AIM: This study aimed to investigate Child Health Services nurses' experiences of adjusting their parental support in response to parents' loneliness and concerns about their parenthood during the COVID-19 pandemic.

DESIGN: The study has a cross-sectional design based on self-reported data.

METHOD: The study is based on a study-specific questionnaire created by the research group and took place in the context of the Child Health Services in two regions of Sweden. All 180 eligible child health nurses were invited to answer the questionnaire, and 130 nurses answered the questionnaire. The questions with fixed answers were analysed using descriptive statistics, and those with free-text answers were analysed using content analysis.

RESULTS: The nurses described parental support as having partly changed during the pandemic; the nurses also described a lack of parental support in groups and how the group-based parental support was replaced with individual targeted visits. Further, the nurses stated that, in encounters with the Child Health Services during the pandemic, parents broadly expressed feeling lonely and isolated in their parenthood.

CONCLUSION: The results of this study can be used to develop parental support in child health services beyond the COVID-19 pandemic. The results shed light on the need for more person-centred parental support at the Child Health Services to avoid parents' feelings of loneliness on both an individual and a group level. The great importance of parenting support in groups highlights the significance of developing this form of parental support in Child Health Services to facilitate parents' feeling secure in their parenting and thus promote the child's health.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

AIMS: An increase in psychosomatic symptoms among adolescents has recently been reported. Few studies have examined the relation between food intake and psychosomatic symptoms. The aim was to study the association between food intake and overall psychosomatic burden and separate psychosomatic symptoms.

METHODS: In this cross-sectional study, we used data from 6248 girls and 7153 boys in south-east Sweden who turned 16 years of age during the academic years 2009/2010 to 2015/2016 and responded to a health questionnaire at the school health services. The association between overall healthy food intake and a low psychosomatic burden was calculated as odds ratios (95% confidence interval) and stratified for other lifestyle habits and gender.

RESULTS: Sixty-nine per cent of the boys and 35% of the girls had a low psychosomatic burden. There was a positive association between an overall healthy food intake and a low psychosomatic burden (P<0.0001), regardless of other lifestyle habits and gender. An overall healthy food intake was also positively associated with a lower frequency of the separate psychosomatic symptoms of concentration difficulties, sleep difficulties, a poor appetite or dizziness (P<0.0001).

CONCLUSIONS: A healthy food intake seems to be associated with a low psychosomatic burden among adolescents. Further knowledge is needed to explore whether an improved food intake can reduce psychosomatic symptoms and enhance mental health.

BACKGROUND: All children should have the possibility to be healthy during childhood, according to the Convention on the Rights of the Child. In Sweden, the Child Health Services (CHS) support all parents and children from birth until the age of six to promote children's health and development. Some Swedish regions have introduced an extended home-visit programme, with CHS nurses and social workers visiting first-time parents together to provide parental support in collaboration. The programme aims to expand the task of promoting the child's health and increase the possibilities of discovering risk factors in families earlier. The aim of the present study is to describe the professionals' experiences of collaboration when introducing the extended home-visit programme to a broader population within the frame of a family centre.

METHODS: The study used a reflexive thematic qualitative approach with focus group interviews. All staff at the family centre were invited to participate: CHS nurses, social workers, and managers who worked with the extended home-visit programme. Data were collected through focus group interviews with each profession separately and analysed through reflexive thematic analysis.

RESULTS: One overarching theme emerged: A key to facilitating early support. Three connected themes - Ease for everyone on the family's terms, From working alone to becoming a team, and A matter of supporting structures - illuminated the participants' experiences. Their driving force was early detection of risk factors or needs in the family, to be able to provide support. The collaboration was enhanced by the different professional competencies complementing each other. That all were located at the family centre together was also important to facilitate collaboration.

CONCLUSIONS: The extended home-visits were appreciated and experienced as useful by all participants. That a family centre organization already existed was one of the facilitators, functioning as a meeting point to expand the collaboration. The managers' support was essential, and it was experienced as positive that the organization invested resources to allow employees to participate in the development of the extended home-visit programmes. This way of working has the potential to add value for the children and families, and the CHS would benefit from using the extended home-visit programme further.

Background

The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO).

Method

The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness.

Result

The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits.

Conclusion

This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA.

Trial registration

Not applicable.

BACKGROUND: In Sweden, population-based targeted health dialogues are an important part of health promotion and disease prevention in primary health care. Targeted health dialogues are performed with a pedagogical approach to allow individuals to reflect over their resources, situation and motivation to change lifestyle habits together with a healthcare professional.

AIM: The aim of this study was to explore healthcare professionals' experiences of targeted health dialogues in primary health care.

METHODS: Three focus group interviews were conducted with 20 healthcare professionals. The interviews were analysed using qualitative content analysis.

RESULTS: The main category A possibility to promote healthy behaviours and prevent disease describes how the targeted health dialogues were experienced as a valuable opportunity to promote health among inhabitants. The significance of the primary healthcare centre's health promotion and prevention strategies was emphasised to enable the targeted health dialogues as a part of the assignment to promote health. These strategies were expressed as shared focus and organisational space and support making it possible for example to reach all socioeconomic groups. The work with targeted health dialogue was described as a complex task requiring extensive competence. Furthermore, the pedagogical tool including the visual health profile was experienced to have an important impact on the dialogue offering direction for actions to promote health and prevent disease.

CONCLUSIONS: Targeted health dialogues can be a valuable opportunity for healthcare professionals in primary health care to promote a healthy lifestyle among inhabitants. Certain preconditions at both the meso- and the micro level is however required for this to come about.

BACKGROUND: The Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents' perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.

OBJECTIVE: The aim of the present study was to explore parents' perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.

PARTICIPANTS AND SETTING: Eighteen parents (13 women and five men) in two Swedish counties participated in the study.

METHODS: Semi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.

RESULTS: Three themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse's professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.

CONCLUSIONS: The study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family's situation during the child's upbringing and an opportunity to access support if needed.

Aim: To explore the experiences of health visits within the school health services from the perspective of adolescents with migration experiences.

Design: A descriptive qualitative study.

Methods: Data were collected using focus groups and semi-structured individual interviews with adolescents with migration experiences aged 13–17 years old. Analysis was conducted using reflexive thematic analysis.

Results: The results described adolescents reading the signs in the guided interaction between them and the school nurses. Reading the signs illustrated the adolescents' continuous interpretation of the interaction with the school nurse, and their decisions on how to respond throughout the health visit. These interpretations influenced the adolescents' shifting willingness to talk about their health and how they adapted to the space of participation provided by the school nurse. The interpretation also influenced their experiences of health visits as focusing on their health without making them feel singled out.

Conclusion: Although individual considerations might be warranted in health visits with adolescents with migration experiences, the results indicate that similarities in intrapersonal communication in various encounters between adolescents and health professionals might be greater than any differences. Healthcare encounters with adolescents with migration experiences might thus need to be conducted with an awareness that adolescents read the signs in the guided interaction and that similarities in this interaction are greater than any differences.

BACKGROUND: Becoming a parent can be challenging. Becoming a parent for the first time during the COVID-19 pandemic might pose additional challenges, as the pandemic has imposed restrictions on society, thus affecting parental support. There were changes in parental support from child health services and preschools available for all children and their parents, so called open preschools, have been closed. This study explored first-time parents' experiences of the parental support they received during the COVID-19 pandemic.

METHODS: A qualitative study involving individual semi-structured interviews with nine first-time mothers who had been on parental leave during the pandemic was conducted. Data were analyzed with inductive content analysis and the results are presented in a main category with three generic categories.

RESULTS: The main category is entitled, A gap between the needs of parental support and the support provided, and it encompasses three generic categories: The first category, Formal support, refers to support from child health nurses and open preschools. The second category, Lack of formal support, encompasses the lack of person-centred support and lack of parental groups. The third category, Informal support, encompasses support from family, friends, and social media.

CONCLUSIONS: The findings indicate that under the restrictions imposed by the pandemic, first-time mothers expressed the need for person-centred support to both parents which will ensure that all parents get the support they expect and need. The participants also expressed a desire for adapted parental groups that are feasible despite the restrictions to allow them to connect with other parents and build networks.

BACKGROUND: Early support for children and families in need can improve children's health and development. In a Swedish region, a new working model called Safe Environment for Every Kid (SEEK) was introduced in the Child Health Services to facilitate the early identification of psychosocial risk factors.

OBJECTIVE: The aim of this study was to describe the adoption and introduction of the SEEK model in the Child Health Services of Region Jönköping County.

METHODS: Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed separately by a thematic approach. The results were then interpreted together with documents (including CHS management meeting notes and documents describing planning and training sessions) using an exploratory mixed-methods approach to give a comprehensive description of the adoption and introduction of the SEEK model.

RESULTS: The results show that the SEEK model improved coordination and collaboration, which led to better integrated care for children and families. The structure was regarded as supportive when introducing the SEEK model in Child Health Services. The questionnaire, as part of the SEEK model, was used in 88% of possible health visits. The most reported reason for not using it was a lack of time.

CONCLUSIONS: The desire to make a difference and thereby promote better health and development for children was a crucial factor for the nurses in adopting the SEEK model in their clinical practice. The design using coaches was also appreciated and supported the adoption and introduction of the SEEK model.

PATIENT OR PUBLIC CONTRIBUTION: Parents and healthcare professionals did not contribute to the research process. The results are based on dialogues between CHS nurses and parents after the parents filled in the SEEK questionnaire, providing an understanding of professional relationships when dealing with challenging issues.

Background: It is important that easy-to-use measures like subjective questions about physical activity (PA) and sedentary behaviour are valid and reliable providing accurate measures, when they are used in health promotion work aiming to support people to improve their lifestyle habits such as PA. The aim of this study was to evaluate the concurrent validity of a structured interview form estimating self-reported PA and a question about sitting time used in Swedish targeted health dialogues in the context of primary health care. Method: The study was conducted in the southern part of Sweden. To evaluate concurrent validity of the interview form, time spent in moderate-to-vigorous physical activities (MVPA) and energy expenditure related to MVPA estimated by an interview form was compared with the same measures assessed by an ActiGraph GT3X-BT accelerometer. To evaluate a question about sitting time, the Swedish School of Sport and Health Sciences’ single-item question about sitting time (SED-GIH) was compared with measures from an activPAL inclinometer. Statistical analyses included deriving Bland‒Altman plots and calculating Spearman’s rank correlation coefficients. Result: Bland‒Altman plots indicated lower absolute variation in the difference between self-reported and device-based PA measures for lower PA levels, both for energy expenditure and time spent in MVPA. No systematic over- or underestimation was observed. The Spearman’s correlation coefficient between self-reported and device-based PA measures was 0.27 (p = 0.014) for time spent in MVPA and 0.26 (p = 0.022) for energy expenditure. The correlation coefficient between the single item question and device-based sitting time measures was 0.31 (p = 0.002). Sitting time was underestimated by 74% of the participants. Conclusion: The PA interview form and the SED-GIH question on sitting time may be of value in targeted health dialogues in primary health care with the intention to support sedentary and insufficiently physically active persons in increasing their physical activity and limiting their sitting time. The questionnaires are easy to use and are more cost effective than device-based measures, especially regarding population-based interventions conducted in primary health care for thousands of participants such as targeted health dialogues. Clinical trial registration: Not applicable.