How have changes in accessibility and public funding influenced contraceptive use among Norwegian adolescents? A cohort study.

INTRODUCTION: The Norwegian Government introduced in 2002 a reimbursement scheme for hormonal contraceptives to adolescents at the same time as public health nurses and midwives received authorization to prescribe hormonal contraceptives. This study examines the impact of increased accessibility and public funding on hormonal contraceptive use among adolescents. MATERIAL AND METHODS: The Norwegian Prescription Database, Statistics Norway, and Norwegian Institute of Public Health served as data sources for this cohort study. The study population comprised 174 653 Norwegian women born 1989-1990, 1994-1995, and 1999-2000. We examined use of hormonal contraceptives through dispensed prescriptions from age 12 through age 19 with duration of first continuous use as primary outcome. The statistical analyses were done in SPSS using chi-squared test, survival analysis, and Joinpoint regression analysis with p-values < 0.05. RESULTS: By age 19, ~75% of the cohorts had used at least one hormonal method. The main providers of the first prescription were general practitioners and public health nurses. Starters of progestogen-only pills (POPs) have increased across the cohorts, while starters of combined oral contraceptives (COCs) have decreased. The use of long-acting reversible contraceptives (LARCs) has increased since its inclusion in the reimbursement scheme (2015). Most switchers shifted from COCs or POPs as a start method to implants after LARCs became part of the reimbursement scheme. There has been a significant increase across the cohorts in the number of women who continuously used hormonal contraceptives from start to the end of the calendar year they became 19 years with the same method and after switching methods. We could not correlate changes in decreasing trends for teenage births or induced abortions (Joinpoint analysis) to time for implementation or changes in the reimbursement of hormonal contraceptives from 2002. CONCLUSIONS: Primarily public health nurses and to a lesser extent midwives became soon after they received authorization to prescribe COCs important providers. The expansion of the reimbursement scheme to cover POPs, patches, vaginal ring, and depot medroxyprogesterone acetate in 2006 had minor impact on increasing the proportion of long-term first-time users. However, the inclusion of LARCs in 2015 significantly increased the proportion of long-term first-time hormonal contraceptive users.

Development of an outcome indicator framework for a universal health visiting programme using routinely collected data.

BACKGROUND: Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators. METHODS: A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators. RESULTS: Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6-8 weeks, whilst 63.2% had BMI recorded at 27-30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two. CONCLUSIONS: Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.

Public health nurses' experiences with mental health promotion for adolescent immigrants in schools: A qualitative study.

AIMS AND OBJECTIVES: This study aimed to explore public health nurses' experiences with mental health promotion for adolescent immigrants in lower secondary and high school, aiming to enhance knowledge and insights for effective mental health promotion. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative design employing a hermeneutic approach was chosen. Thirteen public health nurses were selected using purposive criterion sampling and snowballing. Thematic analysis was applied, adhering to COREQ guidelines for transparency. ETHICAL ISSUES AND APPROVAL: The research was approved by the Norwegian Centre for Research Data. The guidelines of the National Committee for Research Ethics in the Social Sciences and the Humanities were followed. RESEARCH METHODS, INSTRUMENTS, AND/OR INTERVENTIONS: Data were collected through three focus-group interviews (n = 13), using semi-structured interview guides to explore the experiences of public health nurses in promoting mental health among adolescent immigrants. OUTCOME MEASURES: This study identified three key themes: (i) Striving to understand adolescent immigrants' mental health aspects, including both positive and negative aspects; (ii) Different strategies for promoting mental health, viewing adolescents as both recipients and contributors to their well-being; and (iii) Barriers to public health nurses' promotion of mental health, including language, cultural, and knowledge-related obstacles and trust issues. RESULTS: Public health nurses noted that language barriers and trust issues often delayed adolescent immigrants from seeking help for mental health concerns. Cultural competence and empathy were deemed crucial. To meet these needs, public health nurses must build rapport with parents, collaborate with professionals, implement follow-up programmes, and advocate for policy changes. STUDY LIMITATIONS: Limitations of this qualitative study include potential bias from the authors' background and non-generalizability of results to other contexts. CONCLUSIONS: In conclusion, public health nurses' experiences reveal the need for enhanced cultural competence, language proficiency, and trust-building to better serve adolescent immigrants. Collaborative efforts, follow-up programmes, and policy advocacy are essential to improve mental health promotion in school settings.

A balancing act-midwives' and public health nurses' experiences with breastfeeding counselling.

AIMS AND OBJECTIVES: To explore midwives' and public-health nurses' experiences of breastfeeding counselling in order to provide a deeper insight into breastfeeding counselling. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative design was used, and qualitative content analysis was conducted to analyse the data in accordance with the phenomenological hermeneutic tradition. ETHICAL ISSUES AND APPROVAL: The Norwegian Centre for Research Data approved this study. All participants provided written consent. RESEARCH METHODS: Four focus-group interviews were conducted on a sample of eight midwives and 13 public-health nurses in Norway. RESULTS: Three interrelated themes describing the meaning of midwives' and public-health nurses' experiences with breastfeeding counselling emerged from the analysis: Breastfeeding Counselling Means Responsibility for Collaboration and Facilitation, Being Confident as a Breastfeeding Counsellor Means Striving for Professional Competence and Supporting the Individual Breastfeeding Family Means Being Sensitive and Adapting to Novel Situations. STUDY LIMITATIONS: The focus groups comprised a mix of midwives and public-health nurses, which may have inhibited honest declaration of these professionals' opinions of each other. CONCLUSION: Midwives and public-health nurses regard structural factors and prioritising breastfeeding support in society as important for providing good breastfeeding counselling. Midwives and public-health nurses strive to find a balance between relying on their own competence, promoting breastfeeding in accordance with guidelines and respecting mothers' choices. Healthcare professionals require knowledge about breastfeeding, good clinical judgement, a listening attitude and openness to how breastfeeding affects mother's everyday life to provide good breastfeeding care.

An innovative referral system: Bridging healthcare providers and community supports for pregnant and parenting people.

The connection between community healthcare providers and available community-based programs is often weak. For community members to be connected with services, a strong referral link between providers and programs is paramount. The Referral Express and Central Hub (REACH) project was born out of this need for Nurse-Family Partnership (NFP) program sites in the Denver Metro area of Colorado to be better connected and coordinated with local referral sources. The objective of the REACH pilot was to create a centralized referral system and determine its feasibility in practice. After a 12-month pilot, this innovative referral system supported the increase in a number of referral partners to Denver Metro area sites, an increase in clients served across the Denver Metro area, as well as an increase in the "refer to enroll" rate which increased by 37%. The success of the pilot of REACH led the developers to test the process on a second program, Child First, which was also successful. REACH has proved to be sustainable and continues to operate for both programs. Additionally, REACH acts as a consultant to NFP sites outside the Denver Metro area, in the state of Colorado, as each site works to increase its relationships with referral partners.

Using data visualization to characterize whole-person health of public health nurses.

OBJECTIVE: To characterize patterns in whole-person health of public health nurses (PHNs). DESIGN AND SAMPLE: Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self-identified as female (96.2%), white (86.4%), between the ages 25-44 (54.5%) and 45-64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50-75,000 (30.3%) and $75-100,000/year (29.5%). MEASUREMENTS: Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole-person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health-related Behaviors domains. RESULTS: PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = -5.270, p < .001) and needs (t = -3.659, p < .001) compared to others (n = 53). CONCLUSIONS: PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole-person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health.

Public health nurses' experiences of ethical responsibility: A meta-ethnography.

Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal that these nurses often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors' overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses' ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses' moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice.

A cross-sectional study on public health nurses' disaster competencies and influencing factors during the COVID-19 pandemic in Korea.

Public health nurses are performing various roles during the COVID-19 pandemic: counseling, surveillance, specimen collection, epidemiological investigation, education, and vaccination. This study investigated their disaster competencies in the context of emerging infectious diseases, and identified their influencing factors based on Deci and Ryan's self-determination theory. A convenience sample of 242 was selected from public health nurses working in a metropolitan city of South Korea. Data were collected using a structured questionnaire and analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation, and multiple regression analysis using the SPSS Statistics ver. 23.0. Results showed that the significant factors influencing disaster competencies included "willingness to respond to a disaster," "preventive behavior," "experience of receiving education on emerging infectious diseases response," "public health center experience," "job satisfaction," and "education." This regression model explained 33.2% of the variance in disaster competencies. "Willingness to respond to a disaster" was the strongest factor affecting disaster competencies. Based on these results, it is concluded that interventions to improve disaster competencies and psychological well-being of public health nurses are needed. Additionally, strategies such as creating a supportive work environment, deploying experienced nurses primarily on the front line, and reducing the tasks of permanent public health nurses should be implemented.

Experiences of Norwegian child and school health nurses with the "Starting Right™" child health assessment innovation: a qualitative interview study.

BACKGROUND: Although child health services are well established in Norway, the use of information technology for the systematic collection of evidence-based child- and proxy-reported health measures may be beneficial in the early identification of child development problems. The Norwegian "Starting Right™" health service innovation consists of parent- and child-reported online structured health assessments tools, including practical routines for child and school health assessments. The aim of this study was to explore the experiences of child and school health nurses with the Starting Right innovation. METHODS: We used a qualitative design and conducted three focus group interviews with 18 child and school health nurses from three child health centres one year after the implementation of the innovation. RESULTS: The experiences of professionals with the Starting Right innovation were captured by three themes: (1) the digital innovation could be used to obtain a good overview of a child's health and development; (2) interpreting the questionnaires was a challenge; and (3) implementing the new digital innovation was time-consuming. CONCLUSIONS: Overall, the child and school health nurses experienced that the Starting Right innovation was useful for providing a comprehensive overview of child development and health. The challenges related to interpreting the parents' scores and follow-up of children, as well as providing the questionnaires in relevant foreign languages, should be addressed to allow all children and families to be reached.

Population health assessment project: An innovative strategy for teaching principles of epidemiology.

Public health nurses (PHNs) use principles of epidemiology in their work with communities; however, teaching these concepts at the baccalaureate level can be challenging. To reinforce the epidemiologic concepts taught in the classroom, two nursing faculty in our baccalaureate nursing program developed a population health project that allows students to explore concepts of epidemiology within the context of a population health concern. This article describes how the project provides students with a realistic opportunity to research the health issue. As a part of the project, students collect and analyze data about the health concern at the county, state, and national level. The project also requires students to identify local agencies who provide services for people who are impacted by the health issue and describe their role and function within the community. Furthermore, students discuss the roles and responsibilities of nurses in managing the population health concern under investigation. In doing so, students recognize how epidemiology informs population level nursing care. If nursing students understand epidemiological concepts, they will be better prepared to educate the communities they serve after graduation when a population health crisis, such as the recent COVID-19 pandemic, occurs.

Factors associated with the utilization of community assessment models among Japanese nurses.

OBJECTIVES: This study aimed to identify factors related to the practical utilization of community health needs assessment (CHNA) models that public health nurses (PHNs) learned in their fundamental education. DESIGN: A nationwide questionnaire survey was conducted via postal mail. SAMPLE: We randomly selected 630 public health institutes in Japan. The participants were 3397 full-time novice and mid-level PHNs. MEASUREMENTS: The questionnaire included the participants' basic personal information, six items regarding the perception of CHNA with a 4-point Likert scale, learned models in their undergraduate education, their utilization in practical settings, and the reasons for their answer in narrative form. RESULTS: There were 951 valid responses. The results of logistic regression showed that the significant positively factors with model utilization were perception of CHNA as "not troublesome" or "not impossible as they learned," continuing education with 5 years of experience, and identification of the learned model in continuing education. Furthermore, the results of text mining showed the reasons for non-utilization of the model included being "busy" and having a lack of "opportunity." CONCLUSIONS: This study showed the associated factors with rare utilization of a learned model for PHNs. These findings may suggest improvement of continuing education and development of an appropriate assessment model.

A randomized controlled study of an e-learning program (YURAIKU-PRO) for public health nurses to support parents with severe and persistent mental illness and their family members.

BACKGROUND: Supporting parents with severe and persistent mental illness (SPMI) requires knowledge, skills, and a positive attitude toward parenthood. We developed a Japanese e-learning program for public health nurses (PHNs) to enable them to support parents with SPMI and their family members. This study aimed to evaluate the effectiveness of the program in improving the knowledge, skills, attitudes, and self-efficacy of PHNs in supporting them. METHODS: A three-hour video-based e-learning program was developed. A randomized controlled trial was conducted with 176 PHNs responsible for maternal and child health in Japan. The outcome measures included the Sense of Coping Difficulty/Possibility Scale, skills to support people with SPMI, and achievement of program goals. Outcome data were collected at three time points during the study: baseline (T1), post-intervention (T2), and one month after T2 (T3) using self-administered electronic questionnaires. Outcome measures were assessed by comparing the two groups at the endpoint (T3) using t-tests and ANOVA. Effectiveness over time was assessed using a mixed model for repeated measures, with group and time interactions as fixed effects. RESULTS: The study participants were randomly allocated to two groups:89 in the intervention group, and 87 in the control group. The total score and the scores in the two subscales of the Sense of Coping Difficulty/Possibility Scale in the intervention group at T3 were significantly higher than those in the control group, as shown by the t-test and ANOVA (all p<0.001). The Sense of Coping Difficulty subscale had a large effect size (Cohen's d=1.27). The analysis of the results of a mixed model for repeated measures showed that the group and time interactions on all outcome measures were not significantly different at T1 but were significantly different at T2 and T3. CONCLUSIONS: The program was effective one month after its completion, particularly in reducing PHNs' difficulties in supporting parents with SPMI. TRIAL REGISTRATION: UMIN000045765, November 1, 2021.

"Not everybody approaches it that way": Nurse-trained health department directors' leadership strategies and skills in public health.

Evidence points to nurses as possessing particular skills which are important for public health leadership; in particular, investigators have found that a nurse public health director is strongly associated with positive health department performance. To better understand this association and to guide the effective deployment of nurse leaders, researchers sought to explore the specific leadership strategies used by nurse public health directors, using a critical thematic analysis approach to examine these leadership strategies in the context of certain ideologies, power differentials, and social hierarchies. Data were collected via semistructured interviews conducted from July to September 2020 with 13 nurse public health directors from across the United States. Major themes illustrate a distinct picture of the nursing approach to public health leadership: (a) approaching their work with an other-focused lens, (b) applying theoretical knowledge, (c) navigating the political side of their role, and (d) leveraging their nursing identity. Findings articulate the nurse public health director's distinctive combination of skills which reflect the interprofessional nature of public health nursing practice. Such skills demonstrate a specialized approach that may set nurse leaders apart from other types of leaders in carrying out significant public health work.

Public health nurses' professional dignity: An interview study in Finland.

BACKGROUND: Dignity is a central human value supported by nurses' professional ethics. In previous studies, nurses in clinical practice have experienced that dignity increased their work well-being and pride of work. Dignity is also strictly interweaved to professional identity in the different nursing' roles, but little is known about dignity among public health nurses and primary care settings. PURPOSE: This study aimed to describe the perceptions of nursing's professional dignity of public health nurses in primary care in Finland. RESEARCH DESIGN: An inductive qualitative descriptive approach with semi-structured focus group interviews was utilised. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-seven Finnish public health nurses were interviewed via eight semi-structured focus group interviews in primary health care settings. ETHICAL CONSIDERATIONS: Before data collection, research permissions were obtained from participating health care centres. This type of research in Finland, with competent adult participants, does not require ethical pre-assessment but written and oral informed consent obtained before the interviews. FINDINGS: Based on our findings, public health nurses perceived that professional dignity was (1) part of their self-respect, an observed daily value based on their acknowledged competence. Besides, they perceived that (2) service users' trust in public health nurses was a strong expression of professional dignity, and it could be uncovered when recipients of care utilised their services. In addition, public health nurses experienced that (3) professional dignity was an expression of different intertwined interprofessional and social factors. DISCUSSION AND CONCLUSION: Professional dignity is simultaneously an essential prerequisite and an outcome of public health nurses' work. In future, more information would be needed to implement strategies in primary health care to foster nurses' professional dignity also in international public health arenas.

Factors influencing public health nurses' ethical sensitivity during the pandemic.

BACKGROUND: Ethical sensitivity is a prerequisite for ethical nursing practices. Efforts to improve nurses' ethical sensitivity are required to correctly recognise ethical conflicts and for sound decision-making. Because an emerging infectious disease response involves complex ethical issues, it is important to understand the factors that influence public health nurses' ethical sensitivity while caring for patients with COVID-19, an emerging infectious disease. OBJECTIVES: This study aims to identify the relationship between nursing professionalism, the organisation's ethical climate, and the ethical sensitivity of nurses who care for emerging infectious disease patients in Korean public health centres. Further, it sought to identify factors influencing ethical sensitivity and the mediating effect of the organisational ethical climate to inform guidelines and improve ethical sensitivity. RESEARCH DESIGN: This was a cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected from February 3 to 8 March 2021. Participants included 167 nurses caring for patients with COVID-19 in public health centres in South Korea. ETHICAL CONSIDERATION: This study was approved by the Institutional Review Board of the Chung-Ang University and followed the principles of research ethics. RESULTS: The factors influencing ethical sensitivity were working at a COVID-19 disease direct response department, nursing professionalism, and organisation's ethical climate. The organisation's ethical climate showed a partial mediating effect on the influence of nursing professionalism on ethical sensitivity. CONCLUSION: Our findings show that nurses' ethical sensitivity can be improved by refining the organisation's ethical climate and nursing professionalism.

Prefectural public health nurses' support in human resource development of municipal public health nurses in Japan.

Objective　This study aimed to explore the support extended by prefectural public health nurses (PHNs) toward the human resource development (HRD) of municipal PHNs in Japan.Methods　We performed a qualitative descriptive study involving nine prefectural PHNs from April 2019 to May 2020. The data were collected through semi-structured interviews using an interview guide, described qualitatively, coded, and then categorized.Results　Five categories were extracted. "Clarifying the needs and problems related to HRD and daily PHN activities in the municipalities," "Creating an environment where all municipal PHNs have equal opportunities for off-the-job training," and "Helping municipal PHNs recognize the meaning of practice and develop an evaluation perspective" were extracted from the prefectural government PHNs and prefectural health center (HC) PHNs. "Clarifying problems and future prospects to encourage the growth of PHNs" and "Creating an environment where the significance and value of the activities of PHNs are recognized within the organization and HRD can easily take place" were extracted from the HC PHNs.Conclusion　Much of the HRD support provided by the prefectural PHNs to the municipal PHNs was analogous to the PHN activities provided to the community and residents. To promote HRD effectively, prefectural PHNs should apply their individual care skills to the HRD of municipal PHNs.

[Impact of COVID-19 on Japanese municipal public health nurses and public health practices related to communication with community residents].

Objective　This study analyzed the impact of COVID-19 on municipal public health nurses and public health practices related to communication with community residents.Method　A self-administered questionnaire survey targeted 474 public health nurses working in 40 municipalities in Japan's Aomori Prefecture. Participants were asked about the following basic attributes: whether they provided care for people who were COVID-19 positive or were in close contact with infected people; physical or mental impacts; how each work area was impacted; how mask-wearing affected their communication with community residents; positive and negative aspects of current infection-control measures; how they communicated and shared information with residents as they provided care; challenges and initiatives; and creative work efforts. We conducted the survey from September 23 to October 7, 2020, and analyzed the data using SPSS and KH Coder.Results　We received 228 responses (48.1% valid responses); 11.4% reported that they provided care or were in close contact with people who were COVID-19 positive. At least 60% of respondents had been impacted mentally. Mask-wearing hindered communication with community residents, however, it did not significantly impact trust-building. COVID-19 measures had a positive impact on respondents' public health work as infection-prevention awareness increased and infection-control measures advanced. Meetings, including online conferences, became more efficient, and nurses had opportunities to reexamine their work performance. Negative consequences included weakened communication with residents, slander against infected people, increased stress among residents, repercussions from not going out, and difficulty implementing necessary public health services. Most of the interaction, information sharing, and support for residents were carried out over the phone. Responses regarding new challenges and initiatives were classified into six categories: public health services that consider infection-control measures; various preventive measures; efforts to establish new lifestyles; review of methods for conducting group-health check-ups; review of operations and implementation of creative efforts in providing health guidance; and review of meetings, training sessions, and online conferences.Conclusion　The survey revealed that COVID-19 affected most public health nurses mentally. Challenges in providing in-person care were reported. Nurses faced significant obstacles communicating with residents; however, they reported that services incorporating infection-control measures were progressively gaining traction. Nurses are exploring new communication methods based on established community trust. Furthermore, it is necessary to explore public health services that fulfill both the current and future community requirements.

[Perceptual changes among public health nurses brought on through a newly adopted system for providing continuous support in the municipality: Modelled at its core on Finnish practice for maternity and child health clinics (Neuvola)].

Objectives　This study targeted public health nurses in a Japanese municipality that had newly adopted the core components of the Finnish system to provide continuous support to families with children until preschool. It sought to analyze changes in their perceptions for activities in maternal and child health care before and after the adoption.Methods　Relevant data were collected through semi-structured focus group interviews, following an interview guide, conducted from September to October 2020. The study protocol was approved by the Ethics Committee of Osaka City University in Japan.Results　A total of 12 public health nurses participated. Prior to the adoption of the system modelled on Finnish practice, these nurses were dedicated to addressing the risks regarding families with children (especially those at high risk) through continuous engagement. However, they were hesitant to proactively engage with families at lower risk as non-continuous, one-off engagements resulted in a patchwork response. After the system was adopted, the nurses became aware of the trust cultivated with families under their care, which included those at lower risk, that enabled them to respond to the changing needs flexibly. The nurses recognized that they had acquired the capability to notice the subtle signs of changes, engage more proactively with the families under their care, and deliver the necessary preventive interventions at an early stage. They also demonstrated joy and satisfaction derived from the growth of children and mothers under their care, as well as keen awareness of the need to improve their professional skills, even though they were busy.Conclusion　These findings indicate that the continuous support system modelled on the core components from Finland enables public health nurses to proactively engage with families at lower risk and deliver preventive interventions at an early stage. The system also motivated Japanese public health nurses who found greater pleasure in their work.

Implementation of the norwegian 'Starting right' child health service innovation: implementation adjustments, adoption, and acceptability.

BACKGROUND: An increased and/or stable proportion of the child and adolescent population reports symptoms of impaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reported outcome measures need to be implemented in child and school health services for decision support and identification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation from the pilot implementation of the Norwegian 'Starting Right' health service innovation including an online child health assessment tool and practical routines, and (b) measure practitioners´ adoption and parental acceptability. METHODS: We used a mixed-methods design to qualitatively examine adjustments from working notes and meeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systems log. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in the implementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive and narrative analysis approach using Fixsen et al.´s core implementation components to code and sort adjustments. RESULTS: Core implementation components were adjusted throughout the pilot implementation. Researchers´ increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. We launched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory and higher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B (96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-old children (98 %) compared with younger ones (78-85 %), and in cases where both parents received the questionnaires. CONCLUSIONS: The 'Starting Right' health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.

Genetics education program to help public health nurses improve their knowledge and enhance communities' genetic literacy: a pilot study.

BACKGROUND: As human genetics knowledge develops, public genetic literacy needs to be increased, though the educational capacity for this purpose has not yet been fully developed. Under this circumstance, the daily work of public health nurses can be viewed as an opportunity to enhance public genetic literacy. However, in Japan, there is not only a lack of public knowledge of human genomics but also a lack of public health nurses' recognition about genomic literacy. A short-term education program was implemented as a pilot study. This study aimed to examine the effectiveness of the program to support public health nurses' activity aimed at promoting health services-related genetic literacy. METHODS: The genetics education program was implemented in December 2019, in Kagoshima, Japan. Twenty-three public health nurses cooperated with the research. The program was composed of a case study on consultation, a lecture on hereditary diseases, and a discussion on the role of public health nurses. Familial hypercholesterolemia was used as the topic of the case study. We evaluated scores for cognition, affect, and psychomotor characteristics related to their learning goals before and after the program using Wilcoxon signed-rank tests. Answers in the consultation were qualitatively analyzed. RESULTS: The mean cognitive score, capturing provision of explanations of hereditary disease, was 6.3 before the program but increased significantly to 9.3 after the program (p < 0.001). For the affective score, the goal of which was deepening interest in human genetics, the mean score increased significantly from 8.5 before to 11.0 after (p < 0.001). For the psychomotor score, addressing the need for genetic consultation, the mean score increased significantly from 4.4 before to 8.1 after (p < 0.001). Prominent themes extracted from descriptions on the worksheet post training included, "providing advice and accurate information on genetic disorders" and "referral to a specialized organization." CONCLUSIONS: Our findings indicated that this education program helps public health nurses be positively involved in human genetic disorders. Thus, they may connect to their local community to provide accurate genetics knowledge and advice for health management and promoting genetic literacy.