| 1. |
- Sanneving, Linda, et al.
(author)
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Health system capacity : maternal health policy implementation in the state of Gujarat, India
- 2013
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In: Global Health Action. - 1654-9716 .- 1654-9880. ; 6, s. 19629-
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Journal article (peer-reviewed)abstract
- Introduction: The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007-2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services.Objective: To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method: Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis.Result: Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health.Conclusions: The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.
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| 2. |
- Appelqvist, Emma, et al.
(author)
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Exploring nurses' experiences of a tailored intervention to increase MMR vaccine acceptance in a Somali community in Stockholm, Sweden : a qualitative interview study
- 2023
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In: BMJ Open. - : BMJ. - 2044-6055. ; 13:2, s. 067169-067169
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To explore nurses' experiences of a tailored intervention that supported them with knowledge and tools to use during encounters and dialogue with parents with low vaccine acceptance. DESIGN: A qualitative study with in-depth interviews conducted in 2017. Data were analysed using thematic analysis. SETTING: This study was part of a multicomponent intervention targeting Somali parents and the nurses at child health centres in the Rinkeby and Tensta neighbourhoods of Stockholm. An area with documented low measles, mumps and rubella (MMR) vaccination coverage. Previous research has revealed that Somali parents in the community delayed MMR vaccination due to fear of autism despite lack of scientific evidence. The interventions were implemented in 2015-2017. PARTICIPANTS: Eleven nurses employed at the child health centres involved in the intervention participated in interviews. The tailored intervention targeting nurses included a series of seminars, a narrative film and an information card with key messages for distribution to parents. RESULTS: The qualitative analysis revealed an overarching theme: perception of improved communication with parents. Two underlying themes were identified: (1) feeling more confident to address parents' MMR vaccine concerns and (2) diverse tools as useful support to dispel myth and reduce language barriers. CONCLUSION: From the nurses' perspective, the tailored intervention was useful to improve communication with parents having vaccine concerns. Nurses have a crucial role in vaccine uptake and acceptance. Interventions aiming to strengthen their communication with parents are therefore essential, especially in areas with lower vaccine acceptance.
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| 3. |
- Barboza, Madelene, et al.
(author)
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A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden
- 2018
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In: International Journal for Equity in Health. - : BMC. - 1475-9276. ; 17:1
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Journal article (peer-reviewed)abstract
- BackgroundHealth inequities among children in Sweden persist despite the country’s well-developed welfare system and near universal access to the national child health care programme. A multisectoral extended home visiting intervention, based on the principles of proportionate universalism, has been carried out in a disadvantaged area since 2013. The present study investigates the content of the meetings between families and professionals during the home visits to gain a deeper understanding of how it relates to a health equity perspective on early childhood development.MethodsThree child health care nurses documented 501 visits to the families of 98 children between 2013 and 2016. A qualitative data-driven conventional content analysis was performed on all data from the cycle of six visits per child, and a general content model was developed. Additional content analysis was carried out on the data from visits to families who experienced adverse situations or greater needs.ResultsThe analysis revealed that the home visits covered three main categories of content related to the health, care and development of the child; the strengthening of roles and relations within the new family unit; and the influence and support located in the broader external context around the family. The model of categories and sub-categories proved stable over all six visits. Families with extra needs received continuous attention to their additional issues during the visits, as well as the standard content described in the content model.ConclusionsThis study on home visiting implementation indicates that the participating families received programme content which covered all the domains of nurturing care as recommended by the WHO Commission on Social Determinants of Health and recent research. The content of the home visits can be understood to create enabling conditions for health equity effects. The intervention can be seen to represent a practical example of proportionate universalism.
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| 4. |
- Barboza, Madelene, et al.
(author)
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Contributions of Preventive Social Services in Early Childhood Home Visiting in a Disadvantaged Area of Sweden: The Practice of the Parental Advisor
- 2021
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In: Qualitative Health Research. - : Sage. - 1049-7323 .- 1552-7557. ; 31:8, s. 1380-1391
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Journal article (peer-reviewed)abstract
- Early childhood home visiting to improve health and development is commonly delivered by child health care (CHC) whereas home visitors from the social services are rare. We applied a constructivist grounded theory approach to explore the practice and contributions of parental advisors from the preventive social services in a home visiting collaboration with CHC in a socioeconomically disadvantaged area of Sweden. The analysis rendered a conceptual model of a situation-based practice, built on interactive encounters between parents and professionals. It includes strengthening of positive parenting, connecting parents to additional services, early detection of needs and provision of psychosocial support in accordance with each family’s specific situation. Rooted in the training and experience in social work, the practice can be seen as contributory to the delivery of complex support to families through home visiting and could provide input to efforts of improving training of home visitors in different contexts.
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| 5. |
- Barboza, Madelene, et al.
(author)
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Covid-19 and pathways to health inequities for families in a socioeconomically disadvantaged area of Sweden – qualitative analysis of home visitors’ observations
- 2021
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In: International Journal for Equity in Health. - : BMC. - 1475-9276. ; 20:1
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Journal article (peer-reviewed)abstract
- BackgroundLack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic.MethodsSemi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis.ResultsThe analysis resulted in five pathways on two explanatory levels, affecting parents’ health and parenting capacity and children’s health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families’ access to resources and increases isolation for parents with already limited social support.ConclusionsThe diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity.Trial registrationThe study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097).
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| 6. |
- Barboza, Madelene, et al.
(author)
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Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden
- 2022
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In: BMC Public Health. - : BMC. - 1471-2458. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood.Methods: Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme.Results: The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme.Conclusions: The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities.Trial registration: The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 ).
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| 7. |
- Belita, Alice N., et al.
(author)
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Adolescence and Sexuality in the Context of HIV and AIDS : Views and Concerns of Pupils in a Rural Primary School in Kenya
- 2011
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In: Child Health and Education. - 1911-7558. ; 3:2, s. 122-136
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Journal article (peer-reviewed)abstract
- New HIV infections in Kenya have been mostly among young people 15–24 years of age. The Maasai adolescents are an important group to study asthe Maasai have a distinct culture, which in light of current political and socioeconomic changes could be a risk factor for HIV infection. The aim of this study was to explore the views and concerns of school youth on adolescence and sexuality in the context of HIV and AIDS.A qualitative method using self-generated questions was used. The school youth wrote questions on adolescence, sexuality and HIV and AIDS, or those questions they could not ask their parents or other adults for fear or shame. They reported being curious about sex, sexual urge and feelings that they have. They expressedconfusion about adolescence and their experiences as adolescents in terms of both physical and emotional changes. They are also subject to prohibitivesilence from adults to an extent that they express fear of reporting sexual abuse. Relationship between different sexes was reflected as one that needed to be sanctioned; hence the young people wanted to know how they should relate with each other. They had concerns about condom use that indicated they were exposed to the different discourses on condom use. They showed limited knowledge on HIV and AIDS and STIs and also expressed eagerness to know more about them. In conclusion, communication between parents and their children on issues of sexuality needs to be assessed. Interventions for young people that involve the communities should be encouraged.
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| 8. |
- Burström, Bo, et al.
(author)
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Healthcare utilisation and measles, mumps and rubella vaccination rates among children with an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden - A 3‐year follow‐up
- 2020
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:9, s. 1847-1853
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Journal article (peer-reviewed)abstract
- AimTo follow up healthcare utilisation and measles, mumps and rubella (MMR) vaccination rates among children 0-36 months, receiving an extended postnatal home visiting programme in a disadvantaged area with poorer child health, and in control groups, in Stockholm, Sweden.MethodsWe analysed electronic child health records regarding outpatient visits, inpatient episodes and MMR vaccination for children 0-36 months receiving the home visiting programme (Intervention Group) and in control groups (Control Group and Rinkeby Comparison Group).ResultsChildren in the Intervention Group had significantly higher MMR vaccination rate than children in the Rinkeby Comparison Group. Healthcare utilisation was similar in the Intervention Group and the control groups. In stratified analyses by number of home visits received, children receiving the recommended six home visits had significantly fewer inpatient episodes and somewhat fewer emergency visits than those receiving fewer home visits.ConclusionThe extended home visiting programme had a positive impact on the MMR vaccination rate. Children receiving the recommended six home visits had lower use of inpatient care. In addition to being positively perceived by parents in an area with greater healthcare needs, the programme may have a positive impact on their children's healthcare utilisation.
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| 9. |
- Burström, Bo, et al.
(author)
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Practising proportionate universalism – a study protocol of an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden
- 2017
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In: BMC Health Services Research. - : BMC. - 1472-6963. ; 17:1
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Journal article (peer-reviewed)abstract
- BackgroundIn spite of a well-developed welfare system in Sweden, there are important health divides between residential areas in Stockholm county, with shorter life expectancy in disadvantaged areas. These socioeconomic and health divides also affect children. Extra efforts and organized collaboration by different authorities are required to meet the greater needs of children growing up in these areas.Methods/designThis article reports on the programme logic and evaluation design of an extended postnatal home visiting programme in collaboration between child health services and social services in the Rinkeby area, Stockholm, Sweden, where a large proportion are recent immigrants and more than 50% are at-risk of poverty. The intervention consists of five extra home visits when the child is aged between 2–15 months, jointly by a child health nurse and a social service parental advisor, offered to all parents of first-born children attending Rinkeby child health centre. Parents of first-born children attending child health centres in neighboring areas serve as controls. The evaluation will use a mixed methods approach, including participant observation, in-depth interviews, interviews using structured questionnaires, review and analysis of child health records and records of health care utilization.DiscussionThe intervention has so far been very positively received by the parents (95% participation rate), who seem to perceive that they actually benefit from participating, and also from staff in child health services and social services who find this approach to be in line with their professional intentions. The staff members interviewed also appreciate the inter-professional collaboration. The intervention has sparked activities also in other sectors (the local library, the open child day care centre) of the local area.The timing of the intervention, at the start of the child’s life, may be well suited to support parents in reorienting themselves and finding a positive parenting role, to the benefit of the development of the child. The intervention may be seen as a concrete example of “proportionate universalism”, as a strategy to reduce inequalities in health – applying a universal intervention with increased intensity in groups that have a greater need for it.Trial registrationThe study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097 DOI:10.1186/ISRCTN11832097).
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| 10. |
- Dahir, Gallad, et al.
(author)
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We have almost accepted child spacing. Let's wait on family planning and limiting children' : Focus group discussions among young people with tertiary education in Somalia
- 2023
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In: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 35
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Somalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu.METHODS: A purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19-25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis.FINDINGS: The findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable.CONCLUSION: Our findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.
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