Aims and objectives
The aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden.
Objectives
(a) Identify everyday ...situations in medical and nursing care that illustrate children's active participation in decision‐making, (b) identify various ways of active participation, actual and optimal in situations involving decision‐making and (c) explore factors in nursing and medical care that influence children's active participation in decision‐making.
Background
Despite active participation being a fundamental right for children, they are not always involved in decision‐making processes during their health care. There still remains uncertainty on how to support children to actively participate in decisions concerning their health care.
Design
A qualitative study with overt, nonparticipant observations fulfilling the COREQ checklist criteria.
Methods
Observations of interactions between children aged 2 and 17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made.
Results
Children's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and nonverbal ways of communication during decision‐making. Findings indicated that children's, parents' and healthcare professional's actions influenced children's active participation in decision‐making processes involving healthcare.
Conclusions
Healthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a child‐centred care approach, to ensure children's active participation at a level of their choosing.
Relevance to clinical practice
There is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decision‐making.
Aims and objectives
To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit.
Background
The best interests of the child ...are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations.
Design
A qualitative descriptive study with overt, non‐participant observations fulfilling the COREQ criteria.
Methods
Thirty‐two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and ion of observed patterns of the best interest of the child.
Results
Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child.
Conclusions
Determining the best interest of the child requires a case‐by‐case basis, as it is context‐dependent, situational, flexible and dependent on all actors involved and actual decisions made.
Relevance to clinical practice
Healthcare professionals’ actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals’ communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.
contribute to the existing body of knowledge about the specific needs of first-time parents specifically for early parenthood.
the databases PubMed, MEDLINE, PSYCINFO, CINAHL, EMBASE, Family Studies ...Abstracts, and Web of Science, were searched using search terms: prenatal, antenatal, preparation, education, parents, parenthood. The meta-synthesis included 12 articles representing 12 studies. The meta-ethnographic approach of Nobilt and Hare was used in the meta-synthesis.
first-time expectant and new parents reflect a need for antenatal education to actively include male partners pre- and postnatal. Participants wished for early and realistic information about parenting skills, and to have the opportunity to seek support and help from health professionals when need arose especially during the early postnatal period. Another element was the need to learn both from peers and other new parents coming as guest speakers. Participants wished to have been well informed ahead of time, about the possible changes in their conjugal relationship and the related coping strategies.
equal emphasis should be placed both during the prenatal and postnatal periods in antenatal education classes.
interventions aiming at enhancing positive transitions to parenthood could be introduced early during the postnatal period. Parenthood education classes could adopt adult learning strategies that are participatory, and experiential in nature.
•Antenatal education could actively include expectant parents, pre- and postnatal.•Early and realistic information about parenthood is needed in antenatal classes.•Parenthood education interventions could be introduced early postnatal.•Parenthood education classes could adopt participatory adult learning strategies.
Postpartum depression is considered a major public health problem, which immigrant mothers are at particular risk of being affected by, but it can also have long-lasting traumatic effects on the ...child's health and development. The Edinburgh Postnatal Depression Scale is the world's most commonly employed screening instrument for postpartum depression, used in connection with a clinical interview to screen for symptoms of postpartum depression. The aim of this study was to synthesize health care professionals (HCPs) experiences of identifying signs of postpartum depression and performing screening on immigrant mothers, since previous research suggested that this task might be challenging. The databases CINAHL, PubMed, PsycINFO, SocINDEX, Embase and Cochrane were searched for papers published January 2000-December 2020, reporting qualitative data on immigrants, postpartum depression and the Edinburgh Postnatal Depression Scale. Eight papers representing eight studies from four countries were included and the Critical Appraisal Skills Program was used to assess their quality. The synthesis of studies was guided by Noblit & Hare's seven-step method based on meta-ethnography. The synthesis resulted in two final themes: "I do my best, but I doubt that it's enough" and "I can find no way forward". The themes convey the fear and frustration that health care professionals experienced; fear of missing mothers with signs of postpartum depression, related to feeling uncomfortable in the cross-cultural setting and frustration in handling difficulties associated with communication, translated versions of the Edinburgh Postnatal Depression Scale and cultural implications of postpartum depression. By supporting HCPs' self-efficacy in handling cultural implications of postpartum depression and by developing evidence-based clinical guidelines for the use of interpreters and translated versions of the Edinburgh Postnatal Depression Scale the screening of immigrant mothers may be facilitated.
Children affected by Paediatric Feeding Disorder (PFD) cannot consume enough nourishment by mouth. PFD is highly prevalent and can affect the child's growth and development as well as family life.
To ...illuminate Swedish parents' experiences of living with a child with PFD.
Semi-structured interviews via telephone or video calls were conducted with 14 purposefully recruited mothers and six fathers. The interviews were analysed using content analysis. Ethics approval was obtained, and the parents all gave informed consent.
Four overarching themes emerged: Living with stress; Advocating for the child; Adapting family life; and Gaining hope. Parents described fearing for their child's life and health, feeling pressure over meals and being emotionally affected. They told of experiencing a lack of understanding from healthcare professionals, friends and family. Parents expressed a struggle for help, the need for early interventions and more effective treatment, and developed strategies for coping with the demands of feeding and caring for their child, accepting their living reality. Finding support from a network helped, but the adaptation of daily life affected their family relations. They felt gratitude towards helpful professionals and relief and joy when their child was doing better.
A more cohesive chain of care is important for children with PFD, and guidelines and educational support for healthcare providers are needed. Parental experiences provide a base for knowledge for further development of early detection and intervention for children with PFD.
Nine in ten of the world's 1.74 million adolescents living with human immunodeficiency virus (ALHIV) live in Sub-Saharan Africa. Suboptimal adherence to antiretroviral therapy (ART) and poor viral ...suppression are important problems among adolescents. To guide intervention efforts in this regard, this review presented pooled estimates on the prevalence of adherence and how it is affected by disclosure of HIV status among ALHIV in Sub-Saharan Africa.
A comprehensive search in major databases (Excerpta Medica database (EMBASE), PubMed, Ovid/MEDLINE, HINARI, and Google Scholar) with additional hand searches for grey literature was conducted to locate observational epidemiologic studies published in English up to November 12, 2022 with the following inclusion criteria: primary studies that reported disclosure of HIV status as an exposure variable, had positive adherence to ART as an outcome, and conducted among adolescents and children. The COVIDENCE software was used for a title/abstract screening, full-text screening, the JBI quality assessment checklist, and data extraction. Random effects model was used to pool estimates. Furthermore, sensitivity analysis and subgroup analysis were also conducted by age groups and type of adherence measures used.
This meta-analysis combines the effect estimates from 12 primary studies with 4422 participants. The prevalence of good adherence to ART was 73% (95% CI (confidence interval): 56 to 87; I2 = 98.63%, P = <0.001), and it was higher among adolescents who were aware of their HIV status, 77% (95% CI: 56 to 92; I2 = 98.34%, P = <0.001). Overall, knowledge of HIV status was associated with increased odds of adherence (odds ratio (OR) = 1.88, 95% CI: 1.21 to 2.94; I2 = 79.8%, P = <0.001). This was further supported in a subgroup analysis by age (seven studies, pooled OR = 1.89, 95% CI: 1.06 to 3.37; I2 = 81.3%, P = <0.0001) and whether primary studies controlled for confounding factors (six studies provided adjusted estimates, pooled OR = 2.61, 95% CI: 1.22 to 5.57; I2 = 88.1%, P = <0.001) confirmed this further.
Our meta-analysis and systematic review revealed that knowledge of one's HIV status was associated with adherence to ART, particularly among adolescents. The findings underscored the importance of encouraging disclosure in order to enhance adherence among adolescents.
General Movement assessment (GMA) is considered the golden standard for early identification of infants with a high risk of developing cerebral palsy (CP). The aim of this study was to explore ...parents' lived experience of early risk assessment for CP using a mobile application for home video recording after discharge from hospital stay in the newborn period.
An inductive qualitative design using a hermeneutical phenomenological approach was chosen, and fourteen parents with children at risk of CP were interviewed at home. The hermeneutical phenomenological approach describes humans' lived experiences of a specific phenomenon with a possibility of deeper understanding of the expressed statements. The interviews were analyzed using the fundamental lifeworld existential dimensions as guidelines for describing the parents' lived experience.
The overall understanding of the parents' experience was 'Finding control in an uncontrolled life situation'. During the often-long hospitalizations, the parents struggled with loss of control and difficulty in understanding what was going on. The use of the mobile application followed by a swift result made them feel in control and have a brighter view of the future.
The findings suggest that the mobile application did not seem to worry the parents. Instead, it provided the parents with a sense of active participation in the care and treatment of their child. The mobile application should be accompanied with clear instructions and guidelines for the parents and details about how and when the result is given.
Background
Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for ...parents and thereby make the transition from hospital to home less stressful.
Aim
To develop an eHealth device supporting the transition from hospital to home for parents with a preterm‐born child in Sweden using participatory design.
Method
Employing a framework of complex interventions in health care using participatory design. Parents of preterm‐born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end‐users – parents and professionals – were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis.
Results
Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home.
Conclusion
The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.
Background
Screening immigrant mothers for postpartum depression has been shown to be challenging for health care professionals in handling cultural implications of postpartum depression, ...communicating through interpreter and applying translated versions of the screening scale.
Aim
The aim of the study was to test the feasibility of an evidence‐based educational intervention for Child Health Services nurses in screening non‐native‐speaking immigrant mothers for postpartum depression.
Ethics
The approval was obtained from Swedish Ethical Review Authority, 2018/1063.
Method
Thirty Child Health Services nurses who conducted screening with assistance of interpreter at least three times per year participated. The study was registered at ClinicalTrials.gov (NCT04167709) and a one‐group pretest‐posttest experimental design was applied. Data on the participants' acceptability and response to outcomes of the intervention were collected by an evaluation questionnaire, the Clinical Cultural Competency Training Questionnaire, the General Self‐efficacy Scale and by self‐reported data on general performance of the task. Descriptive statistics were used to present the results of the evaluation questionnaire and general performance of the task. Paired t‐test were used to compare the scores on the General Self‐efficacy scale, while Wilcoxon signed‐ranked test was used to compare the scores on the Clinical Cultural Competency Training Questionnaire. Qualitative data were analysed by content analysis.
Results
All 30 participants stated that they found the content of the intervention satisfying. The intervention was shown to provide new knowledge and improved their ability to meet the requirements linked to the screening procedure. The intervention affected their self‐estimated cultural competence in some aspects but not their self‐efficacy or general performance of the task.
Conclusions
The intervention was found feasible but require adjustment in the design of the practical training sessions. The use of the provided material, a comic strip on parental support and interpreter information needs further evaluation.
Poor adherence to antiretroviral therapy in adolescents living with HIV is a global challenge. One of the key strategies to improve adherence is believed to be the use of digital adherence tools. ...However, evidence is limited in this area. Our objective was to investigate the effectiveness of mobile phone text message reminders in improving ART adherence for adolescents. The preferred reporting item for systematic review and meta-analysis guideline was followed. A literature search was done in five databases (PubMed, Web of Science, Embase, Global Health and Cochrane) in August 2020. Additional searches for studies and grey literature were performed manually. We included studies with quantitative design exploring the effectiveness of text message reminders, targeting adolescents aged 10-19 years. Studies were excluded if the intervention involved phone calls, phone-based applications, or other complex tech services. Mean differences between intervention and standard of care were computed using a random effects model. Subgroup analyses were performed to identify sources of heterogeneity between one-way and two-way text messages. Of 2517 study titles screened, seven eligible studies were included in the systematic review. The total number of participants in the included studies was 987, and the study sample varied from 14 to 332. Five studies showed a positive impact of text messaging in improving adherence, while no significant difference was found between the intervention and the control (standard of care) group in the remaining two studies. The pooled mean difference between the intervention and the control group was 0.05 (95% CI: -0.08 to 0.17). There was considerable heterogeneity among the studies (I.sup.2 = 78%). The meta-analysis of text message reminder interventions did not show a statistically significant difference in the improvement of ART adherence among adolescents living with HIV. The included studies were heterogeneous in the reported clinical outcomes, where the effectiveness of the intervention was identified in small studies which had a short follow-up period. Studies with bigger sample size and a longer follow-up period are needed.
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