Introducing Norwegian parents to the Circle of Security Parenting program during the postpartum period: A qualitative descriptive study.

OBJECTIVE: Public health nurses in Norway provide a range of health promotion and primary prevention services to families in the postpartum period. The study objectives were to describe parents' experiences of: 1) being introduced to the Circle of Security Parenting program during a home visit and 2) participating in a parent group meeting. DESIGN: Qualitative descriptive study. SAMPLE: A purposeful sample of 24 caregivers (n = 15 mothers, n = 9 fathers) parenting an infant. MEASURES: In-depth, semi-structured interviews were conducted to document participants experiences. Content analysis was used to code and categorize the data. FINDINGS: Three main categories with seven subcategories reflected the parents' experiences: 1) Confidence-building home visit, 2) Awareness-raising parental group, 3) Dissemination of knowledge. CONCLUSIONS: The parents experienced the home visit as being on their family's terms and reassuring. The parental group session started a reflection process which made them aware of the importance of being present for their child, how to modify their communication and have a common understanding of childrearing. The parents thought the group was a great way to introduce the Circle of Security Parenting program and experienced it as a continuation of the information presented at the home visit. The introduction provided them with new knowledge.

Twenty years with the public health intervention wheel: Evidence for practice.

The Public Health Intervention Wheel (PHI Wheel) is a population-based practice model for public health nursing practice that encompasses three levels of practice (community, systems, individual/family) and 17 public health interventions. This article shares the story of how the PHI Wheel was created, disseminated, implemented by public health nurses (PHNs) and educators across the globe, and updated with new evidence published in the second edition of Public Health Interventions: Applications for Public Health Nursing in 2019. Evidence on the relevance of PHI Wheel interventions for public health practice in cultural and international settings supports the model's value in explaining PHN practice. This article highlights the experiences of various countries with the PHI Wheel including Canada, Ireland, New Zealand, Norway, Sweden, the United Kingdom, and the United States. The evidence update confirms the relevance of the model to PHN education and practice and reinforces the conviction that development of new evidence is essential for promoting population health.

Norwegian fathers' experiences with a home visiting program.

OBJECTIVE: To explore fathers' experiences with a Norwegian home visiting program during the prenatal period and the first-year postpartum. DESIGN: Qualitative design with interpretive description (ID) as the methodological approach. SAMPLE: Individual interviews with fathers (n = 13) who received home visits by a public health nurse (PHN) within the New Families home visiting program. MEASURES: Interviews were guided by a semi-structured interview-guide, which contained open-ended questions encouraging informants to reflect on their experiences with home visits. The analysis of the data was informed by content analysis. RESULTS: Two main themes that reflect the fathers' experiences emerged: (1) The importance of being on their home ground captures the fathers' experience of receiving home visits and building a trusting relationship with the PHN. (2) Including fathers in the home visit represents their thoughts about the content and focus of the home visits. CONCLUSIONS: Fathers experienced the universal New Families home visiting program as an important contribution towards a more available and tailored service, with the home environment as a suitable arena for developing a trusting relationship with the PHN. However, the fathers often felt insufficiently included in the home visits, with only scant attention towards them as independent caregivers, their emotional reactions, roles, and family relationships. Pre-birth home visits might contribute to strengthening preparations for fatherhood and increase fathers' engagement in the Child Health Service.

Parental experience of counselling about food and feeding practices at the child health centre: A qualitative study.

AIMS AND OBJECTIVES: To investigate how parents experience counselling about food and feeding practices and the use of a communication tool about diet at the child health centre. BACKGROUND: Food-related counselling is a key element in parents' consultations with public health nurses at child health centres. Public health nurses possess limited strategies and tools for addressing nutritional issues, especially in the context of client diversity. DESIGN: An interpretive description approach, fulfilling the COREQ checklist criteria. METHODS: Individual interviews performed between January 2017-May 2017 among parents (n = 12) of children (mean age 28 months) who had been exposed to a communication tool about diet, in regular child health centre consultations with their child. These consultations were included in clinical trial (ClinicalTrials.gov.: Identifier: NCT02266953). RESULTS: Counselling using the communication tool about diet was primarily based on the public health nurse presenting images of healthy food choices. After infancy, consultations sometimes became more time-pressured, inhibiting parents from asking questions related to the child's diet. The parents who had questions related to food allergy or breastfeeding of their child sometimes experienced limited support. Some parents felt overwhelmed with information about healthy food choices if their child's diet differed from the recommendations presented. CONCLUSIONS: The parents' existing expectations and needs had an impact on their satisfaction in relation to their perceptions of nutritional counselling. The use of the communication tool about diet to promote a two-way dialogue instead of providing one-way dietary information might be particularly useful in consultations for parents who do not follow customary recommendations. RELEVANCE TO CLINICAL PRACTICE: If the diet of the family differs from what is recommended, parents often experience limited support at the child health centre. Promoting a two-way dialogue in consultations using a communication tool about diet could help parents in their concerns related to feeding their child.

Overweight adolescents' views on physical activity - experiences of participants in an internet-based intervention: a qualitative study.

BACKGROUND: Overweight and obese adolescents are reported to be less physically active than their peers. Research-based knowledge about their views may contribute to a better understanding of key factors that may foster or undermine motivation for physical activity, and provide knowledge for the future development of interventions. This paper explores experiences of physical activity among overweight adolescents, age 13-14 years, participants in Young & Active, a web-based controlled trial intervention to increase physical activity (ClinicalTrials.gov NCT01700309). The theoretical perspective is based on Self-Determination Theory. METHODS: Two qualitative post-intervention research interviews, with a nine-month interval, were conducted with 21 adolescents, 15 girls and 6 boys to study short-term and long-term changes. The informants were recruited from a total of 84 participants from the Young & Active intervention group. Data were analyzed using qualitative content analysis. RESULTS: The participants associated physical activity with organized sports and physical education classes at school, and as a means of promoting good health and attractive bodies. A majority of the adolescents said that they experienced their health as poorer than other youths, and expressed worries about their fitness and future health. Mastering a physical activity, being together with friends and having fun promoted motivation to perform sports. Not mastering an activity, or not knowing the others made them less motivated. None of the adolescents highlighted the importance of informal active living when asked about their understanding and experiences of physical activity. Consistency was found between the first and second interviews. CONCLUSION: This study adds to limited research on overweight and obese adolescents' experiences of physical activity. The participants' views reflect opinions in society about physical activity, and its importance for health. Viewing physical activity as conducted within organized sports makes it necessary to look into how these are organized, structured and led, and what can be done to support self-esteem, autonomous motivation and participation. The ability to choose among available, affordable and desirable physical activities, together with friends, may promote participation and maintenance.

A falls case summary: Application of the public health nursing intervention wheel.

BACKGROUND: The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. CASE PRESENTATION: A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. METHODS: The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. CONCLUSIONS: The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

A comparison of the Well Child Clinic services in Norway and the Nurse Family Partnership programme in the United States.

AIM AND OBJECTIVES: To present a comparison and a discussion of the Well Child Clinic model in Norway and the Nurse-Family Partnership model in the United States. BACKGROUND: The Nurse Family Partnership programme in the United States is voluntary and not universal. The Well Child Clinic programme in Norway is voluntary but universally available for Norwegian families. As the Well Child Clinics are used by the vast majority of the families in Norway, it is difficult to determine the benefits and outcomes for the families who receive universal services. DESIGN: Qualitative design. METHODS: Authors reviewed the literature on the Norwegian Well Child Clinics and the Nurse Family Partnership programme in the United States and interviewed public health nurses experts on evidence-based home visiting programmes in Minnesota. RESULTS: The similarities between goals and content of the Nurse Family Partnership programme in the United States and the Well Child Clinic services in Norway are emphases on (1) intensive services, (2) a focus on behaviour, (3) the inclusion of both parents and children and (4) programme fidelity. The major difference in the programmes is the focus on a targeted population for the Nurse Family Partnership programme vs. the universal offer of Well Child Clinics in Norway. CONCLUSION: Norway should continue with universal approach to support new families. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families. RELEVANCE TO CLINICAL PRACTICE: Public health nursing leaders in Norway need to advocate for public health nurse ratios that make it possible for public health nurses to follow government guidelines. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families.

Parents' views and experiences when their preschool child is identified as overweight: a qualitative study in primary care.

BACKGROUND: Prevalence of overweight in children has increased significantly in many countries in the past decades. Few parents identify their own children as overweight, especially very young children. Motivating parents is difficult, and interventions to attain normal weight often fail. OBJECTIVE: To explore parents' views and experiences when health professionals identify their preschool child as overweight. METHODS: In-depth interviews were held with parents of 10 overweight children aged 2.5-5.5 years. Parents were recruited at well child clinics in rural parts of eastern Norway. Interviews were recorded digitally, transcribed verbatim and analysed thematically. RESULTS: Parents presented themselves and their toddlers as vulnerable. To protect their child from developing low self-esteem and eating disorders, some parents preferred their child not to be present when discussing overweight. Growth charts were looked upon as objective and useful. Parents talked readily about their own weight experiences. Being overweight themselves represented both a barrier to, and motivation for, dealing with their toddler's overweight. Parents appreciated support from professionals in kindergarten, but grandparents often undermined the parents' effort to make changes. CONCLUSIONS: Early childhood overweight should be addressed in a sensitive and respectful manner and should consider whether the index child should be present during discussion. It may be helpful for clinicians to discuss parents' own weight and dieting experiences and concerns about eating disorders. All the child's caretakers should be considered a target for intervention, and grandparents and kindergarten professionals should be included.

Public health nurse reflections on implementing the New Families home visiting programme: A qualitative study.

AIM: To investigate reflections of public health nurses (PHNs) on implementing the New Families programme, a supplement to the usual Norwegian child health centre programme. It involves user-led decisions on the content and number of home visits offered by the family's PHN from pregnancy week 28 until the child is 2 years. DESIGN: An interpretive description approach. METHODS: Altogether 206 anonymized, undated reflection notes by PHNs becoming familiar with the programme were collected in 2017-2020. NVivo 12 and inductive content analysis were used to convert the data into manageable segments. RESULTS: Focusing on childhood experiences and parental role expectations among prospective parents during home visits was seen as a major shift in the nurses' counselling strategy. Providing relevant information to the parents-to-be ahead of a meeting was important. Given sufficient staff and guidance, the programme was considered a good basis for building a relationship with the family.

"Opening up a well of emotions": A qualitative study of men's emotional experiences in the transition to fatherhood.

AIM: To explore the emotional changes and reactions men experience in their transition to fatherhood. DESIGN: This study used a qualitative design. METHODS: Data were collected through in-depth interviews with 13 Norwegian fathers. RESULTS: Through thematic analysis, three main themes were developed: (1) from self-focus to family perspective; (2) emotional vulnerability; and (3) from insecurity to self-assurance. The themes describe fathers' emotional process during the child's first year of life, ranging from positive feelings like affection and mastery, to challenging feelings like exclusion, jealousy and exhaustion. Many fathers describe taboos and shame over their own emotional reactions, although these can be considered a natural part of the postnatal period.

Supportive counselling by public health nurses for women with postpartum depression.

AIM: This paper is a report of a study examining the effect of supportive counselling by public health nurses on postpartum depression. BACKGROUND: Depression is a common condition following childbirth and may have negative consequences for the child's development, the woman's health and the relationship between the parents. Psychological intervention is a treatment alternative to biological treatment options and may prevent longer-term postpartum depression. METHOD: The study was designed as a pragmatic trial. The study population comprised postpartum women, residing in two Norwegian municipalities, who had delivered a live-born child between June 2005 and December 2006. A total of 228 women were included in the study: 64 in the comparison municipality and 164 in the experimental municipality. Public health nurses (26) in the experimental municipality were trained in identifying postpartum depression and in providing supportive counselling. Pre-tests were conducted using the Edinburgh Postnatal Depression Scale at 6 weeks postpartum. Post-tests using the same Scale were performed at 3 and 6 months postpartum. RESULTS: The depression score decreased statistically significantly in the experimental group compared to the comparison group both at 3 and 6 months postpartum. CONCLUSION: Supportive counselling based on a non-directive counselling method provided by public health nurses is an effective treatment method for postpartum depression. Further research is required to assess the mothers' evaluation of the treatment and appraise methods used for management of postpartum depression in primary health care.

The use of a communication tool about diet at the child health centre: A cluster randomized controlled trial.

Aim: To investigate the effect of a communication tool about diet used in public health nurse consultations with parents compared with standard consultations concerning the 2-year-old child's diet. Design: A cluster randomized controlled trial. Methods: Ten municipalities were selected randomly and matched in pairs. In each pair, the control or intervention group was randomly allocated. Parents were recruited to participate from January 2015 to January 2017. In intervention clusters, a communication tool about diet was used to help the parents (N = 140) to focus on a healthy diet for their child. In the control clusters, parents (N = 110) attended standard consultations. The participants completed semi-quantitative food frequency questionnaires at baseline and end point. Results: No effect of the intervention was seen on the child's daily intake of vegetables or saturated fat, or body mass index. Significantly fewer parents desired more information about food for toddlers in the intervention than in the control group.

Adolescents With Overweight or Obesity: A Qualitative Study of Participation in an Internet-Based Program to Increase Physical Activity.

Adolescents who are overweight or obese are reported to be less active than their peers. Motivation is a critical factor in sustaining physical activity and thereby positive health outcomes. This qualitative study explores how participation in a 12-week Internet-based intervention study, Young & Active, influenced the participants' short-term and long-term motivation to increase and sustain physical activity. The overall purpose of Young & Active was to design, test, and evaluate a health-promoting Internet-based program for use in the school health services in Norway. The program was informed by self-determination theory and motivational interviewing. Two postintervention qualitative research interviews were conducted with 21 adolescents, aged 13 to 14 years, with a 9- to 12-month interval. The adolescents were recruited from a total of 84 participants from the Young & Active study intervention group. Data were analyzed using qualitative content analysis. Self-determination theory was used as a theoretical and explanatory framework. Following the motivational continuum from self-determination theory, all adolescents showed changes in motivation, from extrinsic toward more intrinsic motivation, and for some, a reversal after completing the program. Analysis of the adolescents' utterances formed patterns that could be divided into four main categories: (a) reinforcement of a habit, (b) promotion of competence and enjoyment, (c) boost of temporary change, and (d) reinforcement of adverse habits. An Internet-based intervention may help adolescents increase and sustain physical activity if participation is based on self-choice and if they have sufficient support in their social environments. The intervention alone is not enough to support adolescents who are less motivated or have other challenges in life and may even provoke resistance and reinforce negative health behavior. Such a program may be used together with face-to-face counseling in school health services, provided that it is further refined on a larger scale and that the counseling is performed by qualified health service professionals.

Postnatal depression among Sudanese women: prevalence and validation of the Edinburgh Postnatal Depression Scale at 3 months postpartum.

PURPOSE: Postnatal depression (PND) rates in low-resource countries have reached levels between 4.9% and 59%. Maternal mental health has not been researched in Sudan, and there are no existing statistics on prevalence or significant risk factors for PND. Consequently, no screening test has been validated to screen for PND at the primary health care level. This study investigates the 3 months prevalence of PND and validates the Edinburgh Postnatal Depression Scale (EPDS) against the Mini-International Neuropsychiatric Interview (MINI). METHODOLOGY: Pregnant Sudanese women in the second and third trimesters were recruited to the study during routine antenatal care visits in two major maternity hospitals in Khartoum state. They were screened for PND at 3 months postpartum using the EPDS. Test positive women were matched with test negative women according to nearest date of birth. A clinical psychologist verified their depression status using the MINI. RESULTS: The follow-up rate was 79%. At a cutoff point of ≥12, the 3 months prevalence of PND was 9.2%. The sensitivity and specificity of the EPDS were 89% and 82%, respectively. The EPDS and MINI showed a strong positive relationship (odds ratio =36). The positive predictive value and negative predictive value, using this study's prevalence, were 33% and 98.7%, respectively. The receiver operator characteristic analysis showed an area under the curve of 0.89. The cut-off point ≥12 was the most acceptable point as it had the lowest number needed to diagnose (1.4) and a false-positive rate of 18%. CONCLUSION: The EPDS is a valid tool for screening for PND on a Sudanese population. It was accepted, easily administered, and understood by postnatal women. Health care personnel, especially village midwives, should be trained on screening and referral of depressed women for clinical evaluation and management. Due to limited resources available in Sudan, shorter screening tests need to be validated in the future.

Postnatal depression is a public health nursing issue: perspectives from norway and ireland.

The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers' life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for PHNs; and the research evidence of the benefits of social support in facilitating recovery for new mothers.