Swedish Child Health Services Register: a quality register for child health services and children's well-being

Telehealth use in the well-child health setting. A systematic review of acceptability and effectiveness for families and practitioners

Background

Universal well-child health nursing services in high-resource countries promote the health and well-being of children and families while preventing health inequities. The COVID-19 pandemic and technological advancements have led to the increased use of telehealth in this field. To enhance policies and practices, it's important to understand the acceptability and effectiveness of telehealth, as well as the barriers and enablers to its implementation, and to determine when its use is appropriate and safe.

Objective

To explore the global evidence on the use of telehealth in well-child health settings within high-income countries. Focussing on the effectiveness and acceptability of telehealth, along with the factors affecting its implementation and the considerations for safety from the perspectives of both providers and families.

Design

A mixed methods systematic review.

Methods

A systematic review was conducted following PRISMA guidelines. The inclusion criteria for the review included: primary research papers written in English, conducted in high-income countries, focused on telehealth in the well-child health setting, and involving children under six years of age. The search, which was completed in July 2023, systematically explored the CINAHL, ProQuest Central, PubMed, and Web of Science bibliographic databases. Studies were critically appraised for quality, and relevant data extracted. A convergent segregated approach was employed to synthesise both quantitative and qualitative data, which is presented in a narrative format.

Results

A total of 4,354 records were identified and screened, and 169 full-text papers were assessed for eligibility, resulting in 20 papers for inclusion. Telehealth acceptability among families was reported in 13 of the 20 studies reviewed, with participants expressing high satisfaction regarding its use as a complement to standard care. Only three studies examined practitioners' acceptance, revealing mixed responses. Effectiveness was observed in 15 studies, with no significant differences found between the control and telehealth groups, suggesting that telehealth may achieve outcomes like those of standard care. Four studies identified both enablers and barriers to the implementation of telehealth, though none addressed concerns regarding safety and appropriateness.

Conclusions

Telehealth shows promise for well-child health services, but there is limited evidence of its effectiveness and safety. The COVID-19 pandemic increased its use, yet risks need further exploration. To validate telehealth in this field, we must identify effective applications, tackle implementation barriers, and ensure client safety. Additional research is essential for developing evidence-based policies for future practices.

Introducing a self-managed early communication resource for parents - A mixed methods feasibility study of the Swedish "ComAlong online"

BACKGROUND

Web-based programmes offer parents of children with communication difficulties promising access to parent-mediated, early interventions. However, empirical evaluations of such programmes are limited. This study focused on parents and used mixed methods to examine the feasibility of ComAlong online.

METHODS

ComAlong online is a Swedish, self-managed web-resource teaching parents supportive strategies to promote child communication. Data of different types were collected from a total of 71 parents: ten individual parent interviews, 21 pre-questionnaires and 10 post-questionnaires, and finally 50 anonymous digital evaluation surveys. Descriptive statistics and deductive qualitative content analysis were used.

RESULTS

Findings indicate that parents perceived improved child communication and own competence after using the ComAlong online. The most valued parts included podcasts with experts and videos of parent-child interaction. Parents reported that the resource was easy to use, but they wanted to have gained access to the resource when the child was younger. Suggestions for changes included adding a chat function with experts, a parent net forum, and the possibility of creating personalised playlists of videos and podcasts. Evaluation of the research process revealed difficulties in recruiting parents from local child healthcare services and parents of children not yet with a diagnosis.

CONCLUSIONS

This study supports the potential for self-managed, web-based resources to disseminate evidence-based parent training for supporting early communication development. Importantly, parents lack individual guidance from experts and contact with other parents. Also, measures need to be made to disseminate the resources within local child healthcare services.

Equity of National Essential Public Health Services (NEPHS) in Mainland China, 2019: a cross-sectional study based on the NEPHS database

BACKGROUND

China's National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data.

METHODS

A cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0-6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups.

RESULTS

The NEPHS collected health records for 88.25% of China's permanent residents (95% CI: 79.23%-98.82%). The nationwide vaccination coverage rate was 97.44% (95% CI: 91.33%-99.91%). Newborn visit and child health management rates for children aged 0-6 years were 92.08% (95% CI: 74.85%-98.34%) and 90.87% (95% CI: 82.49%-98.47%), respectively. At the national level, NEPHS service utilization in 2019 was generally equitable, with Gini coefficients below 0.4 for the 15 indicators. Potential large equity gaps were observed in the provision of health education services in Shanghai [Gini coefficient = 0.358 (95% CI: 0.219, 0.444)], Inner Mongolia [Gini coefficient = 0.370 (95% CI: 0.073, 0.440)] and Xinjiang [Gini coefficient = 0.457 (95% CI: 0.217, 0.502)]. Additionally, the utilization of family planning education and sanitation inspection services also indicated potential large and severe equity gap in 13 provinces. The Theil indices revealed that inequities primarily existed within rather than between regions. Province-level results indicated perfect equity in health record management and vaccination coverage, while several provinces showed potential equity gaps in health education and family planning services. Potential equity gaps were also observed in health management services for patients with hypertension and diabetes, particularly in Beijing, Hunan and Xinjiang.

CONCLUSIONS

This study provides evidence for health planning in China's primary health sector and guidance for analyzing equity in national health programs similar to the NEPHS Program.

The prevalence of overweight among 4-year-olds during and after the COVID-19 pandemic was associated with socioeconomic burden

AIM

To assess the prevalence of overweight among Swedish 4 year olds in 2018, 2020 and 2022, taking socioeconomic variables into account.

METHODS

Aggregated regional data on children's body mass index were collected. The socioeconomic Care Need Index (CNI), foreign background, low education, being a single parent, low income and childhood poverty, were assessed. The differences in overweight, including obesity, were tested for Sweden and for regions.

RESULTS

Data were available for 303 843 children, representing 87% of children born in 2014, 2016 and 2018. Overweight or obesity were found in 11 177 (11.4%) of children in 2022, decreasing from 2020 (13.3%, p < 0.001) but at the same level as in 2018. Regional low CNI, low level of foreign background, education and income as well as being a single parent were associated with a higher prevalence of overweight or obesity in all cohorts (p < 0.001). In regions with high levels of childhood poverty, overweight or obesity were more prevalent during (p = 0.009) and after the pandemic (p < 0.001).

CONCLUSION

Three national cohorts demonstrate that the increase in overweight during the COVID-19 pandemic has returned to pre-pandemic levels, but the inequalities in health associated with socioeconomic vulnerability of the regions remained.

Identifying children at risk in Swedish Child Health Services

BACKGROUND

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme.

AIMS

This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index.

METHODS

By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden.

RESULTS

The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions.

CONCLUSIONS

This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

Childhood Overweight and Obesity During and After the COVID-19 Pandemic

This cohort study analyzes the prevalence of overweight and obesity among preschool children in Sweden before, during, and after the COVID-19 pandemic and longitudinal trends in body mass index.