarding parenting and the child's environment) were discussed significantly more often. The use of the GIZ was associated with increased parent-professional agreement on concerns regarding the child's development and increased agreement on the given advice. Parents' satisfaction was significantly higher. Using the GIZ within preventive child health care has positive effects on discussing parenting and environmental circumstances, on the parent-professional agreement and parents' satisfaction.

Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study

BackgroundReproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking.ObjectiveTo investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage.MethodsA cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest.ResultsThe percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16–1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17–1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04–1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04–1.24) had a higher risk of not using modern contraceptives.ConclusionOur study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.

Guideline for referring short or tall children in preventive child health care.

To develop a guideline for preventive child healthcare professionals in orderto improve early detection of pathological disorders associated with short stature (or growth faltering) or tall stature (or accelerated growth). We updated the previous Dutch guideline for short stature in children aged 0-9years and extended it to adolescents (10-17years), and added a guideline for tall stature, based on literature and input from an expert committee. Specificities were calculated in a cohort of healthy Dutch children aged 0-9years (n=970). We investigated the impact of a late onset of puberty on height standard deviation score based on the Dutch growth charts. Growth parameters of the guideline include height, the distance between height and target height and change of height over time. Other parameters include diagnostic clues from medical history and physical examination, for example behavioural problems, precocious or delayed puberty, body disproportion and dysmorphic features. Preventive child healthcare professionals now have an updated guideline for referring short or tall children to specialist care. Further research is needed on the diagnostic yield after referral and specificity at field level.

Innovative postnatal risk assessment in preventive child health Care: A study protocol.

To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways. This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All-2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways. The study was approved in August 2016. Children and their parents, visiting well-baby clinics during regular visits, will participate in the intervention (N=2,650). Additional data of a historical control group (N=2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation. The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family-centred approach in the work process of Preventive Child Health Care nurses and physicians. This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.

Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system.

BackgroundLittle is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision screening, photoscreening or a combination in children aged 3–6 years.MethodsPopulation-based, cross-sectional study in preventive child health care in The Hague. Children aged 3 years (3y), 3 years and 9 months (3y9m) or 5–6 years (5/6y) received the conventional chart vision screening and a test with a photoscreener (Plusoptix S12C). Costs were based on test duration and additional costs for devices and diagnostic work-up.ResultsTwo thousand, one hundred and forty-four children were included. The estimated costs per child screened were €17.44, €20.37 and €6.90 for conventional vision screening at 3y, 3y9m and 5/6y, respectively. For photoscreening, these estimates were €6.61, €7.52 and €9.40 and for photoscreening followed by vision screening if the result was unclear (combination) €9.32 (3y) and €9.33 (3y9m). The number of children detected with amblyopia by age were 9, 14 and 5 (conventional screening), 6, 13 and 3 (photoscreening) and 10 (3y) and 15 (3y9m) (combination), respectively. The estimated costs per child diagnosed with amblyopia were €1500, €1050 and €860 for conventional vision screening, €860, €420 and €1940 for photoscreening and €730 (3y) and €450 (3y9m) for the combination.ConclusionsCombining photoscreening with vision screening seems promising to detect amblyopia in children aged 3y/3y9m, whereas conventional screening seems preferable at 5/6y. As the number of study children with amblyopia is small, further research on the effects of these screening alternatives in detecting children with amblyopia is recommended.

Triage in Preventive Child Healthcare: A novel triage protocol to identify health problems

Abstract Background A triage approach to routine health assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. Each PCH service use their own protocol (with health themes such as visuals disorders, sleeping- and psychosocial problems) to determine whether a follow-up assessment is needed. In this study a novel standardized triage protocol was developed. The aim was to improve the quality of detection of health problems in primary school children by PCH by investigating the quality of detection of health problems and satisfaction of this novel triage protocol. Methods We included 459 primary school children undergoing routine health assessments in 2 PCH services across the Netherlands. We used parent-reported child problems and PCH registry data. After each assessment PCH professionals reported whether they had identified any problems and carried out any additional actions (e.g., additional assessments, referral). The validity of the protocol is assessed, with problems identified by PCH professionals and performing additional actions as criteria. Results Results showed that the psychometric properties of the novel triage protocol were moderate to good. Sensitivity (true positives) and specificity (true negatives) for the novel triage protocol were 0.73 and 0.62, respectively for the identification of any problems, and were 0.91 and 0.41, respectively, for additional PCH actions. Conclusions The novel triage protocol is a valid tool for the detection of health problem in primary school children by PCH. Few children with health problems were missed. Professionals and parents were very satisfied with the novel protocol. Professionals made specific recommendations about adaptations of the protocol to improve efficiency and facilitate implementation in daily PCH practice. Key messages The novel triage protocol is a valid tool for the detection of health problem in primary school children. For optimal implementation in preventive child healthcare the novel triage protocol needs some minor adaptations.

Is the Strengths and Difficulties Questionnaire applicable to lower educated adolescents?

Abstract Background The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a widely used instrument to identify emotional and behavioral problems by Preventive Child Healthcare (PCH). It is a valid instrument in more highly educated adolescents, however evidence regarding lower educated adolescents (vocational school) is lacking. The aim of this study was to compare the psychometric properties of the SDQ-SR when used with less well and more highly educated ('higher') adolescents, and to explore opinions of adolescents and PCH professionals regarding its suitability. Methods We included 426 adolescents (130 lower and 296 higher educated), who completed the SDQ-SR. We compared how the psychometric properties (i.e. internal consistency) applied to lower and higher educated adolescents. We assessed whether the five-factor structure of the SDQ is invariant across different educational levels. Moreover, we interviewed 24 adolescents from pre-vocational secondary education schools, and performed online focus group interviews with 17 PCH professionals. Results The internal consistencies (Cronbach's alphas) per SDQ scale were comparable for lower and higher educated adolescents. On most subscales the lower educated adolescents had higher mean scores than the higher educated adolescents. Findings on differences by educational level for the other psychometric properties, i.e. multi-group invariance and single group (CFA) analyses, were inconsistent, with some measures showing unequal factor loadings but others not. Although professionals and lower educated adolescents reported that the SDQ includes many outdated and difficult words, professionals nevertheless perceived the SDQ-SR as a valid instrument. Conclusions The psychometric properties of the SDQ-SR are sufficient for use among lower educated adolescents. However, for optimal implementation in PCH there is a need for improvement in the wording of the SDQ, as expressed by both professionals and adolescents. Key messages The psychometric properties of the SDQ are sufficient for use among lower educated adolescents. For optimal implementation the SDQ needs to be updated in more understandable language.

Parental mental illness, attendance at preventive child healthcare and dental caries in the offspring: a nation-wide population-based cohort study.

Severe mental illness (SMI) may interfere with parental caregiving practices and offspring development. Adhering to preventive well-child visits and maintaining good oral hygiene during early childhood requires parental involvement. Whether these activities are affected by parental SMI is unclear. The purpose of the present study was to determine whether children exposed to parental SMI are at increased risk of non-attendance to preventive well-child visits and vaccinations at age 0-5years and of child dental caries experience at age 5years. Furthermore, interactions between maternal psychiatric and sociodemographic variables in relation to an adverse child outcome were assessed. Data were obtained from national Danish health registers. All children born in Denmark between January 1997 and December 2010 were followed from birth until their 6th birthday. 679,339 children were included in the study (51% male). Of these, 49,059 children (7.8%) had at least one parent with a lifetime SMI diagnosis. Children of parents with SMI had elevated odds of missing well-child visits and vaccinations (OR 1.41; 95% CI 1.39-1.44, p < 0.0001), and of child dental caries (OR 1.58; 95% CI 1.55-1.62, p < 0.0001). In the presence of maternal SMI, low socioeconomic classification and single-mother status added more to the elevated risk than specific maternal diagnosis or timing of last psychiatric contact. Parents with SMI are less compliant with preventive child healthcare activities than parents without SMI. This indicates a need for practical support to these families in order to prevent inequality in health among their offspring.

The Dutch well child language screening protocol for 2-year-old children was valid for detecting current and later language problems.

AimA little is known about predictive validity of and professionals' adherence to language screening protocols. This study assessed the concurrent and predictive validity of the Dutch well child language screening protocol for 2‐year‐old children and the effects of protocol deviations by professionals.MethodsA prospective cohort study of 124 children recruited and tested between October 2013 and December 2015. Children were recruited from four well child clinics in urban and rural areas. To validate the screening, we assessed children's language ability with standardised language tests following the 2‐year screening and 1 year later. We assessed the concurrent and predictive validity of the screening and of protocol deviations.ResultsAt 2 years, the sensitivity and specificity of the language screening were 0.79 and 0.86, and at 3 years 0.82 and 0.74, respectively. Protocol deviations by professionals were rare (7%) and did not significantly affect the validity of the screening.ConclusionThe language screening protocol was valid for detecting current and later language problems. Deviations from the protocol by professionals were rare and did not affect the concurrent nor predictive validity of the protocol. The 2‐year language screening supports professionals working in preventive child health care and deserves wider implementation in well child care.

Computerized adaptive testing to screen children for emotional and behavioral problems by preventive child healthcare

BackgroundQuestionnaires to detect emotional and behavioral problems (EBP) in Preventive Child Healthcare (PCH) should be short which potentially affects validity and reliability. Simulation studies have shown that Computerized Adaptive Testing (CAT) could overcome these weaknesses. We studied the applicability (using the measures participation rate, satisfaction, and efficiency) and the validity of CAT in routine PCH practice.MethodsWe analyzed data on 461 children aged 10–11 years (response 41%), who were assessed during routine well-child examinations by PCH professionals. Before the visit, parents completed the CAT and the Child Behavior Checklist (CBCL). Satisfaction was measured by parent- and PCH professional-report. Efficiency of the CAT procedure was measured as number of items needed to assess whether a child has serious problems or not. Its validity was assessed using the CBCL as the criterion.ResultsParents and PCH professionals rated the CAT on average as good. The procedure required at average 16 items to assess whether a child has serious problems or not. Agreement of scores on the CAT scales with corresponding CBCL scales was high (range of Spearman correlations 0.59–0.72). Area Under Curves (AUC) were high (range: 0.95–0.97) for the Psycat total, externalizing, and hyperactivity scales using corresponding CBCL scale scores as criterion. For the Psycat internalizing scale the AUC was somewhat lower but still high (0.86).ConclusionsCAT is a valid procedure for the identification of emotional and behavioral problems in children aged 10–11 years. It may support the efficient and accurate identification of children with overall, and potentially also specific, emotional and behavioral problems in routine PCH.

Promoting Child Growth and Development in the Sustainable Development Goals Era: Is It Time for New Thinking?

Growth monitoring and promotion (GMP) programs have been implemented worldwide for decades. Consistent evidence of their effectiveness is lacking and complicated by design and operational differences. Nevertheless, tracking child growth and development is a fundamental component of routine preventive child health care, and governments in 178 countries implement some form of GMP. This article makes the point that despite implementation challenges, there is a compelling need for GMP. It enables a crucial dialogue with families and communities about how to support the healthy growth and development of their children and can be a powerful tool for stimulating action and accountability for child nutrition and development at household, community, subnational, and national levels. We propose that GMP deserves a fresh rethink, with a paradigm shift that tailors GMP programs and activities for different development, geographic, and cultural contexts and considers how to optimize implementation for scalability.

Physical activity around the clock: objectively measured activity patterns in young children of the GECKO Drenthe cohort

BackgroundGiven the widespread problem of physical inactivity, and the continued growth in prevalence of childhood and adolescent obesity, promotion of regular physical activity (PA) among young people has become a public priority. A greater understanding of children’s PA patterns throughout the day is needed to effectively encourage children to be more physically active. Hence this study looking at the distribution of PA in young children throughout the day and its relevance to overweight.MethodsAccelerometers (ActiGraph GT3X, weartime > 600 min/day, ≥3 days) were used to measure the PA of 958 children (aged 5.7 ± 0.8 years, 52% boys) enrolled in the GECKO Drenthe cohort. Levels of sedentary time (ST), light PA (LPA) and moderate-to-vigorous PA (MVPA) were recorded throughout the day and analysed in segments (07:00–09:00, 09:00–12:00, 12:00–15:00, 15:00–18:00, 18:00–21:00). Body mass index was measured by Preventive Child Healthcare nurses and Cole’s (2012) definition of overweight was used. General linear mixed models, adjusted for age, sex and season, were used to analyse patterns of PA and ST throughout the day.ResultsChildren were most sedentary in the early morning (07:00–09:00) and evening (18:00–21:00), and exhibited the most time spent engaged in LPA and MVPA in the afternoon (12:00–15:00) and late afternoon (15:00–18:00). The greatest inter-individual variation in ST, LPA and MVPA among the children occurred in the late afternoon and evening (approximately 40, 30 and 15 min difference per time segment between 25th and 75th percentile, respectively). The most active children (highest quartile of MVPA) were found to be more active and less sedentary throughout the entire day than the least active children (lowest quartile of MVPA). Furthermore, children with overweight were no less active than children without overweight.ConclusionsAt this young age, the relevance of different PA patterns to childhood overweight was minimal. Children were most active in the afternoon and late afternoon. To encourage PA in general, ST can be reduced and PA increased in the early morning and evening. Targeted PA interventions to specifically stimulate the least active children could take place in the late afternoon or evening.

Integrating interconception care in preventive child health care services: The Healthy Pregnancy 4 All program.

BackgroundMost parents with young children pay routine visits to Well-Baby Clinics, or so-called Preventive Child Health Care (PCHC) services. This offers a unique opportunity to promote and deliver interconception care. This study aimed to integrate such care and perform an implementation evaluation.MethodsIn seven Dutch municipalities, PCHC professionals were instructed to discuss the possibility of an interconception care consultation during each routine six-months well-baby visit. The primary outcome of this study was coverage of the intervention, quantified as the proportion of visits during which women were informed about interconception care. Secondary outcomes included adoption, fidelity, feasibility, appropriateness, acceptability and effectiveness of the intervention, studied by surveying PCHC professionals and women considering becoming pregnant.ResultsThe possibility of interconception care was discussed during 29% (n = 1,849) of all visits, and 60% of the PCHC physicians adopted the promotion of interconception care by regularly informing women. About half of the PCHC professionals and most women judged integration of interconception care in PCHC appropriate and acceptable. Estimated feasibility was poor, since 13% of the professionals judged future integration in daily practice as probable. The uptake of interconception care consultations was low (n = 4 consultations).ConclusionsPromotion of interconception care was achieved in approximately one-third of the routine PCHC consultations and appeared promising with regards to adoption, appropriateness and acceptability. However, concerns on feasibility and uptake of interconception care consultations in daily practice remain. Suggestions for improvement may include further integration of interconception care health promotion in routine PCHC consultations, while allocating sufficient resources.

Handover of care and of information by community midwives, maternity care assistants and Preventive Child Healthcare professionals, a qualitative study

IntroductionHandover of care has been internationally acknowledged as an important aspect in patient safety. Families who are vulnerable due to low socio-economic status, a language barrier or poor health skills, benefit especially from a decent handover of care from one healthcare professional to another. The handover from primary midwifery care and maternity care to Preventive Child Healthcare (PCHC) is not always successful, especially not in case of vulnerable families. AimObtaining insight in and providing recommendations for the proces of handover of information by primary midwifery care, maternity care and PCHC in the Netherlands. MethodsA qualitative research through semi-structured interviews was conducted. Community midwives, maternity care nurses and PCHC nurses from three municipalities in the Netherlands were invited for interviews with two researchers. The interviews took place from February to April 2017. The qualitative data was analyzed using NVivo11 software (QSR International). ResultsA total of 18 interviews took place in three different municipalities with representatives of the three professions involved with the handover of care and of information concerning antenatal, postnatal and child healthcare: six community midwives, six maternity care assistants and six PCHC nurses. All those interviewed emphasized the importance of good information transfer in order to provide optimum care, especially when problems within the family ar present. In order to improve care, a large number of healthcare professionals prefered a fully digitized handover of information, providing the privacy of the client is warrented and the system works efficiently. To provide high quality care, it is considered desirable that healthcare workers get to know each other and more peer agreements are prepared. The ‘obstetric collaborative network’ or another structured meeting was considered most suitable for this exchange. ConclusionThis study shows that the handover of care and of information between professionals in the fields of antenatal, postnatal and child healthcare is gaining awareness, but a more rigorous chain of care and collaboration between these disciplines is desired. Digitizing seems important to improve the handover of information.

Reducing growth and developmental problems in children: Development of an innovative postnatal risk assessment.

IntroductionGlobally, awareness of the relevance of both medical and non-medical risk factors influencing growth and development of children has been increasing. The aim of our study was to develop an innovative postnatal risk assessment to be used by the Preventive Child Healthcare (PCHC) to identify at an early stage children at risk for growth (catch-up growth, overweight and obesity) and developmental problems (such as motor, cognitive, psychosocial and language/ speech problems).MethodsWe used the first four steps of the Intervention Mapping process. Step 1: Review of the literature and focus group discussions. Step 2: Identification of program objectives on how to develop and implement a risk assessment in PCHC daily practice. Step 3: Application of the ASE model to initiate behavioral change in the target group. Step 4: Development of the postnatal R4U and a program plan for the implementation in PCHC organizations.ResultsSubsequently in 2015, the 41 item postnatal R4U (the postnatal Rotterdam Reproduction Risk Reduction checklist) was developed according to steps one until four of the Intervention Mapping process and was implemented in four PCHC organizations.ConclusionsIt was feasible to design and implement a postnatal risk assessment identifying both medical and non-medical risks for growth and developmental problems, using the Intervention Mapping process.

Acceptance of Binding Preventive Examinations: A Survey of Parents in Hessen

In 2008, the Child Health Protection Act (Kindergesundheitsschutz-Gesetz) became effective in Hesse. Since then, participation in the early screening examinations U1 to U9 in Hesse is obligatory. The implementation of the law is part of the responsibility of the Hessian Children's Preventive Healthcare Centre (Hessisches Kindervorsorgezentrum (HKVZ)), which invites parents and legal guardians to each examination from U4 up to and including U9. To obtain information on the acceptance of the law, the HKVZ carried out for the first time a survey of parents and legal guardians as part of their quality management. The following questions were raised: How well accepted are obligatory check-ups by Hessian parents? What is the degree of popularity and the limitation of such a law? Along with the letter of invitation to participate in U7a, all parents and legal guardians received an anonymous survey questionnaire to be filled out and returned to the HKVZ. The evaluation took place in the HKVZ. Especially noteworthy are 3 results of the survey: When asked if health problems were detected during the check-ups, 8.94% of the parents and legal guardians answered the question with a "yes". Almost every ninth child examined was found to have health problems during the check-up. The reasons for a missed check-up were comparatively trivial. 96.53% of the respondents had not missed a check-up, only 2.88% answered this question with a "yes" and 0.59% did not give any information here. The most frequent reason for a missed examination with 1.59% was that it was simply "forgotten". In the category "other", 1.12% mentioned a disease of the child or a stay abroad as the most frequent reason for a missed check-up. Difficulty in making an appointment with the pediatrician (0.35% was another reason. The high level of awareness of the Hessian Child Health Protection Act (94.12% of respondents) and the positive ratings of the letters sent by the HKVZ (84.06% good to very good) reflect its acceptance. Further research is needed to confirm the effectiveness of such preventive health care examinations.

The effect of a preconception care outreach strategy: the Healthy Pregnancy 4 All study

BackgroundPreconception care has been acknowledged as an intervention to reduce perinatal mortality and morbidity. However, utilization of preconception care is low because of low awareness of availability and benefits of the service. An outreach strategy was employed to promote uptake of preconception care consultations. Its effect on the uptake of preconception care consultations was evaluated within the Healthy Pregnancy 4 All study.MethodsWe conducted a community-based intervention study. The outreach strategy for preconception care consultations included four approaches: (1) letters from municipal health services; (2) letters from general practitioners; (3) information leaflets by preventive child healthcare services and (4) encouragement by peer health educators. The target population was set as women aged 18 to 41 years in 14 Dutch municipalities with relatively high perinatal morbidity and mortality rates. We evaluated the effect of the outreach strategy by analyzing uptake of preconception care consultations between February 2013 and December 2014. Registration data of applications for preconception care as well as participant questionnaires were obtained for analysis.ResultsThe outreach strategy led to 587 applications for preconception care consultations. The majority of applications (n = 424; 72%) were prompted by the invitation letters (132,129) from the municipalities and general practitioners. The effect of the municipal letter seemed to fade out after 3 months.ConclusionsOutreach strategies amongst the general population promote uptake of preconception care consultations, although on a small scale and with a temporary effect.

Validation of short instruments assessing parental and caregivers' perceptions on child health and development for personalized prevention.

Systematically exploring parental as well as other caregivers' concerns is a main component in preventive child health care (PCHC) for family-centred practice and personalized health care. To facilitate communication and early identification of emerging mental health problems, a PCHC toolkit based on short instruments was developed. This article investigates the reliability and validity of (1) two visual analogue scales (VAS) to assess parent-reported 'parenting' and 'child behaviour', (2) a professional caregiver-reported VAS to assess 'child competence' and (3) the parents' evaluation of developmental status (PEDS) in Dutch PCHC. Parents as well as child care, kindergarten and preschool teachers completed instruments in a community-based sample of children (N = 346) aged 3 years at baseline. The three VAS and PEDS were associated with standardized questionnaires assessing the same constructs. Overall predictive accuracy showed: good to excellent for 'parenting' VAS, fair to good for 'child behaviour' VAS and poor for 'child competence' VAS. The PEDS, 'parenting' VAS and 'child behaviour' VAS, demonstrated high sensitivity at various cut-off points of index test and reference standard. At follow-up, approximately 1 year later, results were similar. Although the 'child competence' VAS scored lower on one aspect of validity, the PEDS and the different VAS are reliable, valid and useful as brief monitoring tools in daily Dutch PCHC practice.

Professionals' preferences and experiences with inter-organizational consultation to assess suspicions of child abuse and neglect.

This study addresses the following questions in cases of suspected child abuse and neglect (CAN) in children up to four years of age: 1) How many professionals intend to seek inter-organizational consultation? 2) What types of organizations do professionals prefer to consult? and 3) What factors can be identified as facilitator(s) or barrier(s) regarding inter-organizational consultation, based on professionals' experiences? Professionals working with children in 101 organizations in a medium-sized Dutch city were invited to fill in an online questionnaire. The questionnaire included a vignette about a suspected case. Quantitative, qualitative, and social network analysis approaches were used to analyze the data. Seventy-eight questionnaires were available for analysis. Fifty-five respondents (71%) intended to seek inter-organizational consultation. Ten different organization types were mentioned. The most frequently mentioned organization was preventive child healthcare. In total, 82 text fragments from 39 participants were available to analyze barriers and facilitators to inter-organizational consultation, 60 fragments that entailed a facilitator and 22 fragments that entailed a barrier. The text fragments were subdivided into twelve factors. The three factors that were most often identified as a facilitator were 'support', 'undertaking action', and 'regard'. Barriers were found in relation to all twelve factors. No specific barrier(s) stood out. This study demonstrated that most professionals are inclined to seek inter-organizational consultation when they suspect CAN. They are especially likely to seek consultation from preventive child health care organizations. Their experiences mainly revealed facilitators and few barriers. The implications for research and practice are also discussed.