Parents’ perceptions of barriers & facilitators for adhering to advice from community health nurses

Abstract Background Childhood obesity is a global health problem and infancy is an important window of opportunity for promoting healthy weight development. In Denmark, community health nurses cover most families with a new-born child leaving a huge potential for promoting healthy weight development. This study examines parents’ perceptions of barriers and facilitators for adhering to advice from the health nurse regarding healthy weight development of their child. Methods Sixteen interviews with parents (children aged 0- 2 years) living in Denmark were conducted. Parents were strategically sampled representing variations across child age, family socioeconomic position, ethnicity, and geography. All interviews were based on a semi-structured interview guide, recorded, and transcribed verbatim and analysed using a thematic analysis. Findings Parents generally experience visits from their health nurse positively. Health nurses are emphasized as a confident and trustful relation and the key informant about children's’ health. Variations in how parents adhere to advice favouring healthy weight development of their child were found. Generally, parents adopted a positive attitude towards the health nurse, also when she addressed behaviour or practice of the parents, but parents expressed the importance of doing so in a non-stigmatising or finger pointing manner. The degree to which parents follow the advice from their health nurse depend on cultural background, advice from family and friends, and use of online information. Conclusions Parents generally have a confident and trustful relation to the health nurse, and she constitutes the key informant on child health. This leaves a potential for the structure of Danish health nurses for future interventions promoting healthy weight development. Adaptation of the future intervention program to the needs of parents will increase the chances of developing a relevant, successful, and sustainable intervention. Key messages • Health nurses are emphasized as a trustful relation and the key informant about children’s’ health, but parents expressed the importance of addressing behaviours in a non-stigmatising manner. • Adapting information gained from parents in development of the trial will increase the chances of a relevant, successful, and sustainable intervention promoting healthy child weight development.


Background:
Evidence suggests that foreign-origin women are at risk of poorer pregnancy outcomes, both worldwide and in Finland. This study examined if foreign-origin women felt adequately supported by healthcare providers during their perinatal care in Finland.

Methods:
Foreign-origin women who gave birth in Finland within the last 3 years were recruited via snowball method as part of the MOM Survey (MS). Data were also extracted from birthing parents' responses to the 2020 national FinChildren Survey (FC), which consisted of data from parents in Finland with 3-6-month-old babies. Only responses submitted to MS from women born outside of Finland (n = 291) and responses submitted to FC by women born in Finland (n = 7984) were analyzed. Reported levels of adequate support from each group were compared using an independent sample proportion ttest. Data were then pooled and analyzed via binomial logistic regression. Results: MS respondents were older, more highly educated, and reported a higher proportion of single parenthood. 70.9% of MS respondents reported receiving adequate support regarding general well-being during pregnancy, compared to 90.2% of FC respondents (p < 0.001). Statistically significant differences (p < 0.001) were also seen in levels of support for parenthood (MS 74.3%, FC 92.8%), depression (MS 68.1%, FC 94.7%), fear of childbirth (MS 81.5%, FC 91.7%), and preparing for childbirth (MS 65.0%, FC 80.6%). After adjusting for age, education, and relationship status, FC mothers were still 4 to 9 times more likely to report receiving adequate support in these areas as compared to their MS counterparts.

Conclusions:
Women born outside of Finland were significantly more likely to report receiving inadequate support in multiple aspects of their perinatal care when compared to Finnish-born women. This held true even after adjusting for demographic differences. More research is needed to better understand this phenomenon and to ensure equitable care in the future. Key messages: Minority populations continue to grow in Finland, a country often seen as a global leader in maternal care. Supporting these populations is imperative to ensure quality maternal healthcare for all. Our observation that foreign-origin women felt less supported during pregnancy suggests that new care models or strategies may be needed to address their unique needs in peripartum care.

Background:
Childhood obesity is a global health problem and infancy is an important window of opportunity for promoting healthy weight development. In Denmark, community health nurses cover most families with a new-born child leaving a huge potential for promoting healthy weight development. This study examines parents' perceptions of barriers and facilitators for adhering to advice from the health nurse regarding healthy weight development of their child.

Methods:
Sixteen interviews with parents (children aged 0-2 years) living in Denmark were conducted. Parents were strategically sampled representing variations across child age, family socioeconomic position, ethnicity, and geography. All interviews were based on a semi-structured interview guide, recorded, and transcribed verbatim and analysed using a thematic analysis.

Findings:
Parents generally experience visits from their health nurse positively. Health nurses are emphasized as a confident and trustful relation and the key informant about children's' health. Variations in how parents adhere to advice favouring healthy weight development of their child were found. Generally, parents adopted a positive attitude towards the health nurse, also when she addressed behaviour or practice of the parents, but parents expressed the importance of doing so in a non-stigmatising or finger pointing manner. The degree to which parents follow the advice from their health nurse depend on cultural background, advice from family and friends, and use of online information.

Conclusions:
Parents generally have a confident and trustful relation to the health nurse, and she constitutes the key informant on child health. This leaves a potential for the structure of Danish health nurses for future interventions promoting healthy weight development. Adaptation of the future intervention program to the needs of parents will increase the chances of developing a relevant, successful, and sustainable intervention. Key messages: Health nurses are emphasized as a trustful relation and the key informant about children's' health, but parents expressed the importance of addressing behaviours in a non-stigmatising manner. Adapting information gained from parents in development of the trial will increase the chances of a relevant, successful, and sustainable intervention promoting healthy child weight development.

Background:
The prevalence of daily second-hand smoke (SHS) exposure among pregnant non-smoking women and children in Egypt is estimated to be about 50% and 55%, respectively. This study aimed to explore barriers to preventing SHS exposure among pregnant women/children and smoking behavior at home in Egypt.

Methods:
Focus group discussions (FGDs) with pregnant women/ mothers of children residing in urban/rural areas (n = 61). Data were coded and analyzed thematically. Results: 61 participants were recruited, aged 18-49. They reported being never smokers and SHS exposure for themselves and their children was mainly at home. Pregnant women/mothers had some general knowledge of the dangers of SHS, but their knowledge appeared incomplete. The most commonly reported barriers to preventing SHS exposure/adopting a smoke free home or workplace were having men who smoke in the household, doctors not being supportive regarding smoking cessation, SHS exposure is socially accepted and fear among women of damaging a relationship; being nervous about asking smokers to stop, and being worried about disputes and arguments with husband. The majority of interviewees' families were reported to allow smoking anywhere in the home; others implemented some measures to prevent SHS, however, these tended to be inconsistently implemented and unlikely to be effective.

Conclusions:
This study increases our knowledge of the barriers of nonsmoking Egyptian pregnant women/mother of children in creating and maintaining smoke free environment for themselves and their children. There is a need to denormalise SHS exposure and better enforcement of smoke free policies. Key messages: Better enforcement of smoke free policies, and more support for smoking cession services are needed in Egypt.
SHS policy, practice, and research should focus on male family members to increase their effectiveness.

Background:
Childhood obesity is a major public health challenge, and it is recommended to promote healthy weight development already during infancy. It is important to co-create interventions to maximize the feasibility and thus improve the chances of successful implementation. This paper describes the cocreation process of the Danish Bloom Trial -an early intervention to promote healthy weight development among children of first-time parents.

Methods:
Development of the trial is inspired by co-creation frameworks and the Intervention Mapping protocol. The co-creation process comprises three stages: 1) Evidence review, qualitative research with community health nurses (CHNs) and parents, and stakeholder consultations; 2) co-creation of the intervention content including workshops and group meetings with CHNs and other stakeholders and focus group discussions with parents; and 3) prototyping, feasibility-and pilot-testing. Currently, we are in stage 2 and have conducted four workshops with CHNs and one parent group discussion.

Results:
During stage 1, we identified the intervention setting; the unique system of CHNs in Danish municipalities. Furthermore, we identified the need for developing intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security to promote healthy child weight development. The main intervention components are a course for CHNs and guidelines on how to talk to parents about behavioral risk factors. The main components for parents are eight home visits and six telephone consultations from CHNs during pregnancy and until the child is 2½ years old and a video library.

Conclusions:
The description of the development of the Bloom Trial provides an example of how to co-create an intervention balancing evidence, the practical work of the implementers and the needs of the families. Co-creation with relevant stakeholders increases the chances of producing a relevant, successful, and sustainable intervention.

Key messages:
The co-creation process resulted in development of intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security from pregnancy to child age 2½ years. Involving parents and stakeholders in the development of an intervention increases the chances of producing a relevant, successful, and sustainable intervention.